Towards simplification of hydrologic modeling: Identification of dominant processes

USGS Publications Warehouse

Markstrom, Steven; Hay, Lauren E.; Clark, Martyn P.

2016-01-01

The Precipitation–Runoff Modeling System (PRMS), a distributed-parameter hydrologic model, has been applied to the conterminous US (CONUS). Parameter sensitivity analysis was used to identify: (1) the sensitive input parameters and (2) particular model output variables that could be associated with the dominant hydrologic process(es). Sensitivity values of 35 PRMS calibration parameters were computed using the Fourier amplitude sensitivity test procedure on 110 000 independent hydrologically based spatial modeling units covering the CONUS and then summarized to process (snowmelt, surface runoff, infiltration, soil moisture, evapotranspiration, interflow, baseflow, and runoff) and model performance statistic (mean, coefficient of variation, and autoregressive lag 1). Identified parameters and processes provide insight into model performance at the location of each unit and allow the modeler to identify the most dominant process on the basis of which processes are associated with the most sensitive parameters. The results of this study indicate that: (1) the choice of performance statistic and output variables has a strong influence on parameter sensitivity, (2) the apparent model complexity to the modeler can be reduced by focusing on those processes that are associated with sensitive parameters and disregarding those that are not, (3) different processes require different numbers of parameters for simulation, and (4) some sensitive parameters influence only one hydrologic process, while others may influence many

Reducing intraoperative red blood cell unit wastage in a large academic medical center.

PubMed

Whitney, Gina M; Woods, Marcella C; France, Daniel J; Austin, Thomas M; Deegan, Robert J; Paroskie, Allison; Booth, Garrett S; Young, Pampee P; Dmochowski, Roger R; Sandberg, Warren S; Pilla, Michael A

2015-11-01

The wastage of red blood cell (RBC) units within the operative setting results in significant direct costs to health care organizations. Previous education-based efforts to reduce wastage were unsuccessful at our institution. We hypothesized that a quality and process improvement approach would result in sustained reductions in intraoperative RBC wastage in a large academic medical center. Utilizing a failure mode and effects analysis supplemented with time and temperature data, key drivers of perioperative RBC wastage were identified and targeted for process improvement. Multiple contributing factors, including improper storage and transport and lack of accurate, locally relevant RBC wastage event data were identified as significant contributors to ongoing intraoperative RBC unit wastage. Testing and implementation of improvements to the process of transport and storage of RBC units occurred in liver transplant and adult cardiac surgical areas due to their history of disproportionately high RBC wastage rates. Process interventions targeting local drivers of RBC wastage resulted in a significant reduction in RBC wastage (p < 0.0001; adjusted odds ratio, 0.24; 95% confidence interval, 0.15-0.39), despite an increase in operative case volume over the period of the study. Studied process interventions were then introduced incrementally in the remainder of the perioperative areas. These results show that a multidisciplinary team focused on the process of blood product ordering, transport, and storage was able to significantly reduce operative RBC wastage and its associated costs using quality and process improvement methods. © 2015 AABB.

Reducing intraoperative red blood cell unit wastage in a large academic medical center

PubMed Central

Whitney, Gina M.; Woods, Marcella C.; France, Daniel J.; Austin, Thomas M.; Deegan, Robert J.; Paroskie, Allison; Booth, Garrett S.; Young, Pampee P.; Dmochowski, Roger R.; Sandberg, Warren S.; Pilla, Michael A.

2015-01-01

BACKGROUND The wastage of red blood cell (RBC) units within the operative setting results in significant direct costs to health care organizations. Previous education-based efforts to reduce wastage were unsuccessful at our institution. We hypothesized that a quality and process improvement approach would result in sustained reductions in intraoperative RBC wastage in a large academic medical center. STUDY DESIGN AND METHODS Utilizing a failure mode and effects analysis supplemented with time and temperature data, key drivers of perioperative RBC wastage were identified and targeted for process improvement. RESULTS Multiple contributing factors, including improper storage and transport and lack of accurate, locally relevant RBC wastage event data were identified as significant contributors to ongoing intraoperative RBC unit wastage. Testing and implementation of improvements to the process of transport and storage of RBC units occurred in liver transplant and adult cardiac surgical areas due to their history of disproportionately high RBC wastage rates. Process interventions targeting local drivers of RBC wastage resulted in a significant reduction in RBC wastage (p <0.0001; adjusted odds ratio, 0.24; 95% confidence interval, 0.15–0.39), despite an increase in operative case volume over the period of the study. Studied process interventions were then introduced incrementally in the remainder of the perioperative areas. CONCLUSIONS These results show that a multidisciplinary team focused on the process of blood product ordering, transport, and storage was able to significantly reduce operative RBC wastage and its associated costs using quality and process improvement methods. PMID:26202213

Lessons Learned in Promoting Evidence-Based Public Health: Perspectives from Managers in State Public Health Departments.

PubMed

Allen, Peg; Jacob, Rebekah R; Lakshman, Meenakshi; Best, Leslie A; Bass, Kathryn; Brownson, Ross C

2018-03-02

Evidence-based public health (EBPH) practice, also called evidence-informed public health, can improve population health and reduce disease burden in populations. Organizational structures and processes can facilitate capacity-building for EBPH in public health agencies. This study involved 51 structured interviews with leaders and program managers in 12 state health department chronic disease prevention units to identify factors that facilitate the implementation of EBPH. Verbatim transcripts of the de-identified interviews were consensus coded in NVIVO qualitative software. Content analyses of coded texts were used to identify themes and illustrative quotes. Facilitator themes included leadership support within the chronic disease prevention unit and division, unit processes to enhance information sharing across program areas and recruitment and retention of qualified personnel, training and technical assistance to build skills, and the ability to provide support to external partners. Chronic disease prevention leaders' role modeling of EBPH processes and expectations for staff to justify proposed plans and approaches were key aspects of leadership support. Leaders protected staff time in order to identify and digest evidence to address the common barrier of lack of time for EBPH. Funding uncertainties or budget cuts, lack of political will for EBPH, and staff turnover remained challenges. In conclusion, leadership support is a key facilitator of EBPH capacity building and practice. Section and division leaders in public health agencies with authority and skills can institute management practices to help staff learn and apply EBPH processes and spread EBPH with partners.

Standardized severe maternal morbidity review: rationale and process.

PubMed

Kilpatrick, Sarah J; Berg, Cynthia; Bernstein, Peter; Bingham, Debra; Delgado, Ana; Callaghan, William M; Harris, Karen; Lanni, Susan; Mahoney, Jeanne; Main, Elliot; Nacht, Amy; Schellpfeffer, Michael; Westover, Thomas; Harper, Margaret

2014-08-01

Severe maternal morbidity and mortality have been rising in the United States. To begin a national effort to reduce morbidity, a specific call to identify all pregnant and postpartum women experiencing admission to an intensive care unit or receipt of 4 or more units of blood for routine review has been made. While advocating for review of these cases, no specific guidance for the review process was provided. Therefore, the aim of this expert opinion is to present guidelines for a standardized severe maternal morbidity interdisciplinary review process to identify systems, professional, and facility factors that can be ameliorated, with the overall goal of improving institutional obstetric safety and reducing severe morbidity and mortality among pregnant and recently pregnant women. This opinion was developed by a multidisciplinary working group that included general obstetrician-gynecologists, maternal-fetal medicine subspecialists, certified nurse-midwives, and registered nurses all with experience in maternal mortality reviews. A process for standardized review of severe maternal morbidity addressing committee organization, review process, medical record abstraction and assessment, review culture, data management, review timing, and review confidentiality is presented. Reference is made to a sample severe maternal morbidity abstraction and assessment form.

Lean methodology for performance improvement in the trauma discharge process.

PubMed

O'Mara, Michael Shaymus; Ramaniuk, Aliaksandr; Graymire, Vickie; Rozzell, Monica; Martin, Stacey

2014-07-01

High-volume, complex services such as trauma and acute care surgery are at risk for inefficiency. Lean process improvement can reduce health care waste. Lean allows a structured look at processes not easily amenable to analysis. We applied lean methodology to the current state of communication and discharge planning on an urban trauma service, citing areas for improvement. A lean process mapping event was held. The process map was used to identify areas for immediate analysis and intervention-defining metrics for the stakeholders. After intervention, new performance was assessed by direct data evaluation. The process was completed with an analysis of effect and plans made for addressing future focus areas. The primary area of concern identified was interservice communication. Changes centering on a standardized morning report structure reduced the number of consult questions unanswered from 67% to 34% (p = 0.0021). Physical therapy rework was reduced from 35% to 19% (p = 0.016). Patients admitted to units not designated to the trauma service had 1.6 times longer stays (p < 0.0001). The lean process lasted 8 months, and three areas for new improvement were identified: (1) the off-unit patients; (2) patients with length of stay more than 15 days contribute disproportionately to length of stay; and (3) miscommunication exists around patient education at discharge. Lean process improvement is a viable means of health care analysis. When applied to a trauma service with 4,000 admissions annually, lean identifies areas ripe for improvement. Our inefficiencies surrounded communication and patient localization. Strategies arising from the input of all stakeholders led to real solutions for communication through a face-to-face morning report and identified areas for ongoing improvement. This focuses resource use and identifies areas for improvement of throughput in care delivery.

Medical review practices for driver licensing volume 3: guidelines and processes in the United States.

DOT National Transportation Integrated Search

2017-04-01

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

Towards the understanding of network information processing in biology

NASA Astrophysics Data System (ADS)

Singh, Vijay

Living organisms perform incredibly well in detecting a signal present in the environment. This information processing is achieved near optimally and quite reliably, even though the sources of signals are highly variable and complex. The work in the last few decades has given us a fair understanding of how individual signal processing units like neurons and cell receptors process signals, but the principles of collective information processing on biological networks are far from clear. Information processing in biological networks, like the brain, metabolic circuits, cellular-signaling circuits, etc., involves complex interactions among a large number of units (neurons, receptors). The combinatorially large number of states such a system can exist in makes it impossible to study these systems from the first principles, starting from the interactions between the basic units. The principles of collective information processing on such complex networks can be identified using coarse graining approaches. This could provide insights into the organization and function of complex biological networks. Here I study models of biological networks using continuum dynamics, renormalization, maximum likelihood estimation and information theory. Such coarse graining approaches identify features that are essential for certain processes performed by underlying biological networks. We find that long-range connections in the brain allow for global scale feature detection in a signal. These also suppress the noise and remove any gaps present in the signal. Hierarchical organization with long-range connections leads to large-scale connectivity at low synapse numbers. Time delays can be utilized to separate a mixture of signals with temporal scales. Our observations indicate that the rules in multivariate signal processing are quite different from traditional single unit signal processing.

Social processes underlying acculturation: a study of drinking behavior among immigrant Latinos in the Northeast United States

PubMed Central

LEE, CHRISTINA S.; LÓPEZ, STEVEN REGESER; COBLY, SUZANNE M.; TEJADA, MONICA; GARCÍA-COLL, CYNTHIA; SMITH, MARCIA

2010-01-01

Study Goals To identify social processes that underlie the relationship of acculturation and heavy drinking behavior among Latinos who have immigrated to the Northeast United States of America (USA). Method Community-based recruitment strategies were used to identify 36 Latinos who reported heavy drinking. Participants were 48% female, 23 to 56 years of age, and were from South or Central America (39%) and the Caribbean (24%). Six focus groups were audiotaped and transcribed. Results Content analyses indicated that the social context of drinking is different in the participants’ countries of origin and in the United States. In Latin America, alcohol consumption was part of everyday living (being with friends and family). Nostalgia and isolation reflected some of the reasons for drinking in the USA. Results suggest that drinking in the Northeastern United States (US) is related to Latinos’ adaptation to a new sociocultural environment. Knowledge of the shifting social contexts of drinking can inform health interventions. PMID:20376331

Identification of different geologic units using fuzzy constrained resistivity tomography

NASA Astrophysics Data System (ADS)

Singh, Anand; Sharma, S. P.

2018-01-01

Different geophysical inversion strategies are utilized as a component of an interpretation process that tries to separate geologic units based on the resistivity distribution. In the present study, we present the results of separating different geologic units using fuzzy constrained resistivity tomography. This was accomplished using fuzzy c means, a clustering procedure to improve the 2D resistivity image and geologic separation within the iterative minimization through inversion. First, we developed a Matlab-based inversion technique to obtain a reliable resistivity image using different geophysical data sets (electrical resistivity and electromagnetic data). Following this, the recovered resistivity model was converted into a fuzzy constrained resistivity model by assigning the highest probability value of each model cell to the cluster utilizing fuzzy c means clustering procedure during the iterative process. The efficacy of the algorithm is demonstrated using three synthetic plane wave electromagnetic data sets and one electrical resistivity field dataset. The presented approach shows improvement on the conventional inversion approach to differentiate between different geologic units if the correct number of geologic units will be identified. Further, fuzzy constrained resistivity tomography was performed to examine the augmentation of uranium mineralization in the Beldih open cast mine as a case study. We also compared geologic units identified by fuzzy constrained resistivity tomography with geologic units interpreted from the borehole information.

System and method for identifying, reporting, and evaluating presence of substance

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

Smith, Maurice; Lusby, Michael; Van Hook, Arthur

A system and method for identifying, reporting, and evaluating a presence of a solid, liquid, gas, or other substance of interest, particularly a dangerous, hazardous, or otherwise threatening chemical, biological, or radioactive substance. The system comprises one or more substantially automated, location self-aware remote sensing units; a control unit; and one or more data processing and storage servers. Data is collected by the remote sensing units and transmitted to the control unit; the control unit generates and uploads a report incorporating the data to the servers; and thereafter the report is available for review by a hierarchy of responsive andmore » evaluative authorities via a wide area network. The evaluative authorities include a group of relevant experts who may be widely or even globally distributed.« less

System and method for identifying, reporting, and evaluating presence of substance

DOEpatents

Smith, Maurice [Kansas City, MO; Lusby, Michael [Kansas City, MO; Van Hook, Arthur [Lotawana, MO; Cook, Charles J [Raytown, MO; Wenski, Edward G [Lenexa, KS; Solyom, David [Overland Park, KS

2012-02-14

A system and method for identifying, reporting, and evaluating a presence of a solid, liquid, gas, or other substance of interest, particularly a dangerous, hazardous, or otherwise threatening chemical, biological, or radioactive substance. The system comprises one or more substantially automated, location self-aware remote sensing units; a control unit; and one or more data processing and storage servers. Data is collected by the remote sensing units and transmitted to the control unit; the control unit generates and uploads a report incorporating the data to the servers; and thereafter the report is available for review by a hierarchy of responsive and evaluative authorities via a wide area network. The evaluative authorities include a group of relevant experts who may be widely or even globally distributed.

System And Method For Identifying, Reporting, And Evaluating Presence Of Substance

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

Smith, Maurice; Lusby, Michael; Hook, Arthur Van

A system and method for identifying, reporting, and evaluating a presence of a solid, liquid, gas, or other substance of interest, particularly a dangerous, hazardous, or otherwise threatening chemical, biological, or radioactive substance. The system comprises one or more substantially automated, location self-aware remote sensing units; a control unit; and one or more data processing and storage servers. Data is collected by the remote sensing units and transmitted to the control unit; the control unit generates and uploads a report incorporating the data to the servers; and thereafter the report is available for review by a hierarchy of responsive andmore » evaluative authorities via a wide area network. The evaluative authorities include a group of relevant experts who may be widely or even globally distributed.« less

Using hyperspectral imaging technology to identify diseased tomato leaves

NASA Astrophysics Data System (ADS)

Li, Cuiling; Wang, Xiu; Zhao, Xueguan; Meng, Zhijun; Zou, Wei

2016-11-01

In the process of tomato plants growth, due to the effect of plants genetic factors, poor environment factors, or disoperation of parasites, there will generate a series of unusual symptoms on tomato plants from physiology, organization structure and external form, as a result, they cannot grow normally, and further to influence the tomato yield and economic benefits. Hyperspectral image usually has high spectral resolution, not only contains spectral information, but also contains the image information, so this study adopted hyperspectral imaging technology to identify diseased tomato leaves, and developed a simple hyperspectral imaging system, including a halogen lamp light source unit, a hyperspectral image acquisition unit and a data processing unit. Spectrometer detection wavelength ranged from 400nm to 1000nm. After hyperspectral images of tomato leaves being captured, it was needed to calibrate hyperspectral images. This research used spectrum angle matching method and spectral red edge parameters discriminant method respectively to identify diseased tomato leaves. Using spectral red edge parameters discriminant method produced higher recognition accuracy, the accuracy was higher than 90%. Research results have shown that using hyperspectral imaging technology to identify diseased tomato leaves is feasible, and provides the discriminant basis for subsequent disease control of tomato plants.

A Module Experimental Process System Development Unit (MEPSDU)

NASA Technical Reports Server (NTRS)

1981-01-01

A cost effective process sequence and machinery for the production of flat plate photovoltaic modules are described. Cells were fabricated using the process sequence which was optimized, as was a lamination procedure. Insulator tapes and edge seal material were identified and tested. Encapsulation materials were evaluated.

[IMPLEMENTATION OF A QUALITY MANAGEMENT SYSTEM IN A NUTRITION UNIT ACCORDING TO ISO 9001:2008].

PubMed

Velasco Gimeno, Cristina; Cuerda Compés, Cristina; Alonso Puerta, Alba; Frías Soriano, Laura; Camblor Álvarez, Miguel; Bretón Lesmes, Irene; Plá Mestre, Rosa; Izquierdo Membrilla, Isabel; García-Peris, Pilar

2015-09-01

the implementation of quality management systems (QMS) in the health sector has made great progress in recent years, remains a key tool for the management and improvement of services provides to patients. to describe the process of implementing a quality management system (QMS) according to the standard ISO 9001:2008 in a Nutrition Unit. the implementation began in October 2012. Nutrition Unit was supported by Hospital Preventive Medicine and Quality Management Service (PMQM). Initially training sessions on QMS and ISO standards for staff were held. Quality Committee (QC) was established with representation of the medical and nursing staff. Every week, meeting took place among members of the QC and PMQM to define processes, procedures and quality indicators. We carry on a 2 months follow-up of these documents after their validation. a total of 4 processes were identified and documented (Nutritional status assessment, Nutritional treatment, Monitoring of nutritional treatment and Planning and control of oral feeding) and 13 operating procedures in which all the activity of the Unit were described. The interactions among them were defined in the processes map. Each process has associated specific quality indicators for measuring the state of the QMS, and identifying opportunities for improvement. All the documents associated with requirements of ISO 9001:2008 were developed: quality policy, quality objectives, quality manual, documents and records control, internal audit, nonconformities and corrective and preventive actions. The unit was certified by AENOR in April 2013. the implementation of a QMS causes a reorganization of the activities of the Unit in order to meet customer's expectations. Documenting these activities ensures a better understanding of the organization, defines the responsibilities of all staff and brings a better management of time and resources. QMS also improves the internal communication and is a motivational element. Explore the satisfaction and expectations of patients can include their view in the design of care processes. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Position sensitive solid-state photomultipliers, systems and methods

DOEpatents

Shah, Kanai S; Christian, James; Stapels, Christopher; Dokhale, Purushottam; McClish, Mickel

2014-11-11

An integrated silicon solid state photomultiplier (SSPM) device includes a pixel unit including an array of more than 2.times.2 p-n photodiodes on a common substrate, a signal division network electrically connected to each photodiode, where the signal division network includes four output connections, a signal output measurement unit, a processing unit configured to identify the photodiode generating a signal or a center of mass of photodiodes generating a signal, and a global receiving unit.

Units of Distinction: Creating a Blueprint for Recognition of High-Performing Medical-Surgical Nursing Units.

PubMed

Jeffery, Alvin D; Mosier, Sammie; Baker, Allison; Korwek, Kimberly; Borum, Cindy; Englebright, Jane

2018-02-01

Hospital medical-surgical (M/S) nursing units are responsible for up to 28 million encounters annually, yet receive little attention from professional organizations and national initiatives targeted to improve quality and performance. We sought to develop a framework recognizing high-performing units within our large hospital system. This was a retrospective data analysis of M/S units throughout a 168-hospital system. Measures represented patient experience, employee engagement, staff scheduling, nursing-sensitive patient outcomes, professional practices, and clinical process measures. Four hundred ninety units from 129 hospitals contributed information to test the framework. A manual scoring system identified the top 5% and recognized them as a "Unit of Distinction." Secondary analyses with machine learning provided validation of the proposed framework. Similar to external recognition programs, this framework and process provide a holistic evaluation useful for meaningful recognition and lay the groundwork for benchmarking in improvement efforts.

Factors impeding flexible inpatient unit design.

PubMed

Pati, Debajyoti; Evans, Jennie; Harvey, Thomas E; Bazuin, Doug

2012-01-01

To identify and examine factors extraneous to the design decision-making process that could impede the optimization of flexibility on inpatient units. A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility. An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010. The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial. Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.

Life Science, A Process Approach, Second Edition: Revised, 1970.

ERIC Educational Resources Information Center

Phare, Wayne; And Others

Seventeen scientific processes are identified and annotated; some suggestions for activities to demonstrate them are given. These processes are used as headings in the teacher's guide to succeeding units on biological classifications, microbiology, physiology of plants and animals, chick embryology and ecology. Similar headings are usually used in…

A Comparative Study on Retirement Process in Korea, Germany, and the United States: Identifying Determinants of Retirement Process.

PubMed

Cho, Joonmo; Lee, Ayoung; Woo, Kwangho

2016-10-01

This study classifies the retirement process and empirically identifies the individual and institutional characteristics determining the retirement process of the aged in South Korea, Germany, and the United States. Using data from the Cross-National Equivalent File, we use a multinomial logistic regression with individual factors, public pension, and an interaction term between an occupation and an education level. We found that in Germany, the elderly with a higher education level were more likely to continue work after retirement with a relatively well-developed social support system, while in Korea, the elderly, with a lower education level in almost all occupation sectors, tended to work off and on after retirement. In the United States, the public pension and the interaction terms have no statistically significant impact on work after retirement. In both Germany and Korea, receiving a higher pension decreased the probability of working after retirement, but the influence of a pension in Korea was much greater than that of Germany. In South Korea, the elderly workers, with lower education levels, tended to work off and on repeatedly because there is no proper security in both the labor market and pension system. © The Author(s) 2016.

Identifying strengths and weaknesses of Quality Management Unit University of Sumatera Utara software using SCAMPI C

NASA Astrophysics Data System (ADS)

Gunawan, D.; Amalia, A.; Rahmat, R. F.; Muchtar, M. A.; Siregar, I.

2018-02-01

Identification of software maturity level is a technique to determine the quality of the software. By identifying the software maturity level, the weaknesses of the software can be observed. As a result, the recommendations might be a reference for future software maintenance and development. This paper discusses the software Capability Level (CL) with case studies on Quality Management Unit (Unit Manajemen Mutu) University of Sumatera Utara (UMM-USU). This research utilized Standard CMMI Appraisal Method for Process Improvement class C (SCAMPI C) model with continuous representation. This model focuses on activities for developing quality products and services. The observation is done in three process areas, such as Project Planning (PP), Project Monitoring and Control (PMC), and Requirements Management (REQM). According to the measurement of software capability level for UMM-USU software, turns out that the capability level for the observed process area is in the range of CL1 and CL2. Planning Project (PP) is the only process area which reaches capability level 2, meanwhile, PMC and REQM are still in CL 1 or in performed level. This research reveals several weaknesses of existing UMM-USU software. Therefore, this study proposes several recommendations for UMM-USU to improve capability level for observed process areas.

Efficient particle-in-cell simulation of auroral plasma phenomena using a CUDA enabled graphics processing unit

NASA Astrophysics Data System (ADS)

Sewell, Stephen

This thesis introduces a software framework that effectively utilizes low-cost commercially available Graphic Processing Units (GPUs) to simulate complex scientific plasma phenomena that are modeled using the Particle-In-Cell (PIC) paradigm. The software framework that was developed conforms to the Compute Unified Device Architecture (CUDA), a standard for general purpose graphic processing that was introduced by NVIDIA Corporation. This framework has been verified for correctness and applied to advance the state of understanding of the electromagnetic aspects of the development of the Aurora Borealis and Aurora Australis. For each phase of the PIC methodology, this research has identified one or more methods to exploit the problem's natural parallelism and effectively map it for execution on the graphic processing unit and its host processor. The sources of overhead that can reduce the effectiveness of parallelization for each of these methods have also been identified. One of the novel aspects of this research was the utilization of particle sorting during the grid interpolation phase. The final representation resulted in simulations that executed about 38 times faster than simulations that were run on a single-core general-purpose processing system. The scalability of this framework to larger problem sizes and future generation systems has also been investigated.

Hydrologic landscape units and adaptive management of intermountain wetlands

USGS Publications Warehouse

Custer, Stephen G.; Sojda, R.S.

2006-01-01

daptive management is often proposed to assist in the management of national wildlife refuges and allows the exploration of alternatives as well as the addition of ne w knowledge as it becomes available. The hydrological landscape unit can be a good foundation for such efforts. Red Rock Lakes National Wildlife Refuge (NWR) is in an intermountain basin dominated by vertical tectonics in the Northern Rocky Mountains. A geographic information system was used to define the boundaries for the hydrologic landscape units there. Units identified include alluvial fan, interfan, stream alluvi um and basin flat. Management alternatives can be informed by ex amination of processes that occu r on the units. For example, an ancient alluvial fan unit related to Red Rock Creek appear s to be isolated from stream flow today, with recharge dominated by precipitation and bedrock springs; while other alluvial fan units in the area have shallow ground water recharged from mountain streams and precipitation. The scale of hydrologic processes in interfan units differs from that in alluvial fan hydrologic landscape units. These differences are important when the refuge is evaluating habitat management activities. Hydrologic landscape units provide scientific unde rpinnings for the refuge’s comprehensive planning process. New geologic, hydrologic, and biologic knowledge can be integrated into the hydrologic landscape unit definition and improve adaptive management.

Monitoring of health care personnel employee and occupational health immunization program practices in the United States.

PubMed

Carrico, Ruth M; Sorrells, Nikka; Westhusing, Kelly; Wiemken, Timothy

2014-01-01

Recent studies have identified concerns with various elements of health care personnel immunization programs, including the handling and management of the vaccine. The purpose of this study was to assess monitoring processes that support evaluation of the care of vaccines in health care settings. An 11-question survey instrument was developed for use in scripted telephone surveys. State health departments in all 50 states in the United States and the District of Columbia were the target audience for the surveys. Data from a total of 47 states were obtained and analyzed. No states reported an existing monitoring process for evaluation of health care personnel immunization programs in their states. Our assessment indicates that vaccine evaluation processes for health care facilities are rare to nonexistent in the United States. Identifying existing practice gaps and resultant opportunities for improvements may be an important safety initiative that protects patients and health care personnel. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Evaluation of solar angle variation over digital processing of LANDSAT imagery. [Brazil

NASA Technical Reports Server (NTRS)

Parada, N. D. J. (Principal Investigator); Novo, E. M. L. M.

1984-01-01

The effects of the seasonal variation of illumination over digital processing of LANDSAT images are evaluated. Original images are transformed by means of digital filtering to enhance their spatial features. The resulting images are used to obtain an unsupervised classification of relief units. After defining relief classes, which are supposed to be spectrally different, topographic variables (declivity, altitude, relief range and slope length) are used to identify the true relief units existing on the ground. The samples are also clustered by means of an unsupervised classification option. The results obtained for each LANDSAT overpass are compared. Digital processing is highly affected by illumination geometry. There is no correspondence between relief units as defined by spectral features and those resulting from topographic features.

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

None

The purpose of this inventory of power plants is to provide a ready reference for planners whose focus is on the state, standard Federal region, and/or national level. Thus the inventory is compiled alphabetically by state within standard Federal regions. The units are listed alphabetically within electric utility systems which in turn are listed alphabetically within states. The locations are identified to county level according to the Federal Information Processing Standards Publication Counties and County Equivalents of the States of the United States. Data compiled include existing and projected electrical generation units, jointly owned units, and projected construction units.

Analyzing Vehicle Operator Deviations

DTIC Science & Technology

2008-07-01

Organization Report No. Scarborough A, Bailey L, Pounds J 9. Performing Organization Name and Address 10. Work Unit No. ( TRAIS ) FAA Civil...Investigation Reporting Form Instructions Use the accompanying flow charts (D4-D14) and Data Reporting Form (D15-D18) to document the results of the...happened, use the Entry Level Flow Chart (D3) to identify the relevant mental processes that were involved in the VOD. For each mental process identified

Fault finder

DOEpatents

Bunch, Richard H.

1986-01-01

A fault finder for locating faults along a high voltage electrical transmission line. Real time monitoring of background noise and improved filtering of input signals is used to identify the occurrence of a fault. A fault is detected at both a master and remote unit spaced along the line. A master clock synchronizes operation of a similar clock at the remote unit. Both units include modulator and demodulator circuits for transmission of clock signals and data. All data is received at the master unit for processing to determine an accurate fault distance calculation.

16 CFR 1615.31 - Labeling, recordkeeping, advertising, retail display and guaranties.

Code of Federal Regulations, 2010 CFR

2010-01-01

... records required must establish a line of continuity through the process of manufacture of each production... manufacturing specifications relating the same to prototype and production testing and to the production units... such sale or delivery shall be identified by production unit or by style. A style is a garment design...

Assessing pine regeneration for the South Central United States

Treesearch

William H. McWilliams

1990-01-01

Poor regeneration of pine following harvest on nonindustrial timberland has been identified as a major cause for loss of pine forests and slowdown of softwood growth in the Southern United States.Developing a strategy for regeneration assessment requires clear definition of sampling objectives, sampling design, and analytical processes. It is important that...

Introduction to Crop Production. Unit A-7.

ERIC Educational Resources Information Center

Luft, Vernon D.; Backlund, Paul

This document is a teacher's guide for a unit in vocational agriculture for college freshmen. It is intended to be used for 20 hours of instruction as an introductory course on the crop industry. It provides a broad background of the industry, including production, marketing, processing, and transportation, with emphasis on identifying major crops…

Integrated Process Modeling-A Process Validation Life Cycle Companion.

PubMed

Zahel, Thomas; Hauer, Stefan; Mueller, Eric M; Murphy, Patrick; Abad, Sandra; Vasilieva, Elena; Maurer, Daniel; Brocard, Cécile; Reinisch, Daniela; Sagmeister, Patrick; Herwig, Christoph

2017-10-17

During the regulatory requested process validation of pharmaceutical manufacturing processes, companies aim to identify, control, and continuously monitor process variation and its impact on critical quality attributes (CQAs) of the final product. It is difficult to directly connect the impact of single process parameters (PPs) to final product CQAs, especially in biopharmaceutical process development and production, where multiple unit operations are stacked together and interact with each other. Therefore, we want to present the application of Monte Carlo (MC) simulation using an integrated process model (IPM) that enables estimation of process capability even in early stages of process validation. Once the IPM is established, its capability in risk and criticality assessment is furthermore demonstrated. IPMs can be used to enable holistic production control strategies that take interactions of process parameters of multiple unit operations into account. Moreover, IPMs can be trained with development data, refined with qualification runs, and maintained with routine manufacturing data which underlines the lifecycle concept. These applications will be shown by means of a process characterization study recently conducted at a world-leading contract manufacturing organization (CMO). The new IPM methodology therefore allows anticipation of out of specification (OOS) events, identify critical process parameters, and take risk-based decisions on counteractions that increase process robustness and decrease the likelihood of OOS events.

Understanding the College Choice Process of United States Military-Affiliated Transfer Students

ERIC Educational Resources Information Center

Ives, Emily Joanne

2017-01-01

This study examined the college choice process of transfer student veterans who are currently enrolled in a public research university. The research presented in this dissertation utilized both quantitative and qualitative strategies to identify key factors in students' college choice process. This study focuses on the following two research…

Evaluation of the effects of the seasonal variation of solar elevation angle and azimuth on the processes of digital filtering and thematic classification of relief units

NASA Technical Reports Server (NTRS)

Parada, N. D. J. (Principal Investigator); Novo, E. M. L. M.

1983-01-01

The effects of the seasonal variation of illumination over digital processing of LANDSAT images are evaluated. Two sets of LANDSAT data referring to the orbit 150 and row 28 were selected with illumination parameters varying from 43 deg to 64 deg for azimuth and from 30 deg to 36 deg for solar elevation respectively. IMAGE-100 system permitted the digital processing of LANDSAT data. Original images were transformed by means of digital filtering so as to enhance their spatial features. The resulting images were used to obtain an unsupervised classification of relief units. Topographic variables (declivity, altitude, relief range and slope length) were used to identify the true relief units existing on the ground. The LANDSAT over pass data show that digital processing is highly affected by illumination geometry, and there is no correspondence between relief units as defined by spectral features and those resulting from topographic features.

Occurrence of invertebrates at 38 stream sites in the Mississippi Embayment study unit, 1996-99

USGS Publications Warehouse

Caskey, Brian J.; Justus, B.G.; Zappia, Humbert

2002-01-01

A total of 88 invertebrate species and 178 genera representing 59 families, 8 orders, 6 classes, and 3 phyla was identified at 38 stream sites in the Mississippi Embayment Study Unit from 1996 through 1999 as part of the National Water-Quality Assessment Program. Sites were selected based on land use within the drainage basins and the availability of long-term streamflow data. Invertebrates were sampled as part of an overall sampling design to provide information related to the status and trends in water quality in the Mississippi Embayment Study Unit, which includes parts of Arkansas, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee. Invertebrate sampling and processing was conducted using nationally standardized techniques developed for the National Water-Quality Assessment Program. These techniques included both a semi-quantitative method, which targeted habitats where invertebrate diversity is expected to be highest, and a qualitative multihabitat method, which samples all available habitat types possible within a sampling reach. All invertebrate samples were shipped to the USGS National Water-Quality Laboratory (NWQL) where they were processed. Of the 365 taxa identified, 156 were identified with the semi-quantitative method that involved sampling a known quantity of what was expected to be the richest habitat, woody debris. The qualitative method, which involved sampling all available habitats, identified 345 taxa The number of organisms identified in the semi-quantitative samples ranged from 74 to 3,295, whereas the number of taxa identified ranged from 9 to 54. The number of organisms identified in the qualitative samples ranged from 42 to 29,634, whereas the number of taxa ranged from 18 to 81. From all the organisms identified, chironomid taxa were the most frequently identified, and plecopteran taxa were among the least frequently identified.

CDO budgeting

NASA Astrophysics Data System (ADS)

Nesladek, Pavel; Wiswesser, Andreas; Sass, Björn; Mauermann, Sebastian

2008-04-01

The Critical dimension off-target (CDO) is a key parameter for mask house customer, affecting directly the performance of the mask. The CDO is the difference between the feature size target and the measured feature size. The change of CD during the process is either compensated within the process or by data correction. These compensation methods are commonly called process bias and data bias, respectively. The difference between data bias and process bias in manufacturing results in systematic CDO error, however, this systematic error does not take into account the instability of the process bias. This instability is a result of minor variations - instabilities of manufacturing processes and changes in materials and/or logistics. Using several masks the CDO of the manufacturing line can be estimated. For systematic investigation of the unit process contribution to CDO and analysis of the factors influencing the CDO contributors, a solid understanding of each unit process and huge number of masks is necessary. Rough identification of contributing processes and splitting of the final CDO variation between processes can be done with approx. 50 masks with identical design, material and process. Such amount of data allows us to identify the main contributors and estimate the effect of them by means of Analysis of variance (ANOVA) combined with multivariate analysis. The analysis does not provide information about the root cause of the variation within the particular unit process, however, it provides a good estimate of the impact of the process on the stability of the manufacturing line. Additionally this analysis can be used to identify possible interaction between processes, which cannot be investigated if only single processes are considered. Goal of this work is to evaluate limits for CDO budgeting models given by the precision and the number of measurements as well as partitioning the variation within the manufacturing process. The CDO variation splits according to the suggested model into contributions from particular processes or process groups. Last but not least the power of this method to determine the absolute strength of each parameter will be demonstrated. Identification of the root cause of this variation within the unit process itself is not scope of this work.

H-theorem and Maxwell demon in quantum physics

NASA Astrophysics Data System (ADS)

Kirsanov, N. S.; Lebedev, A. V.; Sadovskyy, I. A.; Suslov, M. V.; Vinokur, V. M.; Blatter, G.; Lesovik, G. B.

2018-02-01

The Second Law of Thermodynamics states that temporal evolution of an isolated system occurs with non-diminishing entropy. In quantum realm, this holds for energy-isolated systems the evolution of which is described by the so-called unital quantum channel. The entropy of a system evolving in a non-unital quantum channel can, in principle, decrease. We formulate a general criterion of unitality for the evolution of a quantum system, enabling a simple and rigorous approach for finding and identifying the processes accompanied by decreasing entropy in energy-isolated systems. We discuss two examples illustrating our findings, the quantum Maxwell demon and heating-cooling process within a two-qubit system.

Physiotherapists' Perceptions of and Experiences with the Discharge Planning Process in Acute-Care General Internal Medicine Units in Ontario

PubMed Central

Uyeno, Jennifer; Heck, Carol S.

2014-01-01

ABSTRACT Purpose: To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. Methods: A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. Results: Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. Conclusions: Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning. PMID:25125778

The Internal Medicine of the 21st century: Organizational and operational standards.

PubMed

Casariego-Vales, E; Zapatero-Gaviria, A; Elola-Somoza, F J

2017-12-01

The Spanish Society of Internal Medicine has developed a consensus document on the standards and recommendations that they consider essential to the organisation of internal medicine units for conducting their activities efficiently and with high quality. We defined 3 groups of key processes: the care of acutely ill adult patients, the comprehensive care of complex chronic patients and the examination of a patient with a difficult diagnosis and no organ-specific disease. As support processes, we identified the structure and operation of the Internal Medicine units. As strategic processes, we identified training and research. The main subprocesses are structured below, and we established the standards and recommendations for each of them. Lastly, we proposed resulting workloads. The prepared standards must be reviewed within a maximum of 4 years. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Effect of medium on friction and wear properties of compacted graphite cast iron processed by biomimetic coupling laser remelting process

NASA Astrophysics Data System (ADS)

Guo, Qing-chun; Zhou, Hong; Wang, Cheng-tao; Zhang, Wei; Lin, Peng-yu; Sun, Na; Ren, Luquan

2009-04-01

Stimulated by the cuticles of soil animals, an attempt to improve the wear resistance of compact graphite cast iron (CGI) with biomimetic units on the surface was made by using a biomimetic coupled laser remelting process in air and various thicknesses water film, respectively. The microstructures of biomimetic units were examined by scanning electron microscope and X-ray diffraction was used to describe the microstructure and identify the phases in the melted zone. Microhardness was measured and the wear behaviors of biomimetic specimens as functions of different mediums as well as various water film thicknesses were investigated under dry sliding condition, respectively. The results indicated that the microstructure zones in the biomimetic specimens processed with water film are refined compared with that processed in air and had better wear resistance increased by 60%, the microhardness of biomimetic units has been improved significantly. The application of water film provided finer microstructures and much more regular grain shape in biomimetic units, which played a key role in improving the friction properties and wear resistance of CGI.

A Case Study on Improving Intensive Care Unit (ICU) Services Reliability: By Using Process Failure Mode and Effects Analysis (PFMEA)

PubMed Central

Yousefinezhadi, Taraneh; Jannesar Nobari, Farnaz Attar; Goodari, Faranak Behzadi; Arab, Mohammad

2016-01-01

Introduction: In any complex human system, human error is inevitable and shows that can’t be eliminated by blaming wrong doers. So with the aim of improving Intensive Care Units (ICU) reliability in hospitals, this research tries to identify and analyze ICU’s process failure modes at the point of systematic approach to errors. Methods: In this descriptive research, data was gathered qualitatively by observations, document reviews, and Focus Group Discussions (FGDs) with the process owners in two selected ICUs in Tehran in 2014. But, data analysis was quantitative, based on failures’ Risk Priority Number (RPN) at the base of Failure Modes and Effects Analysis (FMEA) method used. Besides, some causes of failures were analyzed by qualitative Eindhoven Classification Model (ECM). Results: Through FMEA methodology, 378 potential failure modes from 180 ICU activities in hospital A and 184 potential failures from 99 ICU activities in hospital B were identified and evaluated. Then with 90% reliability (RPN≥100), totally 18 failures in hospital A and 42 ones in hospital B were identified as non-acceptable risks and then their causes were analyzed by ECM. Conclusions: Applying of modified PFMEA for improving two selected ICUs’ processes reliability in two different kinds of hospitals shows that this method empowers staff to identify, evaluate, prioritize and analyze all potential failure modes and also make them eager to identify their causes, recommend corrective actions and even participate in improving process without feeling blamed by top management. Moreover, by combining FMEA and ECM, team members can easily identify failure causes at the point of health care perspectives. PMID:27157162

Using the Self-Select Paradigm to Delineate the Nature of Speech Motor Programming

ERIC Educational Resources Information Center

Wright, David L.; Robin, Don A.; Rhee, Jooyhun; Vaculin, Amber; Jacks, Adam; Guenther, Frank H.; Fox, Peter T.

2009-01-01

Purpose: The authors examined the involvement of 2 speech motor programming processes identified by S. T. Klapp (1995, 2003) during the articulation of utterances differing in syllable and sequence complexity. According to S. T. Klapp, 1 process, INT, resolves the demands of the programmed unit, whereas a second process, SEQ, oversees the serial…

Application of a hazard and operability study method to hazard evaluation of a chemical unit of the power station.

PubMed

Habibi, E; Zare, M; Barkhordari, A; Mirmohammadi, Sj; Halvani, Ghh

2008-12-28

The aim of this study was to identify the hazards, evaluate their risk factors and determine the measure for promotion of the process and reduction of accidents in the chemical unit of the power station. In this case and qualitative study, HAZOP technique was used to recognize the hazards and problems of operations on the chemical section at power station. Totally, 126 deviations were documented with various causes and consequences. Ranking and evaluation of identified risks indicate that the majority of deviations were categorized as "acceptable" and less than half of that were "unacceptable". The highest calculated risk level (1B) related to both the interruption of acid entry to the discharge pumps and an increased density of the acid. About 27% of the deviations had the lowest risk level (4B). The identification of hazards by HAZOP indicates that it could, systemically, assess and criticize the process of consumption or production of acid and alkali in the chemical unit of power plant.

Women׳s birthplace decision-making, the role of confidence: Part of the Evaluating Maternity Units study, New Zealand.

PubMed

Grigg, Celia P; Tracy, Sally K; Schmied, Virginia; Daellenbach, Rea; Kensington, Mary

2015-06-01

to explore women׳s birthplace decision-making and identify the factors which enable women to plan to give birth in a freestanding midwifery-led primary level maternity unit rather than in an obstetric-led tertiary level maternity hospital in New Zealand. a mixed methods prospective cohort design. data from eight focus groups (37 women) and a six week postpartum survey (571 women, 82%) were analysed using thematic analysis and descriptive statistics. The qualitative data from the focus groups and survey were the primary data sources and were integrated at the analysis stage; and the secondary qualitative and quantitative data were integrated at the interpretation stage. Christchurch, New Zealand, with one tertiary maternity hospital and four primary level maternity units (2010-2012). well (at 'low risk' of developing complications), pregnant women booked to give birth in one of the primary units or the tertiary hospital. All women received midwifery continuity of care, regardless of their intended or actual birthplace. five core themes were identified: the birth process, women׳s self-belief in their ability to give birth, midwives, the health system and birth place. 'Confidence' was identified as the overarching concept influencing the themes. Women who chose to give birth in a primary maternity unit appeared to differ markedly in their beliefs regarding their optimal birthplace compared to women who chose to give birth in a tertiary maternity hospital. The women who planned a primary maternity unit birth expressed confidence in the birth process, their ability to give birth, their midwife, the maternity system and/or the primary unit itself. The women planning to give birth in a tertiary hospital did not express confidence in the birth process, their ability to give birth, the system for transfers and/or the primary unit as a birthplace, although they did express confidence in their midwife. birthplace is a profoundly important aspect of women׳s experience of childbirth. Birthplace decision-making is complex, in common with many other aspects of childbirth. A multiplicity of factors needs converge in order for all those involved to gain the confidence required to plan what, in this context, might be considered a 'countercultural' decision to give birth at a midwife-led primary maternity unit. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Ecoregions of the conterminous United States: evolution of a hierarchical spatial framework

USGS Publications Warehouse

Omernik, James M.; Griffith, Glenn E.

2014-01-01

A map of ecological regions of the conterminous United States, first published in 1987, has been greatly refined and expanded into a hierarchical spatial framework in response to user needs, particularly by state resource management agencies. In collaboration with scientists and resource managers from numerous agencies and institutions in the United States, Mexico, and Canada, the framework has been expanded to cover North America, and the original ecoregions (now termed Level III) have been refined, subdivided, and aggregated to identify coarser as well as more detailed spatial units. The most generalized units (Level I) define 10 ecoregions in the conterminous U.S., while the finest-scale units (Level IV) identify 967 ecoregions. In this paper, we explain the logic underpinning the approach, discuss the evolution of the regional mapping process, and provide examples of how the ecoregions were distinguished at each hierarchical level. The variety of applications of the ecoregion framework illustrates its utility in resource assessment and management.

Ecoregions of the Conterminous United States: Evolution of a Hierarchical Spatial Framework

NASA Astrophysics Data System (ADS)

Omernik, James M.; Griffith, Glenn E.

2014-12-01

A map of ecological regions of the conterminous United States, first published in 1987, has been greatly refined and expanded into a hierarchical spatial framework in response to user needs, particularly by state resource management agencies. In collaboration with scientists and resource managers from numerous agencies and institutions in the United States, Mexico, and Canada, the framework has been expanded to cover North America, and the original ecoregions (now termed Level III) have been refined, subdivided, and aggregated to identify coarser as well as more detailed spatial units. The most generalized units (Level I) define 10 ecoregions in the conterminous U.S., while the finest-scale units (Level IV) identify 967 ecoregions. In this paper, we explain the logic underpinning the approach, discuss the evolution of the regional mapping process, and provide examples of how the ecoregions were distinguished at each hierarchical level. The variety of applications of the ecoregion framework illustrates its utility in resource assessment and management.

Identification of priorities for medication safety in neonatal intensive care.

PubMed

Kunac, Desireé L; Reith, David M

2005-01-01

Although neonates are reported to be at greater risk of medication error than infants and older children, little is known about the causes and characteristics of error in this patient group. Failure mode and effects analysis (FMEA) is a technique used in industry to evaluate system safety and identify potential hazards in advance. The aim of this study was to identify and prioritize potential failures in the neonatal intensive care unit (NICU) medication use process through application of FMEA. Using the FMEA framework and a systems-based approach, an eight-member multidisciplinary panel worked as a team to create a flow diagram of the neonatal unit medication use process. Then by brainstorming, the panel identified all potential failures, their causes and their effects at each step in the process. Each panel member independently rated failures based on occurrence, severity and likelihood of detection to allow calculation of a risk priority score (RPS). The panel identified 72 failures, with 193 associated causes and effects. Vulnerabilities were found to be distributed across the entire process, but multiple failures and associated causes were possible when prescribing the medication and when preparing the drug for administration. The top ranking issue was a perceived lack of awareness of medication safety issues (RPS score 273), due to a lack of medication safety training. The next highest ranking issues were found to occur at the administration stage. Common potential failures related to errors in the dose, timing of administration, infusion pump settings and route of administration. Perceived causes were multiple, but were largely associated with unsafe systems for medication preparation and storage in the unit, variable staff skill level and lack of computerised technology. Interventions to decrease medication-related adverse events in the NICU should aim to increase staff awareness of medication safety issues and focus on medication administration processes.

Developing Statistical Models to Assess Transplant Outcomes Using National Registries: The Process in the United States.

PubMed

Snyder, Jon J; Salkowski, Nicholas; Kim, S Joseph; Zaun, David; Xiong, Hui; Israni, Ajay K; Kasiske, Bertram L

2016-02-01

Created by the US National Organ Transplant Act in 1984, the Scientific Registry of Transplant Recipients (SRTR) is obligated to publicly report data on transplant program and organ procurement organization performance in the United States. These reports include risk-adjusted assessments of graft and patient survival, and programs performing worse or better than expected are identified. The SRTR currently maintains 43 risk adjustment models for assessing posttransplant patient and graft survival and, in collaboration with the SRTR Technical Advisory Committee, has developed and implemented a new systematic process for model evaluation and revision. Patient cohorts for the risk adjustment models are identified, and single-organ and multiorgan transplants are defined, then each risk adjustment model is developed following a prespecified set of steps. Model performance is assessed, the model is refit to a more recent cohort before each evaluation cycle, and then it is applied to the evaluation cohort. The field of solid organ transplantation is unique in the breadth of the standardized data that are collected. These data allow for quality assessment across all transplant providers in the United States. A standardized process of risk model development using data from national registries may enhance the field.

Pre- and post-drill comparison of the Mount Elbert gas hydrate prospect, Alaska North Slope

USGS Publications Warehouse

Lee, M.W.; Agena, W.F.; Collett, T.S.; Inks, T.L.

2011-01-01

In 2006, the United States Geological Survey (USGS) completed a detailed analysis and interpretation of available 2-D and 3-D seismic data, along with seismic modeling and correlation with specially processed downhole well log data for identifying potential gas hydrate accumulations on the North Slope of Alaska. A methodology was developed for identifying sub-permafrost gas hydrate prospects within the gas hydrate stability zone in the Milne Point area. The study revealed a total of 14 gas hydrate prospects in this area.In order to validate the gas hydrate prospecting protocol of the USGS and to acquire critical reservoir data needed to develop a longer-term production testing program, a stratigraphic test well was drilled at the Mount Elbert prospect in the Milne Point area in early 2007. The drilling confirmed the presence of two prominent gas-hydrate-bearing units in the Mount Elbert prospect, and high quality well logs and core data were acquired. The post-drill results indicate pre-drill predictions of the reservoir thickness and the gas-hydrate saturations based on seismic and existing well data were 90% accurate for the upper unit (hydrate unit D) and 70% accurate for the lower unit (hydrate unit C), confirming the validity of the USGS approach to gas hydrate prospecting. The Mount Elbert prospect is the first gas hydrate accumulation on the North Slope of Alaska identified primarily on the basis of seismic attribute analysis and specially processed downhole log data. Post-drill well log data enabled a better constraint of the elastic model and the development of an improved approach to the gas hydrate prospecting using seismic attributes. ?? 2009.

Seed defective reduction in automotive Electro-Deposition Coating Process of truck cabin

NASA Astrophysics Data System (ADS)

Sonthilug, Aekkalag; Chutima, Parames

2018-02-01

The case study company is one of players in Thailand’s Automotive Industry who manufacturing truck and bus for both domestic and international market. This research focuses on a product quality problem about seed defects occurred in the Electro-Deposition Coating Process of truck cabin. The 5-phase of Six Sigma methodology including D-Define, M-Measure, A-Analyze, I-Improve, and C-Control is applied to this research to identify root causes of problem for setting new parameters of each significant factor. After the improvement, seed defects in this process is reduced from 9,178 defects per unit to 876 defects per unit (90% improvement)

Unit Process Wetlands for Removal of Trace Organic Contaminants and Pathogens from Municipal Wastewater Effluents

PubMed Central

Jasper, Justin T.; Nguyen, Mi T.; Jones, Zackary L.; Ismail, Niveen S.; Sedlak, David L.; Sharp, Jonathan O.; Luthy, Richard G.; Horne, Alex J.; Nelson, Kara L.

2013-01-01

Abstract Treatment wetlands have become an attractive option for the removal of nutrients from municipal wastewater effluents due to their low energy requirements and operational costs, as well as the ancillary benefits they provide, including creating aesthetically appealing spaces and wildlife habitats. Treatment wetlands also hold promise as a means of removing other wastewater-derived contaminants, such as trace organic contaminants and pathogens. However, concerns about variations in treatment efficacy of these pollutants, coupled with an incomplete mechanistic understanding of their removal in wetlands, hinder the widespread adoption of constructed wetlands for these two classes of contaminants. A better understanding is needed so that wetlands as a unit process can be designed for their removal, with individual wetland cells optimized for the removal of specific contaminants, and connected in series or integrated with other engineered or natural treatment processes. In this article, removal mechanisms of trace organic contaminants and pathogens are reviewed, including sorption and sedimentation, biotransformation and predation, photolysis and photoinactivation, and remaining knowledge gaps are identified. In addition, suggestions are provided for how these treatment mechanisms can be enhanced in commonly employed unit process wetland cells or how they might be harnessed in novel unit process cells. It is hoped that application of the unit process concept to a wider range of contaminants will lead to more widespread application of wetland treatment trains as components of urban water infrastructure in the United States and around the globe. PMID:23983451

Unit Process Wetlands for Removal of Trace Organic Contaminants and Pathogens from Municipal Wastewater Effluents.

PubMed

Jasper, Justin T; Nguyen, Mi T; Jones, Zackary L; Ismail, Niveen S; Sedlak, David L; Sharp, Jonathan O; Luthy, Richard G; Horne, Alex J; Nelson, Kara L

2013-08-01

Treatment wetlands have become an attractive option for the removal of nutrients from municipal wastewater effluents due to their low energy requirements and operational costs, as well as the ancillary benefits they provide, including creating aesthetically appealing spaces and wildlife habitats. Treatment wetlands also hold promise as a means of removing other wastewater-derived contaminants, such as trace organic contaminants and pathogens. However, concerns about variations in treatment efficacy of these pollutants, coupled with an incomplete mechanistic understanding of their removal in wetlands, hinder the widespread adoption of constructed wetlands for these two classes of contaminants. A better understanding is needed so that wetlands as a unit process can be designed for their removal, with individual wetland cells optimized for the removal of specific contaminants, and connected in series or integrated with other engineered or natural treatment processes. In this article, removal mechanisms of trace organic contaminants and pathogens are reviewed, including sorption and sedimentation, biotransformation and predation, photolysis and photoinactivation, and remaining knowledge gaps are identified. In addition, suggestions are provided for how these treatment mechanisms can be enhanced in commonly employed unit process wetland cells or how they might be harnessed in novel unit process cells. It is hoped that application of the unit process concept to a wider range of contaminants will lead to more widespread application of wetland treatment trains as components of urban water infrastructure in the United States and around the globe.

AFSO 21: Identifying Potential Failure Points in Sustaining Continuous Process Improvement Across the Air Force

DTIC Science & Technology

2007-04-01

Michael W. Wynne, and the Air Force Chief of Staff, General T. Michael Moseley, “our strategy will be a comprehensive effort to improve our work processes...5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...property of the United States government. ii AU/ACSC/2307/AY07 Preface I have always been a proponent of working smarter and not harder. I

Google matrix of business process management

NASA Astrophysics Data System (ADS)

Abel, M. W.; Shepelyansky, D. L.

2011-12-01

Development of efficient business process models and determination of their characteristic properties are subject of intense interdisciplinary research. Here, we consider a business process model as a directed graph. Its nodes correspond to the units identified by the modeler and the link direction indicates the causal dependencies between units. It is of primary interest to obtain the stationary flow on such a directed graph, which corresponds to the steady-state of a firm during the business process. Following the ideas developed recently for the World Wide Web, we construct the Google matrix for our business process model and analyze its spectral properties. The importance of nodes is characterized by PageRank and recently proposed CheiRank and 2DRank, respectively. The results show that this two-dimensional ranking gives a significant information about the influence and communication properties of business model units. We argue that the Google matrix method, described here, provides a new efficient tool helping companies to make their decisions on how to evolve in the exceedingly dynamic global market.

Conceptual design of distillation-based hybrid separation processes.

PubMed

Skiborowski, Mirko; Harwardt, Andreas; Marquardt, Wolfgang

2013-01-01

Hybrid separation processes combine different separation principles and constitute a promising design option for the separation of complex mixtures. Particularly, the integration of distillation with other unit operations can significantly improve the separation of close-boiling or azeotropic mixtures. Although the design of single-unit operations is well understood and supported by computational methods, the optimal design of flowsheets of hybrid separation processes is still a challenging task. The large number of operational and design degrees of freedom requires a systematic and optimization-based design approach. To this end, a structured approach, the so-called process synthesis framework, is proposed. This article reviews available computational methods for the conceptual design of distillation-based hybrid processes for the separation of liquid mixtures. Open problems are identified that must be addressed to finally establish a structured process synthesis framework for such processes.

Theoretical Dimensions of Small Unit Resilience

DTIC Science & Technology

2010-12-01

ending process and everyday and every experience offers a new education. Keep learning and keep moving forward. To my brother and sister Soldiers...strategies and coping mechanisms. 13 Unit Leadership and Coping Willingness to Seek Care Reducing Barriers to Care Family and Marital Support...identifies the following 10 combat skills: Buddies (Cohesion) Accountability Targeted Aggression 14 15 Tactical Awareness Lethally Armed Emotional

Identification of Action Units Related to Affective States in a Tutoring System for Mathematics

ERIC Educational Resources Information Center

Padrón-Rivera, Gustavo; Rebolledo-Mendez, Genaro; Parra, Pilar Pozos; Huerta-Pacheco, N. Sofia

2016-01-01

Affect is an important element of the learning process both in the classroom and with educational technology. This paper presents analyses in relation to the identification of Action Units (AUs) related to affective states and their impact on learning with a tutoring system. To assess affect, a tool was devised to identify AUs on pictures of human…

National Report on Sustainable Forests - 2003

Treesearch

USDA Forest Service

2004-01-01

This report presents a fresh analysis of the available data on the condition of forests in the United States. It uses the criteria and indicators of sustainable forest management endorsed by the Montreal Process, of which the United States is a member country. The report also identifies data gaps and makes recommendations for next steps to move forward the state of the...

Statistical transformation and the interpretation of inpatient glucose control data from the intensive care unit.

PubMed

Saulnier, George E; Castro, Janna C; Cook, Curtiss B

2014-05-01

Glucose control can be problematic in critically ill patients. We evaluated the impact of statistical transformation on interpretation of intensive care unit inpatient glucose control data. Point-of-care blood glucose (POC-BG) data derived from patients in the intensive care unit for 2011 was obtained. Box-Cox transformation of POC-BG measurements was performed, and distribution of data was determined before and after transformation. Different data subsets were used to establish statistical upper and lower control limits. Exponentially weighted moving average (EWMA) control charts constructed from April, October, and November data determined whether out-of-control events could be identified differently in transformed versus nontransformed data. A total of 8679 POC-BG values were analyzed. POC-BG distributions in nontransformed data were skewed but approached normality after transformation. EWMA control charts revealed differences in projected detection of out-of-control events. In April, an out-of-control process resulting in the lower control limit being exceeded was identified at sample 116 in nontransformed data but not in transformed data. October transformed data detected an out-of-control process exceeding the upper control limit at sample 27 that was not detected in nontransformed data. Nontransformed November results remained in control, but transformation identified an out-of-control event less than 10 samples into the observation period. Using statistical methods to assess population-based glucose control in the intensive care unit could alter conclusions about the effectiveness of care processes for managing hyperglycemia. Further study is required to determine whether transformed versus nontransformed data change clinical decisions about the interpretation of care or intervention results. © 2014 Diabetes Technology Society.

Statistical Transformation and the Interpretation of Inpatient Glucose Control Data From the Intensive Care Unit

PubMed Central

Saulnier, George E.; Castro, Janna C.

2014-01-01

Glucose control can be problematic in critically ill patients. We evaluated the impact of statistical transformation on interpretation of intensive care unit inpatient glucose control data. Point-of-care blood glucose (POC-BG) data derived from patients in the intensive care unit for 2011 was obtained. Box–Cox transformation of POC-BG measurements was performed, and distribution of data was determined before and after transformation. Different data subsets were used to establish statistical upper and lower control limits. Exponentially weighted moving average (EWMA) control charts constructed from April, October, and November data determined whether out-of-control events could be identified differently in transformed versus nontransformed data. A total of 8679 POC-BG values were analyzed. POC-BG distributions in nontransformed data were skewed but approached normality after transformation. EWMA control charts revealed differences in projected detection of out-of-control events. In April, an out-of-control process resulting in the lower control limit being exceeded was identified at sample 116 in nontransformed data but not in transformed data. October transformed data detected an out-of-control process exceeding the upper control limit at sample 27 that was not detected in nontransformed data. Nontransformed November results remained in control, but transformation identified an out-of-control event less than 10 samples into the observation period. Using statistical methods to assess population-based glucose control in the intensive care unit could alter conclusions about the effectiveness of care processes for managing hyperglycemia. Further study is required to determine whether transformed versus nontransformed data change clinical decisions about the interpretation of care or intervention results. PMID:24876620

On the detection of functionally coherent groups of protein domains with an extension to protein annotation

PubMed Central

McLaughlin, William A; Chen, Ken; Hou, Tingjun; Wang, Wei

2007-01-01

Background Protein domains coordinate to perform multifaceted cellular functions, and domain combinations serve as the functional building blocks of the cell. The available methods to identify functional domain combinations are limited in their scope, e.g. to the identification of combinations falling within individual proteins or within specific regions in a translated genome. Further effort is needed to identify groups of domains that span across two or more proteins and are linked by a cooperative function. Such functional domain combinations can be useful for protein annotation. Results Using a new computational method, we have identified 114 groups of domains, referred to as domain assembly units (DASSEM units), in the proteome of budding yeast Saccharomyces cerevisiae. The units participate in many important cellular processes such as transcription regulation, translation initiation, and mRNA splicing. Within the units the domains were found to function in a cooperative manner; and each domain contributed to a different aspect of the unit's overall function. The member domains of DASSEM units were found to be significantly enriched among proteins contained in transcription modules, defined as genes sharing similar expression profiles and presumably similar functions. The observation further confirmed the functional coherence of DASSEM units. The functional linkages of units were found in both functionally characterized and uncharacterized proteins, which enabled the assessment of protein function based on domain composition. Conclusion A new computational method was developed to identify groups of domains that are linked by a common function in the proteome of Saccharomyces cerevisiae. These groups can either lie within individual proteins or span across different proteins. We propose that the functional linkages among the domains within the DASSEM units can be used as a non-homology based tool to annotate uncharacterized proteins. PMID:17937820

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

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

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

Prioritization of Stockpile Maintenance with Layered Pareto Fronts

DOE PAGES

Burke, Sarah E.; Anderson-Cook, Christine M.; Lu, Lu; ...

2017-10-11

Difficult choices are required for a decision-making process where resources and budgets are increasingly constrained. This study demonstrates a structured decision-making approach using layered Pareto fronts to identify priorities about how to allocate funds between munitions stockpiles based on their estimated reliability, the urgency of needing available units, and the consequences if adequate numbers of units are not available. This case study, while specific to the characteristics of a group of munitions stockpiles, illustrates the general process of structured decision-making based on first identifying appropriate metrics that summarize the important dimensions of the decision, and then objectively eliminating non-contenders frommore » further consideration. Finally, the final subjective stage incorporates user priorities to select the four stockpiles to receive additional maintenance and surveillance funds based on understanding the trade-offs and robustness to various user priorities.« less

Art Therapy on a Hospital Burn Unit: A Step towards Healing and Recovery.

ERIC Educational Resources Information Center

Russel, Johanna

1995-01-01

Describes how art therapy can benefit patients hospitalized due to severe burns, who suffer psychological as well as physical trauma. Outlines the psychological phases, identifies how burn patients typically experience their healing process, and discusses how art therapy can assist the patient at each stage of the recovery process. (JPS)

A Management Scientist Looks at Education and Education Looks Back.

ERIC Educational Resources Information Center

Ackoff, Russell L.

Three fundamental educational issues which are usually ignored in favor of more trival operating problems are identified as follows: how can the educational process be redesigned to focus on the learning, not teaching, process; how to avoid organizing education around rigid schedules and artifically quantified units of subject matter and instead…

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

PubMed

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

2014-02-01

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

How many schools adopt interviews during the student admission process across the health professions in the United States of America?

PubMed Central

2016-01-01

Health profession schools use interviews during the admissions process to identify certain non-cognitive skills that are needed for success in diverse, inter-professional settings. This study aimed to assess the use of interviews during the student admissions process across health disciplines at schools in the United States of America in 2014. The type and frequency of non-cognitive skills assessed were also evaluated. Descriptive methods were used to analyze a sample of interview rubrics collected as part of a national survey on admissions in the health professions, which surveyed 228 schools of medicine, dentistry, pharmacy, nursing, and public health. Of the 228 schools, 130 used interviews. The most desirable non-cognitive skills from 34 schools were identified as follows: communication skills (30), motivation (22), readiness for the profession (17), service (12), and problem-solving (12). Ten schools reported using the multiple mini-interview format, which may indicate potential for expanding this practice. Disparities in the use of interviewing across health professions should be verified to help schools adopt interviews during student admissions processes. PMID:26924541

How many schools adopt interviews during the student admission process across the health professions in the United States of America?

PubMed

Glazer, Greer; Startsman, Laura F; Bankston, Karen; Michaels, Julia; Danek, Jennifer C; Fair, Malika

2016-01-01

Health profession schools use interviews during the admissions process to identify certain non-cognitive skills that are needed for success in diverse, inter-professional settings. This study aimed to assess the use of interviews during the student admissions process across health disciplines at schools in the United States of America in 2014. The type and frequency of non-cognitive skills assessed were also evaluated. Descriptive methods were used to analyze a sample of interview rubrics collected as part of a national survey on admissions in the health professions, which surveyed 228 schools of medicine, dentistry, pharmacy, nursing, and public health. Of the 228 schools, 130 used interviews. The most desirable non-cognitive skills from 34 schools were identified as follows: communication skills (30), motivation (22), readiness for the profession (17), service (12), and problem-solving (12). Ten schools reported using the multiple mini-interview format, which may indicate potential for expanding this practice. Disparities in the use of interviewing across health professions should be verified to help schools adopt interviews during student admissions processes.

Use of lignocellulosic materials as sorbents for pesticide and phosphate residues

Treesearch

Mandla A. Tshabalala

2006-01-01

We previously reported results from limited field trials of a bark-based filtration unit designed to remove phosphorus from cranberry bog tail water. In that report we also identified some barriers that needed to be overcome to improve the performance of such a filtration unit. One barrier was lack of a cost effective process for large-scale conversion of bark to an...

Beyond the Nation-State: A Process for Determining the Security Strategy for the Integrated United Continent of Europe

DTIC Science & Technology

1990-05-01

shrinking water supply, and shrinking fuel reserves. As these challenges multiply, the source of solutions becomes difficult to identify. A cooperative ... movement of the people through political channels seems to be the emerging source. 5 CHAPTER II IDENTIFYING NEW THREAT AREAS What does all this have to do

Characteristics of health care organizations associated with learning and development: lessons from a pilot study.

PubMed

Nyström, Monica

2009-01-01

Characteristics of health care organizations associated with an ability to learn from experiences and to develop and manage change were explored in this study. Understanding of these characteristics is necessary to identify factors influencing success in learning from the past and achieving future health care quality objectives. A literature review of the quality improvement, strategic organizational development and change management, organizational learning, and microsystems fields identified 20 organizational characteristics, grouped under (a) organizational systems, (b) key actors, and (c) change management processes. Qualitative methods, using interviews, focus group reports, and archival records, were applied to find associations between identified characteristics and 6 Swedish health care units externally evaluated as delivering high-quality care. Strong support for a characteristic was defined as units having more than 4 sources describing the characteristic as an important success factor. Eighteen characteristics had strong support from at least 2 units. The strongest evidence was found for the following: (i) key actors have long-term commitment, provide support, and make sense of ambiguous situations; (ii) organizational systems encourage employee commitment, participation, and involvement; and (iii) change management processes are employed systematically. Based on the results, a new model of "characteristics associated with learning and development in health care organizations" is proposed.

Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study.

PubMed

Dunn, Sandra I; Cragg, Betty; Graham, Ian D; Medves, Jennifer; Gaboury, Isabelle

2018-05-01

Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.

Mural art therapy for young offenders hospitalised with a mental illness.

PubMed

George, Oleen; Kasinathan, John

2015-02-01

To describe a mural art therapy project completed within an adolescent unit of a secure forensic psychiatric hospital. The planning, implementation and consecutive stages of the mural art therapy project are described. Pertinent themes are identified. A cohort of adolescent forensic inpatients was engaged in a group therapeutic process involving collaboration, design and the completion of an art mural. The participants generally approved of the project and identified themes of gaining a sense of achievement, empowerment, teamwork, involvement and ownership. The art mural transformed and improved the visual and spatial environment of the Adolescent unit courtyard. Mural art therapy was acceptable to young offenders hospitalised with mental illness, which has relevance for adolescent psychiatric units and youth detention centres. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Continued investigation of solid propulsion economics. Task 1B: Large solid rocket motor case fabrication methods - Supplement process complexity factor cost technique

NASA Technical Reports Server (NTRS)

Baird, J.

1967-01-01

This supplement to Task lB-Large Solid Rocket Motor Case Fabrication Methods supplies additional supporting cost data and discusses in detail the methodology that was applied to the task. For the case elements studied, the cost was found to be directly proportional to the Process Complexity Factor (PCF). The PCF was obtained for each element by identifying unit processes that are common to the elements and their alternative manufacturing routes, by assigning a weight to each unit process, and by summing the weighted counts. In three instances of actual manufacture, the actual cost per pound equaled the cost estimate based on PCF per pound, but this supplement, recognizes that the methodology is of limited, rather than general, application.

Factors associated with the process of adaptation among Pakistani adolescent females living in United States.

PubMed

Khuwaja, Salma A; Selwyn, Beatrice J; Mgbere, Osaro; Khuwaja, Alam; Kapadia, Asha; McCurdy, Sheryl; Hsu, Chiehwen E

2013-04-01

This study explored post-migration experiences of recently migrated Pakistani Muslim adolescent females residing in the United States. In-depth, semi-structured interviews were conducted with thirty Pakistani Muslim adolescent females between the ages of 15 and 18 years living with their families in Houston, Texas. Data obtained from the interviews were evaluated using discourse analysis to identify major reoccurring themes. Participants discussed factors associated with the process of adaptation to the American culture. The results revealed that the main factors associated with adaptation process included positive motivation for migration, family bonding, social support networks, inter-familial communication, aspiration of adolescents to learn other cultures, availability of English-as-second-language programs, participation in community rebuilding activities, and faith practices, English proficiency, peer pressure, and inter-generational conflicts. This study provided much needed information on factors associated with adaptation process of Pakistani Muslim adolescent females in the United States. The results have important implications for improving the adaptation process of this group and offer potential directions for intervention and counseling services.

Mechanisms Mediating the Perception of Complex Acoustic Patterns

DTIC Science & Technology

1990-11-09

units stimulated by the louder sound include the units stimulated by the fainter sound. Thus, auditory induction corresponds to a rather sophisticated...FIELD GRU - auditory perception, complex sounds I. I 19. ABSTRACT (Continue on reverse if necessary and identify by block number) Five studies were...show how auditory mechanisms employed for the processing of complex nonverbal patterns have been modified for the perception of speech. 2 Richard M

KSC-08pd1901

NASA Image and Video Library

2008-07-02

CAPE CANAVERAL, Fla. – Professor Peter Voci, NYIT MOCAP (Motion Capture) team director, (left) hands a component of the Orion Crew Module mockup to one of three technicians inside the mockup. The technicians wear motion capture suits. The motion tracking aims to improve efficiency of assembly processes and identify potential ergonomic risks for technicians assembling the mockup. The work is being performed in United Space Alliance's Human Engineering Modeling and Performance Lab in the RLV Hangar at NASA's Kennedy Space Center. The motion tracking aims to improve efficiency of assembly processes and identify potential ergonomic risks for technicians assembling the mockup. The work is being performed in United Space Alliance's Human Engineering Modeling and Performance Lab in the RLV Hangar at NASA's Kennedy Space Center. Part of NASA's Constellation Program, the Orion spacecraft will return humans to the moon and prepare for future voyages to Mars and other destinations in our solar system.

KSC-08pd1902

NASA Image and Video Library

2008-07-02

CAPE CANAVERAL, Fla. – A United Space Alliance technician (right) hands off a component of the Orion Crew Module mockup to one of the other technicians inside the mockup. The technicians wear motion capture suits. The motion tracking aims to improve efficiency of assembly processes and identify potential ergonomic risks for technicians assembling the mockup, which was created and built at the New York Institute of Technology by a team led by Prof. Peter Voci, MFA Director at the College of Arts and Sciences. The motion tracking aims to improve efficiency of assembly processes and identify potential ergonomic risks for technicians assembling the mockup. The work is being performed in United Space Alliance's Human Engineering Modeling and Performance Lab in the RLV Hangar at NASA's Kennedy Space Center. Part of NASA's Constellation Program, the Orion spacecraft will return humans to the moon and prepare for future voyages to Mars and other destinations in our solar system.

Utility of a Work Process Classification System for characterizing non-fatal injuries in the Alaskan commercial fishing industry

PubMed Central

Syron, Laura N.; Lucas, Devin L.; Bovbjerg, Viktor E.; Bethel, Jeffrey W.; Kincl, Laurel D.

2016-01-01

Background The US commercial fishing industry is hazardous, as measured by mortality data. However, research on non-fatal injuries is limited. Non-fatal injuries constitute the majority of occupational injuries and can result in workers’ lowered productivity and wages, lost quality of life, and disability. In the United States, a Work Process Classification System (WPCS) has previously been applied in Alaskan freezer-trawl and freezer-longline fleets to identify causes of injuries and specific hazards, but not to other fishing fleets. Objectives This descriptive epidemiologic study aimed to explore the application and modification of the WPCS in multiple Alaskan fleets, characterize non-fatal occupational injuries in these fleets, and identify work processes that could be targeted for further investigation and future injury prevention efforts. Design Traumatic, non-fatal injuries on-board Alaskan commercial fishing vessels were identified through United States Coast Guard investigative reports. Characteristics of injuries, as well as worker characteristics, were analysed. Injuries were coded using the WPCS. Results We successfully utilized the WPCS to code non-fatal injury cases (n = 136). The most frequent main work processes associated with non-fatal injuries included: on-board trawlers, handling frozen fish and processing the catch; on-board vessels using pot/trap gear, handling the gear and shooting/setting the gear; on-board longliners, traffic on board and hauling the gear; and on-board processor vessels, processing the catch, other work with the catch, and handling frozen fish. Conclusions The study confirmed that a WPCS can be applied to multiple Alaskan fleets to identify hazardous tasks. Hazards were unique for each vessel gear type. Future injury prevention efforts should target work processes associated with the most frequent and most severe injuries. Future studies should establish time estimates for work processes in order to determine risk estimates. Efforts to improve non-fatal injury reporting, especially on smaller commercial fishing vessels, should be undertaken. PMID:26782030

Utility of a Work Process Classification System for characterizing non-fatal injuries in the Alaskan commercial fishing industry.

PubMed

Syron, Laura N; Lucas, Devin L; Bovbjerg, Viktor E; Bethel, Jeffrey W; Kincl, Laurel D

2016-01-01

Background The US commercial fishing industry is hazardous, as measured by mortality data. However, research on non-fatal injuries is limited. Non-fatal injuries constitute the majority of occupational injuries and can result in workers' lowered productivity and wages, lost quality of life, and disability. In the United States, a Work Process Classification System (WPCS) has previously been applied in Alaskan freezer-trawl and freezer-longline fleets to identify causes of injuries and specific hazards, but not to other fishing fleets. Objectives This descriptive epidemiologic study aimed to explore the application and modification of the WPCS in multiple Alaskan fleets, characterize non-fatal occupational injuries in these fleets, and identify work processes that could be targeted for further investigation and future injury prevention efforts. Design Traumatic, non-fatal injuries on-board Alaskan commercial fishing vessels were identified through United States Coast Guard investigative reports. Characteristics of injuries, as well as worker characteristics, were analysed. Injuries were coded using the WPCS. Results We successfully utilized the WPCS to code non-fatal injury cases (n = 136). The most frequent main work processes associated with non-fatal injuries included: on-board trawlers, handling frozen fish and processing the catch; on-board vessels using pot/trap gear, handling the gear and shooting/setting the gear; on-board longliners, traffic on board and hauling the gear; and on-board processor vessels, processing the catch, other work with the catch, and handling frozen fish. Conclusions The study confirmed that a WPCS can be applied to multiple Alaskan fleets to identify hazardous tasks. Hazards were unique for each vessel gear type. Future injury prevention efforts should target work processes associated with the most frequent and most severe injuries. Future studies should establish time estimates for work processes in order to determine risk estimates. Efforts to improve non-fatal injury reporting, especially on smaller commercial fishing vessels, should be undertaken.

Utility of a Work Process Classification System for characterizing non-fatal injuries in the Alaskan commercial fishing industry.

PubMed

Syron, Laura N; Lucas, Devin L; Bovbjerg, Viktor E; Bethel, Jeffrey W; Kincl, Laurel D

2016-01-01

The US commercial fishing industry is hazardous, as measured by mortality data. However, research on non-fatal injuries is limited. Non-fatal injuries constitute the majority of occupational injuries and can result in workers' lowered productivity and wages, lost quality of life, and disability. In the United States, a Work Process Classification System (WPCS) has previously been applied in Alaskan freezer-trawl and freezer-longline fleets to identify causes of injuries and specific hazards, but not to other fishing fleets. This descriptive epidemiologic study aimed to explore the application and modification of the WPCS in multiple Alaskan fleets, characterize non-fatal occupational injuries in these fleets, and identify work processes that could be targeted for further investigation and future injury prevention efforts. Traumatic, non-fatal injuries on-board Alaskan commercial fishing vessels were identified through United States Coast Guard investigative reports. Characteristics of injuries, as well as worker characteristics, were analysed. Injuries were coded using the WPCS. We successfully utilized the WPCS to code non-fatal injury cases (n = 136). The most frequent main work processes associated with non-fatal injuries included: on-board trawlers, handling frozen fish and processing the catch; on-board vessels using pot/trap gear, handling the gear and shooting/setting the gear; on-board longliners, traffic on board and hauling the gear; and on-board processor vessels, processing the catch, other work with the catch, and handling frozen fish. The study confirmed that a WPCS can be applied to multiple Alaskan fleets to identify hazardous tasks. Hazards were unique for each vessel gear type. Future injury prevention efforts should target work processes associated with the most frequent and most severe injuries. Future studies should establish time estimates for work processes in order to determine risk estimates. Efforts to improve non-fatal injury reporting, especially on smaller commercial fishing vessels, should be undertaken.

Subsampling for dataset optimisation

NASA Astrophysics Data System (ADS)

Ließ, Mareike

2017-04-01

Soil-landscapes have formed by the interaction of soil-forming factors and pedogenic processes. In modelling these landscapes in their pedodiversity and the underlying processes, a representative unbiased dataset is required. This concerns model input as well as output data. However, very often big datasets are available which are highly heterogeneous and were gathered for various purposes, but not to model a particular process or data space. As a first step, the overall data space and/or landscape section to be modelled needs to be identified including considerations regarding scale and resolution. Then the available dataset needs to be optimised via subsampling to well represent this n-dimensional data space. A couple of well-known sampling designs may be adapted to suit this purpose. The overall approach follows three main strategies: (1) the data space may be condensed and de-correlated by a factor analysis to facilitate the subsampling process. (2) Different methods of pattern recognition serve to structure the n-dimensional data space to be modelled into units which then form the basis for the optimisation of an existing dataset through a sensible selection of samples. Along the way, data units for which there is currently insufficient soil data available may be identified. And (3) random samples from the n-dimensional data space may be replaced by similar samples from the available dataset. While being a presupposition to develop data-driven statistical models, this approach may also help to develop universal process models and identify limitations in existing models.

Use of failure mode, effect and criticality analysis to improve safety in the medication administration process.

PubMed

Rodriguez-Gonzalez, Carmen Guadalupe; Martin-Barbero, Maria Luisa; Herranz-Alonso, Ana; Durango-Limarquez, Maria Isabel; Hernandez-Sampelayo, Paloma; Sanjurjo-Saez, Maria

2015-08-01

To critically evaluate the causes of preventable adverse drug events during the nurse medication administration process in inpatient units with computerized prescription order entry and profiled automated dispensing cabinets in order to prioritize interventions that need to be implemented and to evaluate the impact of specific interventions on the criticality index. This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary consensus committee composed of pharmacists, nurses and doctors evaluated the process of administering medications in a hospital setting in Spain. By analysing the process, all failure modes were identified and criticality was determined by rating severity, frequency and likelihood of failure detection on a scale of 1 to 10, using adapted versions of already published scales. Safety strategies were identified and prioritized. Through consensus, the committee identified eight processes and 40 failure modes, of which 20 were classified as high risk. The sum of the criticality indices was 5254. For the potential high-risk failure modes, 21 different potential causes were found resulting in 24 recommendations. Thirteen recommendations were prioritized and developed over a 24-month period, reducing total criticality from 5254 to 3572 (a 32.0% reduction). The recommendations with a greater impact on criticality were the development of an electronic medication administration record (-582) and the standardization of intravenous drug compounding in the unit (-168). Other improvements, such as barcode medication administration technology (-1033), were scheduled for a longer period of time because of lower feasibility. FMECA is a useful approach that can improve the medication administration process. © 2015 John Wiley & Sons, Ltd.

75 FR 31843 - Identification of Non-Hazardous Secondary Materials That Are Solid Waste

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-04

...On January 2, 2009, the Environmental Protection Agency (EPA or the Agency) issued an Advanced Notice of Proposed Rulemaking (ANPRM) to solicit comment on which non-hazardous secondary materials that are used as fuels or ingredients in combustion units are solid wastes under the Resource Conservation and Recovery Act (RCRA). The meaning of ``solid waste'' as defined under RCRA is of particular importance since it will determine whether a combustion unit is required to meet emissions standards for solid waste incineration units issued under section 129 of the Clean Air Act (CAA) or emissions standards for commercial, industrial, and institutional boilers issued under CAA section 112. CAA section 129 states that the term ``solid waste'' shall have the meaning ``established by the Administrator pursuant to [RCRA].'' EPA is proposing a definition of non-hazardous solid waste that would be used to identify whether non-hazardous secondary materials burned as fuels or used as ingredients in combustion units are solid waste. EPA is also proposing that non-hazardous secondary materials that have been discarded, and are therefore solid wastes, may be rendered products after they have been processed (altered chemically or physically) into a fuel or ingredient product. This proposed rule is necessary to identify units for the purpose of developing certain standards under sections 112 and 129 of the CAA. In addition to this proposed rule, EPA is concurrently proposing air emission requirements under CAA section 112 for industrial, commercial, and institutional boilers and process heaters, as well as air emission requirements under CAA section 129 for commercial and industrial solid waste incineration units.

A Neural Basis of Facial Action Recognition in Humans

PubMed Central

Srinivasan, Ramprakash; Golomb, Julie D.

2016-01-01

By combining different facial muscle actions, called action units, humans can produce an extraordinarily large number of facial expressions. Computational models and studies in cognitive science and social psychology have long hypothesized that the brain needs to visually interpret these action units to understand other people's actions and intentions. Surprisingly, no studies have identified the neural basis of the visual recognition of these action units. Here, using functional magnetic resonance imaging and an innovative machine learning analysis approach, we identify a consistent and differential coding of action units in the brain. Crucially, in a brain region thought to be responsible for the processing of changeable aspects of the face, multivoxel pattern analysis could decode the presence of specific action units in an image. This coding was found to be consistent across people, facilitating the estimation of the perceived action units on participants not used to train the multivoxel decoder. Furthermore, this coding of action units was identified when participants attended to the emotion category of the facial expression, suggesting an interaction between the visual analysis of action units and emotion categorization as predicted by the computational models mentioned above. These results provide the first evidence for a representation of action units in the brain and suggest a mechanism for the analysis of large numbers of facial actions and a loss of this capacity in psychopathologies. SIGNIFICANCE STATEMENT Computational models and studies in cognitive and social psychology propound that visual recognition of facial expressions requires an intermediate step to identify visible facial changes caused by the movement of specific facial muscles. Because facial expressions are indeed created by moving one's facial muscles, it is logical to assume that our visual system solves this inverse problem. Here, using an innovative machine learning method and neuroimaging data, we identify for the first time a brain region responsible for the recognition of actions associated with specific facial muscles. Furthermore, this representation is preserved across subjects. Our machine learning analysis does not require mapping the data to a standard brain and may serve as an alternative to hyperalignment. PMID:27098688

An Integrative Literature Review of Organisational Factors Associated with Admission and Discharge Delays in Critical Care

PubMed Central

Peltonen, Laura-Maria; McCallum, Louise; Siirala, Eriikka; Haataja, Marjaana; Lundgrén-Laine, Heljä; Salanterä, Sanna; Lin, Frances

2015-01-01

The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review. PMID:26558286

Low-Energy, Low-Cost Production of Ethylene by Low- Temperature Oxidative Coupling of Methane

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

Radaelli, Guido; Chachra, Gaurav; Jonnavittula, Divya

In this project, we develop a catalytic process technology for distributed small-scale production of ethylene by oxidative coupling of methane at low temperatures using an advanced catalyst. The Low Temperature Oxidative Coupling of Methane (LT-OCM) catalyst system is enabled by a novel chemical catalyst and process pioneered by Siluria, at private expense, over the last six years. Herein, we develop the LT-OCM catalyst system for distributed small-scale production of ethylene by identifying and addressing necessary process schemes, unit operations and process parameters that limit the economic viability and mass penetration of this technology to manufacture ethylene at small-scales. The outputmore » of this program is process concepts for small-scale LT-OCM catalyst based ethylene production, lab-scale verification of the novel unit operations adopted in the proposed concept, and an analysis to validate the feasibility of the proposed concepts.« less

Manufacturing Enhancement through Reduction of Cycle Time using Different Lean Techniques

NASA Astrophysics Data System (ADS)

Suganthini Rekha, R.; Periyasamy, P.; Nallusamy, S.

2017-08-01

In recent manufacturing system the most important parameters in production line are work in process, TAKT time and line balancing. In this article lean tools and techniques were implemented to reduce the cycle time. The aim is to enhance the productivity of the water pump pipe by identifying the bottleneck stations and non value added activities. From the initial time study the bottleneck processes were identified and then necessary expanding processes were also identified for the bottleneck process. Subsequently the improvement actions have been established and implemented using different lean tools like value stream mapping, 5S and line balancing. The current state value stream mapping was developed to describe the existing status and to identify various problem areas. 5S was used to implement the steps to reduce the process cycle time and unnecessary movements of man and material. The improvement activities were implemented with required suggested and the future state value stream mapping was developed. From the results it was concluded that the total cycle time was reduced about 290.41 seconds and the customer demand has been increased about 760 units.

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

PubMed

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

2008-10-01

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

Ultra-processed food consumption among infants in primary health care in a city of the metropolitan region of São Paulo, Brazil.

PubMed

Relvas, Gláubia Rocha Barbosa; Buccini, Gabriela Dos Santos; Venancio, Sonia Isoyama

2018-06-08

To analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors. A cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Brazil. Specific foods consumed in the previous 24h of the interview were considered to evaluate the consumption of ultra-processed foods. Variables related to mothers' and children's characteristics as well as primary healthcare units were grouped into three blocks of increasingly proximal influence on the outcome. A Poisson regression analysis was performed following a statistical hierarchical modeling to determine factors associated with ultra-processed food intake. The prevalence of ultra-processed food intake was 43.1%. Infants that were not being breastfed had a higher prevalence of ultra-processed food intake but no statistical significance was found. Lower maternal education (prevalence ratio 1.55 [1.08-2.24]) and the child's first appointment at the primary healthcare unit having happened after the first week of life (prevalence ratio 1.51 [1.01-2.27]) were factors associated with the consumption of ultra-processed foods. High consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake. Copyright © 2018 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Chapter 3. Coordination and collaboration with interface units. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster.

PubMed

Joynt, Gavin M; Loo, Shi; Taylor, Bruce L; Margalit, Gila; Christian, Michael D; Sandrock, Christian; Danis, Marion; Leoniv, Yuval; Sprung, Charles L

2010-04-01

To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on enhancing coordination and collaboration between the ICU and other key stakeholders. Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including coordination and collaboration. Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resource use and communications; (2) develop a system of communication, coordination and collaboration between the ICU and key interface departments within the hospital; (3) identify key functions or processes requiring coordination and collaboration, the most important of these being manpower and resources utilization (surge capacity) and re-allocation of personnel, equipment and physical space; (4) develop processes to allow smooth inter-departmental patient transfers; (5) creating systems and guidelines is not sufficient, it is important to: (a) identify the roles and responsibilities of key individuals necessary for the implementation of the guidelines; (b) ensure that these individuals are adequately trained and prepared to perform their roles; (c) ensure adequate equipment to allow key coordination and collaboration activities; (d) ensure an adequate physical environment to allow staff to properly implement guidelines; (6) trigger events for determining a crisis should be defined. Judicious planning and adoption of protocols for coordination and collaboration with interface units are necessary to optimize outcomes during a pandemic.

Replication of clinical innovations in multiple medical practices.

PubMed

Henley, N S; Pearce, J; Phillips, L A; Weir, S

1998-11-01

Many clinical innovations had been successfully developed and piloted in individual medical practice units of Kaiser Permanente in North Carolina during 1995 and 1996. Difficulty in replicating these clinical innovations consistently throughout all 21 medical practice units led to development of the interdisciplinary Clinical Innovation Implementation Team, which was formed by using existing resources from various departments across the region. REPLICATION MODEL: Based on a model of transfer of best practices, the implementation team developed a process and tools (master schedule and activity matrix) to quickly replicate successful pilot projects throughout all medical practice units. The process involved the following steps: identifying a practice and delineating its characteristics and measures (source identification); identifying a team to receive the (new) practice; piloting the practice; and standardizing, including the incorporation of learnings. The model includes the following components for each innovation: sending and receiving teams, an innovation coordinator role, an innovation expert role, a location expert role, a master schedule, and a project activity matrix. Communication depended on a partnership among the location experts (local knowledge and credibility), the innovation coordinator (process expertise), and the innovation experts (content expertise). Results after 12 months of working with the 21 medical practice units include integration of diabetes care team services into the practices, training of more than 120 providers in the use of personal computers and an icon-based clinical information system, and integration of a planwide self-care program into the medical practices--all with measurable improved outcomes. The model for sequential replication and the implementation team structure and function should be successful in other organizational settings.

Culling a clinical terminology: a systematic approach to identifying problematic content.

PubMed Central

Sable, J. H.; Nash, S. K.; Wang, A. Y.

2001-01-01

The College of American Pathologists and the National Health Service (NHS) in the United Kingdom are merging their respective clinical terminologies, SNOMED RT and Clinical Terms Version 3, into a new terminology, SNOMED CT. This requires mapping concept descriptions between the two existing terminologies. During the mapping process, many descriptions were identified as being potentially problematic. They require further review by the SNOMED editorial process before either (1) being incorporated into SNOMED CT, or (2) retired from active use. This article presents data on the concept descriptions that were identified as needing further review during the early phases of SNOMED CT development. Based on this work, we describe fourteen types of problematic terminology content. Identifying problematic terminology content can be approached in a systematic manner. PMID:11825253

Pathology economic model tool: a novel approach to workflow and budget cost analysis in an anatomic pathology laboratory.

PubMed

Muirhead, David; Aoun, Patricia; Powell, Michael; Juncker, Flemming; Mollerup, Jens

2010-08-01

The need for higher efficiency, maximum quality, and faster turnaround time is a continuous focus for anatomic pathology laboratories and drives changes in work scheduling, instrumentation, and management control systems. To determine the costs of generating routine, special, and immunohistochemical microscopic slides in a large, academic anatomic pathology laboratory using a top-down approach. The Pathology Economic Model Tool was used to analyze workflow processes at The Nebraska Medical Center's anatomic pathology laboratory. Data from the analysis were used to generate complete cost estimates, which included not only materials, consumables, and instrumentation but also specific labor and overhead components for each of the laboratory's subareas. The cost data generated by the Pathology Economic Model Tool were compared with the cost estimates generated using relative value units. Despite the use of automated systems for different processes, the workflow in the laboratory was found to be relatively labor intensive. The effect of labor and overhead on per-slide costs was significantly underestimated by traditional relative-value unit calculations when compared with the Pathology Economic Model Tool. Specific workflow defects with significant contributions to the cost per slide were identified. The cost of providing routine, special, and immunohistochemical slides may be significantly underestimated by traditional methods that rely on relative value units. Furthermore, a comprehensive analysis may identify specific workflow processes requiring improvement.

Quality Improvement in Critical Care: Selection and Development of Quality Indicators

PubMed Central

Martin, Claudio M.; Project, The Quality Improvement in Critical Care

2016-01-01

Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

Compact hybrid optoelectrical unit for image processing and recognition

NASA Astrophysics Data System (ADS)

Cheng, Gang; Jin, Guofan; Wu, Minxian; Liu, Haisong; He, Qingsheng; Yuan, ShiFu

1998-07-01

In this paper a compact opto-electric unit (CHOEU) for digital image processing and recognition is proposed. The central part of CHOEU is an incoherent optical correlator, which is realized with a SHARP QA-1200 8.4 inch active matrix TFT liquid crystal display panel which is used as two real-time spatial light modulators for both the input image and reference template. CHOEU can do two main processing works. One is digital filtering; the other is object matching. Using CHOEU an edge-detection operator is realized to extract the edges from the input images. Then the reprocessed images are sent into the object recognition unit for identifying the important targets. A novel template- matching method is proposed for gray-tome image recognition. A positive and negative cycle-encoding method is introduced to realize the absolute difference measurement pixel- matching on a correlator structure simply. The system has god fault-tolerance ability for rotation distortion, Gaussian noise disturbance or information losing. The experiments are given at the end of this paper.

Focal-surface detector for heavy ions

DOEpatents

Erskine, John R.; Braid, Thomas H.; Stoltzfus, Joseph C.

1979-01-01

A detector of the properties of individual charged particles in a beam includes a gridded ionization chamber, a cathode, a plurality of resistive-wire proportional counters, a plurality of anode sections, and means for controlling the composition and pressure of gas in the chamber. Signals generated in response to the passage of charged particles can be processed to identify the energy of the particles, their loss of energy per unit distance in an absorber, and their angle of incidence. In conjunction with a magnetic spectrograph, the signals can be used to identify particles and their state of charge. The detector is especially useful for analyzing beams of heavy ions, defined as ions of atomic mass greater than 10 atomic mass units.

LANDSAT: Non-US standard catalog no. N-33

NASA Technical Reports Server (NTRS)

1975-01-01

A catalog used for dissemination of information regarding the availability of LANDSAT imagery is presented. The Image Processing Facility of the Goddard Space Flight Center, publishes a U.S. and a Non-U.S. Standard Catalog on a monthly schedule, and the catalogs identify imagery which has been processed and input to the data files during the referenced month. The U.S. Standard Catalog includes imagery covering the continental United States, Alaska and Hawaii; the Non-U.S. Catalog identifies all the remaining coverage. Imagery adjacent to the continental U.S. and Alaska borders is included in the U.S. Standard Catalog.

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

D. Muth, Jr.; K. M. Bryden; R. G. Nelson

This study provides a spatially comprehensive assessment of sustainable agricultural residue removal potential across the United States. Earlier assessments determining the quantity of agricultural residue that could be sustainably removed for bioenergy production at the regional and national scale faced a number of computational limitations. These limitations included the number of environmental factors, the number of land management scenarios, and the spatial fidelity and spatial extent of the assessment. This study utilizes integrated multi-factor environmental process modeling and high fidelity land use datasets to perform a spatially comprehensive assessment of sustainably removable agricultural residues across the conterminous United States. Soilmore » type represents the base spatial unit for this study and is modeled using a national soil survey database at the 10 – 100 m scale. Current crop rotation practices are identified by processing land cover data available from the USDA National Agricultural Statistics Service Cropland Data Layer database. Land management and residue removal scenarios are identified for each unique crop rotation and crop management zone. Estimates of county averages and state totals of sustainably available agricultural residues are provided. The results of the assessment show that in 2011 over 150 million metric tons of agricultural residues could have been sustainably removed across the United States. Projecting crop yields and land management practices to 2030, the assessment determines that over 207 million metric tons of agricultural residues will be able to be sustainably removed for bioenergy production at that time.« less

The implementation of a postoperative care process on a neurosurgical unit.

PubMed

Douglas, Mary; Rowed, Sheila

2005-12-01

The postoperative phase is a critical time for any neurosurgical patient. Historically, certain patients having neurosurgical procedures, such as craniotomies and other more complex surgeries, have been nursed postoperatively in the intensive care unit (ICU) for an overnight stay, prior to transfer to a neurosurgical floor. At the Hospital for Sick Children in Toronto, because of challenges with access to ICU beds and the cancellation of surgeries because of lack of available nurses for the ICU setting, this practice was reexamined. A set of criteria was developed to identify which postoperative patients should come directly to the neurosurgical unit immediately following their anesthetic recovery. The criteria were based on patient diagnosis, preoperative condition, comorbidities, the surgical procedure, intraoperative complications, and postoperative status. A detailed process was then outlined that allowed the optimum patients to be selected for this process to ensure patient safety. Included in this process was a postoperative protocol addressing details such as standard physician orders and the levels of monitoring required. Outcomes of this new process include fewer surgical cancellations for patients and families, equally safe, or better patient care, and the conservation of limited ICU resources. The program has currently been expanded to include patients who have undergone endovascular therapies.

A Comparative, Holistic, Multiple-Case Study of the Implementation of the Strategic Thinking Protocol© and Traditional Strategic Planning Processes at a Southeastern University

ERIC Educational Resources Information Center

Robinson, Deborah J.

2012-01-01

This study explores the strategic thinking and strategic planning efforts in a department, college and university in the Southeastern United States. The goal of the study was to identify elements of strategic planning processes that meet the unique organizational features and complexities of a higher education institution. The study employed a…

Carpentry. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains 14 units (with or without subunits), competencies, and competency builders that identify the occupational,…

31 CFR 285.7 - Salary offset.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Secretary, has waived certain requirements of the Computer Matching and Privacy Protection Act of 1988, 5 U... process known as centralized salary offset computer matching, identify Federal employees who owe delinquent nontax debt to the United States. Centralized salary offset computer matching is the computerized...

Cosmetology. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains 17 units (with or without subunits), competencies, and competency builders that identify the occupational,…

[Monitoring evaluation system for high-specialty hospitals].

PubMed

Fajardo Dolci, Germán; Aguirre Gas, Héctor G; Robledo Galván, Héctor

2011-01-01

Hospital evaluation is a fundamental process to identify medical units' objective compliance, to analyze efficiency of resource use and allocation, institutional values and mission alignment, patient safety and quality standards, contributions to research and medical education, and the degree of coordination among medical units and the health system as a whole. We propose an evaluation system for highly specialized regional hospitals through the monitoring of performance indicators. The following are established as base thematic elements in the construction of indicators: safe facilities and equipment, financial situation, human resources management, policy management, organizational climate, clinical activity, quality and patient safety, continuity of care, patients' and providers' rights and obligations, teaching, research, social responsibility, coordination mechanisms. Monitoring refers to the planned and systematic evaluation of valid and reliable indicators, aimed at identifying problems and opportunity areas. Moreover, evaluation is a powerful tool to strengthen decision-making and accountability in medical units.

Factors contributing to the process of intensive care patient discharge: an ethnographic study informed by activity theory.

PubMed

Lin, Frances; Chaboyer, Wendy; Wallis, Marianne; Miller, Anne

2013-08-01

Patient flow from intensive care to acute care units is often problematic and many discharges from intensive care to acute care are unsuccessful on the first attempt. The aim of this study was to explore the factors that influence intensive care patient discharge. This ethnographic study was undertaken in an Australian metropolitan tertiary hospital that had a 14-bed level 3 intensive care unit. Intensive care and acute care unit medical and nursing staff, and other hospital staff who were involved in the intensive care patient discharge process participated in this study. A total of 28 discharges were observed, and 56 one on one interviews were conducted. Data collection techniques including direct observations, semi-structured interviews, and collection of existing documents were used. Activity theory was the theoretical framework that underpinned this study. Three patient activity systems were identified: intensive care patient discharge activity, acute care unit accepting patient activity, and hospital bed management activity. Analysis of the interactions among these activity systems revealed conflicting objects (goals), communication breakdowns, and teamwork issues. Discharge delay was found to be a significant problem, which was associated with limited acute care unit bed availability. Strategies to improve acute care unit bed availability are needed. Routine after-hours ICU discharge could raise patient safety concerns which need to be considered. All team members' input in discharge decision making should be encouraged. Problems identified in clinical handover call for actions to change the handover practice. Activity theory successfully guided the study by providing a practical and descriptive framework for the study, facilitating the understanding of the interrelationships among the activity systems. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Continuity and non-continuity from child- to adulthood in psychiatric clinical studies].

PubMed

Kuwabara, Hitoshi; Kawakubo, Yuki; Kano, Yukiko

2014-01-01

It is difficult to conceive of the development of the brain as a single process, especially when we think about continuity and non-continuity from child- to adulthood. Non-continuity may be present when the brain is developing normally or consistently, or during aging, and development may vary across behavioral, structural, functional, and regional units. Clinical studies that consider the developmental process of change as natural and expected may better incorporate the potential variety and non-continuity than clinical studies that do not consider the process of change. It is likely that these complications are exacerbated because the timing of changes appears to vary across units. If we can identify the critical points of plasticity, temporally appropriate interventions can be developed. A focus on the developmental process of changes in the brain may lead to more rational and effective intervention strategies.

Geomorphology and Geology of the Southwestern Margaritifer Sinus and Argyre Regions of Mars. Part 1: Geological and Geomorphological Overview

NASA Technical Reports Server (NTRS)

Parker, T. J.; Pieri, D. C.

1985-01-01

Based upon Viking Orbiter 1 images of the southwestern portion of the Margaritifer Sinus Quadrangle, the northwestern portion of the Argyre Quadrangle, and a small portion of the southeastern Coprates Quadrangle, three major mountainous of plateau units, seven plains units, and six units related to valley forming processes were identified. The photomosaic is oriented such that it provides good areal coverage of the upper Chryse Trough from Argyre Planitia to just above Margaritifer Chaos as well as of plains units on either side of the Trough. The photomosaic was compiled from Viking Orbiter 1 images ranging in resolution from approximately 150 to 300 meters per pixel printed at a scale of about 1:2,000,000. The characteristics of each geomorphic unit are outlined.

Pharmaceutical quality by design: product and process development, understanding, and control.

PubMed

Yu, Lawrence X

2008-04-01

The purpose of this paper is to discuss the pharmaceutical Quality by Design (QbD) and describe how it can be used to ensure pharmaceutical quality. The QbD was described and some of its elements identified. Process parameters and quality attributes were identified for each unit operation during manufacture of solid oral dosage forms. The use of QbD was contrasted with the evaluation of product quality by testing alone. The QbD is a systemic approach to pharmaceutical development. It means designing and developing formulations and manufacturing processes to ensure predefined product quality. Some of the QbD elements include: Defining target product quality profile; Designing product and manufacturing processes; Identifying critical quality attributes, process parameters, and sources of variability; Controlling manufacturing processes to produce consistent quality over time. Using QbD, pharmaceutical quality is assured by understanding and controlling formulation and manufacturing variables. Product testing confirms the product quality. Implementation of QbD will enable transformation of the chemistry, manufacturing, and controls (CMC) review of abbreviated new drug applications (ANDAs) into a science-based pharmaceutical quality assessment.

Self-Organizing OFDMA System for Broadband Communication

NASA Technical Reports Server (NTRS)

Roy, Aloke (Inventor); Anandappan, Thanga (Inventor); Malve, Sharath Babu (Inventor)

2016-01-01

Systems and methods for a self-organizing OFDMA system for broadband communication are provided. In certain embodiments a communication node for a self organizing network comprises a communication interface configured to transmit data to and receive data from a plurality of nodes; and a processing unit configured to execute computer readable instructions. Further, computer readable instructions direct the processing unit to identify a sub-region within a cell, wherein the communication node is located in the sub-region; and transmit at least one data frame, wherein the data from the communication node is transmitted at a particular time and frequency as defined within the at least one data frame, where the time and frequency are associated with the sub-region.

Graphic Communications--Commercial Photography. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a current comprehensive and verified employer competency program list for graphic communications--commercial photography. Each unit (with or without subunits) contains competencies and competency builders that identify the…

Business Administration and Management. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains eight units (with or without subunits), competencies, and competency builders that identify the…

Coal feed component testing for CDIF

NASA Technical Reports Server (NTRS)

Pearson, C. V.; Snyder, B. K.; Fornek, T. E.

1977-01-01

Investigations conducted during the conceptual design of the Montana MHD Component Development and Integration Facility (CDIF) identified commercially available processing and feeding equipment potentially suitable for use in a reference design. Tests on sub-scale units of this equipment indicated that they would perform as intended.

Dimensions of Improving School Districts.

ERIC Educational Resources Information Center

Pajak, Edward; Glickman, Carl D.

To broaden the scope of effective schools research by including change processes and a wider unit of study, this project investigated three Georgia school districts demonstrating improvements in student achievement for three consecutive years. Research identified these elements: (1) the sequence and influence of events, factors, and people…

Machine Trades. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a current comprehensive and verified employer competency program list for machine trades. Each unit (with or without subunits) contains competencies and competency builders that identify the occupational, academic, and employability…

Welding. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a comprehensive and verified employer competency list for a welding program. It contains units (with or without subunits), competencies, and competency builders that identify the occupational, academic, and employability skills needed…

Dairy Producer. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a current comprehensive and verified employer competency program list for dairy producers. Each unit (with or without subunits) contains competencies and competency builders that identify the occupational, academic, and employability…

Law Enforcement. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a current comprehensive and verified employer competency program list for law enforcement. Each unit (with or without subunits) contains competencies and competency builders that identify the occupational, academic, and employability…

Contamination revealed by indicator microorganism levels during veal processing

USDA-ARS?s Scientific Manuscript database

The United States Department of Agriculture (USDA) Food Safety Inspection Service (FSIS) has identified a higher percentage of non-O157 Shiga toxin-producing Escherichia coli positive samples collected from veal trimmings than from products produced from other cattle slaughter classes. During site ...

Poultry Producer. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a comprehensive and verified employer competency list for a poultry producer program. It contains units (with or without subunits), competencies, and competency builders that identify the occupational, academic, and employability…

Swine Producer. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a comprehensive and verified employer competency list for a swine producer program. It contains units (with or without subunits), competencies, and competency builders that identify the occupational, academic, and employability skills…

Factors Affecting Successful Reintegration

ERIC Educational Resources Information Center

Thomas, David Vittle

2015-01-01

This study explores the perspectives of education practitioners towards the process of reintegrating pupils (many of whom display social, emotional and behavioural difficulties), from a pupil referral unit (PRU) to mainstream educational provision in a rural bilingual Welsh authority, and examines the barriers and facilitators they identified as…

Commercial Art. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains 16 units (with or without subunits), competencies, and competency builders that identify the occupational,…

Crop Producer. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains six units (with or without subunits), competencies, and competency builders that identify the occupational,…

Auto Mechanics. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains 11 units (with or without subunits), competencies, and competency builders that identify the occupational,…

Diesel Mechanics. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a current comprehensive and verified employer competency program list for diesel mechanics. Each unit (with or without subunits) contains competencies and competency builders that identify the occupational, academic, and employability…

The Relationships between Selected Organizational Variables and ATM Technology Adoption in Campus Networking.

ERIC Educational Resources Information Center

Yao, Engui

1998-01-01

Determines the relationships between ATM (Asynchronous Transfer Mode) adoption and four organizational variables: university size, type, finances, and information-processing maturity. Identifies the current status of ATM adoption in campus networking in the United States. Contains 33 references. (DDR)

Development studies for a novel wet oxidation process. Phase 2

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

NONE

1994-07-01

DETOX{sup SM} is a catalyzed wet oxidation process which destroys organic materials in an acidic water solution of iron at 373 to 473 K. The solution can be used repeatedly to destroy great amounts of organic materials. Since the process is conducted in a contained vessel, air emissions from the process can be well controlled. The solution is also capable of dissolving and concentrating many heavy and radioactive metals for eventual stabilization and disposal. The Phase 2 effort for this project is site selection and engineering design for a DETOX demonstration unit. Site selection was made using a set ofmore » site selection criteria and evaluation factors. A survey of mixed wastes at DOE sites was conducted using the Interim Mixed Waste Inventory Report. Sites with likely suitable waste types were identified. Potential demonstration sites were ranked based on waste types, interest, regulatory needs, scheduling, ability to provide support, and available facilities. Engineering design for the demonstration unit is in progress and is being performed by Jacobs Applied Technology. The engineering design proceeded through preliminary process flow diagrams (PFDs), calculation of mass and energy balances for representative waste types, process and instrumentation diagrams (P and IDs), preparation of component specifications, and a firm cost estimate for fabrication of the demonstration unit.« less

High-performance computing with quantum processing units

DOE PAGES

Britt, Keith A.; Oak Ridge National Lab.; Humble, Travis S.; ...

2017-03-01

The prospects of quantum computing have driven efforts to realize fully functional quantum processing units (QPUs). Recent success in developing proof-of-principle QPUs has prompted the question of how to integrate these emerging processors into modern high-performance computing (HPC) systems. We examine how QPUs can be integrated into current and future HPC system architectures by accounting for func- tional and physical design requirements. We identify two integration pathways that are differentiated by infrastructure constraints on the QPU and the use cases expected for the HPC system. This includes a tight integration that assumes infrastructure bottlenecks can be overcome as well asmore » a loose integration that as- sumes they cannot. We find that the performance of both approaches is likely to depend on the quantum interconnect that serves to entangle multiple QPUs. As a result, we also identify several challenges in assessing QPU performance for HPC, and we consider new metrics that capture the interplay between system architecture and the quantum parallelism underlying computational performance.« less

High-performance computing with quantum processing units

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

Britt, Keith A.; Oak Ridge National Lab.; Humble, Travis S.

The prospects of quantum computing have driven efforts to realize fully functional quantum processing units (QPUs). Recent success in developing proof-of-principle QPUs has prompted the question of how to integrate these emerging processors into modern high-performance computing (HPC) systems. We examine how QPUs can be integrated into current and future HPC system architectures by accounting for func- tional and physical design requirements. We identify two integration pathways that are differentiated by infrastructure constraints on the QPU and the use cases expected for the HPC system. This includes a tight integration that assumes infrastructure bottlenecks can be overcome as well asmore » a loose integration that as- sumes they cannot. We find that the performance of both approaches is likely to depend on the quantum interconnect that serves to entangle multiple QPUs. As a result, we also identify several challenges in assessing QPU performance for HPC, and we consider new metrics that capture the interplay between system architecture and the quantum parallelism underlying computational performance.« less

Efficient Acceleration of the Pair-HMMs Forward Algorithm for GATK HaplotypeCaller on Graphics Processing Units.

PubMed

Ren, Shanshan; Bertels, Koen; Al-Ars, Zaid

2018-01-01

GATK HaplotypeCaller (HC) is a popular variant caller, which is widely used to identify variants in complex genomes. However, due to its high variants detection accuracy, it suffers from long execution time. In GATK HC, the pair-HMMs forward algorithm accounts for a large percentage of the total execution time. This article proposes to accelerate the pair-HMMs forward algorithm on graphics processing units (GPUs) to improve the performance of GATK HC. This article presents several GPU-based implementations of the pair-HMMs forward algorithm. It also analyzes the performance bottlenecks of the implementations on an NVIDIA Tesla K40 card with various data sets. Based on these results and the characteristics of GATK HC, we are able to identify the GPU-based implementations with the highest performance for the various analyzed data sets. Experimental results show that the GPU-based implementations of the pair-HMMs forward algorithm achieve a speedup of up to 5.47× over existing GPU-based implementations.

CLABSI Conversations: Lessons From Peer-to-Peer Assessments to Reduce Central Line-Associated Bloodstream Infections.

PubMed

Pham, Julius Cuong; Goeschel, Christine A; Berenholtz, Sean M; Demski, Renee; Lubomski, Lisa H; Rosen, Michael A; Sawyer, Melinda D; Thompson, David A; Trexler, Polly; Weaver, Sallie J; Weeks, Kristina R; Pronovost, Peter J

2016-01-01

A national collaborative helped many hospitals dramatically reduce central line-associated bloodstream infections (CLABSIs), but some hospitals struggled to reduce infection rates. This article describes the development of a peer-to-peer assessment process (CLABSI Conversations) and the practical, actionable practices we discovered that helped intensive care unit teams achieve a CLABSI rate of less than 1 infection per 1000 catheter-days for at least 1 year. CLABSI Conversations was designed as a learning-oriented process, in which a team of peers visited hospitals to surface barriers to infection prevention and to share best practices and insights from successful intensive care units. Common practices led to 10 recommendations: executive and board leaders communicate the goal of zero CLABSI throughout the hospital; senior and unit-level leaders hold themselves accountable for CLABSI rates; unit physicians and nurse leaders own the problem; clinical leaders and infection preventionists build infection prevention training and simulation programs; infection preventionists participate in unit-based CLABSI reduction efforts; hospital managers make compliance with best practices easy; clinical leaders standardize the hospital's catheter insertion and maintenance practices and empower nurses to stop any potentially harmful acts; unit leaders and infection preventionists investigate CLABSIs to identify root causes; and unit nurses and staff audit catheter maintenance policies and practices.

How Differences Between Manager and Clinician Perceptions of Safety Culture Impact Hospital Processes of Care.

PubMed

Richter, Jason; Mazurenko, Olena; Kazley, Abby Swanson; Ford, Eric W

2017-11-04

Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.

Fusion of Heterogeneous Intrusion Detection Systems for Network Attack Detection

PubMed Central

Kaliappan, Jayakumar; Thiagarajan, Revathi; Sundararajan, Karpagam

2015-01-01

An intrusion detection system (IDS) helps to identify different types of attacks in general, and the detection rate will be higher for some specific category of attacks. This paper is designed on the idea that each IDS is efficient in detecting a specific type of attack. In proposed Multiple IDS Unit (MIU), there are five IDS units, and each IDS follows a unique algorithm to detect attacks. The feature selection is done with the help of genetic algorithm. The selected features of the input traffic are passed on to the MIU for processing. The decision from each IDS is termed as local decision. The fusion unit inside the MIU processes all the local decisions with the help of majority voting rule and makes the final decision. The proposed system shows a very good improvement in detection rate and reduces the false alarm rate. PMID:26295058

Fusion of Heterogeneous Intrusion Detection Systems for Network Attack Detection.

PubMed

Kaliappan, Jayakumar; Thiagarajan, Revathi; Sundararajan, Karpagam

2015-01-01

An intrusion detection system (IDS) helps to identify different types of attacks in general, and the detection rate will be higher for some specific category of attacks. This paper is designed on the idea that each IDS is efficient in detecting a specific type of attack. In proposed Multiple IDS Unit (MIU), there are five IDS units, and each IDS follows a unique algorithm to detect attacks. The feature selection is done with the help of genetic algorithm. The selected features of the input traffic are passed on to the MIU for processing. The decision from each IDS is termed as local decision. The fusion unit inside the MIU processes all the local decisions with the help of majority voting rule and makes the final decision. The proposed system shows a very good improvement in detection rate and reduces the false alarm rate.

Information Memory Processing and Retrieval: Relationships of the Intellect with the Processing of a Learning and Cognition Task.

ERIC Educational Resources Information Center

Moser, Gene W.

Reported is one of a series of investigations of the Project on an Information Memory Model. This study was done to test an information memory model for identifying the unit of information structure involved in task cognitions by humans. Four groups of 30 randomly selected subjects (ages 7, 9, 11 and 15 years) performed a sorting task of 14…

Signature and Mechanism of the Epitehlial-to-Mesenchymal Transition. Addendum

DTIC Science & Technology

2011-09-01

as breast cancer . This study seeks to identify genes commonly regulated in the EMT, and identify key regulators of the process. An EMT core gene...Introduction Breast cancer is the most common form of cancer in women in the United States (1). Mortality results not from the primary tumor, but from...complications arising from metastases that have spread beyond the breast itself. Hence, the study of breast cancer progression and metastasis is

Investigation of Bioterrorism-Related Anthrax, United States, 2001: Epidemiologic Findings

PubMed Central

Raghunathan, Pratima L.; Bell, Beth P.; Brechner, Ross; Bresnitz, Eddy A.; Butler, Jay C.; Cetron, Marty; Cohen, Mitch; Doyle, Timothy; Fischer, Marc; Greene, Carolyn; Griffith, Kevin S.; Guarner, Jeannette; Hadler, James L.; Hayslett, James A.; Meyer, Richard; Petersen, Lyle R.; Phillips, Michael; Pinner, Robert; Popovic, Tanja; Quinn, Conrad P.; Reefhuis, Jennita; Reissman, Dori; Rosenstein, Nancy; Schuchat, Anne; Shieh, Wun-Ju; Siegal, Larry; Swerdlow, David L.; Tenover, Fred C.; Traeger, Marc; Ward, John W.; Weisfuse, Isaac; Wiersma, Steven; Yeskey, Kevin; Zaki, Sherif; Ashford, David A.; Perkins, Bradley A.; Ostroff, Steve; Hughes, James; Fleming, David; Koplan, Jeffrey P.; Gerberding, Julie L.

2002-01-01

In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities. PMID:12396909

The Lexis plot for run-off non-life insurance companies in United Kingdom

NASA Astrophysics Data System (ADS)

Samsudin, Humaida Banu

2014-06-01

This study is intended to look at the company's age to be one of the predictor for financially distressed non-life insurance companies in United Kingdom. Financial distress is a condition where a company has difficulty paying off its obligations to its creditors. For this study, Lexis plot is used to identify either younger companies or older companies are in run-off. Run-off is a process where many insurance companies stop underwriting policies long before they reach financial crisis or financial distress. The study utilises financial data of 22 years from year 1985 to year 2006 for 397 companies. From the study, it is identified that younger companies are more in financial distress than older companies.

Moments in Time

PubMed Central

Wittmann, Marc

2011-01-01

It has been suggested that perception and action can be understood as evolving in temporal epochs or sequential processing units. Successive events are fused into units forming a unitary experience or “psychological present.” Studies have identified several temporal integration levels on different time scales which are fundamental for our understanding of behavior and subjective experience. In recent literature concerning the philosophy and neuroscience of consciousness these separate temporal processing levels are not always precisely distinguished. Therefore, empirical evidence from psychophysics and neuropsychology on these distinct temporal processing levels is presented and discussed within philosophical conceptualizations of time experience. On an elementary level, one can identify a functional moment, a basic temporal building block of perception in the range of milliseconds that defines simultaneity and succession. Below a certain threshold temporal order is not perceived, individual events are processed as co-temporal. On a second level, an experienced moment, which is based on temporal integration of up to a few seconds, has been reported in many qualitatively different experiments in perception and action. It has been suggested that this segmental processing mechanism creates temporal windows that provide a logistical basis for conscious representation and the experience of nowness. On a third level of integration, continuity of experience is enabled by working memory in the range of multiple seconds allowing the maintenance of cognitive operations and emotional feelings, leading to mental presence, a temporal window of an individual’s experienced presence. PMID:22022310

41 CFR 105-56.024 - Purpose and scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... offset computer matching, identify Federal employees who owe delinquent non-tax debt to the United States. Centralized salary offset computer matching is the computerized comparison of delinquent debt records with...) administrative offset program, to collect delinquent debts owed to the Federal Government. This process is known...

100-N Area Decision Unit Target Analyte List Development for Soil

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

Ovink, R.

2012-09-18

This report documents the process used to identify source area target analytes in support of the 100-N Area remedial investigation/feasibility study (RI/FS) addendum to the Integrated 100 Area Remedial Investigation/Feasibility Study Work Plan (DOE/RL-2008-46, Rev. 0).

Child Care Guidance, Management, and Service. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains seven units (with or without subunits), competencies, and competency builders that identify the…

Auto Body and Fender. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains 10 units (with or without subunits), competencies, and competency builders that identify the occupational,…

Beef and Sheep Producer. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains 11 units (with or without subunits), competencies, and competency builders that identify the occupational,…

Agricultural Business Feed and Grain Worker. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This comprehensive and verified employer competency list was developed from a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives from Ohio. This competency list contains nine units (with or without subunits), competencies, and competency builders that identify the…

Academic Deficiency: Student Experiences of Institutional Labeling

ERIC Educational Resources Information Center

Barouch-Gilbert, Abraham

2015-01-01

Limited existing research examines how undergraduate students in the United States experience the process of being identified as deficient due to their academic performance. The purpose of this phenomenological study was to explore the lived experiences of college students on academic probation who were labeled academically deficient. Students…

Impact of nowcasting on the production and processing of agricultural crops. [in the US

NASA Technical Reports Server (NTRS)

Dancer, W. S.; Tibbitts, T. W.

1973-01-01

The value was studied of improved weather information and weather forecasting to farmers, growers, and agricultural processing industries in the United States. The study was undertaken to identify the production and processing operations that could be improved with accurate and timely information on changing weather patterns. Estimates were then made of the potential savings that could be realized with accurate information about the prevailing weather and short term forecasts for up to 12 hours. This weather information has been termed nowcasting. The growing, marketing, and processing operations of the twenty most valuable crops in the United States were studied to determine those operations that are sensitive to short-term weather forecasting. Agricultural extension specialists, research scientists, growers, and representatives of processing industries were consulted and interviewed. The value of the crops included in this survey and their production levels are given. The total value for crops surveyed exceeds 24 billion dollars and represents more than 92 percent of total U.S. crop value.

Application of agent-based system for bioprocess description and process improvement.

PubMed

Gao, Ying; Kipling, Katie; Glassey, Jarka; Willis, Mark; Montague, Gary; Zhou, Yuhong; Titchener-Hooker, Nigel J

2010-01-01

Modeling plays an important role in bioprocess development for design and scale-up. Predictive models can also be used in biopharmaceutical manufacturing to assist decision-making either to maintain process consistency or to identify optimal operating conditions. To predict the whole bioprocess performance, the strong interactions present in a processing sequence must be adequately modeled. Traditionally, bioprocess modeling considers process units separately, which makes it difficult to capture the interactions between units. In this work, a systematic framework is developed to analyze the bioprocesses based on a whole process understanding and considering the interactions between process operations. An agent-based approach is adopted to provide a flexible infrastructure for the necessary integration of process models. This enables the prediction of overall process behavior, which can then be applied during process development or once manufacturing has commenced, in both cases leading to the capacity for fast evaluation of process improvement options. The multi-agent system comprises a process knowledge base, process models, and a group of functional agents. In this system, agent components co-operate with each other in performing their tasks. These include the description of the whole process behavior, evaluating process operating conditions, monitoring of the operating processes, predicting critical process performance, and providing guidance to decision-making when coping with process deviations. During process development, the system can be used to evaluate the design space for process operation. During manufacture, the system can be applied to identify abnormal process operation events and then to provide suggestions as to how best to cope with the deviations. In all cases, the function of the system is to ensure an efficient manufacturing process. The implementation of the agent-based approach is illustrated via selected application scenarios, which demonstrate how such a framework may enable the better integration of process operations by providing a plant-wide process description to facilitate process improvement. Copyright 2009 American Institute of Chemical Engineers

Notes from the field: hospitalizations for respiratory disease among unaccompanied children from Central America - multiple States, June-July 2014.

PubMed

Nyangoma, Edith N; Arriola, Carmen Sofia; Hagan, Jose; Socias, Christina; Tomczyk, Sara; Watkins, Louise Francois; Westercamp, Matthew; Kim, Curi

2014-08-15

During October 2013-June 2014, approximately 54,000 unaccompanied children, mostly from the Central American countries of El Salvador, Guatemala, and Honduras, were identified attempting entry into the United States from Mexico, exceeding numbers reported in previous years. Once identified in the United States, U.S. Customs and Border Protection, an agency of the U.S. Department of Homeland Security, processes the unaccompanied children and transfers them to the Office of Refugee Resettlement (ORR), an office of the Administration for Children and Families, U.S. Department of Health and Human Services. ORR cares for the children in shelters until they can be released to a sponsor, typically a parent or relative, who can care for the child while their immigration case is processed. In June 2014, in response to the increased number of unaccompanied children, U.S. Customs and Border Protection expanded operations to accommodate children at a processing center in Nogales, Arizona. ORR, together with the U.S. Department of Defense, opened additional large temporary shelters for the children at Lackland Air Force Base, Texas; U.S. Army Garrison Ft. Sill, Oklahoma; and Naval Base Ventura County, California.

Extraction of volatiles and metals from extraterrestrial ores

NASA Technical Reports Server (NTRS)

Lewis, John S.

1989-01-01

Extraterrestrial materials, processes, and products were identified which are associated with the production of propellants in space, including the most complete possible conversion of the feedstocks for propellant production into useful products with the minimum feasible expenditure of energy. Laboratory research was identified and begun on several processes that promise very large increases in the mass of useful products at the cost of only modest increases in energy consumption. Processes for manufacturing propellants then become processes for making propellants plus metals and refractories. It is the overall yield of useful materials per unit expended energy that matters, not simply the yield of propellants. Three tasks have been undertaken to date: (1) Literature search and compilation of a dBase 3 data base on space materials processing; (2) Gaseous carbonyl extraction and purification of ferrous metals; and (3) Characterization of lunar ilmenite and its simulants.

Effect of microwave argon plasma on the glycosidic and hydrogen bonding system of cotton cellulose.

PubMed

Prabhu, S; Vaideki, K; Anitha, S

2017-01-20

Cotton fabric was processed with microwave (Ar) plasma to alter its hydrophilicity. The process parameters namely microwave power, process gas pressure and processing time were optimized using Box-Behnken method available in the Design Expert software. It was observed that certain combinations of process parameters improved existing hydrophilicity while the other combinations decreased it. ATR-FTIR spectral analysis was used to identify the strain induced in inter chain, intra chain, and inter sheet hydrogen bond and glycosidic covalent bond due to plasma treatment. X-ray diffraction (XRD) studies was used to analyze the effect of plasma on unit cell parameters and degree of crystallinity. Fabric surface etching was identified using FESEM analysis. Thus, it can be concluded that the increase/decrease in the hydrophilicity of the plasma treated fabric was due to these structural and physical changes. Copyright © 2016 Elsevier Ltd. All rights reserved.

How do formulation and process parameters impact blend and unit dose uniformity? Further analysis of the product quality research institute blend uniformity working group industry survey.

PubMed

Hancock, Bruno C; Garcia-Munoz, Salvador

2013-03-01

Responses from the second Product Quality Research Institute (PQRI) Blend Uniformity Working Group (BUWG) survey of industry have been reanalyzed to identify potential links between formulation and processing variables and the measured uniformity of blends and unit dosage forms. As expected, the variability of the blend potency and tablet potency data increased with a decrease in the loading of the active pharmaceutical ingredient (API). There was also an inverse relationship between the nominal strength of the unit dose and the blend uniformity data. The data from the PQRI industry survey do not support the commonly held viewpoint that granulation processes are necessary to create and sustain tablet and capsule formulations with a high degree of API uniformity. There was no correlation between the blend or tablet potency variability and the type of process used to manufacture the product. Although it is commonly believed that direct compression processes should be avoided for low API loading formulations because of blend and tablet content uniformity concerns, the data for direct compression processes reported by the respondents to the PQRI survey suggest that such processes are being used routinely to manufacture solid dosage forms of acceptable quality even when the drug loading is quite low. Copyright © 2012 Wiley Periodicals, Inc.

A Novel Framework Based on FastICA for High Density Surface EMG Decomposition

PubMed Central

Chen, Maoqi; Zhou, Ping

2015-01-01

This study presents a progressive FastICA peel-off (PFP) framework for high density surface electromyogram (EMG) decomposition. The novel framework is based on a shift-invariant model for describing surface EMG. The decomposition process can be viewed as progressively expanding the set of motor unit spike trains, which is primarily based on FastICA. To overcome the local convergence of FastICA, a “peel off” strategy (i.e. removal of the estimated motor unit action potential (MUAP) trains from the previous step) is used to mitigate the effects of the already identified motor units, so more motor units can be extracted. Moreover, a constrained FastICA is applied to assess the extracted spike trains and correct possible erroneous or missed spikes. These procedures work together to improve the decomposition performance. The proposed framework was validated using simulated surface EMG signals with different motor unit numbers (30, 70, 91) and signal to noise ratios (SNRs) (20, 10, 0 dB). The results demonstrated relatively large numbers of extracted motor units and high accuracies (high F1-scores). The framework was also tested with 111 trials of 64-channel electrode array experimental surface EMG signals during the first dorsal interosseous (FDI) muscle contraction at different intensities. On average 14.1 ± 5.0 motor units were identified from each trial of experimental surface EMG signals. PMID:25775496

Improving the medical records department processes by lean management.

PubMed

Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

2015-01-01

Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. The study represents one of the few attempts trying to eliminate wastes in the MRD.

Expedient antibiotics production: Final report

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

Bienkowski, P.R.; Byers, C.H.; Lee, D.D.

The literature on the manufacture, separation and purification, and clinical uses of antibiotics was reviewed, and a bibliography of the pertinent material was completed. Five antimicrobial drugs, penicillin V and G, (and amoxicillin with clavulanic acid), Cephalexin (a cephalosporin), tetracycline and oxytetracycline, Bacitracin (topical), and sulfonamide (chemically produced) were identified for emergency production. Plants that manufacture antibiotics in the continental United States, Mexico, and Puerto Rico have been identified along with potential alternate sites such as those where SCP, enzyme, and fermentation ethanol are produced. Detailed process flow sheets and process descriptions have been derived from the literature and documented.more » This investigation revealed that a typical antibiotic-manufacturing facility is composed of two main sections: (1) a highly specialized, but generic, fermentation unit and (2) a multistep, complex separation and purification unit which is specific to a particular antibiotic product. The fermentation section requires specialized equipment for operation in a sterile environment which is not usually available in other industries. The emergency production of antibiotics under austere conditions will be feasible only if a substantial reduction in the complexity and degree of separation and purity normally required can be realized. Detailed instructions were developed to assist state and federal officials who would be directing the resumption of antibiotic production after a nuclear attack. 182 refs., 54 figs., 26 tabs.« less

Opportunities and Barriers to Resource Recovery and Recycling from Shredder Residue in the United States

NASA Astrophysics Data System (ADS)

Nayak, Naren; Apelian, Diran

2014-11-01

Shredder residue is the by-product remaining after ferrous and nonferrous metals have been recovered from the processing of vehicles, white goods, and peddler scrap. Shredder residue consists of glass, plastics, rubber, dirt, and small amounts of metal. It is estimated that 5-7 million tons of this shredder residue are landfilled each year in the United States. Technical advancements, coupled with European Union directives and the economic climate, have transformed the recycling of shredder residue in Europe. In the United States, however, regulatory controls and the cheap cost of landfill have worked against the advancement of recycling and recovery of this resource. The Argonne National Laboratory, which is funded by the U.S. Department of Energy, has investigated the effectiveness of recycling shredder residue into polymers. Other research has examined the use of shredder residue in waste-to-energy applications. To improve our ability to process and recycle shredder residue, an investigation of the regulatory, economic, and technological challenges was undertaken. The objective was to conduct a comprehensive review of work done to date, to document the composition of typical shredder output and to identify potential recoverable items (residual metals, plastics, rubber, foam, etc.). Along with uncovering potential new markets, the research would identify the technical, regulatory, and economic barriers to developing those markets.

Error reporting in transfusion medicine at a tertiary care centre: a patient safety initiative.

PubMed

Elhence, Priti; Shenoy, Veena; Verma, Anupam; Sachan, Deepti

2012-11-01

Errors in the transfusion process can compromise patient safety. A study was undertaken at our center to identify the errors in the transfusion process and their causes in order to reduce their occurrence by corrective and preventive actions. All near miss, no harm events and adverse events reported in the 'transfusion process' during 1 year study period were recorded, classified and analyzed at a tertiary care teaching hospital in North India. In total, 285 transfusion related events were reported during the study period. Of these, there were four adverse (1.5%), 10 no harm (3.5%) and 271 (95%) near miss events. Incorrect blood component transfusion rate was 1 in 6031 component units. ABO incompatible transfusion rate was one in 15,077 component units issued or one in 26,200 PRBC units issued and acute hemolytic transfusion reaction due to ABO incompatible transfusion was 1 in 60,309 component units issued. Fifty-three percent of the antecedent near miss events were bedside events. Patient sample handling errors were the single largest category of errors (n=94, 33%) followed by errors in labeling and blood component handling and storage in user areas. The actual and near miss event data obtained through this initiative provided us with clear evidence about latent defects and critical points in the transfusion process so that corrective and preventive actions could be taken to reduce errors and improve transfusion safety.

Development of unconfined conditions in multi-aquifer flow systems: a case study in the Rajshahi Barind, Bangladesh

NASA Astrophysics Data System (ADS)

Rushton, K. R.; Zaman, M. Asaduz

2017-01-01

Identifying flow processes in multi-aquifer flow systems is a considerable challenge, especially if substantial abstraction occurs. The Rajshahi Barind groundwater flow system in Bangladesh provides an example of the manner in which flow processes can change with time. At some locations there has been a decrease with time in groundwater heads and also in the magnitude of the seasonal fluctuations. This report describes the important stages in a detailed field and modelling study at a specific location in this groundwater flow system. To understand more about the changing conditions, piezometers were constructed in 2015 at different depths but the same location; water levels in these piezometers indicate the formation of an additional water table. Conceptual models are described which show how conditions have changed between the years 2000 and 2015. Following the formation of the additional water table, the aquifer system is conceptualised as two units. A pumping test is described with data collected during both the pumping and recovery phases. Pumping test data for the Lower Unit are analysed using a computational model with estimates of the aquifer parameters; the model also provided estimates of the quantity of water moving from the ground surface, through the Upper Unit, to provide an input to the Lower Unit. The reasons for the substantial changes in the groundwater heads are identified; monitoring of the recently formed additional water table provides a means of testing whether over-abstraction is occurring.

Student-Powered Solutions

ERIC Educational Resources Information Center

Battistoni, Rick

2004-01-01

This article describes Project 540, a national civic education program that directly engages high school students in the democratic process. During Project 540's first year (2002-2003) more than 140,000 students in 230 high schools in the United States participated in Project 540 to identify issues they cared about and take part in civic…

Fertilizer/Chemical Sales and Service Worker. Ohio's Competency Analysis Profile.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

This Ohio Competency Analysis Profile (OCAP), derived from a modified Developing a Curriculum (DACUM) process, is a current comprehensive and verified employer competency program list for fertilizer/chemical sales and service workers. Each unit (with or without subunits) contains competencies and competency builders that identify the occupational,…

"It's All Human Error!": When a School Science Experiment Fails

ERIC Educational Resources Information Center

Viechnicki, Gail Brendel; Kuipers, Joel

2006-01-01

This paper traces the sophisticated negotiations to re-inscribe the authority of Nature when a school science experiment fails during the enactment of a highly rated science curriculum unit. Drawing on transcriptions from classroom videotapes, we identify and describe four primary patterns of interaction that characterize this process, arguing…

10 CFR 430.24 - Units to be tested.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the method includes an ARM/simulation adjustment factor(s), determine the value(s) of the factors(s... process. (v) If request for approval is for an updated ARM, manufacturers must identify modifications made to the ARM since the last submittal, including any ARM/simulation adjustment factor(s) added since...

Planning for Interagency Cooperation in Rural Development. CARD Report 45.

ERIC Educational Resources Information Center

Rogers, David L.; Glick, Edward L.

With a major emphasis on cooperative planning in rural development, three elements of development process were identified: (1) integration of units involved, occurring when several organizations contribute to a larger collective effort; (2) decentralized planning and local initiative, occurring when planning initiative is at the local level; (3)…

76 FR 66260 - Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-26

... number of management measures, such as closure thresholds, gear restrictions, and possession limits. The... recommended zero JVP because U.S. shoreside processing capacity for mackerel has expanded. The Council... personal identifying information (e.g., name, address, etc.) submitted voluntarily by the sender will be...

THE U.S. ENVIRONMENTAL PROTECTION AGENCY'S STRESSOR IDENTIFICATION GUIDANCE: A PROCESS FOR DETERMINING THE PROBABLE CAUSES OF BIOLOGICAL IMPAIRMENTS

EPA Science Inventory

The United States Environmental Protection Agency (USEPA) has ongoing programs to encourage the evaluation of stream condition based on biological indicators. Bioassessments reveal impairments but do not identify causes of impairments, a necessary step in the restoration of aqua...

Advanced Manufacturing Office Clean Water Processing Technologies

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

None

The DOE Office of Energy Efficiency and Renewable Energy (EERE)’s Advanced Manufacturing Office partners with industry, small business, universities, and other stakeholders to identify and invest in emerging technologies with the potential to create high-quality domestic manufacturing jobs and enhance the global competitiveness of the United States.

Accreditation Outcome Scores: Teacher Attitudes toward the Accreditation Process and Professional Development

ERIC Educational Resources Information Center

Ulmer, Phillip Gregory

2015-01-01

Accreditation is an essential component in the history of education in the United States and is a central catalyst for quality education, continuous improvement, and positive growth in student achievement. Although previous researchers identified teachers as an essential component in meeting accreditation outcomes, additional information was…

40 CFR 1500.2 - Policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., regulations, and public laws of the United States in accordance with the policies set forth in the Act and in... procedures required by law or by agency practice so that all such procedures run concurrently rather than... human environment. (e) Use the NEPA process to identify and assess the reasonable alternatives to...

Onboard data processing and compression for a four-sensor suite: the SERENA experiment.

NASA Astrophysics Data System (ADS)

Mura, A.; Orsini, S.; Di Lellis, A.; Lazzarotto, F.; Barabash, S.; Livi, S.; Torkar, K.; Milillo, A.; De Angelis, E.

2013-09-01

SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is an instrument package that will fly on board the BepiColombo/Mercury Planetary Orbiter (MPO). SERENA instrument includes four units: ELENA (Emitted Low Energy Neutral Atoms), a neutral particle analyzer/imager to detect ion sputtering and backscattering from Mercury's surface; STROFIO (Start from a Rotating FIeld mass spectrometer), a mass spectrometer to identify atomic masses released from the surface; MIPA (Miniature Ion Precipitation Analyzer) and PICAM (Planetary Ion Camera), two ion spectrometers to monitor the precipitating solar wind and measure the plasma environment around Mercury. The System Control Unit architecture is such that all four sensors are connected to a high resolution FPGA, which dialogs with a dedicated high-performance data processing unit. The unpredictability of the data rate, due to the peculiarities of these investigations, leads to several possible scenarios for the data compression and handling. In this study we first discuss about the predicted data volume that comes from the optimized operation strategy, and then we report on the instrument data processing and compression.

Influence of technical processing units on chemical composition and antimicrobial activity of carrot (Daucus carrot L.) juice essential oil.

PubMed

Ma, Tingting; Luo, Jiyang; Tian, Chengrui; Sun, Xiangyu; Quan, Meiping; Zheng, Cuiping; Kang, Lina; Zhan, Jicheng

2015-03-01

The effect of three processing units (blanching, enzyme liquefaction, pasteurisation) on chemical composition and antimicrobial activity of carrot juice essential oil was investigated in this paper. A total of 36 compounds were identified by GC-MS from fresh carrot juice essential oil. The main constituents were carotol (20.20%), sabinene (12.80%), β-caryophyllene (8.04%) and α-pinene (6.05%). Compared with the oil of fresh juice, blanching and pasteurisation could significantly decrease the components of the juice essential oil, whereas enzyme liquefaction had no considerable effect on the composition of juice essential oil. With regard to the antimicrobial activity, carrot juice essential oil could cause physical damage and morphological alteration on microorganisms, while the three different processing units showed noticeable differences on the species of microorganisms, the minimum inhibitory concentration and minimum bactericidal concentration. Results revealed that the carrot juice essential oil has great potential for application as a natural antimicrobial applied in pharmaceutical and food industries. Copyright © 2014 Elsevier Ltd. All rights reserved.

Technology and development requirements for advanced coal conversion systems

NASA Technical Reports Server (NTRS)

1981-01-01

A compendium of coal conversion process descriptions is presented. The SRS and MC data bases were utilized to provide information paticularly in the areas of existing process designs and process evaluations. Additional information requirements were established and arrangements were made to visit process developers, pilot plants, and process development units to obtain information that was not otherwise available. Plant designs, process descriptions and operating conditions, and performance characteristics were analyzed and requirements for further development identified and evaluated to determine the impact of these requirements on the process commercialization potential from the standpoint of economics and technical feasibility. A preliminary methodology was established for the comparative technical and economic assessment of advanced processes.

Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers.

PubMed

Sendlhofer, Gerald; Brunner, Gernot; Tax, Christa; Falzberger, Gebhard; Smolle, Josef; Leitgeb, Karina; Kober, Brigitte; Kamolz, Lars Peter

2015-01-01

For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach. To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified. Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM. The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk managers supported the centrally coordinated CRM process. There is a strong commitment among management, academia, clinicians, and administration to foster cooperation. The introduction of CRM led to a visible shift with regard to patient safety culture throughout the entire organization. Still, there is a long way to go to keep people engaged in CRM and work on national and international patient safety initiatives to continuously decrease potential hazards.

A historical review of additives and modifiers used in paving asphalt refining processes in the United States.

PubMed

Mundt, Diane J; Adams, Robert C; Marano, Kristin M

2009-11-01

The U.S. asphalt paving industry has evolved over time to meet various performance specifications for liquid petroleum asphalt binder (known as bitumen outside the United States). Additives to liquid petroleum asphalt produced in the refinery may affect exposures to workers in the hot mix paving industry. This investigation documented the changes in the composition and distribution of the liquid petroleum asphalt products produced from petroleum refining in the United States since World War II. This assessment was accomplished by reviewing documents and interviewing individual experts in the industry to identify current and historical practices. Individuals from 18 facilities were surveyed; the number of facilities reporting use of any material within a particular class ranged from none to more than half the respondents. Materials such as products of the process stream, polymers, elastomers, and anti-strip compounds have been added to liquid petroleum asphalt in the United States over the past 50 years, but modification has not been generally consistent by geography or time. Modifications made to liquid petroleum asphalt were made generally to improve performance and were dictated by state specifications.

Chemical interaction matrix between reagents in a Purex based process

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

Brahman, R.K.; Hennessy, W.P.; Paviet-Hartmann, P.

2008-07-01

The United States Department of Energy (DOE) is the responsible entity for the disposal of the United States excess weapons grade plutonium. DOE selected a PUREX-based process to convert plutonium to low-enriched mixed oxide fuel for use in commercial nuclear power plants. To initiate this process in the United States, a Mixed Oxide (MOX) Fuel Fabrication Facility (MFFF) is under construction and will be operated by Shaw AREVA MOX Services at the Savannah River Site. This facility will be licensed and regulated by the U.S. Nuclear Regulatory Commission (NRC). A PUREX process, similar to the one used at La Hague,more » France, will purify plutonium feedstock through solvent extraction. MFFF employs two major process operations to manufacture MOX fuel assemblies: (1) the Aqueous Polishing (AP) process to remove gallium and other impurities from plutonium feedstock and (2) the MOX fuel fabrication process (MP), which processes the oxides into pellets and manufactures the MOX fuel assemblies. The AP process consists of three major steps, dissolution, purification, and conversion, and is the center of the primary chemical processing. A study of process hazards controls has been initiated that will provide knowledge and protection against the chemical risks associated from mixing of reagents over the life time of the process. This paper presents a comprehensive chemical interaction matrix evaluation for the reagents used in the PUREX-based process. Chemical interaction matrix supplements the process conditions by providing a checklist of any potential inadvertent chemical reactions that may take place. It also identifies the chemical compatibility/incompatibility of the reagents if mixed by failure of operations or equipment within the process itself or mixed inadvertently by a technician in the laboratories. (aut0010ho.« less

Distributive Distillation Enabled by Microchannel Process Technology

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

Arora, Ravi

The application of microchannel technology for distributive distillation was studied to achieve the Grand Challenge goals of 25% energy savings and 10% return on investment. In Task 1, a detailed study was conducted and two distillation systems were identified that would meet the Grand Challenge goals if the microchannel distillation technology was used. Material and heat balance calculations were performed to develop process flow sheet designs for the two distillation systems in Task 2. The process designs were focused on two methods of integrating the microchannel technology 1) Integrating microchannel distillation to an existing conventional column, 2) Microchannel distillation formore » new plants. A design concept for a modular microchannel distillation unit was developed in Task 3. In Task 4, Ultrasonic Additive Machining (UAM) was evaluated as a manufacturing method for microchannel distillation units. However, it was found that a significant development work would be required to develop process parameters to use UAM for commercial distillation manufacturing. Two alternate manufacturing methods were explored. Both manufacturing approaches were experimentally tested to confirm their validity. The conceptual design of the microchannel distillation unit (Task 3) was combined with the manufacturing methods developed in Task 4 and flowsheet designs in Task 2 to estimate the cost of the microchannel distillation unit and this was compared to a conventional distillation column. The best results were for a methanol-water separation unit for the use in a biodiesel facility. For this application microchannel distillation was found to be more cost effective than conventional system and capable of meeting the DOE Grand Challenge performance requirements.« less

Coal conversion processes and analysis methodologies for synthetic fuels production. [technology assessment and economic analysis of reactor design for coal gasification

NASA Technical Reports Server (NTRS)

1979-01-01

Information to identify viable coal gasification and utilization technologies is presented. Analysis capabilities required to support design and implementation of coal based synthetic fuels complexes are identified. The potential market in the Southeast United States for coal based synthetic fuels is investigated. A requirements analysis to identify the types of modeling and analysis capabilities required to conduct and monitor coal gasification project designs is discussed. Models and methodologies to satisfy these requirements are identified and evaluated, and recommendations are developed. Requirements for development of technology and data needed to improve gasification feasibility and economies are examined.

The influence of care interventions on the continuity of sleep of intensive care unit patients1

PubMed Central

Hamze, Fernanda Luiza; de Souza, Cristiane Chaves; Chianca, Tânia Couto Machado

2015-01-01

Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit. Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software. Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8%) caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients. Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients. PMID:26487127

The semantics of Chemical Markup Language (CML): dictionaries and conventions.

PubMed

Murray-Rust, Peter; Townsend, Joe A; Adams, Sam E; Phadungsukanan, Weerapong; Thomas, Jens

2011-10-14

The semantic architecture of CML consists of conventions, dictionaries and units. The conventions conform to a top-level specification and each convention can constrain compliant documents through machine-processing (validation). Dictionaries conform to a dictionary specification which also imposes machine validation on the dictionaries. Each dictionary can also be used to validate data in a CML document, and provide human-readable descriptions. An additional set of conventions and dictionaries are used to support scientific units. All conventions, dictionaries and dictionary elements are identifiable and addressable through unique URIs.

Accelerated signal encoding and reconstruction using pixon method

DOEpatents

Puetter, Richard; Yahil, Amos; Pina, Robert

2005-05-17

The method identifies a Pixon element, which is a fundamental and indivisible unit of information, and a Pixon basis, which is the set of possible functions from which the Pixon elements are selected. The actual Pixon elements selected from this basis during the reconstruction process represents the smallest number of such units required to fit the data and representing the minimum number of parameters necessary to specify the image. The Pixon kernels can have arbitrary properties (e.g., shape, size, and/or position) as needed to best fit the data.

The semantics of Chemical Markup Language (CML): dictionaries and conventions

PubMed Central

2011-01-01

The semantic architecture of CML consists of conventions, dictionaries and units. The conventions conform to a top-level specification and each convention can constrain compliant documents through machine-processing (validation). Dictionaries conform to a dictionary specification which also imposes machine validation on the dictionaries. Each dictionary can also be used to validate data in a CML document, and provide human-readable descriptions. An additional set of conventions and dictionaries are used to support scientific units. All conventions, dictionaries and dictionary elements are identifiable and addressable through unique URIs. PMID:21999509

Work and retirement among a cohort of older men in the United States, 1966-1983.

PubMed

Hayward, M D; Grady, W R

1990-08-01

Multivariate increment-decrement working life tables are estimated for a cohort of older men in the United States for the period 1966-1983. The approach taken allows multiple processes to be simultaneously incorporated into a single model, resulting in a more realistic portrayal of a cohort's late-life labor force behavior. In addition, because the life table model is developed from multivariate hazard equations, we identify the effects of sociodemographic characteristics on the potentially complex process by which the labor force career is ended. In contrast to the assumed homogeneity of previous working life table analyses, the present study shows marked differences in labor force mobility and working and nonworking life expectancy according to occupation, class of worker, education, race, and marital status. We briefly discuss the implications of these findings for inequities of access to retirement, private and public pension consumption, and future changes in the retirement process.

Ventilator-associated pneumonia improvement program.

PubMed

Murray, Theresa; Goodyear-Bruch, Caryl

2007-01-01

Ventilator-associated pneumonia (VAP) is a significant clinical problem associated with increased intensive care unit and hospital length of stay and substantial increases in delivery cost and associated morbidity and mortality. With system changes and management of the environment of care, the incidence of VAP was reduced in seven of our intensive care units across the system. Steps necessary to reduce VAP were identified and put into place in all the intensive care units. Patient positioning, oral care, nutrition, and management of comfort drugs are a few of the processes addressed to reduce VAP. Standardization of these essential care practices can reduce the incidence of this nosocomial infection and its associated increases in the cost of care delivery and mortality.

Data cleaning and management protocols for linked perinatal research data: a good practice example from the Smoking MUMS (Maternal Use of Medications and Safety) Study.

PubMed

Tran, Duong Thuy; Havard, Alys; Jorm, Louisa R

2017-07-11

Data cleaning is an important quality assurance in data linkage research studies. This paper presents the data cleaning and preparation process for a large-scale cross-jurisdictional Australian study (the Smoking MUMS Study) to evaluate the utilisation and safety of smoking cessation pharmacotherapies during pregnancy. Perinatal records for all deliveries (2003-2012) in the States of New South Wales (NSW) and Western Australia were linked to State-based data collections including hospital separation, emergency department and death data (mothers and babies) and congenital defect notifications (babies in NSW) by State-based data linkage units. A national data linkage unit linked pharmaceutical dispensing data for the mothers. All linkages were probabilistic. Twenty two steps assessed the uniqueness of records and consistency of items within and across data sources, resolved discrepancies in the linkages between units, and identified women having records in both States. State-based linkages yielded a cohort of 783,471 mothers and 1,232,440 babies. Likely false positive links relating to 3703 mothers were identified. Corrections of baby's date of birth and age, and parity were made for 43,578 records while 1996 records were flagged as duplicates. Checks for the uniqueness of the matches between State and national linkages detected 3404 ID clusters, suggestive of missed links in the State linkages, and identified 1986 women who had records in both States. Analysis of content data can identify inaccurate links that cannot be detected by data linkage units that have access to personal identifiers only. Perinatal researchers are encouraged to adopt the methods presented to ensure quality and consistency among studies using linked administrative data.

Guidelines for the processing and quality assurance of benthic invertebrate samples collected as part of the National Water-Quality Assessment Program

USGS Publications Warehouse

Cuffney, T.F.; Gurtz, M.E.; Meador, M.R.

1993-01-01

Benthic invertebrate samples are collected as part of the U.S. Geological Survey's National Water-Quality Assessment Program. This is a perennial, multidisciplinary program that integrates biological, physical, and chemical indicators of water quality to evaluate status and trends and to develop an understanding of the factors controlling observed water quality. The Program examines water quality in 60 study units (coupled ground- and surface-water systems) that encompass most of the conterminous United States and parts of Alaska and Hawaii. Study-unit teams collect and process qualitative and semi-quantitative invertebrate samples according to standardized procedures. These samples are processed (elutriated and subsampled) in the field to produce as many as four sample components: large-rare, main-body, elutriate, and split. Each sample component is preserved in 10-percent formalin, and two components, large-rare and main-body, are sent to contract laboratories for further processing. The large-rare component is composed of large invertebrates that are removed from the sample matrix during field processing and placed in one or more containers. The main-body sample component consists of the remaining sample materials (sediment, detritus, and invertebrates) and is subsampled in the field to achieve a volume of 750 milliliters or less. The remaining two sample components, elutriate and split, are used for quality-assurance and quality-control purposes. Contract laboratories are used to identify and quantify invertebrates from the large-rare and main-body sample components according to the procedures and guidelines specified within this document. These guidelines allow the use of subsampling techniques to reduce the volume of sample material processed and to facilitate identifications. These processing procedures and techniques may be modified if the modifications provide equal or greater levels of accuracy and precision. The intent of sample processing is to determine the quantity of each taxon present in the semi-quantitative samples or to list the taxa present in qualitative samples. The processing guidelines provide standardized laboratory forms, sample labels, detailed sample processing flow charts, standardized format for electronic data, quality-assurance procedures and checks, sample tracking standards, and target levels for taxonomic determinations. The contract laboratory (1) is responsible for identifications and quantifications, (2) constructs reference collections, (3) provides data in hard copy and electronic forms, (4) follows specified quality-assurance and quality-control procedures, and (5) returns all processed and unprocessed portions of the samples. The U.S. Geological Survey's Quality Management Group maintains a Biological Quality-Assurance Unit, located at the National Water-Quality Laboratory, Arvada, Colorado, to oversee the use of contract laboratories and ensure the quality of data obtained from these laboratories according to the guidelines established in this document. This unit establishes contract specifications, reviews contractor performance (timeliness, accuracy, and consistency), enters data into the National Water Information System-II data base, maintains in-house reference collections, deposits voucher specimens in outside museums, and interacts with taxonomic experts within and outside the U.S. Geological Survey. This unit also modifies the existing sample processing and quality-assurance guidelines, establishes criteria and testing procedures for qualifying potential contract laboratories, identifies qualified taxonomic experts, and establishes voucher collections.

Fuel processing for PEM fuel cells: transport and kinetic issues of system design

NASA Astrophysics Data System (ADS)

Zalc, J. M.; Löffler, D. G.

In light of the distribution and storage issues associated with hydrogen, efficient on-board fuel processing will be a significant factor in the implementation of PEM fuel cells for automotive applications. Here, we apply basic chemical engineering principles to gain insight into the factors that limit performance in each component of a fuel processor. A system consisting of a plate reactor steam reformer, water-gas shift unit, and preferential oxidation reactor is used as a case study. It is found that for a steam reformer based on catalyst-coated foils, mass transfer from the bulk gas to the catalyst surface is the limiting process. The water-gas shift reactor is expected to be the largest component of the fuel processor and is limited by intrinsic catalyst activity, while a successful preferential oxidation unit depends on strict temperature control in order to minimize parasitic hydrogen oxidation. This stepwise approach of sequentially eliminating rate-limiting processes can be used to identify possible means of performance enhancement in a broad range of applications.

A Model for Effective Performance in the Indonesian Navy.

DTIC Science & Technology

1987-06-01

Navy LMET I AWBRAC’ (COAGAU0 OAl reVerie of necoiuary and .dfmtk by block num"ber) 7,- This thesis describes a process of designing a management ...effective from ineffective manager . In the process of building the model two main steps are taken. First, a literature study of the empirical analysis of... management competencies was conducted to identify management competencies in the United States in general and the U.S. Navy in particular. Second, a

A Module Experimental Process System Development Unit (MEPSDU)

NASA Technical Reports Server (NTRS)

1982-01-01

Restructuring research objectives from a technical readiness demonstration program to an investigation of high risk, high payoff activities associated with producing photovoltaic modules using non-CZ sheet material is reported. Deletion of the module frame in favor of a frameless design, and modification in cell series parallel electrical interconnect configuration are reviewed. A baseline process sequence was identified for the fabrication of modules using the selected dendritic web sheet material, and economic evaluations of the sequence were completed.

Effect of low-purity Fenton reagents on toxicity of textile dyeing effluent to Daphnia magna.

PubMed

Na, Joorim; Yoo, Jisu; Nam, Gwiwoong; Jung, Jinho

2017-09-20

This study aimed to identify the source of toxicity in textile dyeing effluent collected from February to July 2016, using Daphnia magna as a test organism. Toxicity identification evaluation (TIE) procedures were used to identify the toxicants in textile dyeing effluent, and Jar testing to simulate the Fenton process was conducted to identify the source of toxicants. Textile dyeing effluent was acutely toxic to D. magna [from 1.5 to 9.7 toxic units (TU)] during the study period. TIE results showed that Zn derived from the Fenton process was a key toxicant in textile dyeing effluent. Additionally, Jar testing revealed that low-purity Fenton reagents (FeCl 2 and FeSO 4 ), which contained large amounts of Zn (89 838 and 610 mg L -1 , respectively), were the source of toxicity. Although we were unable to conclusively identify the residual toxicity (approx. 1.4 TU of 9.71 TU) attributable to unknown toxicants in textile dyeing effluent, the findings of this study suggest that careful operation of the Fenton treatment process could contribute to eliminating its unintended toxic effects on aquatic organisms.

A consensus exercise identifying priorities for research into clinical effectiveness among children's orthopaedic surgeons in the United Kingdom.

PubMed

Perry, D C; Wright, J G; Cooke, S; Roposch, A; Gaston, M S; Nicolaou, N; Theologis, T

2018-05-01

Aims High-quality clinical research in children's orthopaedic surgery has lagged behind other surgical subspecialties. This study used a consensus-based approach to identify research priorities for clinical trials in children's orthopaedics. Methods A modified Delphi technique was used, which involved an initial scoping survey, a two-round Delphi process and an expert panel formed of members of the British Society of Children's Orthopaedic Surgery. The survey was conducted amongst orthopaedic surgeons treating children in the United Kingdom and Ireland. Results A total of 86 clinicians contributed to both rounds of the Delphi process, scoring priorities from one (low priority) to five (high priority). Elective topics were ranked higher than those relating to trauma, with the top ten elective research questions scoring higher than the top question for trauma. Ten elective, and five trauma research priorities were identified, with the three highest ranked questions relating to the treatment of slipped capital femoral epiphysis (mean score 4.6/ 5), Perthes' disease (4.5) and bone infection (4.5). Conclusion This consensus-based research agenda will guide surgeons, academics and funders to improve the evidence in children's orthopaedic surgery and encourage the development of multicentre clinical trials. Cite this article: Bone Joint J 2018;100-B:680-4.

Crew Activity Analyzer

NASA Technical Reports Server (NTRS)

Murray, James; Kirillov, Alexander

2008-01-01

The crew activity analyzer (CAA) is a system of electronic hardware and software for automatically identifying patterns of group activity among crew members working together in an office, cockpit, workshop, laboratory, or other enclosed space. The CAA synchronously records multiple streams of data from digital video cameras, wireless microphones, and position sensors, then plays back and processes the data to identify activity patterns specified by human analysts. The processing greatly reduces the amount of time that the analysts must spend in examining large amounts of data, enabling the analysts to concentrate on subsets of data that represent activities of interest. The CAA has potential for use in a variety of governmental and commercial applications, including planning for crews for future long space flights, designing facilities wherein humans must work in proximity for long times, improving crew training and measuring crew performance in military settings, human-factors and safety assessment, development of team procedures, and behavioral and ethnographic research. The data-acquisition hardware of the CAA (see figure) includes two video cameras: an overhead one aimed upward at a paraboloidal mirror on the ceiling and one mounted on a wall aimed in a downward slant toward the crew area. As many as four wireless microphones can be worn by crew members. The audio signals received from the microphones are digitized, then compressed in preparation for storage. Approximate locations of as many as four crew members are measured by use of a Cricket indoor location system. [The Cricket indoor location system includes ultrasonic/radio beacon and listener units. A Cricket beacon (in this case, worn by a crew member) simultaneously transmits a pulse of ultrasound and a radio signal that contains identifying information. Each Cricket listener unit measures the difference between the times of reception of the ultrasound and radio signals from an identified beacon. Assuming essentially instantaneous propagation of the radio signal, the distance between that beacon and the listener unit is estimated from this time difference and the speed of sound in air.] In this system, six Cricket listener units are mounted in various positions on the ceiling, and as many as four Cricket beacons are attached to crew members. The three-dimensional position of each Cricket beacon can be estimated from the time-difference readings of that beacon from at least three Cricket listener units

Medical review practices for driver licensing : Volume 1 : a case study of guidelines and processes in seven U.S. States.

DOT National Transportation Integrated Search

2016-10-01

This report is the first of three examining driver medical review practices in the United States and how they fulfilled the basic functions of identifying, assessing, and rendering licensing decisions on medically at-risk drivers. The aim was not to ...

Introduction to Agricultural Products and Processing. Teacher Edition.

ERIC Educational Resources Information Center

Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

This document consists of the teacher's guide to a module designed to teach high school students entry-level job competencies in the new areas of agriculture that are now emerging. The module, one of a series of publications designed to identify these new competencies, contains 11 instructional units that cover the following topics: trends in…

Focal Points, Endogenous Processes, and Exogenous Shocks in the Autism Epidemic

ERIC Educational Resources Information Center

Liu, Kayuet; Bearman, Peter S.

2015-01-01

Autism prevalence has increased rapidly in the United States during the past two decades. We have previously shown that the diffusion of information about autism through spatially proximate social relations has contributed significantly to the epidemic. This study expands on this finding by identifying the focal points for interaction that drive…

Home Language Survey Data Quality Self-Assessment. REL 2017-198

ERIC Educational Resources Information Center

Henry, Susan F.; Mello, Dan; Avery, Maria-Paz; Parker, Caroline; Stafford, Erin

2017-01-01

Most state departments of education across the United States recommend or require that districts use a home language survey as the first step in a multistep process of identifying students who qualify for English learner student services. School districts typically administer the home language survey to parents and guardians during a student's…

Development of a corn and soybean labeling procedure for use with profile parameter classification

NASA Technical Reports Server (NTRS)

Magness, E. R. (Principal Investigator)

1982-01-01

Some essential processes for the development of a green-number-based logic for identifying (labeling) crops in LANDSAT imagery are documented. The supporting data and subsequent conclusions that resulted from development of a specific labeling logic for corn and soybean crops in the United States are recorded.

A Hierarchical Model and Analysis of Factors Affecting the Adoption of Timber as a Bridge

Treesearch

Robert L. Smith; Robert J. Bush; Daniel L. Schmoldt

1995-01-01

The Analytical Hierarchy Process was used to characterize the bridge material selection decisions of highway engineers and local highway officials across the United States. State Department of Transportation engineers, private consulting engineers, and local highway officials were personally interviewed in Mississippi, Virginia, Washington, and Wisconsin to identify...

Competence Is for Everyone. Unit 4: Competence

ERIC Educational Resources Information Center

Kent, Martha Whalen; Kent, Dale

These materials are part of a four-module series, "Competence Is for Everyone," designed to specify and reduce limitations on the learning and use of skills that people experience because of their sex or race. The series identifies three areas that function to maintain inequalities: the process of making judgments or appraisals,…

IMPACT OF DECISION-MAKING STRATEGIES AND COMMUNICATION PROCESSES ON THE PUBLIC ACCEPTABILITY OF MUNICIPAL WASTE COMBUSTION RESIDUE UTILIZATION IN THE UNITED STATES

EPA Science Inventory

Of the identified current and proposed construction projects in which municipal solid waste combustion residues replace traditionally used materials, approximately half are located on landfills or other property controlled by project sponsors, one third are in publicly accessible...

Landmarks in the Judicial Interpretation of Civil Rights in America.

ERIC Educational Resources Information Center

Abraham, Henry J.

1990-01-01

Discusses a faculty seminar on landmark cases in the judicial interpretation of civil rights in the United States. States that the seminar is designed as a faculty development project to enhance the teaching of the Bill of Rights. Identifies the nature of the judicial process. Includes seminar syllabus and suggested readings. (RW)

An exploration of social support as a factor in the return-to-work process.

PubMed

Lysaght, Rosemary M; Larmour-Trode, Sherrey

2008-01-01

Despite evidence that inter-personal relationships are important in human resource management, little is understood about the nature of workplace social support in a disability context, or what features of support are important to the success of return-to-work programs. The purpose of this qualitative study was to explore workplace disability support from worker and supervisory perspectives and to identify salient features for work re-entry. A total of 8 supervisors and 18 previously injured workers from a range of work units in a Canadian municipality were interviewed, and their views concerning supportive and unsupportive behaviours in work-re-entry situations were recorded and analyzed. A full range of social support dimensions were reported to be relevant, and were seen as arising from a variety of sources (e.g. supervisor, co-workers, disability manager, work unit, and outside of work). Respondents identified trust, communication and knowledge of disability as key precursors to a successful return-to-work process. Future research should explore the specific contributions of support to work rehabilitation outcomes as well as interventions to enhance available supports.

Preparing your intensive care unit to respond in crisis: considerations for critical care clinicians.

PubMed

Daugherty, Elizabeth L; Rubinson, Lewis

2011-11-01

In recent years, healthcare disaster planning has grown from its early place as an occasional consideration within the manuals of emergency medical services and emergency department managers to a rapidly growing field, which considers continuity of function, surge capability, and process changes across the spectrum of healthcare delivery. A detailed examination of critical care disaster planning was undertaken in 2007 by the Task Force for Mass Critical Care of the American College of Chest Physicians Critical Care Collaborative Initiative. We summarize the Task Force recommendations and available updated information to answer a fundamental question for critical care disaster planners: What is a prepared intensive care unit and how do I ensure my unit's readiness? Database searches and review of relevant published literature. Preparedness is essential for successful response, but because intensive care units face many competing priorities, without defining "preparedness for what," the task can seem overwhelming. Intensive care unit disaster planners should, therefore, along with the entire hospital, participate in a hospital or regionwide planning process to 1) identify critical care response vulnerabilities; and 2) clarify the hazards for which their community is most at risk. The process should inform a comprehensive written preparedness plan targeting the most worrisome scenarios and including specific guidance on 1) optimal use of space, equipment, and staffing for delivery of critical care to significantly increased patient volumes; 2) allocation of resources for provision of essential critical care services under conditions of absolute scarcity; 3) intensive care unit evacuation; and 4) redundant internal communication systems and means for timely data collection. Critical care disaster planners have a complex, challenging task. Experienced planners will agree that no disaster response is perfect, but careful planning will enable the prepared intensive care unit to respond effectively in times of crisis.

Patterns in Nature Forming Patterns in Minds: An Evaluation of an Introductory Physics Unit

NASA Astrophysics Data System (ADS)

Sheaffer, Christopher Ryan

Educators are increasingly focused on the process over the content. In science especially, teachers want students to understand the nature of science and investigation. The emergence of scientific inquiry and engineering design teaching methods have led to the development of new teaching and evaluation methods that concentrate on steps in a process rather than facts in a topic. Research supports the notion that an explicit focus on the scientific process can lead to student science knowledge gains. In response to new research and standards many teachers have been developing teaching methods that seem to work well in their classrooms, but lack the time and resources to test them in other classroom environments. A high school Physics teacher (Bradford Hill) has developed a unit called Patterns in Nature (PIN) with objectives relating mathematical modeling to the scientific process. Designed for use in his large public school classroom, the unit was taken and used in a charter school with small classes. This study looks at specifically whether or not the PIN unit effectively teaches students how to graph the data they gather and fit an appropriate mathematical pattern, using that model to predict future measurements. Additionally, the study looks at the students' knowledge and views about the nature of science and the process of scientific investigation as it is affected by the PIN unit. Findings show that students are able to identify and apply patterns to data, but have difficulties explaining the meaning of the math. Students' show increases in their knowledge of the process of science, and the majority develop positive views about science in general. A major goal of this study is to place this unit in the cyclical process of Design-Based Research and allow for Pattern in Nature's continuous improvement, development and evaluation. Design-Based Research (DBR) is an approach that can be applied to the implementation and evaluation of classroom materials. This method incorporates the complexities of different contexts and changing treatments into the research methods and analysis. From the use of DBR teachers can understand more about how the designed materials affect the students. Others may be able to use the development and analysis of PIN study as a guide to look at similar aspects of science units developed elsewhere.

Improving the Discharge Process to Optimize Patient Throughput in an Academic Teaching Hospital and Level I Trauma Center

DTIC Science & Technology

2004-02-22

order to minimize Emergency Center overcrowding and ambulance diversions. The purpose of this study was to identify impeding systematic delays in the...turnaround times. A pilot study was conducted on two medicine and two surgery inpatient nursing units to analyze bed turnaround times and discharge times of...to the BTGH executive leadership who identified a need for this study : Mr. George Masi, Associate Administrator; Ms. Beth De Guzman, Chief Nursing

Improving the medical records department processes by lean management

PubMed Central

Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

2015-01-01

Background: Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. Aims: The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. Materials and Methods: This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. Statistical Analysis Used: The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. Results: The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. Conclusion: The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. Originality/Value: The study represents one of the few attempts trying to eliminate wastes in the MRD. PMID:26097862

Chapter 3. Coordination and collaboration with interface units

PubMed Central

Joynt, Gavin M.; Loo, Shi; Taylor, Bruce L.; Margalit, Gila; Christian, Michael D.; Sandrock, Christian; Danis, Marion; Leoniv, Yuval

2016-01-01

Purpose To provide recommendations and standard operating procedures (SOPs) for intensive care unit (ICU) and hospital preparations for an influenza pandemic or mass disaster with a specific focus on enhancing coordination and collaboration between the ICU and other key stakeholders. Methods Based on a literature review and expert opinion, a Delphi process was used to define the essential topics including coordination and collaboration. Results Key recommendations include: (1) establish an Incident Management System with Emergency Executive Control Groups at facility, local, regional/state or national levels to exercise authority and direction over resource use and communications; (2) develop a system of communication, coordination and collaboration between the ICU and key interface departments within the hospital; (3) identify key functions or processes requiring coordination and collaboration, the most important of these being manpower and resources utilization (surge capacity) and re-allocation of personnel, equipment and physical space; (4) develop processes to allow smooth inter-departmental patient transfers; (5) creating systems and guidelines is not sufficient, it is important to: (a) identify the roles and responsibilities of key individuals necessary for the implementation of the guidelines; (b) ensure that these individuals are adequately trained and prepared to perform their roles; (c) ensure adequate equipment to allow key coordination and collaboration activities; (d) ensure an adequate physical environment to allow staff to properly implement guidelines; (6) trigger events for determining a crisis should be defined. Conclusions Judicious planning and adoption of protocols for coordination and collaboration with interface units are necessary to optimize outcomes during a pandemic. PMID:20213418

Adolescent Risk Screening Instruments for Primary Care: An Integrative Review Utilizing the Donabedian Framework.

PubMed

Hiott, Deanna B; Phillips, Shannon; Amella, Elaine

2017-07-31

Adolescent risk-taking behavior choices can affect future health outcomes. The purpose of this integrative literature review is to evaluate adolescent risk screening instruments available to primary care providers in the United States using the Donabedian Framework of structure, process, and outcome. To examine the literature concerning multidimensional adolescent risk screening instruments available in the United States for use in the primary care setting, library searches, ancestry searches, and Internet searches were conducted. Library searches included a systematic search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier, Health Source Nursing Academic Ed, Medline, PsycINFO, the Psychology and Behavioral Sciences Collection, and PubMed databases with CINAHL headings using the following Boolean search terms: "primary care" and screening and pediatric. Criteria for inclusion consisted of studies conducted in the United States that involved broad multidimensional adolescent risk screening instruments for use in the pediatric primary care setting. Instruments that focused solely on one unhealthy behavior were excluded, as were developmental screens and screens not validated or designed for all ages of adolescents. In all 25 manuscripts reviewed, 16 screens met the inclusion criteria and were included in the study. These 16 screens were examined for factors associated with the Donabedian structure-process-outcome model. This review revealed that many screens contain structural issues related to cost and length that inhibit provider implementation in the primary care setting. Process limitations regarding the report method and administration format were also identified. The Pediatric Symptom Checklist was identified as a free, short tool that is valid and reliable.

Using in situ simulation to evaluate operational readiness of a children's hospital-based obstetrics unit.

PubMed

Ventre, Kathleen M; Barry, James S; Davis, Deborah; Baiamonte, Veronica L; Wentworth, Allen C; Pietras, Michele; Coughlin, Liza; Barley, Gwyn

2014-04-01

Relocating obstetric (OB) services to a children's hospital imposes demands on facility operations, which must be met to ensure quality care and a satisfactory patient experience. We used in situ simulations to prospectively and iteratively evaluate operational readiness of a children's hospital-based OB unit before it opened for patient care. This project took place at a 314-bed, university-affiliated children's hospital. We developed 3 full-scale simulation scenarios depicting a concurrent maternal and neonatal emergency. One scenario began with a standardized patient experiencing admission; the mannequin portrayed a mother during delivery. We ran all 3 scenarios on 2 dates scheduled several weeks apart. We ran 2 of the scenarios on a third day to verify the reliability of key processes. During the simulations, content experts completed equipment checklists, and participants identified latent safety hazards. Each simulation involved a unique combination of scheduled participants who were supplemented by providers from responding ancillary services. The simulations involved 133 scheduled participants representing OB, neonatology, and anesthesiology. We exposed and addressed operational deficiencies involving equipment availability, staffing, interprofessional communication, and systems issues such as transfusion protocol failures and electronic order entry challenges. Process changes between simulation days 1 to 3 decreased the elapsed time between transfusion protocol activation and blood arrival to the operating room and labor/delivery/recovery/postpartum setting. In situ simulations identified multiple operational deficiencies on the OB unit, allowing us to take corrective action before its opening. This project may guide other children's hospitals regarding care processes likely to require significant focus and possible modification to accommodate an OB service.

Implementing Family Meetings Into a Respiratory Care Unit: A Care and Communication Quality Improvement Project.

PubMed

Loeslie, Vicki; Abcejo, Ma Sunnimpha; Anderson, Claudia; Leibenguth, Emily; Mielke, Cathy; Rabatin, Jeffrey

Substantial evidence in critical care literature identifies a lack of quality and quantity of communication between patients, families, and clinicians while in the intensive care unit. Barriers include time, multiple caregivers, communication skills, culture, language, stress, and optimal meeting space. For patients who are chronically critically ill, the need for a structured method of communication is paramount for discussion of goals of care. The objective of this quality improvement project was to identify barriers to communication, then develop, implement, and evaluate a process for semistructured family meetings in a 9-bed respiratory care unit. Using set dates and times, family meetings were offered to patients and families admitted to the respiratory care unit. Multiple avenues of communication were utilized to facilitate attendance. Utilizing evidence-based family meeting literature, a guide for family meetings was developed. Templates were developed for documentation of the family meeting in the electronic medical record. Multiple communication barriers were identified. Frequency of family meeting occurrence rose from 31% to 88%. Staff satisfaction with meeting frequency, meeting length, and discussion of congruent goals of care between patient/family and health care providers improved. Patient/family satisfaction with consistency of message between team members; understanding of medications, tests, and dismissal plan; and efficacy to address their concerns with the medical team improved. This quality improvement project was implemented to address the communication gap in the care of complex patients who require prolonged hospitalizations. By identifying this need, engaging stakeholders, and developing a family meeting plan to meet to address these needs, communication between all members of the patient's care team has improved.

Conceptualizing Surrogate Decision-Making at End of Life in the Intensive Care Unit using Cognitive Task Analysis

PubMed Central

Dionne-Odom, J. Nicholas; Willis, Danny G.; Bakitas, Marie; Crandall, Beth; Grace, Pamela J.

2014-01-01

Background Surrogate decision-makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. Purpose Identify and describe the underlying psychological processes of surrogate decision-making for adults at EOL in the ICU. Method Qualitative case study design using a cognitive task analysis (CTA) interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center’s ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semi-structured CTA interviews. Discussion The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions: gist impressions, distressing emotions, and moral intuitions impact a SDM’s judgment about the acceptability of either the patient’s medical treatments or his or her condition. Conclusion The framework offers initial insights about the underlying psychological processes of surrogate decision-making and may facilitate enhanced decision support for SDMs. PMID:25982772

Conceptualizing surrogate decision making at end of life in the intensive care unit using cognitive task analysis.

PubMed

Dionne-Odom, J Nicholas; Willis, Danny G; Bakitas, Marie; Crandall, Beth; Grace, Pamela J

2015-01-01

Surrogate decision makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. To identify and describe the underlying psychological processes of surrogate decision making for adults at EOL in the ICU. Qualitative case study design using a cognitive task analysis interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center's ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semistructured cognitive task analysis interviews. The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions (gist impressions, distressing emotions, and moral intuitions) impact an SDM's judgment about the acceptability of either the patient's medical treatments or his or her condition. The framework offers initial insights about the underlying psychological processes of surrogate decision making and may facilitate enhanced decision support for SDMs. Copyright © 2015 Elsevier Inc. All rights reserved.

[Work process and workers' health in a food and nutrition unit: prescribed versus actual work].

PubMed

Colares, Luciléia Granhen Tavares; Freitas, Carlos Machado de

2007-12-01

This study focuses on the relationship between the work process in a food and nutrition unit and workers' health, in the words of the participants themselves. Direct observation, a semi-structured interview, and focus groups were used to collect the data. The reference was the dialogue between human ergonomics and work psychodynamics. The results showed that work organization in the study unit represents a routine activity, the requirements of which in terms of the work situation are based on criteria set by the institution. Variability in the activities is influenced mainly by the available equipment, instruments, and materials, thereby generating improvisation in meal production that produces both a physical and psychological cost for workers. Dissatisfaction during the performance of tasks results mainly from the supervisory style and relationship to immediate superiors. Workers themselves proposed changes in the work organization, based on greater dialogue and trust between supervisors and the workforce. Finally, the study identifies the need for an intervention that encourages workers' participation as agents of change.

A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences.

PubMed

Smith, Michael A; Clayman, Marla L; Frader, Joel; Arenson, Melanie; Haber-Barker, Natalie; Ryan, Claire; Emanuel, Linda; Michelson, Kelly

2018-06-19

Little is known about how decision-making conversations occur during pediatric intensive care unit (PICU) family conferences (FCs). Describe the decision-making process and implementation of shared decision making (SDM) during PICU FCs. Observational study. University-based tertiary care PICU, including 31 parents and 94 PICU healthcare professionals involved in FCs. We recorded, transcribed, and analyzed 14 PICU FCs involving decision-making discussions. We used a modified grounded theory and content analysis approach to explore the use of traditionally described stages of decision making (DM) (information exchange, deliberation, and determining a plan). We also identified the presence or absence of predefined SDM elements. DM involved the following modified stages: information exchange; information-oriented deliberation; plan-oriented deliberation; and determining a plan. Conversations progressed through stages in a nonlinear manner. For the main decision discussed, all conferences included a presentation of the clinical issues, treatment alternatives, and uncertainty. A minority of FCs included assessing the family's understanding (21%), assessing the family's need for input from others (28%), exploring the family's desired decision-making role (35%), and eliciting the family's opinion (42%). In the FCs studied, we found that DM is a nonlinear process. We also found that several SDM elements that could provide information about parents' perspectives and needs did not always occur, identifying areas for process improvement.

Compliance of clinical microbiology laboratories in the United States with current recommendations for processing respiratory tract specimens from patients with cystic fibrosis.

PubMed

Zhou, Juyan; Garber, Elizabeth; Desai, Manisha; Saiman, Lisa

2006-04-01

Respiratory tract specimens from patients with cystic fibrosis (CF) require unique processing by clinical microbiology laboratories to ensure detection of all potential pathogens. The present study sought to determine the compliance of microbiology laboratories in the United States with recently published recommendations for CF respiratory specimens. Microbiology laboratory protocols from 150 of 190 (79%) CF care sites were reviewed. Most described the use of selective media for Burkholderia cepacia complex (99%), Staphylococcus aureus (82%), and Haemophilus influenzae (89%) and identified the species of all gram-negative bacilli (87%). Only 52% delineated the use of agar diffusion assays for susceptibility testing of Pseudomonas aeruginosa. Standardizing laboratory practices will improve treatment, infection control, and our understanding of the changing epidemiology of CF microbiology.

Nanosilver as a disinfectant in dental unit waterlines ...

EPA Pesticide Factsheets

Dental unit water lines (DUWL) are susceptible to biofilm development and bacterial growth leading to water contamination, causing health and ecological effects. This study monitors the interactions between a commonly used nanosilver disinfectant (ASAP-AGX-32, an antimicrobial cleaner for dental units, 0.0032% Ag) and biofilm development in DUWL. To simulate the disinfection scenario, an in-house DUWL model was assembled and biofilm accumulation was allowed. Subsequent to biofilm development, the disinfection process was performed according to the manufacturer's instructions. The pristine nanosilver particles in the cleaner measured between 3 and 5 nm in diameter and were surrounded by a stabilizing polymer. However, the polymeric stabilizing agent diminished over the disinfection process, initiating partial AgNPs aggregation. Furthermore, surface speciation of the pristine AgNPs were identified as primarily AgO, and after the disinfection process, transformations to AgCl were observed. The physicochemical characteristics of AgNPs are known to govern their fate, and transport and environmental implications. Hence, knowledge of the AgNPs characteristics after the disinfection process (usage scenario) is of significance. This study demonstrates the adsorption of AgNPs onto biofilm surfaces and, therefore, will assist in illustration of the toxicity mechanisms of AgNPs to bacteria and biofilms. This work can be an initial step in better understanding how

Manmade organic compounds in the surface waters of the United States: a review of current understanding

USGS Publications Warehouse

Smith, James A.; Witkowski, Patrick J.; Fusillo, Thomas V.

1987-01-01

This report reviews the occurrence and distribution of manmade organic compounds in the surface waters of the United States. On the basis of their aqueous solubilities, nonionic organic compounds partition themselves between water, dissolved organic matter, particulate organic matter, and the lipid reservoirs of aquatic organisms. Ionized organic compounds can be absorbed to sediments, thereby reducing their aqueous concentrations. Transformation processes of photolysis, hydrolysis, biodegradation, and volatilization can attenuate organic compounds, and attenuation rate commonly follow a first-order kinetic process. Eight groups of manmade organic compounds are discussed: 1. Polychlorinated biphenyls and organochlorine insecticides, 2. Carbamate and organophosphorus insecticides, 3. Herbicides, 4. Phenols, 5. Halogenated aliphatic and monocyclic aromatic hydrocarbons, 6. Phthalate esters, 7. Polychlorinated dibenzo-p-dioxins, and 8. Polycyclic aromatic hydrocarbons. For each compound group, data pertaining to use, production, and properties are presented and discussed. Processes that influence that the environmental fate of each group, as determined primarily through laboratory studies, are reviewed, and important fate processes are identified. Environmental concentrations of compounds from each group in water, biota, and sediment are given to demonstrate representative values for comparison to concentrations determined during ongoing research. Finally, where sufficient data exist, regional and temporal contamination trends in the United States are discussed.

Manmade organic compounds in the surface waters of the United States; a review of current understanding

USGS Publications Warehouse

Smith, James A.; Witkowski, P.J.; Fusillo, Thomas V.

1988-01-01

This report reviews the occurrence and distribution of manmade organic compounds in the surface waters of the United States. On the basis of their aqueous solubilities, nonionic organic compounds partition themselves among water, dissolved organic matter, particulate organic matter, and the lipid reservoirs of aquatic organisms. Ionized organic compounds can be adsorbed to sediments, thereby reducing their aqueous concentrations. Transformation processes of photolysis, hydrolysis, biodegradation, and volatilization can attenuate organic compounds, and attenuation rates commonly follow a first-order kinetic process. Eight groups of manmade organic compounds are discussed: 1. Polychlorinated biphenyls and organochlorine insecticides, 2. Carbamate and organophosphorus insecticides, 3. Herbicides, 4. Phenols, 5. Halogenated aliphatic and monocyclic aromatic hydrocarbons, 6. Phthalate esters, 7. Polychlorinated dibenzo-p-dioxins, and 8. Polycyclic aromatic hydrocarbons. For each compound group, data pertaining to use, production, and properties are presented and discussed. Processes that influence the environmental fate of each group, as determined primarily through laboratory studies, are reviewed, and important fate processes are identified. Environmental concentrations of compounds from each group in water, biota, and sediment are given to demonstrate representative values for comparison with concentrations determined during ongoing research. Finally, where data are sufficient, regional and temporal contamination trends in the United States are discussed.

Exploring the institutional logics of health professions education scholarship units.

PubMed

Varpio, Lara; O'Brien, Bridget; Hu, Wendy; Ten Cate, Olle; Durning, Steven J; van der Vleuten, Cees; Gruppen, Larry; Irby, David; Humphrey-Murto, Susan; Hamstra, Stanley J

2017-07-01

Although health professions education scholarship units (HPESUs) share a commitment to the production and dissemination of rigorous educational practices and research, they are situated in many different contexts and have a wide range of structures and functions. In this study, the authors explore the institutional logics common across HPESUs, and how these logics influence the organisation and activities of HPESUs. The authors analysed interviews with HPESU leaders in Canada (n = 12), Australia (n = 21), New Zealand (n = 3) and the USA (n = 11). Using an iterative process, they engaged in inductive and deductive analyses to identify institutional logics across all participating HPESUs. They explored the contextual factors that influence how these institutional logics impact each HPESU's structure and function. Participants identified three institutional logics influencing the organisational structure and functions of an HPESU: (i) the logic of financial accountability; (ii) the logic of a cohesive education continuum, and (iii) the logic of academic research, service and teaching. Although most HPESUs embodied all three logics, the power of the logics varied among units. The relative power of each logic influenced leaders' decisions about how members of the unit allocate their time, and what kinds of scholarly contribution and product are valued by the HPESU. Identifying the configuration of these three logics within and across HPESUs provides insights into the reasons why individual units are structured and function in particular ways. Having a common language in which to discuss these logics can enhance transparency, facilitate evaluation, and help leaders select appropriate indicators of HPESU success. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Making things happen through challenging goals: leader proactivity, trust, and business-unit performance.

PubMed

Crossley, Craig D; Cooper, Cecily D; Wernsing, Tara S

2013-05-01

Building on decades of research on the proactivity of individual performers, this study integrates research on goal setting and trust in leadership to examine manager proactivity and business unit sales performance in one of the largest sales organizations in the United States. Results of a moderated-mediation model suggest that proactive senior managers establish more challenging goals for their business units (N = 50), which in turn are associated with higher sales performance. We further found that employees' trust in the manager is a critical contingency variable that facilitates the relationship between challenging sales goals and subsequent sales performance. This research contributes to growing literatures on trust in leadership and proactivity by studying their joint effects at a district-unit level of analysis while identifying district managers' tendency to set challenging goals as a process variable that helps translate their proactivity into the collective performance of their units. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Educating fellows in practice-based learning and improvement and systems-based practice: The value of quality improvement in clinical practice.

PubMed

Carey, William A; Colby, Christopher E

2013-02-01

In 1999, the Accreditation Council for Graduate Medical Education identified 6 general competencies in which all residents must receive training. In the decade since these requirements went into effect, practice-based learning and improvement (PBLI) and systems-based practice (SBP) have proven to be the most challenging competencies to teach and assess. Because PBLI and SBP both are related to quality improvement (QI) principles and processes, we developed a QI-based curriculum to teach these competencies to our fellows. This experiential curriculum engaged our fellows in our neonatal intensive care unit's (NICU's) structured QI process. After identifying specific patient outcomes in need of improvement, our fellows applied validated QI methods to develop evidence-based treatment protocols for our neonatal intensive care unit. These projects led to immediate and meaningful improvements in patient care and also afforded our fellows various means by which to demonstrate their competence in PBLI and SBP. Our use of portfolios enabled us to document our fellows' performance in these competencies quite easily and comprehensively. Given the clinical and educational structures common to most intensive care unit-based training programs, we believe that a QI-based curriculum such as ours could be adapted by others to teach and assess PBLI and SBP. Copyright © 2013 Elsevier Inc. All rights reserved.

Process Improvement to Enhance Quality in a Large Volume Labor and Birth Unit.

PubMed

Bell, Ashley M; Bohannon, Jessica; Porthouse, Lisa; Thompson, Heather; Vago, Tony

The goal of the perinatal team at Mercy Hospital St. Louis is to provide a quality patient experience during labor and birth. After the move to a new labor and birth unit in 2013, the team recognized many of the routines and practices needed to be modified based on different demands. The Lean process was used to plan and implement required changes. This technique was chosen because it is based on feedback from clinicians, teamwork, strategizing, and immediate evaluation and implementation of common sense solutions. Through rapid improvement events, presence of leaders in the work environment, and daily huddles, team member engagement and communication were enhanced. The process allowed for team members to offer ideas, test these ideas, and evaluate results, all within a rapid time frame. For 9 months, frontline clinicians met monthly for a weeklong rapid improvement event to create better experiences for childbearing women and those who provide their care, using Lean concepts. At the end of each week, an implementation plan and metrics were developed to help ensure sustainment. The issues that were the focus of these process improvements included on-time initiation of scheduled cases such as induction of labor and cesarean birth, timely and efficient assessment and triage disposition, postanesthesia care and immediate newborn care completed within approximately 2 hours, transfer from the labor unit to the mother baby unit, and emergency transfers to the main operating room and intensive care unit. On-time case initiation for labor induction and cesarean birth improved, length of stay in obstetric triage decreased, postanesthesia recovery care was reorganized to be completed within the expected 2-hour standard time frame, and emergency transfers to the main hospital operating room and intensive care units were standardized and enhanced for efficiency and safety. Participants were pleased with the process improvements and quality outcomes. Working together as a team using the Lean process, frontline clinicians identified areas that needed improvement, developed and implemented successful strategies that addressed each gap, and enhanced the quality and safety of care for a large volume perinatal service.

Personnel involved in the development of nuclear standards in the United States, 1976

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

Johnson, E.B.

1977-03-01

The development of voluntary nuclear standards in the United States is an active and necessary endeavor of the technical community concerned with the safe, orderly, and economic development of the nuclear potential. There are almost 8000 people presently involved either in writing voluntary standards and codes or in the management and processing roles necessary for their approval and promulgation. This document records the current participation of these people as member, chairman, or secretary of about 900 identified committees and projects. The standards projects are identified with the organizations that are responsible for the preparation, review, and maintenance of the standardsmore » and that provide support through supervisory committees and headquarters staff. The directory has four major sections: personnel, employers, committees, and a KWIC index of committee titles. The directory can be used to identify those nuclear standards projects currently active, to indicate the participation of employers, and to recognize the contributions of individuals to these often interdisciplinary activities.« less

Personnel involved in the development of nuclear standards in the United States, 1975

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

Johnson, E.B.

The development of voluntary nuclear standards in the United States is an active and necessary endeavor of the technical community concerned with the safe, orderly, and economic development of the nuclear potential. There are almost 8000 people presently involved either in writing voluntary standards and codes or in the management and processing roles necessary for their approval and promulgation. This document records the current participation of these people as member, chairman, or secretary of about 900 identified committees and projects. The standards projects are identified with the organizations that are responsible for the preparation, review, and maintenance of the standardsmore » and that provide support through supervisory committees and headquarters staff. The Directory has four major sections: personnel, employers, committees, and a KWIC Index of committee titles. The Directory can be used to identify those nuclear standards projects currently active, to indicate the participation of employers, and to recognize the contributions of individuals to these often interdisciplinary activities.« less

[Nurse's concept in the managerial conception of a basic health unit].

PubMed

Passos, Joanir Pereira; Ciosak, Suely Itsuko

2006-12-01

This study is part of a larger survey called "Use of indicators in nurses' managerial practice in Basic Health Care Units in the city of Rio de Janeiro", which was carried out in the Basic Health Care Units of the Planning Area 5.3 and whose objectives were to identify nurses' conception regarding the tools required for management in those units and to discuss the role of management in organizing health services. The study is descriptive and data were collected in interviews with seven nurse managers. The results show that health services actions are organized and directed to the purpose of the working process through the relationship established between the object, the instruments and the final product, and that for those nurses the end result to be achieved is client's satisfaction and the quality of medical and nursing care.

Minimize Solvent Oxidation with NO X Pre-Scrubbing

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

Sexton, Andrew; Sachde, Darshan; Vance, Austyn

A novel method to remove nitrogen dioxide (NO 2) from the flue gas of coal-fired power plants with CO 2 capture was further developed for commercial implementation. The technology leverages the equipment and chemistry in an existing (sulfur dioxide) SO 2 polishing scrubber upstream of the main CO 2 capture unit to remove the NO 2, preventing degradation of the CO 2 capture solvent and formation of nitrosamines (environmental hazards). The research in this report focuses on further evaluation of the chemical additives and operating conditions associated with the NO 2 removal process to define conditions for commercial scale testingmore » and deployment. Experimental work systematically evaluated a series of potential additives to minimize the oxidation of sulfite in a representative SO 2 pre-scrubber solution (sulfite, in turn, absorbs NO 2). The additive combinations and concentrations were varied alongside important process conditions such as temperature, oxygen concentration, and metals present in solution to mimic the conditions expected in a commercial system. Important results of the parametric experimental work include identifying a new, potent sulfite oxidation inhibitor, revealing the importance of combining inhibitors with metal chelating agents, validation of a low-cost additive process, and development of a new semi-empirical model to represent mechanisms associated with sulfite oxidation. In addition, the experimental work reveled the impact of operating at higher temperatures (representative of a field test unit), which will guide the selection and concertation of additives as well. Engineering analysis found that waste solutions from the pre-scrubber with NO 2 additives may potentially be integrated with existing processes on site (e.g., flue gas desulfurization unit). In addition, techno-economic analysis identified potential net savings as large as $1.30/tonne CO 2 captured and quantified the potential benefit of low cost additive options actively being pursued by the development team. Finally, the experimental results and engineering analysis supported the development of a detailed field testing plan and protocol to evaluate the technology at near-commercial scale. The field test preparation included development of procedures to introduce chemical additives to an existing SO 2 polishing unit and identification of representative flue gas conditions based on a review of existing plants. These activities will have direct bearing on operation and design of commercial units.« less

Methodologies for processing plant material into acceptable food on a small scale

NASA Technical Reports Server (NTRS)

Parks, Thomas R.; Bindon, John N.; Bowles, Anthony J. G.; Golbitz, Peter; Lampi, Rauno A.; Marquardt, Robert F.

1994-01-01

Based on the Controlled Environment Life Support System (CELSS) production of only four crops, wheat, white potatoes, soybeans, and sweet potatoes; a crew size of twelve; a daily planting/harvesting regimen; and zero-gravity conditions, estimates were made on the quantity of food that would need to be grown to provide adequate nutrition; and the corresponding amount of biomass that would result. Projections were made of the various types of products that could be made from these crops, the unit operations that would be involved, and what menu capability these products could provide. Equipment requirements to perform these unit operations were screened to identify commercially available units capable of operating (or being modified to operate) under CELSS/zero-gravity conditions. Concept designs were developed for those equipment needs for which no suitable units were commercially available. Prototypes of selected concept designs were constructed and tested on a laboratory scale, as were selected commercially available units. This report discusses the practical considerations taken into account in the various design alternatives, some of the many product/process factors that relate to equipment development, and automation alternatives. Recommendations are made on both general and specific areas in which it was felt additional investigation would benefit CELSS missions.

Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting

PubMed Central

Lopez, Karen Dunn; Cary, Michael P; Kanak, Mary F

2010-01-01

Objective To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. Design A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls. Measurements Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time–motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale). Results Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive ‘head data’, temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients. Conclusion Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units. PMID:20442150

Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting.

PubMed

Lopez, Karen Dunn; Gerling, Gregory J; Cary, Michael P; Kanak, Mary F

2010-01-01

To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls. Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time-motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale). Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive 'head data', temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients. Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units.

Wireless structural monitoring for homeland security applications

NASA Astrophysics Data System (ADS)

Kiremidjian, Garo K.; Kiremidjian, Anne S.; Lynch, Jerome P.

2004-07-01

This paper addresses the development of a robust, low-cost, low power, and high performance autonomous wireless monitoring system for civil assets such as large facilities, new construction, bridges, dams, commercial buildings, etc. The role of the system is to identify the onset, development, location and severity of structural vulnerability and damage. The proposed system represents an enabling infrastructure for addressing structural vulnerabilities specifically associated with homeland security. The system concept is based on dense networks of "intelligent" wireless sensing units. The fundamental properties of a wireless sensing unit include: (a) interfaces to multiple sensors for measuring structural and environmental data (such as acceleration, displacements, pressure, strain, material degradation, temperature, gas agents, biological agents, humidity, corrosion, etc.); (b) processing of sensor data with embedded algorithms for assessing damage and environmental conditions; (c) peer-to-peer wireless communications for information exchange among units(thus enabling joint "intelligent" processing coordination) and storage of data and processed information in servers for information fusion; (d) ultra low power operation; (e) cost-effectiveness and compact size through the use of low-cost small-size off-the-shelf components. An integral component of the overall system concept is a decision support environment for interpretation and dissemination of information to various decision makers.

Techno-Economic analysis of solar photovoltaic power plant for small scale fish processing in Kota Langsa - a case study

NASA Astrophysics Data System (ADS)

Widodo, S. B.; Hamdani; Rizal, T. A.; Pambudi, N. A.

2018-02-01

In Langsa, fisheries are the sector leaders by fulfilling a capacity of about 6,050 tons per year and on the other hand, fish-aquaculture reaches 1,200 tons per year on average. The fish processing is conducted through catches and aquaculture. The facilities on which this processing takes place are divided into an ice factory unit, a gutting and cutting unit, a drying unit and a curing unit. However, the energy and electricity costs during the production process has become major constraint because of the increase in the fishermen’s production and income. In this study, the potential and cost-effectiveness of photovoltaic solar power plant to meet the energy demands of fish processing units have been analysed. The energy requirements of fish processing units have reached an estimate of 130 kW, while the proposed design of solar photovoltaic electricity generation is of 200 kW in an area of 0,75 hectares. In this analysis, given the closeness between the location of the processing units and the fish supply auctions, the assumption is made that the photovoltaic plants (OTR) were installed on the roof of the building as compared to the solar power plants (OTL) installed on the outside of the location. The results shows that the levelized cost of OTR instalation is IDR 1.115 per kWh, considering 25 years of plant life-span at 10% of discount rate, with a simple payback period of 13.2 years. OTL levelized energy, on the other hand, is at IDR 997.5 per kWh with a simple payback period of 9.6 years. Blood is an essential component of living creatures in the vascular space. For possible disease identification, it can be tested through a blood test, one of which can be seen from the form of red blood cells. The normal and abnormal morphology of the red blood cells of a patient is very helpful to doctors in detecting a disease. With the advancement of digital image processing technology can be used to identify normal and abnormal blood cells of a patient. This research used self-organizing map method to classify the normal and abnormal form of red blood cells in the digital image. The use of self-organizing map neural network method can be implemented to classify the normal and abnormal form of red blood cells in the input image with 93,78% accuracy testing.

Stroke units: research and reality. Results from the National Sentinel Audit of Stroke

PubMed Central

Rudd, A; Hoffman, A; Irwin, P; Pearson, M; Lowe, D; on, b

2005-01-01

Objectives: To use data from the 2001–2 National Stroke Audit to describe the organisation of stroke units in England, Wales and Northern Ireland, and to see if key characteristics deemed effective from the research literature were present. Design: Data were collected as part of the National Sentinel Audit of Stroke in 2001, both on the organisation and structure of inpatient stroke care and the process of care to hospitals managing stroke patients. Setting: 240 hospitals from England, Wales and Northern Ireland took part in the 2001–2 National Stroke Audit, a response rate of over 95%. These sites audited a total of 8200 patients. Audit tool: Royal College of Physicians Intercollegiate Working Party Stroke Audit Tool. Results: 73% of hospitals participating in the audit had a stroke unit but only 36% of stroke admissions spent any time on one. Only 46% of all units describing themselves as stroke units had all five organisational characteristics that previous research literature had identified as being key features, while 26% had four and 28% had three or less. Better organisation was associated with better process of care for patients, with patients managed on stroke units receiving better care than those managed in other settings. Conclusion: The National Service Framework for Older People set a target for all hospitals treating stroke patients to have a stroke unit by April 2004. This study suggests that in many hospitals this is being achieved without adequate resource and expertise. PMID:15691997

[Evaluation of nursing care systematization through the phases of nursing process performance and registration in a teaching hospital].

PubMed

Reppetto, Maria Angela; de Souza, Mariana Fernandes

2005-01-01

This descriptive study was carried out in a teaching hospital at São Paulo city and had as objective to identify the phases performance and registration of nursing care systematization and the most frequent nursing diagnoses. Data were collected retrospectively from 135 patients records of three units: Cardiology, Adult Infectious Diseases and Neurosurgery, from January to July, 2002. The phases: history, nursing diagnoses, prescription, evolution and assessment were performed and registered in the three units, however, it was verified systematization gaps performance related to nursing diagnoses registered without the realization of nursing history and nursing prescriptions without evolution. The most frequent nursing diagnosis in the three units was risk for infection.

National Counterintelligence Strategy of the United States of America 2016

DTIC Science & Technology

2015-01-01

including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson...while protecting sensitive information and assets from FIE theft , manipulation, or exploitation;  Identify vulnerabilities and threats to...process into supply chain operations to secure the supply chain from exploitation and reduce its vulnerability to disruption;  Expand partnerships

Border Pedagogy and the Acculturation of Korean Students in U.S. Institutions of Higher Education

ERIC Educational Resources Information Center

Green, Randy

2010-01-01

This study aimed at identifying learning and teaching strategies that can promote the process of acculturation for Korean students in institutions of higher education in the United States. In particular, the study attempted to pinpoint ways in which these students and their instructors can become aware of and resist educational tendencies and…

Beyond Organic and Fair Trade? An Analysis of Ecolabel Preferences in the United States

ERIC Educational Resources Information Center

Howard, Philip H.; Allen, Patricia

2010-01-01

The success of alternative food initiatives indicates increasing interest in changing the way food is produced, processed, and sold. Ecolabels such as organic and Fair Trade have entered the mainstream marketplace, and other voluntary identifiers on products are emerging to address criteria not included in these successful initiatives. Little is…

An Analysis of the Process of Teacher Evaluation in the Community College.

ERIC Educational Resources Information Center

Menzie, John Carroll

An analysis of teacher evaluation as practiced during 1971-1972 and 1972-1973 in community colleges throughout the United States is presented. To identify the concepts and outcomes of teacher evaluation a survey was made of current literature, two questionnaires were sent to 226 community colleges, and 67 interviews were conducted. There are…

Yellow Book File of Program Procedures in Education for the Mentally Retarded. Administrative Manual.

ERIC Educational Resources Information Center

Kansas State Dept. of Education, Topeka. Div. of Education Services.

The document is a brief collection of materials which provide a framework whereby local Kansas education units can individually and collectively identify ways to use the statewide effort to strengthen existing programs of service or develop new approaches at the local level for educating the mentally retarded. Part I introduces the process systems…

Planning for Library Automation in the United States.

ERIC Educational Resources Information Center

Culbertson, Don S.

The 15-year history of the development of library automation is traced, and four major obstacles which had to be overcome are identified: the lack of funds for development, programing, and testing; the need for a common data base; the need for cooperative arrangements among institutions; and the need for widely-available on-line processing. Seven…

Candid Reflections on the Departure of Black Women Faculty from Academe in the United States

ERIC Educational Resources Information Center

Chambers, Crystal Renee

2012-01-01

Critical content analysis is used to identify content within blogs, exposing views within academe that reinforce and normalize racist, sexist, and interactively racist and sexist perspectives. The two themes explored here are unfairness and subjectivities within personnel processes and the qualifications of Black women faculty, as raised through a…

Women and Office Automation: Issues for the Decade Ahead.

ERIC Educational Resources Information Center

Women's Bureau (DOL), Washington, DC.

More than 7 million workers in the United States today use computer-based video display terminals to do word and data processing; an overwhelming number of these workers are women. Women make up most of the occupational groups identified as "administrative support," and they are particularly affected by the changes taking place in the workplace.…

Fission meter

DOEpatents

Rowland, Mark S [Alamo, CA; Snyderman, Neal J [Berkeley, CA

2012-04-10

A neutron detector system for discriminating fissile material from non-fissile material wherein a digital data acquisition unit collects data at high rate, and in real-time processes large volumes of data directly into information that a first responder can use to discriminate materials. The system comprises counting neutrons from the unknown source and detecting excess grouped neutrons to identify fission in the unknown source.

75 FR 33775 - Purified Carboxymethylcellulose From Mexico: Notice of Preliminary Results of Antidumping Duty...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-15

... sales, we examine stages in the marketing process and selling functions along the chain of distribution...-users and distributors in the United States. For the home market, Amtex identified two channels of distribution: end users (channel 1) and distributors (channel 2). See Amtex's Section A Response at A13. Amtex...

AN EXAMINATION OF CITIZEN PARTICIPATION AND PROCEDURAL FAIRNESS IN LARGE-SCALE URBAN TREE PLANTING INITIATIVES IN THE UNITED STATES

EPA Science Inventory

This project will result in a typology of the degrees and forms of citizen participation in large-scale urban tree planting initiatives. It also will identify specific aspects of urban tree planting processes that residents perceive as fair and unfair, which will provide ad...

Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations.

PubMed

Bui, David P; Pollack Porter, Keshia; Griffin, Stephanie; French, Dustin D; Jung, Alesia M; Crothers, Stephen; Burgess, Jefferey L

2017-11-17

Emergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments. Three fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation. Three to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver visibility while backing, and increased training frequency and enhanced training. The RM process was generally acceptable to department participants and considered useful. All departments reported that the focused and systematic analysis of crashes was particularly helpful. Implementation of controls was a commonly cited challenge. Proactive RM of ESVCs in three US fire departments was positively received and supported the establishment of interventions tailored to each department's needs and priorities.

A guide to processing bat acoustic data for the North American Bat Monitoring Program (NABat)

USGS Publications Warehouse

Reichert, Brian; Lausen, Cori; Loeb, Susan; Weller, Ted; Allen, Ryan; Britzke, Eric; Hohoff, Tara; Siemers, Jeremy; Burkholder, Braden; Herzog, Carl; Verant, Michelle

2018-06-14

The North American Bat Monitoring Program (NABat) aims to improve the state of conservation science for all species of bats shared by the United States, Canada, and Mexico. To accomplish this goal, NABat offers guidance and standardized protocols for acoustic monitoring of bats. In this document, “A Guide to Processing Bat Acoustic Data for the North American Bat Monitoring Program (NABat),” we provide general recommendations and specific workflows for the process of identifying bat species from acoustic files recorded using the NABat stationary point and mobile transect acoustic monitoring protocols.

Informatics for the Modern Intensive Care Unit.

PubMed

Anderson, Diana C; Jackson, Ashley A; Halpern, Neil A

Advanced informatics systems can help improve health care delivery and the environment of care for critically ill patients. However, identifying, testing, and deploying advanced informatics systems can be quite challenging. These processes often require involvement from a collaborative group of health care professionals of varied disciplines with knowledge of the complexities related to designing the modern and "smart" intensive care unit (ICU). In this article, we explore the connectivity environment within the ICU, middleware technologies to address a host of patient care initiatives, and the core informatics concepts necessary for both the design and implementation of advanced informatics systems.

The interprocess NIR sampling as an alternative approach to multivariate statistical process control for identifying sources of product-quality variability.

PubMed

Marković, Snežana; Kerč, Janez; Horvat, Matej

2017-03-01

We are presenting a new approach of identifying sources of variability within a manufacturing process by NIR measurements of samples of intermediate material after each consecutive unit operation (interprocess NIR sampling technique). In addition, we summarize the development of a multivariate statistical process control (MSPC) model for the production of enteric-coated pellet product of the proton-pump inhibitor class. By developing provisional NIR calibration models, the identification of critical process points yields comparable results to the established MSPC modeling procedure. Both approaches are shown to lead to the same conclusion, identifying parameters of extrusion/spheronization and characteristics of lactose that have the greatest influence on the end-product's enteric coating performance. The proposed approach enables quicker and easier identification of variability sources during manufacturing process, especially in cases when historical process data is not straightforwardly available. In the presented case the changes of lactose characteristics are influencing the performance of the extrusion/spheronization process step. The pellet cores produced by using one (considered as less suitable) lactose source were on average larger and more fragile, leading to consequent breakage of the cores during subsequent fluid bed operations. These results were confirmed by additional experimental analyses illuminating the underlying mechanism of fracture of oblong pellets during the pellet coating process leading to compromised film coating.

Firing behavior of vestibular neurons during active and passive head movements: vestibulo-spinal and other non-eye-movement related neurons

NASA Technical Reports Server (NTRS)

McCrea, R. A.; Gdowski, G. T.; Boyle, R.; Belton, T.; Peterson, B. W. (Principal Investigator)

1999-01-01

The firing behavior of 51 non-eye movement related central vestibular neurons that were sensitive to passive head rotation in the plane of the horizontal semicircular canal was studied in three squirrel monkeys whose heads were free to move in the horizontal plane. Unit sensitivity to active head movements during spontaneous gaze saccades was compared with sensitivity to passive head rotation. Most units (29/35 tested) were activated at monosynaptic latencies following electrical stimulation of the ipsilateral vestibular nerve. Nine were vestibulo-spinal units that were antidromically activated following electrical stimulation of the ventromedial funiculi of the spinal cord at C1. All of the units were less sensitive to active head movements than to passive whole body rotation. In the majority of cells (37/51, 73%), including all nine identified vestibulo-spinal units, the vestibular signals related to active head movements were canceled. The remaining units (n = 14, 27%) were sensitive to active head movements, but their responses were attenuated by 20-75%. Most units were nearly as sensitive to passive head-on-trunk rotation as they were to whole body rotation; this suggests that vestibular signals related to active head movements were cancelled primarily by subtraction of a head movement efference copy signal. The sensitivity of most units to passive whole body rotation was unchanged during gaze saccades. A fundamental feature of sensory processing is the ability to distinguish between self-generated and externally induced sensory events. Our observations suggest that the distinction is made at an early stage of processing in the vestibular system.

A flexible system to capture sample vials in a storage box - the box vial scanner.

PubMed

Nowakowski, Steven E; Kressin, Kenneth R; Deick, Steven D

2009-01-01

Tracking sample vials in a research environment is a critical task and doing so efficiently can have a large impact on productivity, especially in high volume laboratories. There are several challenges to automating the capture process, including the variety of containers used to store samples. We developed a fast and robust system to capture the location of sample vials being placed in storage that allows the laboratories the flexibility to use sample containers of varying dimensions. With a single scan, this device captures the box identifier, the vial identifier and the location of each vial within a freezer storage box. The sample vials are tracked through a barcode label affixed to the cap while the boxes are tracked by a barcode label on the side of the box. Scanning units are placed at the point of use and forward data to a sever application for processing the scanned data. Scanning units consist of an industrial barcode reader mounted in a fixture positioning the box for scanning and providing lighting during the scan. The server application transforms the scan data into a list of storage locations holding vial identifiers. The list is then transferred to the laboratory database. The box vial scanner captures the IDs and location information for an entire box of sample vials into the laboratory database in a single scan. The system accommodates a wide variety of vials sizes by inserting risers under the sample box and a variety of storage box layouts are supported via the processing algorithm on the server.

Process, cost, and clinical quality: the initial oral contraceptive visit.

PubMed

McMullen, Michael J; Woolford, Samuel W; Moore, Charles L; Berger, Barry M

2013-01-01

To demonstrate how the analysis of clinical process, cost, and outcomes can identify healthcare improvements that reduce cost without sacrificing quality, using the example of the initial visit associated with oral contraceptive pill use. Cross-sectional study using data collected by HealthMETRICS between 1996 and 2009. Using data collected from 106 sites in 24 states, the unintended pregnancy (UIP) rate, effectiveness of patient education, and unit visit cost were calculated. Staff type providing education and placement of education were recorded. Two-way analysis of variance models were created and tested for significance to identify differences between groups. Sites using nonclinical staff to provide education outside the exam were associated with lower cost, higher education scores, and a UIP rate no different from that of sites using clinical staff. Sites also providing patient education during the physical examination were associated with higher cost, lower education scores, and a UIP rate no lower than that of sites providing education outside of the exam. Through analyzing process, cost, and quality, lower-cost processes that did not reduce clinical quality were identified. This methodology is applicable to other clinical services for identifying low-cost processes that do not result in lower clinical quality. By using nonclinical staff educators to provide education outside of the physical examination, sites could save an average of 32% of the total cost of the visit.

Exploring the decision-making process in the delivery of physiotherapy in a stroke unit.

PubMed

McGlinchey, Mark P; Davenport, Sally

2015-01-01

The aim of this study was to explore the decision-making process in the delivery of physiotherapy in a stroke unit. A focused ethnographical approach involving semi-structured interviews and observations of clinical practice was used. A purposive sample of seven neurophysiotherapists and four patients participated in semi-structured interviews. From this group, three neurophysiotherapists and four patients were involved in observation of practice. Data from interviews and observations were analysed to generate themes. Three themes were identified: planning the ideal physiotherapy delivery, the reality of physiotherapy delivery and involvement in the decision-making process. Physiotherapists used a variety of clinical reasoning strategies and considered many factors to influence their decision-making in the planning and delivery of physiotherapy post-stroke. These factors included the therapist's clinical experience, patient's presentation and response to therapy, prioritisation, organisational constraints and compliance with organisational practice. All physiotherapists highlighted the importance to involve patients in planning and delivering their physiotherapy. However, there were varying levels of patient involvement observed in this process. The study has generated insight into the reality of decision-making in the planning and delivery of physiotherapy post-stroke. Further research involving other stroke units is required to gain a greater understanding of this aspect of physiotherapy. Implications for Rehabilitation Physiotherapists need to consider multiple patient, therapist and organisational factors when planning and delivering physiotherapy in a stroke unit. Physiotherapists should continually reflect upon how they provide physiotherapy, with respect to the duration, frequency and time of day sessions are delivered, in order to guide current and future physiotherapy delivery. As patients may demonstrate varying levels of participation in deciding and understanding how physiotherapy is delivered, physiotherapists need to adjust how they engage patients in the decision-making process and manage patient expectations accordingly.

Analysis of the policymaking process in Burkina Faso's health sector: case studies of the creation of two health system support units.

PubMed

Zida, Andre; Lavis, John N; Sewankambo, Nelson K; Kouyate, Bocar; Moat, Kaelan; Shearer, Jessica

2017-02-13

Burkina Faso has made a number of health system policy decisions to improve performance on health indicators and strengthen responsiveness to health-related challenges. These included the creation of a General Directorate of Health Information and Statistics (DGISS) and a technical unit to coordinate performance-based financing (CT-FBR). We analysed the policymaking processes associated with the establishment of these units, and documented the factors that influenced this process. We used a multiple-case study design based on Kingdon's agenda-setting model to investigate the DGISS and CT-FBR policymaking processes. Data were collected from interviews with key informants (n = 28), published literature, policy documents (including two strategic and 230 action plans), and 55 legal/regulatory texts. Interviews were analysed using thematic qualitative analysis. Data from the documentary analysis were triangulated with the qualitative interview data. Key factors influencing the policymaking processes associated with the two units involved the 'problem' (problem identification), 'policy' (formation of policy proposals), and 'politics' (political climate/change) streams, which came together in a way that resulted in proposals being placed on the decision agenda. A number of problems with Burkina Faso's health information and financing systems were identified. Policy proposals for the DGISS and CT-FBR units were developed in response to these problems, emerging from several sources including development partners. Changes in political and public service administrations (specifically the 2008 appointment of a new Minister of Health and the establishment of a new budget allocation system), with corresponding changes in the actors and interests involved, appeared key in elevating the proposals to the decision agenda. Efforts to improve performance on health indicators and strengthen responsiveness to health-related challenges need focus on the need for a compelling problem, a viable policy, and conducive politics in order to make it to the decision agenda.

Feral pig populations are structured at fine spatial scales in tropical Queensland, Australia.

PubMed

Lopez, Jobina; Hurwood, David; Dryden, Bart; Fuller, Susan

2014-01-01

Feral pigs occur throughout tropical far north Queensland, Australia and are a significant threat to biodiversity and World Heritage values, agriculture and are a vector of infectious diseases. One of the constraints on long-lasting, local eradication of feral pigs is the process of reinvasion into recently controlled areas. This study examined the population genetic structure of feral pigs in far north Queensland to identify the extent of movement and the scale at which demographically independent management units exist. Genetic analysis of 328 feral pigs from the Innisfail to Tully region of tropical Queensland was undertaken. Seven microsatellite loci were screened and Bayesian clustering methods used to infer population clusters. Sequence variation at the mitochondrial DNA control region was examined to identify pig breed. Significant population structure was identified in the study area at a scale of 25 to 35 km, corresponding to three demographically independent management units (MUs). Distinct natural or anthropogenic barriers were not found, but environmental features such as topography and land use appear to influence patterns of gene flow. Despite the strong, overall pattern of structure, some feral pigs clearly exhibited ancestry from a MU outside of that from which they were sampled indicating isolated long distance dispersal or translocation events. Furthermore, our results suggest that gene flow is restricted among pigs of domestic Asian and European origin and non-random mating influences management unit boundaries. We conclude that the three MUs identified in this study should be considered as operational units for feral pig control in far north Queensland. Within a MU, coordinated and simultaneous control is required across farms, rainforest areas and National Park Estates to prevent recolonisation from adjacent localities.

Optimizing SIEM Throughput on the Cloud Using Parallelization.

PubMed

Alam, Masoom; Ihsan, Asif; Khan, Muazzam A; Javaid, Qaisar; Khan, Abid; Manzoor, Jawad; Akhundzada, Adnan; Khan, Muhammad Khurram; Farooq, Sajid

2016-01-01

Processing large amounts of data in real time for identifying security issues pose several performance challenges, especially when hardware infrastructure is limited. Managed Security Service Providers (MSSP), mostly hosting their applications on the Cloud, receive events at a very high rate that varies from a few hundred to a couple of thousand events per second (EPS). It is critical to process this data efficiently, so that attacks could be identified quickly and necessary response could be initiated. This paper evaluates the performance of a security framework OSTROM built on the Esper complex event processing (CEP) engine under a parallel and non-parallel computational framework. We explain three architectures under which Esper can be used to process events. We investigated the effect on throughput, memory and CPU usage in each configuration setting. The results indicate that the performance of the engine is limited by the number of events coming in rather than the queries being processed. The architecture where 1/4th of the total events are submitted to each instance and all the queries are processed by all the units shows best results in terms of throughput, memory and CPU usage.

Chapter 5, "License Renewal and Aging Management for Continued Service

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

Naus, Dan J

As of August 2011, there were 104 commercial nuclear power reactors licensed to operate in 31 states in the United States. Initial operating licenses in the United States are granted for a period of 40 years. In order to help assure an adequate energy supply, the USNRC has established a timely license renewal process and clear requirements that are needed to ensure safe plant operation for an extended plant life. The principals of license renewal and the basic requirements that address license renewal are identified as well as additional sources of guidance that can be utilized as part of themore » license renewal process. Aging management program inspections and operating experience related to the concrete and steel containment structures are provided. Finally, several lessons learned are provided based on containment operating experience.« less

Streamlined Approach for Environmental Restoration (SAFER) Plan for Corrective Action Unit 117: Area 26 Pluto Disassembly Facility, Nevada Test Site, Nevada With Errata Sheets, Revision 0

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

Pat Matthews

This Streamlined Approach for Environmental Restoration (SAFER) Plan addresses the actions needed to achieve closure for Corrective Action Unit (CAU) 117, Pluto Disassembly Facility, identified in the Federal Facility Agreement and Consent Order. Corrective Action Unit 117 consists of one Corrective Action Site (CAS), CAS 26-41-01, located in Area 26 of the Nevada Test Site. This plan provides the methodology for field activities needed to gather the necessary information for closing CAS 26-41-01. There is sufficient information and process knowledge from historical documentation and investigations of similar sites regarding the expected nature and extent of potential contaminants to recommend closuremore » of CAU 117 using the SAFER process. Additional information will be obtained by conducting a field investigation before finalizing the appropriate corrective action for this CAS. The results of the field investigation will support a defensible recommendation that no further corrective action is necessary following SAFER activities. This will be presented in a Closure Report that will be prepared and submitted to the Nevada Division of Environmental Protection (NDEP) for review and approval. The site will be investigated to meet the data quality objectives (DQOs) developed on June 27, 2007, by representatives of NDEP; U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office; Stoller-Navarro Joint Venture; and National Security Technologies, LLC. The DQO process was used to identify and define the type, amount, and quality of data needed to determine and implement appropriate corrective actions for CAS 26-41-01 in CAU 117.« less

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.

Identifying carcinogens: the tobacco industry and regulatory politics in the United States.

PubMed

Cook, Daniel M; Bero, Lisa A

2006-01-01

The process of identifying carcinogens for purposes of health and safety regulation has been contested internationally. The U.S. government produces a "Report on Carcinogens" every two years, which lists known and likely human carcinogenic substances. In the late 1990s the tobacco industry responded to the proposed listing of secondhand smoke with a multi-part strategy. Despite industry efforts to challenge both the substance of the report and the agency procedures, environmental tobacco smoke was declared by the agency in 2000 to be a known human carcinogen. A subsequent lawsuit, launched by chemical interests but linked to the tobacco industry, failed, but it produced a particular legal precedent of judicial review that is favorable to all regulated industries. The authors argue that, in this case, tobacco industry regulation contradicts academic expectations of business regulatory victories. However, the tobacco industry's participation in the regulatory process influenced the process in favor of all regulated industry.

The effect of object processing in content-dependent source memory

PubMed Central

2013-01-01

Background Previous studies have suggested that the study condition of an item influences how the item is encoded. However, it is still unclear whether subsequent source memory effects are dependent upon stimulus content when the item and context are unitized. The present fMRI study investigated the effect of encoding activity sensitive to stimulus content in source memory via unitization. In the scanner, participants were instructed to integrate a study item, an object in either a word or a picture form, with perceptual context into a single image. Results Subsequent source memory effects independent of stimulus content were identified in the left lateral frontal and parietal regions, bilateral fusiform areas, and the left perirhinal cortex extending to the anterior hippocampus. Content-dependent subsequent source memory effects were found only with words in the left medial frontal lobe, the ventral visual stream, and bilateral parahippocampal regions. Further, neural activity for source memory with words extensively overlapped with the region where pictures were preferentially processed than words, including the left mid-occipital cortex and the right parahippocampal cortex. Conclusions These results indicate that words that were accurately remembered with correct contextual information were processed more like pictures mediated by integrated imagery operation, compared to words that were recognized with incorrect context. In contrast, such processing did not discriminate subsequent source memory with pictures. Taken together, these findings suggest that unitization supports source memory for both words and pictures and that the requirement of the study task interacts with the nature of stimulus content in unitized source encoding. PMID:23848969

Runoff sensitivity to snowmelt process representation for the conterminous United States

NASA Astrophysics Data System (ADS)

Driscoll, J. M.; Sexstone, G. A.

2017-12-01

Watershed-scale hydrologic models that operate at a continental extent must balance detailed descriptions of spatiotemporal variability against simplified process representations across a diverse range of physiographic and climatic regimes. Some of these models describe the sub-grid variability of snow-cover extent and snowmelt processes using snow depletion curves (SDCs), which relate the snow covered area to the snow water equivalent (SWE). The U.S. Geological Survey's National Hydrologic Modeling (NHM) system run with the daily-timestep Precipitation Runoff Modeling System (PRMS), or NHM-PRMS, originally used two default SDCs to describe snowmelt processes: one for hydrologic response units with elevations above treeline and one for hydrologic response units with elevations below treeline. Seeking to improve upon this approach, spatially-distributed SWE, derived from Snow Data Assimilation System (SNODAS) over eleven years, was used to develop new, site-specific SDCs for each hydrologic response unit in the NHM-PRMS. This study investigates the sensitivity of NHM-PRMS to changes in SDCs for a 30-year historical period by first running the NHM-PRMS with the default binary SDCs and then with the site-specific SDCs. Comparison of simulated snowmelt and streamflow response during the snowmelt season allows for spatial analysis and grouping of the sensitivity of streamflow to changes in snowmelt dynamics. Site-specific SDCs allow for the identification and categorization of areas where faster or slower snowmelt could have a greater impact to water resources. These new SDCs can be used to identify locations where increased SWE observation density would be most useful for seasonal water availability assessments.

Understanding the development of minimum unit pricing of alcohol in Scotland: a qualitative study of the policy process.

PubMed

Katikireddi, Srinivasa Vittal; Hilton, Shona; Bonell, Chris; Bond, Lyndal

2014-01-01

Minimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing's development by taking a 'multiple-lenses' approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon's multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking. Semi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation. The three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy 'image' to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions. Evidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy.

Understanding the Development of Minimum Unit Pricing of Alcohol in Scotland: A Qualitative Study of the Policy Process

PubMed Central

Katikireddi, Srinivasa Vittal; Hilton, Shona; Bonell, Chris; Bond, Lyndal

2014-01-01

Background Minimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing’s development by taking a ‘multiple-lenses’ approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon’s multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking. Methods Semi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation. Findings The three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy ‘image’ to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions. Conclusions Evidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy. PMID:24670519

EnergySolution's Clive Disposal Facility Operational Research Model - 13475

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

Nissley, Paul; Berry, Joanne

2013-07-01

EnergySolutions owns and operates a licensed, commercial low-level radioactive waste disposal facility located in Clive, Utah. The Clive site receives low-level radioactive waste from various locations within the United States via bulk truck, containerised truck, enclosed truck, bulk rail-cars, rail boxcars, and rail inter-modals. Waste packages are unloaded, characterized, processed, and disposed of at the Clive site. Examples of low-level radioactive waste arriving at Clive include, but are not limited to, contaminated soil/debris, spent nuclear power plant components, and medical waste. Generators of low-level radioactive waste typically include nuclear power plants, hospitals, national laboratories, and various United States government operatedmore » waste sites. Over the past few years, poor economic conditions have significantly reduced the number of shipments to Clive. With less revenue coming in from processing shipments, Clive needed to keep its expenses down if it was going to maintain past levels of profitability. The Operational Research group of EnergySolutions were asked to develop a simulation model to help identify any improvement opportunities that would increase overall operating efficiency and reduce costs at the Clive Facility. The Clive operations research model simulates the receipt, movement, and processing requirements of shipments arriving at the facility. The model includes shipment schedules, processing times of various waste types, labor requirements, shift schedules, and site equipment availability. The Clive operations research model has been developed using the WITNESS{sup TM} process simulation software, which is developed by the Lanner Group. The major goals of this project were to: - identify processing bottlenecks that could reduce the turnaround time from shipment arrival to disposal; - evaluate the use (or idle time) of labor and equipment; - project future operational requirements under different forecasted scenarios. By identifying processing bottlenecks and unused equipment and/or labor, improvements to operating efficiency could be determined and appropriate cost saving measures implemented. Model runs forecasting various scenarios helped illustrate potential impacts of certain conditions (e.g. 20% decrease in shipments arrived), variables (e.g. 20% decrease in labor), or other possible situations. (authors)« less

ZBB--a new skill for the financial manager.

PubMed

Thompson, G B; Pyhrr, P A

1979-03-01

Zero-based budgeting (ZBB) is a management decision-making tool currently gaining wide acceptance. ZBB is a budgeting approach which is useful for planning, controlling and coordinating financial and human resources. It involves the re-evaluation of all budgeted activities in terms of priorities established by the management. The traditional process of incremental budgeting differs from ZBB in that only the planned changes are evaluated in the former. In incremental budgeting, the base budget is considered authorized and required little attention. The ZBB process focuses on the whol budget. This is accomplished by: (1) identifying decision units; (2) evaluating each decision unit in terms of performance, costs, benefits, and alternate means of accomplishiing the objectives; (3) ranking the decision packages; and (4) preparing a budget for the highest priority decision packages. The effect of the ZBB approach is that new high priority programs may be funded by eliminating or reducing existing lower-priority programs. ZBB is viewed as a logical process which can combine many of the elements of good management.

Who, when, and how? Marine planning stakeholder involvement preferences--a case study of the Solent, United Kingdom.

PubMed

Maguire, Bernadine; Potts, Jonathan; Fletcher, Stephen

2011-11-01

The introduction of a marine planning system throughout English territorial waters over the next decade provides an opportunity for stakeholder input to the management of the marine environment. Stakeholder involvement has been identified as an important component of successful development and subsequent implementation of marine planning but it has to be recognised that the views and interest of stakeholders can vary greatly, thus the desire for involvement with the process is unlikely to be uniform. This paper presents the views of stakeholders within the Solent, United Kingdom on their potential involvement with the marine planning process. Interestingly, it highlights a strong variability of views within and across sectors. Assuming the situation in the Solent is typical of groups of stakeholders throughout the country, the lack of uniformity in the potential involvement from different stakeholders may present a challenge in achieving a representative and truly collaborative marine planning process. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Process and Impact of Stakeholder Engagement in Developing a Pediatric Intensive Care Unit Communication and Decision-Making Intervention.

PubMed

Michelson, Kelly N; Frader, Joel; Sorce, Lauren; Clayman, Marla L; Persell, Stephen D; Fragen, Patricia; Ciolino, Jody D; Campbell, Laura C; Arenson, Melanie; Aniciete, Danica Y; Brown, Melanie L; Ali, Farah N; White, Douglas

2016-12-01

Stakeholder-developed interventions are needed to support pediatric intensive care unit (PICU) communication and decision-making. Few publications delineate methods and outcomes of stakeholder engagement in research. We describe the process and impact of stakeholder engagement on developing a PICU communication and decision-making support intervention. We also describe the resultant intervention. Stakeholders included parents of PICU patients, healthcare team members (HTMs), and research experts. Through a year-long iterative process, we involved 96 stakeholders in 25 meetings and 26 focus groups or interviews. Stakeholders adapted an adult navigator model by identifying core intervention elements and then determining how to operationalize those core elements in pediatrics. The stakeholder input led to PICU-specific refinements, such as supporting transitions after PICU discharge and including ancillary tools. The resultant intervention includes navigator involvement with parents and HTMs and navigator-guided use of ancillary tools. Subsequent research will test the feasibility and efficacy of our intervention.

Shortcomings with Tree-Structured Edge Encodings for Neural Networks

NASA Technical Reports Server (NTRS)

Hornby, Gregory S.

2004-01-01

In evolutionary algorithms a common method for encoding neural networks is to use a tree structured assembly procedure for constructing them. Since node operators have difficulties in specifying edge weights and these operators are execution-order dependent, an alternative is to use edge operators. Here we identify three problems with edge operators: in the initialization phase most randomly created genotypes produce an incorrect number of inputs and outputs; variation operators can easily change the number of input/output (I/O) units; and units have a connectivity bias based on their order of creation. Instead of creating I/O nodes as part of the construction process we propose using parameterized operators to connect to preexisting I/O units. Results from experiments show that these parameterized operators greatly improve the probability of creating and maintaining networks with the correct number of I/O units, remove the connectivity bias with I/O units and produce better controllers for a goal-scoring task.

Identifying the Critical Components for a Conceptual Understanding of the Mole in Secondary Science Classrooms

ERIC Educational Resources Information Center

Fang, Su-Chi; Hart, Christina; Clarke, David

2016-01-01

The amount of substance and its unit the mole is a basic concept in chemistry. However, previous research has shown that teaching and learning the concept are challenging tasks for both teachers and students. The purpose of this study was to pinpoint the problems which emerge in the teaching and learning process, and provide integrated suggestions…

Elements of Good Teaching and Good Teachers: A Theoretical Framework and Effective Strategies for Special Educators

ERIC Educational Resources Information Center

Austin, Vance L.

2015-01-01

Within schools in the United States, teachers must now acquire the skills and dispositions necessary to effectively teach students with a wide variety of needs. As an important first step, the effective behaviors of successful teachers need to be considered. The author has identified three key components that are integral to that process; namely,…

A Look at Long-Term Strategic Planning: Comparing and Contrasting the United States Government 3D Planning Model and a Non-Governmental Organization

DTIC Science & Technology

2012-04-11

labor . The first phase is primarily focused at the community level with education, training, and developing skills. Phase two is a transition to...incorporates design into the framework as the project is identified and reinserted several times in the process, to include toward the end of

Competence Is for Everyone. Unit 4: Competence in Our Society. Intermediate Level. (Student Text and Teacher's Edition).

ERIC Educational Resources Information Center

Kent, Martha Whalen; And Others

These materials are part of a four-module series, "Competence Is for Everyone," designed to specify and reduce limitations on the learning and use of skills that people experience because of their sex or race. The series identifies three areas that function to maintain inequalities: the process of making judgments or appraisals,…

Peeling Back the Layers of Policy and School Reform: Revealing the Structural and Social Complexities within

ERIC Educational Resources Information Center

Woodside-Jiron, Haley; Gehsmann, Kristin M.

2009-01-01

This article explores the complex process of school change over a six-year period in one high-poverty, urban elementary school in a northeastern city of the United States. The school included in this instrumental case study was identified by its State Department of Education as "being in need of improvement" in March 2000. Findings…

Transforming Tenure: Using Value-Added Modeling to Identify Ineffective Teachers. Civic Report. No. 70

ERIC Educational Resources Information Center

Winters, Marcus A.

2012-01-01

Public school teachers in the United States are famously difficult to dismiss. The reason is simple: after three years on the job, most receive tenure--after a brief and subjective evaluation process in which few receive negative ratings. In recent years, some school districts have experimented with changes in tenure rules. They seek the power to…

Evaluation of the quality of the teaching-learning process in undergraduate courses in Nursing.

PubMed

González-Chordá, Víctor Manuel; Maciá-Soler, María Loreto

2015-01-01

to identify aspects of improvement of the quality of the teaching-learning process through the analysis of tools that evaluated the acquisition of skills by undergraduate students of Nursing. prospective longitudinal study conducted in a population of 60 secondyear Nursing students based on registration data, from which quality indicators that evaluate the acquisition of skills were obtained, with descriptive and inferential analysis. nine items were identified and nine learning activities included in the assessment tools that did not reach the established quality indicators (p<0.05). There are statistically significant differences depending on the hospital and clinical practices unit (p<0.05). the analysis of the evaluation tools used in the article "Nursing Care in Welfare Processes" of the analyzed university undergraduate course enabled the detection of the areas for improvement in the teachinglearning process. The challenge of education in nursing is to reach the best clinical research and educational results, in order to provide improvements to the quality of education and health care.

Energy and exergy analysis of an ethanol reforming process for solid oxide fuel cell applications.

PubMed

Tippawan, Phanicha; Arpornwichanop, Amornchai

2014-04-01

The fuel processor in which hydrogen is produced from fuels is an important unit in a fuel cell system. The aim of this study is to apply a thermodynamic concept to identify a suitable reforming process for an ethanol-fueled solid oxide fuel cell (SOFC). Three different reforming technologies, i.e., steam reforming, partial oxidation and autothermal reforming, are considered. The first and second laws of thermodynamics are employed to determine an energy demand and to describe how efficiently the energy is supplied to the reforming process. Effect of key operating parameters on the distribution of reforming products, such as H2, CO, CO2 and CH4, and the possibility of carbon formation in different ethanol reformings are examined as a function of steam-to-ethanol ratio, oxygen-to-ethanol ratio and temperatures at atmospheric pressure. Energy and exergy analysis are performed to identify the best ethanol reforming process for SOFC applications. Copyright © 2014 Elsevier Ltd. All rights reserved.

Risk assessment and management approaches on mental health units.

PubMed

Woods, P

2013-11-01

This exploratory and descriptive study took place in one Canadian province. The study aimed to: (1) to identify and describe the nature and extent of current risk assessment and management approaches used in the adult inpatient mental health and forensic units; and (2) to identify good practice and shortfalls in the nature and extent of the approaches currently utilized. Data were collected from 48 participants through nine focus groups. Participants reported that they used a clinical approach to risk assessment. They had also not considered risk assessment and management as a proactive structured process. Education and training was also limited and skills were developed over time through practice. Five keys issues are discussed as important: reliance on clinical judgement alone is not the best choice to make; the need to consider risk as a whole concept; risk management being more reactive than proactive; education and training; and client involvement in risk assessment. © 2012 John Wiley & Sons Ltd.

Joint Egypt/United States report on Egypt/United States cooperative energy assessment. Volume 1 of 5 Vols. Executive summary, main report and appendices

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

Not Available

1979-04-01

The International Energy Assessment Program between Egypt and the U.S. was formulated from mid-March to mid-July, 1978. The assessment identified energy demand and supply options for Egypt that are consistent with its indigenous energy resources; assessed Egypt's ability to effectively use those options; and identified measures by which Egypt's energy-planning activities could be improved. The assessment addressed all known and potential energy supply options (oil, gas, coal, oil shale, hydroelectric, nuclear power, geothermal, solar, wind, and biomass). Using the Reference Energy System, two future energy supply/demand balances are constructed (for 1985 and the year 2000) and these are compared withmore » a historical (1975) supply/demand balance. The feasibility of each of the options is established in terms of the availability of the required resources and of the processing, conversion, transport, and utilization technology.« less

State Models to Incentivize and Streamline Small Hydropower Development

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

Curtis, Taylor; Levine, Aaron; Johnson, Kurt

In 2016, the hydropower fleet in the United States produced more than 6 percent (approximately 265,829 gigawatt-hours [GWh]) of the total net electricity generation. The median-size hydroelectric facility in the United States is 1.6 MW and 75 percent of total facilities have a nameplate capacity of 10 MW or less. Moreover, the U.S. Department of Energy's Hydropower Vision study identified approximately 79 GW hydroelectric potential beyond what is already developed. Much of the potential identified is at low-impact new stream-reaches, existing conduits, and non-powered dams with a median project size of 10 MW or less. To optimize the potential andmore » value of small hydropower development, state governments are crafting policies that provide financial assistance and expedite state and federal review processes for small hydroelectric projects. This report analyzes state-led initiatives and programs that incentivize and streamline small hydroelectric development.« less

Relationships among NANDA-I diagnoses, nursing outcomes classification, and nursing interventions classification by nursing students for patients in medical-surgical units in Korea.

PubMed

Noh, Hyun Kyung; Lee, Eunjoo

2015-01-01

The purpose of this study was to identify NANDA-I, Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC; NNN) linkages used by Korean nursing students during their clinical practice in medical-surgical units. A comparative descriptive research design was used to measure the effects of nursing interventions from 153 nursing students in South Korea. Nursing students selected NNN using a Web-based nursing process documentation system. Data were analyzed by paired t-test. Eighty-two NANDA-I diagnoses, 116 NOC outcomes, and 163 NIC interventions were identified. Statistically significant differences in patients' preintervention and postintervention outcome scores were observed. By determining patient outcomes linked to interventions and how the degree of outcomes change after interventions, the effectiveness of the interventions can be evaluated. © 2014 NANDA International, Inc.

Burn severity mapping in Australia 2009

USGS Publications Warehouse

McKinley, Randy; Clark, J.; Lecker, Jennifer

2012-01-01

In 2009, the Victoria Department of Sustainability and Environment estimated approximately 430,000 hectares of Victoria Australia were burned by numerous bushfires. Burned Area Emergency Response (BAER) teams from the United States were deployed to Victoria to assist local fire managers. The U.S. Geological Survey Earth Resources Observation and Science Center (USGS/EROS) and U.S. Forest Service Remote Sensing Applications Center (USFS/RSAC) aided the support effort by providing satellite-derived "soil burn severity " maps for over 280,000 burned hectares. In the United States, BAER teams are assembled to make rapid assessments of burned lands to identify potential hazards to public health and property. An early step in the assessment process is the creation of a soil burn severity map used to identify hazard areas and prioritize treatment locations. These maps are developed primarily using Landsat satellite imagery and the differenced Normalized Burn Ratio (dNBR) algorithm.

Recurrent seascape units identify key ecological processes along the western Antarctic Peninsula.

PubMed

Bowman, Jeff S; Kavanaugh, Maria T; Doney, Scott C; Ducklow, Hugh W

2018-04-10

The western Antarctic Peninsula (WAP) is a bellwether of global climate change and natural laboratory for identifying interactions between climate and ecosystems. The Palmer Long-Term Ecological Research (LTER) project has collected data on key ecological and environmental processes along the WAP since 1993. To better understand how key ecological parameters are changing across space and time, we developed a novel seascape classification approach based on in situ temperature, salinity, chlorophyll a, nitrate + nitrite, phosphate, and silicate. We anticipate that this approach will be broadly applicable to other geographical areas. Through the application of self-organizing maps (SOMs), we identified eight recurrent seascape units (SUs) in these data. These SUs have strong fidelity to known regional water masses but with an additional layer of biogeochemical detail, allowing us to identify multiple distinct nutrient profiles in several water masses. To identify the temporal and spatial distribution of these SUs, we mapped them across the Palmer LTER sampling grid via objective mapping of the original parameters. Analysis of the abundance and distribution of SUs since 1993 suggests two year types characterized by the partitioning of chlorophyll a into SUs with different spatial characteristics. By developing generalized linear models for correlated, time-lagged external drivers, we conclude that early spring sea ice conditions exert a strong influence on the distribution of chlorophyll a and nutrients along the WAP, but not necessarily the total chlorophyll a inventory. Because the distribution and density of phytoplankton biomass can have an impact on biomass transfer to the upper trophic levels, these results highlight anticipated links between the WAP marine ecosystem and climate. © 2018 John Wiley & Sons Ltd.

[Evaluation of the vital emergency action plan at the Navarre Hospital (Spain)].

PubMed

Tirapu, Belén; Rodrigo, Isabel; Gost, Javier; Aranguren, María Isabel; Ezcurra, Paz

2010-07-01

Healthcare organizations are placing great emphasis on the care of patients with cardiopulmonary arrest (CPA) since interventions based on the scientific evidence can decrease both the mortality rate and sequelae. Nevertheless, there are limited comprehensive assessments covering all the resources and interventions required when a vital emergency arises. To evaluate the effectiveness of the vital emergency action plan at the Navarre Hospital by analyzing a panel of 70 indicators. Structure and process indicators were assessed in 25 clinical units at the Navarre Hospital from April to June 2008. The structure and review process of CPR carts were analyzed, defibrillators were tested and 40 simulations involving 144 professionals were evaluated. Nonconformities were found in 86% of the indicators evaluated. The percentages of compliance in the indicators of structure ranged from 39.6% to 100%. In the evaluation of process, conformity ranged from 2.5% to 100%. The percentages of simulations meeting time standards varied between 17.5% and 45%. In 37.5% of the simulations, at least 50% of trained staff were present in the unit. In 32.3% of the simulations, the standard for the number of people in the unit who participated in the simulations was achieved. This study identified problems in the structure and process of a vital emergency action plan without, at this stage, evaluating patient outcomes. Copyright © 2010 Elsevier España S.L. All rights reserved.

SAR operational aspects

NASA Astrophysics Data System (ADS)

Holmdahl, P. E.; Ellis, A. B. E.; Moeller-Olsen, P.; Ringgaard, J. P.

1981-12-01

The basic requirements of the SAR ground segment of ERS-1 are discussed. A system configuration for the real time data acquisition station and the processing and archive facility is depicted. The functions of a typical SAR processing unit (SPU) are specified, and inputs required for near real time and full precision, deferred time processing are described. Inputs and the processing required for provision of these inputs to the SPU are dealt with. Data flow through the systems, and normal and nonnormal operational sequence, are outlined. Prerequisites for maintaining overall performance are identified, emphasizing quality control. The most demanding tasks to be performed by the front end are defined in order to determine types of processors and peripherals which comply with throughput requirements.

Influencing Factors and Workpiece's Microstructure in Laser-Assisted Milling of Titanium

NASA Astrophysics Data System (ADS)

Wiedenmann, R.; Liebl, S.; Zaeh, M. F.

Today's lightweight components have to withstand increasing mechanical and thermal loads. Therefore, advanced materials substitute conventional materials like steel or aluminum alloys. Using these high-performance materials the associated costs become prohibitively high. This paper presents the newest fundamental investigations on the hybrid process 'laser-assisted milling' which is an innovative technique to process such materials. The focus is on the validation of a numerical database for a CAD/CAM process control unit which is calculated by using simulation. Prior to that, the influencing factors on a laser-assisted milling process are systematically investigated using Design of Experiments (DoE) to identify the main influencing parameters coming from the laser and the milling operation.

Evaluation Metrics for Biostatistical and Epidemiological Collaborations

PubMed Central

Rubio, Doris McGartland; del Junco, Deborah J.; Bhore, Rafia; Lindsell, Christopher J.; Oster, Robert A.; Wittkowski, Knut M.; Welty, Leah J.; Li, Yi-Ju; DeMets, Dave

2011-01-01

Increasing demands for evidence-based medicine and for the translation of biomedical research into individual and public health benefit have been accompanied by the proliferation of special units that offer expertise in biostatistics, epidemiology, and research design (BERD) within academic health centers. Objective metrics that can be used to evaluate, track, and improve the performance of these BERD units are critical to their successful establishment and sustainable future. To develop a set of reliable but versatile metrics that can be adapted easily to different environments and evolving needs, we consulted with members of BERD units from the consortium of academic health centers funded by the Clinical and Translational Science Award Program of the National Institutes of Health. Through a systematic process of consensus building and document drafting, we formulated metrics that covered the three identified domains of BERD practices: the development and maintenance of collaborations with clinical and translational science investigators, the application of BERD-related methods to clinical and translational research, and the discovery of novel BERD-related methodologies. In this article, we describe the set of metrics and advocate their use for evaluating BERD practices. The routine application, comparison of findings across diverse BERD units, and ongoing refinement of the metrics will identify trends, facilitate meaningful changes, and ultimately enhance the contribution of BERD activities to biomedical research. PMID:21284015

Health care units and human resources management trends.

PubMed

André, Adriana Maria; Ciampone, Maria Helena Trench; Santelle, Odete

2013-02-01

To identify factors producing new trends in basic health care unit management and changes in management models. This was a prospective study with ten health care unit managers and ten specialists in the field of Health in São Paulo, Southeastern Brazil, in 2010. The Delphi methodology was adopted. There were four stages of data collection, three quantitative and the fourth qualitative. The first three rounds dealt with changing trends in management models, manager profiles and required competencies, and the Mann-Whitney test was used in the analysis. The fourth round took the form of a panel of those involved, using thematic analysis. The main factors which are driving change in basic health care units were identified, as were changes in management models. There was consensus that this process is influenced by the difficulties in managing teams and by politics. The managers were found to be up-to-date with trends in the wider context, with the arrival of social health organizations, but they are not yet anticipating these within the institutions. Not only the content, but the professional development aspect of training courses in this area should be reviewed. Selection and recruitment, training and assessment of these professionals should be guided by these competencies aligned to the health service mission, vision, values and management models.

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

Muth, David J.; Bryden, Kenneth Mark; Nelson, R. G.

This study provides a spatially comprehensive assessment of sustainable agricultural residue removal potential across the United States for bioenergy production. Earlier assessments determining the quantity of agricultural residue that could be sustainably removed for bioenergy production at the regional and national scale faced a number of computational limitations. These limitations included the number of environmental factors, the number of land management scenarios, and the spatial fidelity and spatial extent of the assessment. This study utilizes integrated multi-factor environmental process modeling and high fidelity land use datasets to perform the sustainable agricultural residue removal assessment. Soil type represents the base spatialmore » unit for this study and is modeled using a national soil survey database at the 10–100 m scale. Current crop rotation practices are identified by processing land cover data available from the USDA National Agricultural Statistics Service Cropland Data Layer database. Land management and residue removal scenarios are identified for each unique crop rotation and crop management zone. Estimates of county averages and state totals of sustainably available agricultural residues are provided. The results of the assessment show that in 2011 over 150 million metric tons of agricultural residues could have been sustainably removed across the United States. Projecting crop yields and land management practices to 2030, the assessment determines that over 207 million metric tons of agricultural residues will be able to be sustainably removed for bioenergy production at that time. This biomass resource has the potential for producing over 68 billion liters of cellulosic biofuels.« less

Implementation of an Inpatient Pediatric Sepsis Identification Pathway.

PubMed

Bradshaw, Chanda; Goodman, Ilyssa; Rosenberg, Rebecca; Bandera, Christopher; Fierman, Arthur; Rudy, Bret

2016-03-01

Early identification and treatment of severe sepsis and septic shock improves outcomes. We sought to identify and evaluate children with possible sepsis on a pediatric medical/surgical unit through successful implementation of a sepsis identification pathway. The sepsis identification pathway, a vital sign screen and subsequent physician evaluation, was implemented in October 2013. Quality improvement interventions were used to improve physician and nursing adherence with the pathway. We reviewed charts of patients with positive screens on a monthly basis to assess for nursing recognition/physician notification, physician evaluation for sepsis, and subsequent physician diagnosis of sepsis and severe sepsis/septic shock. Adherence data were analyzed on a run chart and statistical process control p-chart. Nursing and physician pathway adherence of >80% was achieved over a 6-month period and sustained for the following 6 months. The direction of improvements met standard criteria for special causes. Over a 1-year period, there were 963 admissions to the unit. Positive screens occurred in 161 (16.7%) of these admissions and 38 (23.5%) of these had a physician diagnosis of sepsis, severe sepsis, or septic shock. One patient with neutropenia and septic shock had a negative sepsis screen due to lack of initial fever. Using quality improvement methodology, we successfully implemented a sepsis identification pathway on our pediatric unit. The pathway provided a standardized process to identify and evaluate children with possible sepsis requiring timely evaluation and treatment. Copyright © 2016 by the American Academy of Pediatrics.

A survey of current ostrich handling and transport practices in North America with reference to ostrich welfare and transportation guidelines set up in other countries.

PubMed

Bejaei, M; Cheng, K M

2014-02-01

Appropriate management of an ostrich's exposure to stressors during preslaughter handling and transport practices can improve its well-being and product quality. Because of the lack of information about ostrich farming and transportation in North America and lack of developed Codes of Practice for ratite transport in Canada and the United States, the first objective of our research was to identify current preslaughter handling and transport practices of the ostrich industry in Canada and the United States, and to identify potential welfare issues based on the current practices. The second objective of this research was to review ostrich transport welfare standards and guidelines from Australia, European Union, New Zealand, and South Africa to investigate if those guidelines are applicable to Canadian and American ostrich production systems. Preliminary producer interviews, on-farm visits, and literature review information sources were used to design a producer questionnaire that was used to survey producers by Internet and mail surveying methods to identify existing ostrich transport norms in Canada and the United States. Based on the results of our producer survey and review of the transport standards and guidelines, we conclude that following factors are potential ostrich handling and transport welfare issues in Canada and the United States: lack of scientific information about welfare of ostriches during handling and transport; unfamiliarity of handlers and birds with handling and transport practices; not considering birds' social bounds, sex, behavior, and physical state in mixing them during handling and transport process; lack of an established specific maximum water and feed withdrawal duration for ostrich transport in Canada and the United States; lack of a specific vehicle designed for ratite transportation in Canada and the United States considering different physical body characteristics of ostriches compared with other species; exposure of birds to natural light during transport inside the trailer; overcrowding; and long transportation in Canada and the United States. Results of this research will contribute toward developing Codes of Practice for preslaughter handling, transportation, and slaughter of ostriches in Canada and the United States.

Panel 2: anticipatory risk assessment: identifying, assessing, and mitigating exposure risks before they occur.

PubMed

Guidotti, Tee L; Pacha, Laura

2011-07-01

Health threats place the military mission and deployed service members at risk. A commander's focus is on preventing acute health risks, such as diarrhea, because these quickly compromise the mission. However, in recent conflicts chronic and long-term illness risks have emerged as concerns. Department of Defense and Joint Chiefs of Staff mandates require documentation of exposures and environmental conditions to reconstruct exposures and evaluate future health risks. Current processes for identifying and assessing hazards, including identification and assessment before deployment and in time to take action to prevent or reduce exposures, when followed, are generally adequate for known hazards. Identifying and addressing novel, unexpected risks remain challenges. Armed conflicts are associated with rapidly changing conditions, making ongoing hazard identification and assessment difficult. Therefore, surveillance of the environment for hazards and surveillance of personnel for morbidity must be practiced at all times. Communication of risk information to decision makers is critical but problematic. Preventive Medicine (PM) personnel should take responsibility for communicating this information to non-PM military medical people and to military commanders. Communication of risks identified and lessons learned between PM personnel of different military units is extremely important when one military unit replaces another in a deployed environment.

Use of multi-sensor active fire detections to map fires in the United States: the future of monitoring trends in burn severity

USGS Publications Warehouse

Picotte, Joshua J.; Coan, Michael; Howard, Stephen M.

2014-01-01

The effort to utilize satellite-based MODIS, AVHRR, and GOES fire detections from the Hazard Monitoring System (HMS) to identify undocumented fires in Florida and improve the Monitoring Trends in Burn Severity (MTBS) mapping process has yielded promising results. This method was augmented using regression tree models to identify burned/not-burned pixels (BnB) in every Landsat scene (1984–2012) in Worldwide Referencing System 2 Path/Rows 16/40, 17/39, and 1839. The burned area delineations were combined with the HMS detections to create burned area polygons attributed with their date of fire detection. Within our study area, we processed 88,000 HMS points (2003–2012) and 1,800 Landsat scenes to identify approximately 300,000 burned area polygons. Six percent of these burned area polygons were larger than the 500-acre MTBS minimum size threshold. From this study, we conclude that the process can significantly improve understanding of fire occurrence and improve the efficiency and timeliness of assessing its impacts upon the landscape.

Pre-conceptual Development and characterization of an extruded graphite composite fuel for the TREAT Reactor

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

Luther, Erik; Rooyen, Isabella van; Leckie, Rafael

2015-03-01

In an effort to explore fuel systems that are more robust under accident scenarios, the DOE-NE has identified the need to resume transient testing. The Transient Reactor Test (TREAT) facility has been identified as the preferred option for the resumption of transient testing of nuclear fuel in the United States. In parallel, NNSA’s Global Threat Reduction Initiative (GTRI) Convert program is exploring the needs to replace the existing highly enriched uranium (HEU) core with low enriched uranium (LEU) core. In order to construct a new LEU core, materials and fabrication processes similar to those used in the initial core fabricationmore » must be identified, developed and characterized. In this research, graphite matrix fuel blocks were extruded and materials properties of were measured. Initially the extrusion process followed the historic route; however, the project was expanded to explore methods to increase the graphite content of the fuel blocks and explore modern resins. Materials properties relevant to fuel performance including density, heat capacity and thermal diffusivity were measured. The relationship between process defects and materials properties will be discussed.« less

The application of theories of the policy process to obesity prevention: a systematic review and meta-synthesis.

PubMed

Clarke, Brydie; Swinburn, Boyd; Sacks, Gary

2016-10-13

Theories of the policy process are recommended as tools to help explain both policy stasis and change. A systematic review of the application of such theoretical frameworks within the field of obesity prevention policy was conducted. A meta-synthesis was also undertaken to identify the key influences on policy decision-making. The review identified 17 studies of obesity prevention policy underpinned by political science theories. The majority of included studies were conducted in the United States (US), with significant heterogeneity in terms of policy level (e.g., national, state) studied, areas of focus, and methodologies used. Many of the included studies were methodologically limited, in regard to rigour and trustworthiness. Prominent themes identified included the role of groups and networks, political institutions, and political system characteristics, issue framing, the use of evidence, personal values and beliefs, prevailing political ideology, and timing. The limited application of political science theories indicates a need for future theoretically based research into the complexity of policy-making and multiple influences on obesity prevention policy processes.

Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives.

PubMed

Gainer, Ryan A; Curran, Janet; Buth, Karen J; David, Jennie G; Légaré, Jean-Francois; Hirsch, Gregory M

2017-07-01

Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.

Using Lean principles to manage throughput on an inpatient rehabilitation unit.

PubMed

Chiodo, Anthony; Wilke, Ruste; Bakshi, Rishi; Craig, Anita; Duwe, Doug; Hurvitz, Edward

2012-11-01

Performance improvement is a mainstay of operations management and maintenance of certification. In this study at a University Hospital inpatient rehabilitation unit, Lean management techniques were used to manage throughput of patients into and out of the inpatient rehabilitation unit. At the start of this process, the average admission time to the rehabilitation unit was 5:00 p.m., with a median time of 3:30 p.m., and no patients received therapy on the day of admission. Within 8 mos, the mean admission time was 1:22 p.m., 50% of the patients were on the rehabilitation unit by 1:00 p.m., and more than 70% of all patients received therapy on the day of admission. Negative variance from this performance was evaluated, the identification of inefficient discharges holding up admissions as a problem was identified, and a Lean workshop was initiated. Once this problem was tackled, the prime objective of 70% of patients receiving therapy on the date of admission was consistently met. Lean management tools are effective in improving throughput on an inpatient rehabilitation unit.

LANDSAT: Non-US standard catalog no. N-36. [LANDSAT imagery for August, 1975

NASA Technical Reports Server (NTRS)

1975-01-01

Information regarding the availability of LANDSAT imagery processed and input to the data files by the NASA Data Processing Facility is published on a monthly basis. The U.S. Standard Catalog includes imagery covering the continental United States, Alaska, and Hawaii. The Non-U.S. Standard Catalog identifies all the remaining coverage. Sections 1 and 2 describe the contents and format for the catalogs and the associated microfilm. Section 3 provides a cross reference defining the beginning and ending dates for LANDSAT cycles.

LANDSAT 2 world standard catalog, 1 May - 31 July 1978. [LANDSAT imagery for May through July 1978

NASA Technical Reports Server (NTRS)

1978-01-01

Information regarding the availability of LANDSAT imagery processed and input to the data files by the NASA Data Processing Facility is published on a monthly basis. The U.S. Standard Catalog includes imagery covering the continental United States, Alaska and Hawaii. The Non-U.S. Standard Catalog identifies all the remaining coverage. Sections 1 and 2 describe the contents and format for the catalogs and the associated microfilm. Section 3 provides a cross-reference defining the beginning and ending dates for LANDSAT cycles.

LANDSAT: Non-US standard catalog no. N-30. [LANDSAT imagery for February, 1975

NASA Technical Reports Server (NTRS)

1975-01-01

Information regarding the availability of LANDSAT imagery processed and input to the data files by the NASA Data Processing Facility is published on a monthly basis. The U.S. Standard Catalog includes imagery covering the continental United States, Alaska, and Hawaii. The Non-U.S. Standard Catalog identifies all the remaining coverage. Sections 1 and 2 describe the contents and format for the catalogs and the associated microfilm. Section 3 provides a cross-reference defining the beginning and ending dates for LANDSAT cycles.

Geology of central Libya Montes, Mars: Aqueous alteration history from mineralogical and morphological mapping

NASA Astrophysics Data System (ADS)

Tirsch, D.; Bishop, J. L.; Voigt, J. R. C.; Tornabene, L. L.; Erkeling, G.; Jaumann, R.

2018-11-01

We analyze the emplacement chronology and aqueous alteration history of distinctive mineral assemblages and related geomorphic units near Hashir and Bradbury impact craters located within the Libya Montes, which are part of the southern rim of the Isidis Basin on Mars. We derive our results from a spectro-morphological mapping project that combines spectral detections from CRISM near-infrared imagery with geomorphology and topography from HRSC, CTX, and HiRISE imagery. Through this combination of data sets, we were able to use the morphology associated with specific mineral detections to extrapolate the possible extent of the units hosting these compositions. We characterize multiple units consistent with formation through volcanic, impact, hydrothermal, lacustrine and evaporative processes. Altered pyroxene-bearing basement rocks are unconformably overlain by an olivine-rich unit, which is in turn covered by a pyroxene-bearing capping unit. Aqueously altered outcrops identified here include nontronite, saponite, beidellite, opal, and dolomite. The diversity of mineral assemblages suggests that the nature of aqueous alteration at Libya Montes varied in space and time. This mineralogy together with geologic features shows a transition from Noachian aged impact-induced hydrothermal alteration and the alteration of Noachian bedrock by neutral to slightly basic waters via Hesperian aged volcanic emplacements and evaporative processes in lacustrine environments followed by Amazonian resurfacing in the form of aeolian erosion.

Programmable partitioning for high-performance coherence domains in a multiprocessor system

DOEpatents

Blumrich, Matthias A [Ridgefield, CT; Salapura, Valentina [Chappaqua, NY

2011-01-25

A multiprocessor computing system and a method of logically partitioning a multiprocessor computing system are disclosed. The multiprocessor computing system comprises a multitude of processing units, and a multitude of snoop units. Each of the processing units includes a local cache, and the snoop units are provided for supporting cache coherency in the multiprocessor system. Each of the snoop units is connected to a respective one of the processing units and to all of the other snoop units. The multiprocessor computing system further includes a partitioning system for using the snoop units to partition the multitude of processing units into a plurality of independent, memory-consistent, adjustable-size processing groups. Preferably, when the processor units are partitioned into these processing groups, the partitioning system also configures the snoop units to maintain cache coherency within each of said groups.

Application of computational methods to the design and characterisation of porous molecular materials.

PubMed

Evans, Jack D; Jelfs, Kim E; Day, Graeme M; Doonan, Christian J

2017-06-06

Composed from discrete units, porous molecular materials (PMMs) possess unique properties not observed for conventional, extended, solids, such as solution processibility and permanent porosity in the liquid phase. However, identifying the origin of porosity is not a trivial process, especially for amorphous or liquid phases. Furthermore, the assembly of molecular components is typically governed by a subtle balance of weak intermolecular forces that makes structure prediction challenging. Accordingly, in this review we canvass the crucial role of molecular simulations in the characterisation and design of PMMs. We will outline strategies for modelling porosity in crystalline, amorphous and liquid phases and also describe the state-of-the-art methods used for high-throughput screening of large datasets to identify materials that exhibit novel performance characteristics.

Use of FMEA analysis to reduce risk of errors in prescribing and administering drugs in paediatric wards: a quality improvement report

PubMed Central

Lago, Paola; Bizzarri, Giancarlo; Scalzotto, Francesca; Parpaiola, Antonella; Amigoni, Angela; Putoto, Giovanni; Perilongo, Giorgio

2012-01-01

Objective Administering medication to hospitalised infants and children is a complex process at high risk of error. Failure mode and effect analysis (FMEA) is a proactive tool used to analyse risks, identify failures before they happen and prioritise remedial measures. To examine the hazards associated with the process of drug delivery to children, we performed a proactive risk-assessment analysis. Design and setting Five multidisciplinary teams, representing different divisions of the paediatric department at Padua University Hospital, were trained to analyse the drug-delivery process, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure and plan changes in practices. Primary outcome To identify higher-priority potential failure modes as defined by RPNs and planning changes in clinical practice to reduce the risk of patients harm and improve safety in the process of medication use in children. Results In all, 37 higher-priority potential failure modes and 71 associated causes and effects were identified. The highest RPNs related (>48) mainly to errors in calculating drug doses and concentrations. Many of these failure modes were found in all the five units, suggesting the presence of common targets for improvement, particularly in enhancing the safety of prescription and preparation of endovenous drugs. The introductions of new activities in the revised process of administering drugs allowed reducing the high-risk failure modes of 60%. Conclusions FMEA is an effective proactive risk-assessment tool useful to aid multidisciplinary groups in understanding a process care and identifying errors that may occur, prioritising remedial interventions and possibly enhancing the safety of drug delivery in children. PMID:23253870

Use of FMEA analysis to reduce risk of errors in prescribing and administering drugs in paediatric wards: a quality improvement report.

PubMed

Lago, Paola; Bizzarri, Giancarlo; Scalzotto, Francesca; Parpaiola, Antonella; Amigoni, Angela; Putoto, Giovanni; Perilongo, Giorgio

2012-01-01

Administering medication to hospitalised infants and children is a complex process at high risk of error. Failure mode and effect analysis (FMEA) is a proactive tool used to analyse risks, identify failures before they happen and prioritise remedial measures. To examine the hazards associated with the process of drug delivery to children, we performed a proactive risk-assessment analysis. Five multidisciplinary teams, representing different divisions of the paediatric department at Padua University Hospital, were trained to analyse the drug-delivery process, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure and plan changes in practices. To identify higher-priority potential failure modes as defined by RPNs and planning changes in clinical practice to reduce the risk of patients harm and improve safety in the process of medication use in children. In all, 37 higher-priority potential failure modes and 71 associated causes and effects were identified. The highest RPNs related (>48) mainly to errors in calculating drug doses and concentrations. Many of these failure modes were found in all the five units, suggesting the presence of common targets for improvement, particularly in enhancing the safety of prescription and preparation of endovenous drugs. The introductions of new activities in the revised process of administering drugs allowed reducing the high-risk failure modes of 60%. FMEA is an effective proactive risk-assessment tool useful to aid multidisciplinary groups in understanding a process care and identifying errors that may occur, prioritising remedial interventions and possibly enhancing the safety of drug delivery in children.

Geomorphology subprogram: Geomorphological map of Occidental region of Bolivia, utilizing ERTS imagery

NASA Technical Reports Server (NTRS)

Brockmann, C. E. (Principal Investigator); Suarez, M. M.

1973-01-01

The author has identified the following significant results. Due to the receipt of ERTS-1 imagery, Bolivia will have for the first time a geomorphological map at a scale of 1:100,000. Now the researcher and the student will be able to compare the distribution of the existing shapes of the country, which have been modelled by diverse processes, factors, and agents. This geomorphological information will be very useful in its application to mining, especially alluvial beds, engineering work, and other geological studies. This map is divided into ten geomorphological units which coincide with the geostructural units of the western region of the country.

[Intraprofessional communication during shift change].

PubMed

Martín Pérez, Sonsoles; Vázquez Calatayud, Mónica; Lizarraga Ursúa, Yolanta; Oroviogoicoechea Ortega, Cristina

2013-05-01

Effective communication between professionals is crucial to ensure patient safety. 1) Explore the intraprofessional communication process during nurse shift change; 2) identify improvement strategies to facilitate optimal communication process. Exploratory study conducted from January to May 2011 in an intermediate unit. There were performed 16 structured observations of the communication process and 4 semistructured interviews and 16 anonymous surveys (designed by the evidence, interviews and observations) to the nurses who agreed to participate in the study. Strengths: complete process and the usefulness of the computer record. lack of common structure, repetition and forgetfulness of information, numerous interruptions during the process and noise. The 68.75% of nurses said that part of the transmitted information was irrelevant and too long. All of them perceived the need for changes in the existing process. Some strategies were identified to improve the development of a guide based on the mnemonic SBAR. It was adapted to the structure of the software as well as a change in location for the transmission of information. We propose to have an effective intraprofessional communication in order to ensure patient safety. In addition the transmission of information during the shift change should be done through a systematic process in a quiet place without interruptions.

Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

PubMed

Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

Fate of aflatoxins and fumonisins during the processing of maize into food products in Benin.

PubMed

Fandohan, P; Zoumenou, D; Hounhouigan, D J; Marasas, W F O; Wingfield, M J; Hell, K

2005-02-15

The fate of aflatoxins and fumonisins, two mycotoxins that cooccur in maize, was studied through the traditional processing of naturally contaminated maize in mawe, makume, ogi, akassa, and owo, maize-based foods common in Benin, West Africa. Levels of total aflatoxin and fumonisin were measured at the main unit operations of processing, and the unit operations that induce significant reduction of mycotoxin level were identified. Overall reduction of mycotoxin level was more significant during the preparation of makume (93% reduction of aflatoxins, 87% reduction of fumonisins) and akassa (92% reduction of aflatoxins, 50% reduction of fumonisins) than that of owo (40% reduction of aflatoxins, 48% reduction of fumonisins). Sorting, winnowing, washing, crushing combined with dehulling of maize grains were the unit operations that appeared very effective in achieving significant mycotoxin removal. Aflatoxins and fumonisins were significantly recovered in discarded mouldy and damaged grains and in washing water. Fermentation and cooking showed little effect. During the preparation of ogi and akassa, reduction of fumonisin levels measured in food matrix was lower (50%) compared to mawe and makume, probably due to significant fumonisin release in ogi supernatant. Consequently, the use of ogi supernatant for preparing beverages or traditional herbal medicines could be harmful as it is likely to be contaminated with mycotoxin from the raw maize.

Safety Management of a Clinical Process Using Failure Mode and Effect Analysis: Continuous Renal Replacement Therapies in Intensive Care Unit Patients.

PubMed

Sanchez-Izquierdo-Riera, Jose Angel; Molano-Alvarez, Esteban; Saez-de la Fuente, Ignacio; Maynar-Moliner, Javier; Marín-Mateos, Helena; Chacón-Alves, Silvia

2016-01-01

The failure mode and effect analysis (FMEA) may improve the safety of the continuous renal replacement therapies (CRRT) in the intensive care unit. We use this tool in three phases: 1) Retrospective observational study. 2) A process FMEA, with implementation of the improvement measures identified. 3) Cohort study after FMEA. We included 54 patients in the pre-FMEA group and 72 patients in the post-FMEA group. Comparing the risks frequencies per patient in both groups, we got less cases of under 24 hours of filter survival time in the post-FMEA group (31 patients 57.4% vs. 21 patients 29.6%; p < 0.05); less patients suffered circuit coagulation with inability to return the blood to the patient (25 patients [46.3%] vs. 16 patients [22.2%]; p < 0.05); 54 patients (100%) versus 5 (6.94%) did not get phosphorus levels monitoring (p < 0.05); in 14 patients (25.9%) versus 0 (0%), the CRRT prescription did not appear on medical orders. As a measure of improvement, we adopt a dynamic dosage management. After the process FMEA, there were several improvements in the management of intensive care unit patients receiving CRRT, and we consider it a useful tool for improving the safety of critically ill patients.

Collaboration processes and perceived effectiveness of integrated care projects in primary care: a longitudinal mixed-methods study.

PubMed

Valentijn, Pim P; Ruwaard, Dirk; Vrijhoef, Hubertus J M; de Bont, Antoinette; Arends, Rosa Y; Bruijnzeels, Marc A

2015-10-09

Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness. A longitudinal mixed-methods study design based on two data sources (surveys and interviews) was used to identify the perceived degree of integration and patterns in collaboration among 42 ICPs in primary care in The Netherlands. We used cluster analysis to identify distinct subgroups of ICPs based on the final perceived degree of integration from a professional, organisational and system perspective. With the use of ANOVAs, the subgroups were contrasted based on: 1) changes in collaboration processes over time (shared ambition, interests and mutual gains, relationship dynamics, organisational dynamics and process management) and 2) final perceived effectiveness (i.e. rated success) at the professional, organisational and system levels. The ICPs were classified into three subgroups with: 'United Integration Perspectives (UIP)', 'Disunited Integration Perspectives (DIP)' and 'Professional-oriented Integration Perspectives (PIP)'. ICPs within the UIP subgroup made the strongest increase in trust-based (mutual gains and relationship dynamics) as well as control-based (organisational dynamics and process management) collaboration processes and had the highest overall effectiveness rates. On the other hand, ICPs with the DIP subgroup decreased on collaboration processes and had the lowest overall effectiveness rates. ICPs within the PIP subgroup increased in control-based collaboration processes (organisational dynamics and process management) and had the highest effectiveness rates at the professional level. The differences across the three subgroups in terms of the development of collaboration processes and the final perceived effectiveness provide evidence that united stakeholders' perspectives are achieved through a constructive collaboration process over time. Disunited perspectives at the professional, organisation and system levels can be aligned by both trust-based and control-based collaboration processes.

BMP2 repression and optimized culture conditions promote human bone marrow-derived mesenchymal stem cell isolation.

PubMed

Kay, Alasdair Gawain; Dale, Tina Patricia; Akram, Khondoker Mehedi; Mohan, Param; Hampson, Karen; Maffulli, Nicola; Spiteri, Monica A; El Haj, Alicia Jennifer; Forsyth, Nicholas Robert

2015-01-01

Human mesenchymal stem cells (hMSC) are multipotent progenitor cells. We propose the optimization of hMSC isolation and recovery using the application of a controlled hypoxic environment. We evaluated oxygen, glucose and serum in the recovery of hMSC from bone marrow (BMhMSC). Colony forming units-fibroblastic, cell numbers, tri-lineage differentiation, immunofluorescence and microarray were used to confirm and characterize BMhMSC. In an optimized (2% O(2), 4.5 g/l glucose and 5% serum) environment both colony forming units-fibroblastic (p = 0.01) and cell numbers (p = 0.0001) were enhanced over standard conditions. Transcriptional analysis identified differential expression of bone morphogenetic protein 2 (BMP2) and, putatively, chemokine (C-X-C motif) receptor 2 (CXCR2) signaling pathways. We have detailed a potential milestone in the process of refinement of the BMhMSC isolation process.

Precursor of transition to turbulence: spatiotemporal wave front.

PubMed

Bhaumik, S; Sengupta, T K

2014-04-01

To understand transition to turbulence via 3D disturbance growth, we report here results obtained from the solution of Navier-Stokes equation (NSE) to reproduce experimental results obtained by minimizing background disturbances and imposing deterministic excitation inside the shear layer. A similar approach was adopted in Sengupta and Bhaumik [Phys. Rev. Lett. 107, 154501 (2011)], where a route of transition from receptivity to fully developed turbulent stage was explained for 2D flow in terms of the spatio-temporal wave-front (STWF). The STWF was identified as the unit process of 2D turbulence creation for low amplitude wall excitation. Theoretical prediction of STWF for boundary layer was established earlier in Sengupta, Rao, and Venkatasubbaiah [Phys. Rev. Lett. 96, 224504 (2006)] from the Orr-Sommerfeld equation as due to spatiotemporal instability. Here, the same unit process of the STWF during transition is shown to be present for 3D disturbance field from the solution of governing NSE.

Optimizing Maintenance of Constraint-Based Database Caches

NASA Astrophysics Data System (ADS)

Klein, Joachim; Braun, Susanne

Caching data reduces user-perceived latency and often enhances availability in case of server crashes or network failures. DB caching aims at local processing of declarative queries in a DBMS-managed cache close to the application. Query evaluation must produce the same results as if done at the remote database backend, which implies that all data records needed to process such a query must be present and controlled by the cache, i. e., to achieve “predicate-specific” loading and unloading of such record sets. Hence, cache maintenance must be based on cache constraints such that “predicate completeness” of the caching units currently present can be guaranteed at any point in time. We explore how cache groups can be maintained to provide the data currently needed. Moreover, we design and optimize loading and unloading algorithms for sets of records keeping the caching units complete, before we empirically identify the costs involved in cache maintenance.

[Quality planning of Family Health Units using Quality Function Deployment (QFD)].

PubMed

Volpato, Luciana Fernandes; Meneghim, Marcelo de Castro; Pereira, Antonio Carlos; Ambrosano, Gláucia Maria Bovi

2010-08-01

Quality is an indispensible requirement in the health field, and its pursuit is necessary in order to meet demands by a population that is aware of its rights, as part of the essence of good work relations, and to decrease technological costs. Quality thus involves all parties to the process (users and professionals), and is no longer merely an attribute of the health service. This study aimed to verify the possibility of quality planning in the Family Health Units, using Quality Function Deployment (QFD). QFD plans quality according to user satisfaction, involving staff professionals and identifying new approaches to improve work processes. Development of the array, called the House of Quality, is this method's most important characteristics. The results show a similarity between the quality demanded by users and the quality planned by professionals. The current study showed that QFD is an efficient tool for quality planning in public health services.

Developing family rooms in mental health inpatient units: an exploratory descriptive study.

PubMed

Isobel, Sophie; Foster, Kim; Edwards, Clair

2015-06-19

Family-friendly spaces for children and families to visit inpatient mental health units are recommended in international mental health guidelines as one way to provide service delivery that is responsive to the needs of parent-consumers and families. There is a lack of evidence on the implementation of family-friendly spaces or Family Rooms. This study aimed to explore the development, role, and function of Family Rooms in four mental health inpatient units in a local health district in NSW Australia. An exploratory descriptive inductive-deductive design using multiple data sources was employed. Methods included Family Room usage and parental status data over a 12 week period, an open-ended questionnaire, and semi-structured interviews with 20 nurses. Available parental status data indicated that between 8-14 % of inpatients were parents of dependent children under 18. Family Room usage was multipurpose and used specifically for children & families 29 % of the time. As spaces in the units, Family Rooms were perceived as acknowledging of the importance of family, and providing comfortable, secure spaces for parent-consumers and their children and family to maintain connections. Units did not have local policies or guidelines on the development, maintenance, and/or use of the rooms. Despite long-standing recognition of the need to identify consumers' parental status, there remains a lack of systematic processes for identifying parents in mental health inpatient services nationally. Family Rooms as spaces within inpatient units acknowledge the importance of families and are a step towards provision of family-focused mental health care. Recommendations for establishing and maintaining Family Rooms are outlined.

How personal and standardized coordination impact implementation of integrated care.

PubMed

Benzer, Justin K; Cramer, Irene E; Burgess, James F; Mohr, David C; Sullivan, Jennifer L; Charns, Martin P

2015-10-02

Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.

Reliability and performance of a system-on-a-chip by predictive wear-out based activation of functional components

DOEpatents

Cher, Chen-Yong; Coteus, Paul W; Gara, Alan; Kursun, Eren; Paulsen, David P; Schuelke, Brian A; Sheets, II, John E; Tian, Shurong

2013-10-01

A processor-implemented method for determining aging of a processing unit in a processor the method comprising: calculating an effective aging profile for the processing unit wherein the effective aging profile quantifies the effects of aging on the processing unit; combining the effective aging profile with process variation data, actual workload data and operating conditions data for the processing unit; and determining aging through an aging sensor of the processing unit using the effective aging profile, the process variation data, the actual workload data, architectural characteristics and redundancy data, and the operating conditions data for the processing unit.

Early Intervention for At-Risk Children in the North Central Region: A Comparative Analysis of Selected State Education Agencies' Policies.

ERIC Educational Resources Information Center

Kunesh, Linda G.

The primary purpose of this policy study was to identify and examine early intervention policies for young children at risk of academic failure in selected state education agencies (SEAs) in the North Central Region of the United States. The secondary purpose was to document the processes by which the selected states in the north central…

The Right Student: An Exploration of the Qualities Desired in the Next Generation of Nursing Students, Leading to Improved Selection Processes within Nursing and Midwifery

ERIC Educational Resources Information Center

Norrie, Peter; Day, Jacqui; Ford, Karen; Knifton, Christopher; Welyczko, Nicola; Harrison, Penny; Robson, Elizabeth; Tremayne, Penny

2012-01-01

This project explored ways in which student selection in nursing can be developed. Original research was undertaken throughout the United Kingdom using qualitative interviews with a range of academic staff and partners from practice. A conceptual framework was produced which identified five categories which can confidently be seen as…

Prevention of Posttraumatic Contractures with Ketotifen (PERK)

DTIC Science & Technology

2016-10-01

the Peer Reviewed Orthopaedic Research Program (PRORP) Clinical Trial Award (CTA), W81XWH-16-PRORP-CTA, was submitted. Database development and Pre...and Safety Months Identify database and partner – Clinical Research Unit 1-2 Completed Develop Case Report Forms, consent forms 6-12 Case...report forms completed, consent forms pending – 80% completed Develop database and multicenter submission process 12-18 In progress, 30% completed

Frances Kelsey and Thalidomide in the US: A Case Study Relating to Pharmaceutical Regulations.

ERIC Educational Resources Information Center

Seidman, Lisa A.; Warren, Noreen

2002-01-01

Presents a case study on the story of Dr. Frances Kelsey and the drug thalidomide, which was widely used in Europe for its therapeutic effects in the 1960s and later identified as having multiple effects on the body during development by the Food and Drug Administration (FDA). Describes the drug approval process in the United States and…

Conceptual and empirical themes regarding the design of technology transfer programs : a review of wood utilization research in the United States

Treesearch

Paul V. Ellefson; Michael A. Kilgore; Kenneth E. Skog; Christopher D. Risbrudt

2011-01-01

Transfer of technologies produced by research is critical to innovation within all organizations. The intent of this paper is to take stock of the conceptual underpinnings of technology transfer processes as they relate to wood utilization research and to identify conditions that promote the successful transfer of research results. Conceptually, research utilization...

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

PubMed

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

2015-11-25

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

Activity-based costing in radiology. Application in a pediatric radiological unit.

PubMed

Laurila, J; Suramo, I; Brommels, M; Tolppanen, E M; Koivukangas, P; Lanning, P; Standertskjöld-Nordenstam, G

2000-03-01

To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management. A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system. The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%. Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.

Adsorption of the herbicides diquat and difenzoquat on polyurethane foam: Kinetic, equilibrium and computational studies.

PubMed

Vinhal, Jonas O; Nege, Kassem K; Lage, Mateus R; de M Carneiro, José Walkimar; Lima, Claudio F; Cassella, Ricardo J

2017-11-01

This work reports a study about the adsorption of the herbicides diquat and difenzoquat from aqueous medium employing polyurethane foam (PUF) as the adsorbent and sodium dodecylsulfate (SDS) as the counter ion. The adsorption efficiency was shown to be dependent on the concentration of SDS in solution, since the formation of an ion-associate between cationic herbicides (diquat and difenzoquat) and anionic dodecylsulfate is a fundamental step of the process. A computational study was carried out to identify the possible structure of the ion-associates that are formed in solution. They are probably formed by three units of dodecylsulfate bound to one unit of diquat, and two units of dodecylsulfate bound to one unit of difenzoquat. The results obtained also showed that 95% of both herbicides present in 45mL of a solution containing 5.5mgL -1 could be retained by 300mg of PUF. The experimental data were well adjusted to the Freundlich isotherm (r 2 ≥ 0.95) and to the pseudo-second-order kinetic equation. Also, the application of Morris-Weber and Reichenberg equations indicated that an intraparticle diffusion process is active in the control of adsorption kinetics. Copyright © 2017 Elsevier Inc. All rights reserved.

Developing an experimental case in aluminium foils 1100 to determine the maximum angle of formability in a piece by Dieless-SPIF process

NASA Astrophysics Data System (ADS)

Gabriel, Paramo; Adrian, Benitez

2014-07-01

Incremental sheet forming by the method of single point incremental forming Dieless-SPIF, is a widely studied process, experimented and developed in countries with high manufacturing technologies, with friendly costs when the productive configuration in a productivity system is based in small production batches. United states, United kingdom and France lead this type of studies and cases, developing various proof with experimental geometries, different from the national environment such as Colombia, Bolivia, Chile, Ecuador and Peru where this process where discretely studied. Previously mentioned, it pretends develop an experimental case of a particular geometry, identifying the maximum formability angle of material permissible for the forming of a piece in one pass, the analysis of forming limit curve (FLC), with the objective to emphasizes in this innovative method based in CAD-CAM technologies, compare with other analogous process of deformation sheet metal like embossing, take correct decisions about the viability and applicability of this process (Dieless) in a particular industrial piece, which responses to the necessities of productive configurations mentioned and be highly taken like a manufacturing alternative to the other conventional process of forming sheet metal like embossing, for systems with slow batches production.

Device and method to enhance availability of cluster-based processing systems

NASA Technical Reports Server (NTRS)

Lupia, David J. (Inventor); Ramos, Jeremy (Inventor); Samson, Jr., John R. (Inventor)

2010-01-01

An electronic computing device including at least one processing unit that implements a specific fault signal upon experiencing an associated fault, a control unit that generates a specific recovery signal upon receiving the fault signal from the at least one processing unit, and at least one input memory unit. The recovery signal initiates specific recovery processes in the at least one processing unit. The input memory buffers input data signals input to the at least one processing unit that experienced the fault during the recovery period.

Audit of rheumatology services for adolescents and young adults in the UK. British Paediatric Rheumatology Group.

PubMed

McDonagh, J E; Foster, H E; Hall, M A; Chamberlain, M A

2000-06-01

Juvenile idiopathic arthritis (JIA) is associated with significant morbidity in adulthood with at least one third of children continuing to have active inflammatory disease into their adult years and up to 60% of all patients continuing to have some limitation of their activities of daily living. A survey of service provision for these young people in the transition from paediatric to adult rheumatology care was therefore undertaken. A postal questionnaire was sent to all 92 members of the British Paediatric Rheumatology Group, representing 61 units providing a paediatric rheumatology service in the UK and Eire. Fifty-five replies were received representing a 60% completion rate of doctors and 84% of units on the mailing list. The majority of respondents were adult rheumatologists (n = 36, 65%) with 42% of respondents based in teaching hospitals. A median of 24 patients (new and follow-up, range 1-225) were seen in a median of two paediatric rheumatology clinics (range 0-15) per month. Eighteen per cent of units had a dedicated adolescent clinic (n = 9) with a median of one clinic per month and a median number of new patients per month of two (range 0-24) and 10 review patients (4-32). All the adolescent clinics involved an adult rheumatologist with five having a paediatrician in clinic and four having access to a paediatrician. The majority of clinics involved a specialist registrar (n = 6), a nurse specialist (n = 6), an occupational therapist (n = 6) and a physiotherapist (n = 5). The majority of clinics had flexible entry and exit criteria. In seven clinics there was a standardized process of transfer, first discussed at a median age of 13 yr (range 12-16) but no unit provided literature or organized pre-visits for this process. A demand for patient information resources (e.g. disease and drug information, careers) specifically aimed at adolescents with rheumatic diseases was identified. Generic health issues were only addressed by two clinics. Obstacles to current service provision and ideas for future developments were identified. This survey identifies a heterogeneity of provision of healthcare for adolescents with rheumatic disease and highlights the potential for further research and development.

Development studies of a novel wet oxidation process

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

Rogers, T.W.; Dooge, P.M.

1996-12-31

The objective of this study is to develop a novel catalytic chemical oxidation process that can be used to effectively treat multi-component wastes with a minimum of pretreatment characterization, thus providing a versatile, non-combustion method which will destroy hazardous organic compounds while simultaneously containing and concentrating toxic and radioactive metals for recovery or disposal in a readily stabilized matrix. Although the DETOX{sup SM} process had been tested to a limited extent for potential application to mixed wastes, there had not been sufficient experience with the process to determine its range of application to multicomponent waste forms. The potential applications ofmore » the process needed to be better identified. Then, the process needed to be demonstrated on wastes and remediate types on a practical scale in order that data could be obtained on application range, equipment size, capital and operating costs, effectiveness, safety, reliability, permittability, and potential commercial applications of the process. The approach for the project was, therefore, to identify the potential range of applications of the process (Phase I), to choose demonstration sites and design a demonstration prototype (Phase II), to fabricate and shakedown the demonstration unit (Phase III), then finally to demonstrate the process on surrogate hazardous and mixed wastes, and on actual mixed wastes (Phase IV).« less

Antimicrobial and anti-inflammatory activity of switchgrass-derived extractives

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

Labbe, Nicole; Ownley, Bonnie H.; Gwinn, Kimberly D.

Switchgrass is an increasingly important biofuel crop, but knowledge of switchgrass fungal pathogens is not extensive. The purpose of this research was to identify the fungal pathogens that decrease crop yield of switchgrass grown in Tennessee and to investigate a potential sustainable disease management strategy from a value-added by-product of the switchgrass biofuel conversion process. The specific objectives were 1) to identify and characterize prevalent fungal pathogens of switchgrass in Tennessee, 2) assess switchgrass seed produced in the United States for seedborne fungal pathogens, and 3) evaluate switchgrass extractives for antimicrobial activity against plant pathogens.

Signature and Mechanism of the Epithelial-to-Mesenchymal Transition

DTIC Science & Technology

2011-05-01

such as breast cancer . This study seeks to identify genes commonly regulated in the EMT, and identify key regulators of the process. An EMT core...Appendices…………………………………………………………………………… NA 4 Introduction Breast cancer is the most common form of cancer in women in the United...Hence, the study of breast cancer progression and metastasis is as important as the study of what causes the cancer to arise in the first place. The

Spatially-explicit modeling of multi-scale drivers of aboveground forest biomass and water yield in watersheds of the Southeastern United States.

PubMed

Ajaz Ahmed, Mukhtar Ahmed; Abd-Elrahman, Amr; Escobedo, Francisco J; Cropper, Wendell P; Martin, Timothy A; Timilsina, Nilesh

2017-09-01

Understanding ecosystem processes and the influence of regional scale drivers can provide useful information for managing forest ecosystems. Examining more local scale drivers of forest biomass and water yield can also provide insights for identifying and better understanding the effects of climate change and management on forests. We used diverse multi-scale datasets, functional models and Geographically Weighted Regression (GWR) to model ecosystem processes at the watershed scale and to interpret the influence of ecological drivers across the Southeastern United States (SE US). Aboveground forest biomass (AGB) was determined from available geospatial datasets and water yield was estimated using the Water Supply and Stress Index (WaSSI) model at the watershed level. Our geostatistical model examined the spatial variation in these relationships between ecosystem processes, climate, biophysical, and forest management variables at the watershed level across the SE US. Ecological and management drivers at the watershed level were analyzed locally to identify whether drivers contribute positively or negatively to aboveground forest biomass and water yield ecosystem processes and thus identifying potential synergies and tradeoffs across the SE US region. Although AGB and water yield drivers varied geographically across the study area, they were generally significantly influenced by climate (rainfall and temperature), land-cover factor1 (Water and barren), land-cover factor2 (wetland and forest), organic matter content high, rock depth, available water content, stand age, elevation, and LAI drivers. These drivers were positively or negatively associated with biomass or water yield which significantly contributes to ecosystem interactions or tradeoff/synergies. Our study introduced a spatially-explicit modelling framework to analyze the effect of ecosystem drivers on forest ecosystem structure, function and provision of services. This integrated model approach facilitates multi-scale analyses of drivers and interactions at the local to regional scale. Copyright © 2017 Elsevier Ltd. All rights reserved.

Maritime Domain Awareness: C4I for the 1000 Ship Navy

DTIC Science & Technology

2009-12-04

unit action, provide unit sensed contacts, coordinate unit operations, process unit information, release image , and release contact report, Figure 33...Intelligence Tasking Request Intelligence Summary Release Unit Person Incident Release Unit Vessel Incident Process Intelligence Tasking Release Image ...xi LIST OF FIGURES Figure 1. Functional Problem Sequence Process Flow. ....................................................4 Figure 2. United

Pelagic Life and Depth: Coastal Physical Features in West Africa Shape the Genetic Structure of the Bonga Shad, Ethmalosa fimbriata

PubMed Central

Durand, Jean-Dominique; Guinand, Bruno; Dodson, Julian J.; Lecomte, Frédéric

2013-01-01

The bonga shad, Ethmalosa fimbriata, is a West African pelagic species still abundant in most habitats of its distribution range and thought to be only recently affected by anthropogenic pressure (habitat destruction or fishing pressure). Its presence in a wide range of coastal habitats characterised by different hydrodynamic processes, represents a case study useful for evaluating the importance of physical structure of the west African shoreline on the genetic structure of a small pelagic species. To investigate this question, the genetic diversity of E. fimbriata was assessed at both regional and species range scales, using mitochondrial (mt) and nuclear DNA markers. Whereas only three panmictic units were identified with mtDNA at the large spatial scale, nuclear genetic markers (EPIC: exon-primed intron-crossing) indicated a more complex genetic pattern at the regional scale. In the northern-most section of shad’s distribution range, up to 4 distinct units were identified. Bayesian inference as well as spatial autocorrelation methods provided evidence that gene flow is impeded by the presence of deep-water areas near the coastline (restricting the width of the coastal shelf), such as the Cap Timiris and the Kayar canyons in Mauritania and Senegal, respectively. The added discriminatory power provided by the use of EPIC markers proved to be essential to detect the influence of more subtle, contemporary processes (e.g. gene flow, barriers, etc.) acting within the glacial refuges identified previously by mtDNA. PMID:24130890

Mortality reporting in interventional radiology: experience of a pilot audit with the Scottish Audit of Surgical Mortality.

PubMed

White, R D; Ingram, S; Moss, J G; Pace, N; Chakraverty, S

2013-10-01

To describe the initial pilot phase of the 2009 Scottish Audit of Surgical Mortality (SASM), which includes outcomes and difficulties that arose during any interventional radiology (IR) procedure performed on patients in this audit over an 18 month period. Approximately 40 consultant interventional radiologists from all units in Scotland elected to participate in the audit. Each response was then peer reviewed after anonymisation of the patient and institution. If a relevant ACON (area for consideration or area of concern) was generated, this was checked by one of the other reviewers before communication with the original reporting radiologist and colleagues. There was then a right of reply by the reporting unit before formal documentation was sent out. Initial results were analysed after 18 months period, during which time 95 forms relating to deaths of surgical inpatients were sent to interventional radiologists identified as having been involved in an IR procedure at some time during the patient's admission. Seventy-one forms had been returned by July 2010, of which 46 had gone through the entire SASM process. From these, 10 ACONs were attributed. Anonymised case vignettes and reports from these were used as educational tools. Involvement with SASM is a useful process. Significant safety issues and learning points were identified in the pilot. The majority of ACONs identified by the audit were in patients who had undergone percutaneous biliary interventions. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Process Mining-Based Method of Designing and Optimizing the Layouts of Emergency Departments in Hospitals.

PubMed

Rismanchian, Farhood; Lee, Young Hoon

2017-07-01

This article proposes an approach to help designers analyze complex care processes and identify the optimal layout of an emergency department (ED) considering several objectives simultaneously. These objectives include minimizing the distances traveled by patients, maximizing design preferences, and minimizing the relocation costs. Rising demand for healthcare services leads to increasing demand for new hospital buildings as well as renovating existing ones. Operations management techniques have been successfully applied in both manufacturing and service industries to design more efficient layouts. However, high complexity of healthcare processes makes it challenging to apply these techniques in healthcare environments. Process mining techniques were applied to address the problem of complexity and to enhance healthcare process analysis. Process-related information, such as information about the clinical pathways, was extracted from the information system of an ED. A goal programming approach was then employed to find a single layout that would simultaneously satisfy several objectives. The layout identified using the proposed method improved the distances traveled by noncritical and critical patients by 42.2% and 47.6%, respectively, and minimized the relocation costs. This study has shown that an efficient placement of the clinical units yields remarkable improvements in the distances traveled by patients.

Optimizing SIEM Throughput on the Cloud Using Parallelization

PubMed Central

Alam, Masoom; Ihsan, Asif; Javaid, Qaisar; Khan, Abid; Manzoor, Jawad; Akhundzada, Adnan; Khan, M Khurram; Farooq, Sajid

2016-01-01

Processing large amounts of data in real time for identifying security issues pose several performance challenges, especially when hardware infrastructure is limited. Managed Security Service Providers (MSSP), mostly hosting their applications on the Cloud, receive events at a very high rate that varies from a few hundred to a couple of thousand events per second (EPS). It is critical to process this data efficiently, so that attacks could be identified quickly and necessary response could be initiated. This paper evaluates the performance of a security framework OSTROM built on the Esper complex event processing (CEP) engine under a parallel and non-parallel computational framework. We explain three architectures under which Esper can be used to process events. We investigated the effect on throughput, memory and CPU usage in each configuration setting. The results indicate that the performance of the engine is limited by the number of events coming in rather than the queries being processed. The architecture where 1/4th of the total events are submitted to each instance and all the queries are processed by all the units shows best results in terms of throughput, memory and CPU usage. PMID:27851762

A systematic review and development of a classification framework for factors associated with missing patient-reported outcome data.

PubMed

Palmer, Michael J; Mercieca-Bebber, Rebecca; King, Madeleine; Calvert, Melanie; Richardson, Harriet; Brundage, Michael

2018-02-01

Missing patient-reported outcome data can lead to biased results, to loss of power to detect between-treatment differences, and to research waste. Awareness of factors may help researchers reduce missing patient-reported outcome data through study design and trial processes. The aim was to construct a Classification Framework of factors associated with missing patient-reported outcome data in the context of comparative studies. The first step in this process was informed by a systematic review. Two databases (MEDLINE and CINAHL) were searched from inception to March 2015 for English articles. Inclusion criteria were (a) relevant to patient-reported outcomes, (b) discussed missing data or compliance in prospective medical studies, and (c) examined predictors or causes of missing data, including reasons identified in actual trial datasets and reported on cover sheets. Two reviewers independently screened titles and abstracts. Discrepancies were discussed with the research team prior to finalizing the list of eligible papers. In completing the systematic review, four particular challenges to synthesizing the extracted information were identified. To address these challenges, operational principles were established by consensus to guide the development of the Classification Framework. A total of 6027 records were screened. In all, 100 papers were eligible and included in the review. Of these, 57% focused on cancer, 23% did not specify disease, and 20% reported for patients with a variety of non-cancer conditions. In total, 40% of the papers offered a descriptive analysis of possible factors associated with missing data, but some papers used other methods. In total, 663 excerpts of text (units), each describing a factor associated with missing patient-reported outcome data, were extracted verbatim. Redundant units were identified and sequestered. Similar units were grouped, and an iterative process of consensus among the investigators was used to reduce these units to a list of factors that met the guiding principles. The list was organized on a framework, using an iterative consensus-based process. The resultant Classification Framework is a summary of the factors associated with missing patient-reported outcome data described in the literature. It consists of 5 components (instrument, participant, centre, staff, and study) and 46 categories, each with one or more sub-categories or examples. A systematic review of the literature revealed 46 unique categories of factors associated with missing patient-reported outcome data, organized into 5 main component groups. The Classification Framework may assist researchers to improve the design of new randomized clinical trials and to implement procedures to reduce missing patient-reported outcome data. Further research using the Classification Framework to inform quantitative analyses of missing patient-reported outcome data in existing clinical trials and to inform qualitative inquiry of research staff is planned.

Processing device with self-scrubbing logic

DOEpatents

Wojahn, Christopher K.

2016-03-01

An apparatus includes a processing unit including a configuration memory and self-scrubber logic coupled to read the configuration memory to detect compromised data stored in the configuration memory. The apparatus also includes a watchdog unit external to the processing unit and coupled to the self-scrubber logic to detect a failure in the self-scrubber logic. The watchdog unit is coupled to the processing unit to selectively reset the processing unit in response to detecting the failure in the self-scrubber logic. The apparatus also includes an external memory external to the processing unit and coupled to send configuration data to the configuration memory in response to a data feed signal outputted by the self-scrubber logic.

Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital.

PubMed

Hoffmeister, Louíse Viecili; de Moura, Gisela Maria Schebella Souto

2015-01-01

to evaluate the use of identification wristbands among patients hospitalized in inpatient units. quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process.

The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care.

PubMed

Carlfjord, S; Andersson, A; Nilsen, P; Bendtsen, P; Lindberg, M

2010-12-01

The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC. © 2010 Blackwell Publishing Ltd.

Evaluation metrics for biostatistical and epidemiological collaborations.

PubMed

Rubio, Doris McGartland; Del Junco, Deborah J; Bhore, Rafia; Lindsell, Christopher J; Oster, Robert A; Wittkowski, Knut M; Welty, Leah J; Li, Yi-Ju; Demets, Dave

2011-10-15

Increasing demands for evidence-based medicine and for the translation of biomedical research into individual and public health benefit have been accompanied by the proliferation of special units that offer expertise in biostatistics, epidemiology, and research design (BERD) within academic health centers. Objective metrics that can be used to evaluate, track, and improve the performance of these BERD units are critical to their successful establishment and sustainable future. To develop a set of reliable but versatile metrics that can be adapted easily to different environments and evolving needs, we consulted with members of BERD units from the consortium of academic health centers funded by the Clinical and Translational Science Award Program of the National Institutes of Health. Through a systematic process of consensus building and document drafting, we formulated metrics that covered the three identified domains of BERD practices: the development and maintenance of collaborations with clinical and translational science investigators, the application of BERD-related methods to clinical and translational research, and the discovery of novel BERD-related methodologies. In this article, we describe the set of metrics and advocate their use for evaluating BERD practices. The routine application, comparison of findings across diverse BERD units, and ongoing refinement of the metrics will identify trends, facilitate meaningful changes, and ultimately enhance the contribution of BERD activities to biomedical research. Copyright © 2011 John Wiley & Sons, Ltd.

In-plant testing of membranes to treat electroplating wastewater

NASA Technical Reports Server (NTRS)

Shah, D. B.; Talu, Orhan

1995-01-01

This is the final report submitted for the work performed under the NASA Cooperative Agreement NCC3-301 for the project entitled 'In-Plant Testing of Membranes To Treat Electroplating Waste water'. The main objective of the research project was to determine if the crosslinked polyacrylic acid salt films developed by NASA scientists could be used for heavy metal removal from the wastewater generated by the metals-finishing or electroplating industry. A variety of tasks identified in the original proposal were completed. These included: (1) analysis of our industrial partner Aetna Plating's zinc electroplating process and its wastewater treatment needs for zinc removal; (2) design and construction of a laboratory-scale unit to continuously supply and remove the ion exchange films from the zinc wastewater; (3) performance of a series of runs on such a unit to determine its operating characteristics; and (4) design of a prototype unit for use at the industrial site. In addition, there were a number of tasks that had not been identified in the original proposal but were later judged to be necessary for the successful completion of the project. These were: (1) batch equilibrium and kinetic experiments with analysis of the experimental results to accurately determine the equilibrium and kinetic parameters for the ion exchange films; (2 ) simulation studies for proper design of the prototype unit; and (3) preliminary runs to exchange the films from H form to Calcium form.

"No one has yet properly articulated what we are trying to achieve": a discourse analysis of interviews with revalidation policy leaders in the United Kingdom.

PubMed

Archer, Julian; Regan de Bere, Sam; Nunn, Suzanne; Clark, Jonathan; Corrigan, Oonagh

2015-01-01

To analyze prevailing definitions of revalidation (i.e., a recently instituted system of ongoing review for all physicians in the United Kingdom), the circumstances of their origin, and proposed applications, after a protracted and sometimes difficult decade in development. This was to support a more consensual approach to revalidation policy before its launch in 2012. In 2010 and 2011, the authors carried out a critical discourse analysis of interviews with 31 medical and legal revalidation policy makers. These individuals represented the main stakeholder bodies, including the General Medical Council, Academy of Medical Royal Colleges, British Medical Association, National Health Service Employers, and the departments of health from across the United Kingdom. The authors identified two overarching discourses: regulation and professionalism, held together by patients as "discursive glue." Regulation frames revalidation as a way to identify "bad apples," requiring a summative approach and minimum standards. Professionalism looks to revalidation as a process by which all doctors improve, requiring evolving standards and a developmental model. These two discourses were not mutually exclusive; indeed, most interviewees used them interchangeably. However, they are in some regards at odds. Their coexistence has been supported by a shared discursive formation around patients. Yet the authors found little patient-centered policy in revalidation in its current form. The authors concluded that patients need to be recognized, making them present with an active voice. They also stressed the importance of established and ongoing evaluation of medical regulation as a policy and process.

Barriers and perceived needs for understanding and using research among emergency nurses.

PubMed

Chan, Garrett K; Barnason, Susan; Dakin, Cynthia L; Gillespie, Gordon; Kamienski, Mary C; Stapleton, Stephen; Williams, Jennifer; Juarez, Altair; Li, Suling

2011-01-01

Nurses are involved in conducting research and incorporating evidence into their practice. However, barriers exist at the individual, unit, and organizational level related to understanding, conducting, and evaluating the evidence. The Emergency Nurses Association (ENA) conducted a study to understand levels of education in research, the extent of experience, and needs and barriers to research at the individual and organizational levels in emergency nursing. A cross-sectional survey design was used to poll members of the ENA. A 62-item survey instrument was designed to assess five areas: 1) nurses' research values, skills, experience, and awareness; 2) organizational settings' opportunities, barriers, and limitations to research; 3) nurses' understanding and comprehension of research and evidence; 4) presentation and accessibility of research; and 5) continuing educational topics to improve knowledge of the research process. Respondents (n = 948) identified barriers at the individual level that included lack of knowledge about critiquing research studies and familiarity with the research process. Barriers at the unit level included obtaining help from administrators and other staff in starting a project or having the authority to change practice. Barriers at the institution level included lack of support systems such as protected time to conduct research or implement changes in practice. Emergency nurses are highly motivated and interested in learning more about conducting and utilizing research to improve practice. Perceived personal, unit-based, and organizational barriers were identified through this research in an effort to highlight areas for improvement at the local and national levels. Copyright © 2011 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

The geological history of Northeast Syrtis Major, Mars

NASA Astrophysics Data System (ADS)

Bramble, Michael S.; Mustard, John F.; Salvatore, Mark R.

2017-09-01

As inferred from orbital spectroscopic data, Northeast Syrtis Major bears considerable mineral diversity that spans the Noachian-Hesperian boundary despite its small geographic area. In this study we use observations from the High Resolution Imaging Science Experiment, supplemented with Context Camera imagery, to characterize and map the lateral extent of geomorphic units in Northeast Syrtis Major, and constrain the geomorphic context of the orbital-identified mineral signatures. Using recent observations, we confirm previous mineralogy identified with the Compact Reconnaissance Imaging Spectrometer for Mars, and greatly extend the lateral extent of visible to near-infrared investigation utilizing the greater coverage. Analysis of Thermal Emission Imaging System observations reveals further physical properties and distribution of the geomorphic units. The stratigraphy, which spans the Noachian-Hesperian boundary, displays significant morphological heterogeneity at the decameter scale, but it is unifiable under five distinct geomorphic units. Our paired morphological and mineralogical analysis allows us to construct a detailed geological history of Northeast Syrtis Major. Several geological events that occurred in Northeast Syrtis Major-including the formation of the post-Isidis crust, the emplacement of an olivine-rich unit, the formation of sulfate minerals, and the emplacement of the Syrtis Major Volcanics-can be related to regional and global processes constraining the local chronology. Other mineralogical indicators, particularly the formation of Al-phyllosilicates, are difficult to place in the temporal sequence. They are observed in isolated patches on the post-Isidis crust, not as a distinct stratigraphic unit as observed elsewhere in Nili Fossae, suggesting their formation via isolated leaching or through alteration of initial compositional heterogeneities within the crust. Exposures of an olivine-rich unit are intermittently observed to form quasi-circular landforms, suggestive of emplacement in circular depressions, which may indicate a period of cratering between the formation of the Isidis basin and the deposition of the olivine-rich unit. We identify and discuss intriguing large linear features of the olivine-rich unit, reminiscent of dyke-fed volcanism, that have raised bounding ridges suggestive of contact metamorphism with the crust. We compile, review, and discuss many of the outstanding questions and running hypotheses relevant to our mapping area. A synthesis of our geomorphic mapping with recent literature reveals a well-defined geological history with extensive aqueous activity at Northeast Syrtis Major that is amassed in a stratigraphic sequence spanning a time likely greater than 250 million years of geological history. Our geomorphic and spectral analyses confirm that Northeast Syrtis Major exhibits considerable geomorphic and mineralogic diversity within a relatively small geographic area that is representative of the geologic processes occurring throughout the broader Nili Fossae region during the Noachian and Hesperian. Northeast Syrtis Major adds to this sequence by exposing the diverse environmental history of this region as observed through the presence of alteration minerals not present in this fidelity or proximity elsewhere in Nili Fossae.

Social policy devolution: a historical review of Canada, the United kingdom, and the United States (1834-1999).

PubMed

Dunlop, Judith M

2009-01-01

This paper explores the recurring themes of devolution and social policy across time and nation in Canada, the United Kingdom, and the United States. Devolution is defined as the transfer of responsibility from national governments to state and local levels. Using a historical framework, the central/local tensions that characterize devolution and social policy in these countries are noted from 1834 to the late 1990s. This chronology shows that despite their geographical, ideological, and cultural differences, all of these countries have shifted responsibility for social provision back and forth between central and local governments in similar ways throughout the three eras delineated in this analysis. Clearly, devolution characterizes the current social policy climate in these three countries and across many Western democracies. Recent trends in the environment such as privatization, mandatory collaboration, community capacity building, and service integration are identified, and process questions are presented as a guide for practitioners who seek to explore the current devolution reality.

A case study examination of structure and function in a state health department chronic disease unit.

PubMed

Alongi, Jeanne

2015-04-01

I explored the structural and operational practices of the chronic disease prevention and control unit of a state health department and proposed a conceptual model of structure, function, and effectiveness for future study. My exploratory case study examined 7 elements of organizational structure and practice. My interviews with staff and external stakeholders of a single chronic disease unit yielded quantitative and qualitative data that I coded by perspective, process, relationship, and activity. I analyzed these for patterns and emerging themes. Chi-square analysis revealed significant correlations among collaboration with goal ambiguity, political support, and responsiveness, and evidence-based decisions with goal ambiguity and responsiveness. Although my study design did not permit conclusions about causality, my findings suggested that some elements of the model might facilitate effectiveness for chronic disease units and should be studied further. My findings might have important implications for identifying levers around which capacity can be built that may strengthen effectiveness.

Piloting Medication Histories in a Pediatric Postanesthesia Care Unit.

PubMed

Lake, Nathan; Nawer, Humaira; Wagner, Deborah

2018-05-18

Develop a medication history process for pediatric postanesthesia care unit (PACU) patients to identify discrepancies between home and inpatient medications and prevent medication errors. Pilot an evidence-based practice change to perform PACU medication histories. Inpatients or surgical admissions to general care units at a pediatric tertiary care 348-bed hospital ages 2-18 years were included. Parents/guardians were asked about their child's prescription and over-the-counter medications, allergies, and adherence. Data included patient age, surgery, medication categories, and error classifications. Information was compared to the patient's medical record. From June to July 2016, 75 medication histories were performed, covering 44.6% of eligible cases within the period. Seventy-four discrepancies were found, the most frequent being omission. The medication category with the most errors was vitamins/herbals/supplements. The workflow designed assessed discrepancy frequency and type in surgical patients' medication lists when transitioning from the PACU to general care units. Copyright © 2018 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

A Case Study Examination of Structure and Function in a State Health Department Chronic Disease Unit

PubMed Central

2015-01-01

Objectives. I explored the structural and operational practices of the chronic disease prevention and control unit of a state health department and proposed a conceptual model of structure, function, and effectiveness for future study. Methods. My exploratory case study examined 7 elements of organizational structure and practice. My interviews with staff and external stakeholders of a single chronic disease unit yielded quantitative and qualitative data that I coded by perspective, process, relationship, and activity. I analyzed these for patterns and emerging themes. Results. Chi-square analysis revealed significant correlations among collaboration with goal ambiguity, political support, and responsiveness, and evidence-based decisions with goal ambiguity and responsiveness. Conclusions. Although my study design did not permit conclusions about causality, my findings suggested that some elements of the model might facilitate effectiveness for chronic disease units and should be studied further. My findings might have important implications for identifying levers around which capacity can be built that may strengthen effectiveness. PMID:25689211

A survey-based benchmarking approach for health care using the Baldrige quality criteria.

PubMed

Jennings, K; Westfall, F

1994-09-01

Since 1988, manufacturing and service industries have been using the Malcolm Baldrige National Quality Award to assess their management processes (for example, leadership, information, and analysis) against critical performance criteria. Recognizing that the typical Baldrige assessment is time intensive and dependent on intensive training, The Pacer Group, a consulting firm in Dayton, Ohio, developed a self-assessment tool based on the Baldrige criteria which provides a snapshot assessment of an organization's management practices. The survey was administered at 25 hospitals within a health care system. Hospitals were able to compare their scores with other hospitals in the system, as well as the scores of a Baldrige award winner. Results were also analyzed on a systemwide basis to identify strengths and weaknesses across the system. For all 25 hospitals, the following areas were identified as strengths: management of process quality, leadership, and customer focus and satisfaction. Weaknesses included lack of employee involvement in the quality planning process, poor design of quality systems, and lack of cross-departmental cooperation. One of the surveyed hospitals launched improvement initiatives in knowledge of improvement tools and methods and in a patient satisfaction focus. A team was formed to improve the human resource management system. Also, a new unit was designed using patient-centered care principles. A team re-evaluated every operation that affected patients on the unit. A survey modeled after the Baldrige Award criteria can be useful in benchmarking an organization's quality improvement practices.

Are NCAA Division I Athletes Prepared for End-of-Athletic-Career Transition? A Literature Review.

PubMed

Miller, Lauren; Buttell, Frederick P

2018-01-01

This review focuses on research that specifically highlights the constructs, paradigms, and factors that impact the end-of-athletic-career transition. However, the majority of the research conducted around this topic is established outside of the United States and regarding professional athletes. The National Collegiate Athletic Association (NCAA) is one of the most dominant athletic institutions in the world, and arguably transitions the most end-of-athletic-career athletes per year, and minimal research exists on this specific collegiate athletic population. The purpose of this review is to review the existent literature on this topic and highlight the leading research and components impacting athletes during the end-of-athletic-career transition in order to inform future research and practices with the college athletics population. This review utilizes a Client Oriented Practical Evidence Search question as an Evidence Based Practice approach to guide the literature search and literature review process while identifying the leading research contributing to end-of-athletic-career transition. Following rigorous search criteria, a total of 14 articles were included in the literature review. The selected articles identified central constructs impacting the athletic career transition process, including retirement planning, identity loss, coping skills, and support systems. Additional research is warranted in the United States, particularly with the NCAA collegiate athletes in order to better understand the end-of-athletic-career transition process, as well as instituting interventions to increase resilience in college senior NCAA athletes transitioning out of sport.

Boiling process modelling peculiarities analysis of the vacuum boiler

NASA Astrophysics Data System (ADS)

Slobodina, E. N.; Mikhailov, A. G.

2017-06-01

The analysis of the low and medium powered boiler equipment development was carried out, boiler units possible development directions with the purpose of energy efficiency improvement were identified. Engineering studies for the vacuum boilers applying are represented. Vacuum boiler heat-exchange processes where boiling water is the working body are considered. Heat-exchange intensification method under boiling at the maximum heat- transfer coefficient is examined. As a result of the conducted calculation studies, heat-transfer coefficients variation curves depending on the pressure, calculated through the analytical and numerical methodologies were obtained. The conclusion about the possibility of numerical computing method application through RPI ANSYS CFX for the boiling process description in boiler vacuum volume was given.

Technical Standards for Command and Control Information Systems (CCISs) and Information Technology

DTIC Science & Technology

1994-02-01

formatting, transmitting, receiving, and processing imagery and imagery-related information. The N1TFS is in essence the suite of individual standards...also known as Limited Operational Capability-Europe) and the German Joint Analysis System Military Intelligence ( JASMIN ). Among the approaches being... essence , the other systems utilize a one-level address space where addressing consists of identifying the fire support unit. However, AFATDS utilizes a two

Faculty-Specific Factors of Degree of HE Internationalization: An Evaluation of Four Faculties of a Post-1992 University in the United Kingdom

ERIC Educational Resources Information Center

Jiang, Nan; Carpenter, Victoria

2013-01-01

Purpose: The purpose of this paper is to investigate the difference in the process of higher education (HE) internationalization across faculties in a post-1992 university and to identify faculty-specific factors through evaluating the four faculties in the case study. Design/methodology/approach: A qualitative research is conducted in a post-1992…

NEMS Freight Transportation Module Improvement Study

EIA Publications

2015-01-01

The U.S. Energy Information Administration (EIA) contracted with IHS Global, Inc. (IHS) to analyze the relationship between the value of industrial output, physical output, and freight movement in the United States for use in updating analytic assumptions and modeling structure within the National Energy Modeling System (NEMS) freight transportation module, including forecasting methodologies and processes to identify possible alternative approaches that would improve multi-modal freight flow and fuel consumption estimation.

Legal, Institutional, and Economic Indicators of Forest Conservation and Sustainable Management: Review of Information Available for the United States

Treesearch

Paul V. Ellefson; Calder M. Hibbard; Michael A. Kilgore; James E. Granskog

2005-01-01

This review looks at the Nation’s legal, institutional, and economic capacity to promote forest conservation and sustainable resource management. It focuses on 20 indicators of Criterion Seven of the so-called Montreal Process and involves an extensive search and synthesis of information from a variety of sources. It identifies ways to fill information gaps and improve...

Installation Restoration Program (IRP). Operable Unit B1 Remedial Investigation/Feasibility Study

DTIC Science & Technology

1993-07-01

Alternative Evaluation Criteria ......................... 8-2 8-2 Remedial Alternative Evaluation Criteria Rating System ................ 8-3 8-3...ies, various technologies and process options relative numerical rating system was developed were identified and screened on the basis of (see Table 8-2...extensive paving and PCBs were found (north/central ditch). This storm drainage system , and because of the ditch was paved with asphalt in 1981; before

Market Analysis and Material Evaluation of Coagulants for Reverse Osmosis Water Purification Units

DTIC Science & Technology

1990-09-28

three identified primary coagulants. Electrocoagulation , an emerging technology, was also discovered as being a relatively new area of research with great...there is yet another avenue the Army needs to explore -- electrocoagulation . 4.3.2 Electrocoagulation | * Electrocoagulation processes utilize an...7). A typical electrocoagulator consists of a combination of a treating chamber, which operates as an electrolytic cell, with a water-inlet and a

Contingency plans for chromium utilization. Publication NMAB-335

NASA Technical Reports Server (NTRS)

1978-01-01

The United States depends entirely on foreign sources for the critical material, chromium, making it very vulnerable to supply disruptions. The effectiveness of programs such as stockpiling, conservation, and research and development for substitutes to reduce the impact of disruption of imports of chromite and ferrochromium are discussed. Alternatives for decreasing chromium consumption also are identified for chromium-containing materials in the areas of design, processing, and substitution.

Development of a pest risk analysis for Phytophthora ramorum for the European Union; the key deliverable from the EU-Funded project RAPRA

Treesearch

Claire Sansford; Alan Inman; Joan Webber

2010-01-01

Pest Risk Analysis (PRA) is an internationally recognized, structured process of determining whether plant pests and pathogens that are absent from a country or area could enter, establish, and cause an economic or environmental risk that is deemed unacceptable. PRA is also used to help identify phytosanitary measures to reduce risks to an acceptable level. United...

Metabolomics by Gas Chromatography-Mass Spectrometry: the combination of targeted and untargeted profiling

PubMed Central

Fiehn, Oliver

2016-01-01

Gas chromatography-mass spectrometry (GC-MS)-based metabolomics is ideal for identifying and quantitating small molecular metabolites (<650 daltons), including small acids, alcohols, hydroxyl acids, amino acids, sugars, fatty acids, sterols, catecholamines, drugs, and toxins, often using chemical derivatization to make these compounds volatile enough for gas chromatography. This unit shows that on GC-MS- based metabolomics easily allows integrating targeted assays for absolute quantification of specific metabolites with untargeted metabolomics to discover novel compounds. Complemented by database annotations using large spectral libraries and validated, standardized standard operating procedures, GC-MS can identify and semi-quantify over 200 compounds per study in human body fluids (e.g., plasma, urine or stool) samples. Deconvolution software enables detection of more than 300 additional unidentified signals that can be annotated through accurate mass instruments with appropriate data processing workflows, similar to liquid chromatography-MS untargeted profiling (LC-MS). Hence, GC-MS is a mature technology that not only uses classic detectors (‘quadrupole’) but also target mass spectrometers (‘triple quadrupole’) and accurate mass instruments (‘quadrupole-time of flight’). This unit covers the following aspects of GC-MS-based metabolomics: (i) sample preparation from mammalian samples, (ii) acquisition of data, (iii) quality control, and (iv) data processing. PMID:27038389

Modeling of selected ceramic processing parameters employed in the fabrication of 238PuO 2 fuel pellets

DOE PAGES

Brockman, R. A.; Kramer, D. P.; Barklay, C. D.; ...

2011-10-01

Recent deep space missions utilize the thermal output of the radioisotope plutonium-238 as the fuel in the thermal to electrical power system. Since the application of plutonium in its elemental state has several disadvantages, the fuel employed in these deep space power systems is typically in the oxide form such as plutonium-238 dioxide ( 238PuO 2). As an oxide, the processing of the plutonium dioxide into fuel pellets is performed via ''classical'' ceramic processing unit operations such as sieving of the powder, pressing, sintering, etc. Modeling of these unit operations can be beneficial in the understanding and control of processingmore » parameters with the goal of further enhancing the desired characteristics of the 238PuO 2 fuel pellets. A finite element model has been used to help identify the time-temperature-stress profile within a pellet during a furnace operation taking into account that 238PuO 2 itself has a significant thermal output. The results of the modeling efforts will be discussed.« less

Grand Junction projects office mixed-waste treatment program, VAC*TRAX mobile treatment unit process hazards analysis

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

Bloom, R.R.

1996-04-01

The objective of this report is to demonstrate that a thorough assessment of the risks associated with the operation of the Rust Geotech patented VAC*TRAX mobile treatment unit (MTU) has been performed and documented. The MTU was developed to treat mixed wastes at the US Department of Energy (DOE) Albuquerque Operations Office sites. The MTU uses an indirectly heated, batch vacuum dryer to thermally desorb organic compounds from mixed wastes. This process hazards analysis evaluated 102 potential hazards. The three significant hazards identified involved the inclusion of oxygen in a process that also included an ignition source and fuel. Changesmore » to the design of the MTU were made concurrent with the hazard identification and analysis; all hazards with initial risk rankings of 1 or 2 were reduced to acceptable risk rankings of 3 or 4. The overall risk to any population group from operation of the MTU was determined to be very low; the MTU is classified as a Radiological Facility with low hazards.« less

Recommendations on basic requirements for intensive care units: structural and organizational aspects.

PubMed

Valentin, Andreas; Ferdinande, Patrick

2011-10-01

To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine. The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine (ESICM) identified the basic requirements for ICUs by a comprehensive literature search and an iterative process with several rounds of consensus finding with the participation of 47 intensive care physicians from 23 countries. The starting point of this process was an ESICM recommendation published in 1997 with the need for an updated version. The document consists of operational guidelines and design recommendations for ICUs. In the first part it covers the definition and objectives of an ICU, functional criteria, activity criteria, and the management of equipment. The second part deals with recommendations with respect to the planning process, floorplan and connections, accommodation, fire safety, central services, and the necessary communication systems. This document provides a detailed framework for the planning or renovation of ICUs based on a multinational consensus within the ESICM.

LANDSAT non-US standard catalog, 1 May 1977 - 31 May 1977

NASA Technical Reports Server (NTRS)

1977-01-01

Information regarding the availability of LANDSAT imagery processed and input to the data files by the NASA Data Processing Facility is published on a monthly basis. The U.S. Standard Catalog includes imagery covering the continental United States, Alaska and Hawaii. the Non-U.S. Standard Catalog identifies all the remaining coverage. Sections 1 and 2 describe the contents and format for the catalogs and associated microfilm. Section 3 provides a cross-reference defining the beginning and ending dates for LANDSAT cycles. Sections 4 and 5 cover LANDSAT-1 and LANDSAT-2 coverage, respectively.

Federal Employees Health Benefits Program: Removal of Eligible and Ineligible Individuals From Existing Enrollments. Final rule.

PubMed

2018-01-23

The United States Office of Personnel Management (OPM) is issuing a final rule amending Federal Employees Health Benefits (FEHB) Program regulations to provide a process for removal of certain identified individuals who are found not to be eligible as family members from FEHB enrollments. This process would apply to individuals for whom there is a failure to provide adequate documentation of eligibility when requested. This action also amends Federal Employees Health Benefits (FEHB) Program regulations to allow certain eligible family members to be removed from existing self and family or self plus one enrollments.

Electronic manufacturing and packaging in Japan

NASA Technical Reports Server (NTRS)

Kelly, Michael J.; Boulton, William R. (Editor); Kukowski, John A.; Meieran, Eugene S.; Pecht, Michael; Peeples, John W.; Tummala, Rao R.

1995-01-01

This report summarizes the status of electronic manufacturing and packaging technology in Japan in comparison to that in the United States, and its impact on competition in electronic manufacturing in general. In addition to electronic manufacturing technologies, the report covers technology and manufacturing infrastructure, electronics manufacturing and assembly, quality assurance and reliability in the Japanese electronics industry, and successful product realization strategies. The panel found that Japan leads the United States in almost every electronics packaging technology. Japan clearly has achieved a strategic advantage in electronics production and process technologies. Panel members believe that Japanese competitors could be leading U.S. firms by as much as a decade in some electronics process technologies. Japan has established this marked competitive advantage in electronics as a consequence of developing low-cost, high-volume consumer products. Japan's infrastructure, and the remarkable cohesiveness of vision and purpose in government and industry, are key factors in the success of Japan's electronics industry. Although Japan will continue to dominate consumer electronics in the foreseeable future, opportunities exist for the United States and other industrial countries to capture an increasingly large part of the market. The JTEC panel has identified no insurmountable barriers that would prevent the United States from regaining a significant share of the consumer electronics market; in fact, there is ample evidence that the United States needs to aggressively pursue high-volume, low-cost electronic assembly, because it is a critical path leading to high-performance electronic systems.

Processing device with self-scrubbing logic

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

Wojahn, Christopher K.

An apparatus includes a processing unit including a configuration memory and self-scrubber logic coupled to read the configuration memory to detect compromised data stored in the configuration memory. The apparatus also includes a watchdog unit external to the processing unit and coupled to the self-scrubber logic to detect a failure in the self-scrubber logic. The watchdog unit is coupled to the processing unit to selectively reset the processing unit in response to detecting the failure in the self-scrubber logic. The apparatus also includes an external memory external to the processing unit and coupled to send configuration data to the configurationmore » memory in response to a data feed signal outputted by the self-scrubber logic.« less

Experiencing organ donation: feelings of relatives after consent1

PubMed Central

Fernandes, Marli Elisa Nascimento; Bittencourt, Zélia Zilda Lourenço de Camargo; Boin, Ilka de Fátima Santana Ferreira

2015-01-01

Objective: to identify experiences and feelings on the organ donation process, from the perspective of a relative of an organ donor in a transplant unit. Method: this was exploratory research using a qualitative approach, performed with seven family members of different organ donors, selected by a lottery. Sociodemographic data and the experiences regarding the donation process were collected through semi-structured interviews. The language material was transcribed and submitted to content analysis. Results: poor sensitivity of the medical staff communicating the relative's brain death - the potential donor - and the lack of socio-emotional support prior to the situation experienced by the family was highlighted by participants. Conclusions: the study identified the need to provide social-emotional support for families facing the experience of the organ donation process. From these findings, other care and management practices in health must be discussed to impact the strengthening of the family ties, post-donation, as well as the organ procurement indexes. PMID:26487140

Thinking in clinical nursing practice: a study of critical care nurses' thinking applying the think-aloud, protocol analysis method.

PubMed

Han, Kyung-Ja; Kim, Hesook Suzie; Kim, Mae-Ja; Hong, Kyung-Ja; Park, Sungae; Yun, Soon-Nyoung; Song, Misoon; Jung, Yoenyi; Kim, Haewon; Kim, Dong-Oak Debbie; Choi, Heejung; Kim, Kyungae

2007-06-01

The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice. A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis. Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities. This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.

Evaluation of the quality of the teaching-learning process in undergraduate courses in Nursing 1

PubMed Central

González-Chordá, Víctor Manuel; Maciá-Soler, María Loreto

2015-01-01

Abstract Objective: to identify aspects of improvement of the quality of the teaching-learning process through the analysis of tools that evaluated the acquisition of skills by undergraduate students of Nursing. Method: prospective longitudinal study conducted in a population of 60 secondyear Nursing students based on registration data, from which quality indicators that evaluate the acquisition of skills were obtained, with descriptive and inferential analysis. Results: nine items were identified and nine learning activities included in the assessment tools that did not reach the established quality indicators (p<0.05). There are statistically significant differences depending on the hospital and clinical practices unit (p<0.05). Conclusion: the analysis of the evaluation tools used in the article "Nursing Care in Welfare Processes" of the analyzed university undergraduate course enabled the detection of the areas for improvement in the teachinglearning process. The challenge of education in nursing is to reach the best clinical research and educational results, in order to provide improvements to the quality of education and health care. PMID:26444173

Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children.

PubMed

Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Stinson, Jennifer; Harrison, Denise; Victor, J Charles

2014-11-25

Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation. Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period. Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies. Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

In vivo imaging of the neurovascular unit in CNS disease

PubMed Central

Merlini, Mario; Davalos, Dimitrios; Akassoglou, Katerina

2014-01-01

The neurovascular unit—comprised of glia, pericytes, neurons and cerebrovasculature—is a dynamic interface that ensures physiological central nervous system (CNS) functioning. In disease dynamic remodeling of the neurovascular interface triggers a cascade of responses that determine the extent of CNS degeneration and repair. The dynamics of these processes can be adequately captured by imaging in vivo, which allows the study of cellular responses to environmental stimuli and cell-cell interactions in the living brain in real time. This perspective focuses on intravital imaging studies of the neurovascular unit in stroke, multiple sclerosis (MS) and Alzheimer disease (AD) models and discusses their potential for identifying novel therapeutic targets. PMID:25197615

A behavioral science/behavioral medicine core curriculum proposal for Japanese undergraduate medical education.

PubMed

Tsutsumi, Akizumi

2015-01-01

Behavioral science and behavioral medicine have not been systematically taught to Japanese undergraduate medical students. A working group under the auspices of Japanese Society of Behavioral Medicine developed an outcome-oriented curriculum of behavioral science/behavioral medicine through three processes: identifying the curriculum contents, holding a joint symposium with related societies, and defining outcomes and proposing a learning module. The behavioral science/behavioral medicine core curriculum consists of 11 units of lectures and four units of practical study. The working group plans to improve the current core curriculum by devising formative assessment methods so that students can learn and acquire attitude as well as the skills and knowledge necessary for student-centered clinical practice.

[Stress in the nursing team of an emergency medical service].

PubMed

Panizzon, Cristiane; Luz, Anna Maria Hecker; Fensterseifer, Lísia Maria

2008-09-01

This exploratory study aimed at determining stress levels and stressors, verifying the association between stress and studied variables, and identifying the predictive stress factors in an emergency nursing team. Data were collected using a social-demographic questionnaire and a scale of labor pressure sources applied with 98 workers. Chi-square test and Spearman correlation test results showed a high stress level, and identified work load as the main stressor. All pressure sources at work had a positive significant correlation with stress leve, and the following predictors were identified: work load, problems related to the client, and organizational processes and structure. The results indicate the need of management changes in the emergency unit in order to reduce the stress of the nursing team.

Mapping barriers and intervention activities to behaviour change theory for Mobilization of Vulnerable Elders in Ontario (MOVE ON), a multi-site implementation intervention in acute care hospitals.

PubMed

Moore, Julia E; Mascarenhas, Alekhya; Marquez, Christine; Almaawiy, Ummukulthum; Chan, Wai-Hin; D'Souza, Jennifer; Liu, Barbara; Straus, Sharon E

2014-10-30

As evidence-informed implementation interventions spread, they need to be tailored to address the unique needs of each setting, and this process should be well documented to facilitate replication. To facilitate the spread of the Mobilization of Vulnerable Elders in Ontario (MOVE ON) intervention, the aim of the current study is to develop a mapping guide that links identified barriers and intervention activities to behaviour change theory. Focus groups were conducted with front line health-care professionals to identify perceived barriers to implementation of an early mobilization intervention targeted to hospitalized older adults. Participating units then used or adapted intervention activities from an existing menu or developed new activities to facilitate early mobilization. A thematic analysis was performed on the focus group data, emphasizing concepts related to barriers to behaviour change. A behaviour change theory, the 'capability, opportunity, motivation-behaviour (COM-B) system', was used as a taxonomy to map the identified barriers to their root causes. We also mapped the behaviour constructs and intervention activities to overcome these. A total of 46 focus groups were conducted across 26 hospital inpatient units in Ontario, Canada, with 261 participants. The barriers were conceptualized at three levels: health-care provider (HCP), patient, and unit. Commonly mentioned barriers were time constraints and workload (HCP), patient clinical acuity and their perceived 'sick role' (patient), and lack of proper equipment and human resources (unit level). Thirty intervention activities to facilitate early mobilization of older adults were implemented across hospitals; examples of unit-developed intervention activities include the 'mobility clock' communication tool and the use of staff champions. A mapping guide was created with barriers and intervention activities matched though the lens of the COM-B system. We used a systematic approach to develop a guide, which maps barriers, intervention activities, and behaviour change constructs in order to tailor an implementation intervention to the local context. This approach allows implementers to identify potential strategies to overcome local-level barriers and to document adaptations.

Seeking Humanizing Care in Patient-Centered Care Process: A Grounded Theory Study.

PubMed

Cheraghi, Mohammad Ali; Esmaeili, Maryam; Salsali, Mahvash

Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

Planet Four: Terrains - Discovery of araneiforms outside of the South Polar layered deposits

NASA Astrophysics Data System (ADS)

Schwamb, Megan E.; Aye, Klaus-Michael; Portyankina, Ganna; Hansen, Candice J.; Allen, Campbell; Allen, Sarah; Calef, Fred J.; Duca, Simone; McMaster, Adam; Miller, Grant R. M.

2018-07-01

We present the results of a systematic mapping of seasonally sculpted terrains on the South Polar region of Mars with the Planet Four: Terrains (P4T) online citizen science project. P4T enlists members of the general public to visually identify features in the publicly released Mars Reconnaissance Orbiter Context Camera (CTX) images. In particular, P4T volunteers are asked to identify: (1) araneiforms (including features with a central pit and radiating channels known as 'spiders'); (2) erosional depressions, troughs, mesas, ridges, and quasi-circular pits characteristic of the South Polar Residual Cap (SPRC) which we collectively refer to as 'Swiss cheese terrain', and (3) craters. In this work we present the distributions of our high confidence classic spider araneiforms and Swiss cheese terrain identifications in 90 CTX images covering 11% of the South polar regions at latitudes ≤ -75° N. We find no locations within our high confidence spider sample that also have confident Swiss cheese terrain identifications. Previously spiders were reported as being confined to the South Polar Layered Deposits (SPLD). Our work has provided the first identification of spiders at locations outside of the SPLD, confirmed with high resolution HiRISE (High Resolution Imaging Science Experiment) imaging. We find araneiforms on the Amazonian and Hesperian polar units and the Early Noachian highland units, with 75% of the identified araneiform locations in our high confidence sample residing on the SPLD. With our current coverage, we cannot confirm whether these are the only geologic units conducive to araneiform formation on the Martian South Polar region. Our results are consistent with the current CO2 jet formation scenario with the process exploiting weaknesses in the surface below the seasonal CO2 ice sheet to carve araneiform channels into the regolith over many seasons. These new regions serve as additional probes of the conditions required for channel creation in the CO2 jet process.

Model-Based Sensor Placement for Component Condition Monitoring and Fault Diagnosis in Fossil Energy Systems

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

Mobed, Parham; Pednekar, Pratik; Bhattacharyya, Debangsu

Design and operation of energy producing, near “zero-emission” coal plants has become a national imperative. This report on model-based sensor placement describes a transformative two-tier approach to identify the optimum placement, number, and type of sensors for condition monitoring and fault diagnosis in fossil energy system operations. The algorithms are tested on a high fidelity model of the integrated gasification combined cycle (IGCC) plant. For a condition monitoring network, whether equipment should be considered at a unit level or a systems level depends upon the criticality of the process equipment, its likeliness to fail, and the level of resolution desiredmore » for any specific failure. Because of the presence of a high fidelity model at the unit level, a sensor network can be designed to monitor the spatial profile of the states and estimate fault severity levels. In an IGCC plant, besides the gasifier, the sour water gas shift (WGS) reactor plays an important role. In view of this, condition monitoring of the sour WGS reactor is considered at the unit level, while a detailed plant-wide model of gasification island, including sour WGS reactor and the Selexol process, is considered for fault diagnosis at the system-level. Finally, the developed algorithms unify the two levels and identifies an optimal sensor network that maximizes the effectiveness of the overall system-level fault diagnosis and component-level condition monitoring. This work could have a major impact on the design and operation of future fossil energy plants, particularly at the grassroots level where the sensor network is yet to be identified. In addition, the same algorithms developed in this report can be further enhanced to be used in retrofits, where the objectives could be upgrade (addition of more sensors) and relocation of existing sensors.« less

Nurse manager perspective of staff participation in unit level shared governance.

PubMed

Cox Sullivan, Sheila; Norris, Mitzi R; Brown, Lana M; Scott, Karen J

2017-11-01

To examine the nurse manager perspective surrounding implementation of unit level shared governance in one Veterans Health Administration facility. Nursing shared governance is a formal model allowing nursing staff decision-making input into clinical practice, quality improvement, evidence-based practice and staff professional development. Unit level shared governance is a management process where decision authority is delegated to nursing staff at the unit level. Convenience sampling was used to recruit ten nurse managers who participated in face-to-face semi-structured interviews. Data were analysed using content analysis and constant comparison techniques. Demographic data were described using descriptive statistics. The participants included seven female and three male nurse managers with seven Caucasian and three African American. Participant quotes were clustered to identify sub-themes that were then grouped into four global themes to describe unit level shared governance. The global themes were: (1) motivation, (2) demotivation, (3) recommendations for success, and (4) outcomes. These research findings resonate with previous studies that shared governance may be associated with increased nurse empowerment, self-management, engagement, and satisfaction. These findings reflect the need for nurse managers to promote and recognize staff participation in unit level shared governance. © 2017 John Wiley & Sons Ltd.

Risk of transmission of bovine spongiform encephalopathy to humans in the United States: report of the Council on Scientific Affairs. American Medical Association.

PubMed

Tan, L; Williams, M A; Khan, M K; Champion, H C; Nielsen, N H

The risk of possible transmission of bovine spongiform encephalopathy (BSE) in the United States is a substantial public health concern. To systematically review the current scientific literature and discuss legislation and regulations that have been implemented to prevent the disease. Literature review using the MEDLINE, EMBASE, and Lexis/Nexis databases for 1975 through 1997 on the terms bovine spongiform encephalopathy, prion diseases, prions, and Creutzfeldt-Jakob syndrome. The Internet was used to identify regulatory actions and health surveillance. MEDLINE, EMBASE, and Lexis/Nexis databases were searched from 1975 through 1997 for English-language articles that provided information on assessment of transmission risk. Unique circumstances in the United Kingdom caused the emergence and propagation of BSE in cattle, including widespread use of meat and bonemeal cattle feed derived from scrapie-infected sheep and the adoption of a new type of processing that did not reduce the amount of infectious prions prior to feeding. Many of these circumstances do not exist in the United States. In the United Kingdom, new variant Creutzfeldt-Jakob disease probably resulted from the ingestion of BSE-contaminated processed beef. The United Kingdom and the European Union now have strong regulations in place to stop the spread of BSE. While BSE has not been observed in the United States, the US government has surveillance and response plans in effect. Current risk of transmission of BSE in the United States is minimal because (1) BSE has not been shown to exist in this country; (2) adequate regulations exist to prevent entry of foreign sources of BSE into the United States; (3) adequate regulations exist to prevent undetected cases of BSE from uncontrolled amplification within the US cattle population; and (4) adequate preventive guidelines exist to prevent high-risk bovine materials from contaminating products intended for human consumption.

The application of hazard analysis and critical control points and risk management in the preparation of anti-cancer drugs.

PubMed

Bonan, Brigitte; Martelli, Nicolas; Berhoune, Malik; Maestroni, Marie-Laure; Havard, Laurent; Prognon, Patrice

2009-02-01

To apply the Hazard analysis and Critical Control Points method to the preparation of anti-cancer drugs. To identify critical control points in our cancer chemotherapy process and to propose control measures and corrective actions to manage these processes. The Hazard Analysis and Critical Control Points application began in January 2004 in our centralized chemotherapy compounding unit. From October 2004 to August 2005, monitoring of the process nonconformities was performed to assess the method. According to the Hazard Analysis and Critical Control Points method, a multidisciplinary team was formed to describe and assess the cancer chemotherapy process. This team listed all of the critical points and calculated their risk indexes according to their frequency of occurrence, their severity and their detectability. The team defined monitoring, control measures and corrective actions for each identified risk. Finally, over a 10-month period, pharmacists reported each non-conformity of the process in a follow-up document. Our team described 11 steps in the cancer chemotherapy process. The team identified 39 critical control points, including 11 of higher importance with a high-risk index. Over 10 months, 16,647 preparations were performed; 1225 nonconformities were reported during this same period. The Hazard Analysis and Critical Control Points method is relevant when it is used to target a specific process such as the preparation of anti-cancer drugs. This method helped us to focus on the production steps, which can have a critical influence on product quality, and led us to improve our process.

Achieving organizational change in pediatric pain management

PubMed Central

Dowden, Stephanie; McCarthy, Maria; Chalkiadis, George

2008-01-01

BACKGROUND: Pain in hospitalized children is often under-treated. Little information exists to guide the process of organizational change with a view to improving pain management practices. OBJECTIVES: To describe the process and results of a hospital-wide review of pain management practices designed to identify deficiencies in service provision and recommend directions for change in a pediatric hospital. DESIGN: Prospective consultation of the clinical staff of a specialist pediatric hospital, using qualitative research methodology involving semistructured individual and group interviews. Recommendations based on the interview findings were made by a hospital-appointed working party. RESULTS: A total of 454 staff (27% of all clinical staff) from a variety of professional backgrounds, representing almost every hospital unit or department, were interviewed. Procedural and persistent (chronic) pain was identified as the area needing the most improvement. Barriers to improving pain management included variability in practice, outmoded beliefs and inadequate knowledge, factors which were seen to contribute to a culture of slow or no change. Recommendations of the working party and changes achieved after the review are described. CONCLUSION: The review process identified deficiencies in the management of pain in children, and barriers to its effective management. With institutional support, the present review has guided improvement. PMID:18719714

Dynamic conservation of forest genetic resources in 33 European countries.

PubMed

Lefèvre, François; Koskela, Jarkko; Hubert, Jason; Kraigher, Hojka; Longauer, Roman; Olrik, Ditte C; Schüler, Silvio; Bozzano, Michele; Alizoti, Paraskevi; Bakys, Remigijus; Baldwin, Cathleen; Ballian, Dalibor; Black-Samuelsson, Sanna; Bednarova, Dagmar; Bordács, Sándor; Collin, Eric; de Cuyper, Bart; de Vries, Sven M G; Eysteinsson, Thröstur; Frýdl, Josef; Haverkamp, Michaela; Ivankovic, Mladen; Konrad, Heino; Koziol, Czesław; Maaten, Tiit; Notivol Paino, Eduardo; Oztürk, Hikmet; Pandeva, Ivanova Denitsa; Parnuta, Gheorghe; Pilipovič, Andrej; Postolache, Dragos; Ryan, Cathal; Steffenrem, Arne; Varela, Maria Carolina; Vessella, Federico; Volosyanchuk, Roman T; Westergren, Marjana; Wolter, Frank; Yrjänä, Leena; Zariŋa, Inga

2013-04-01

Dynamic conservation of forest genetic resources (FGR) means maintaining the genetic diversity of trees within an evolutionary process and allowing generation turnover in the forest. We assessed the network of forests areas managed for the dynamic conservation of FGR (conservation units) across Europe (33 countries). On the basis of information available in the European Information System on FGR (EUFGIS Portal), species distribution maps, and environmental stratification of the continent, we developed ecogeographic indicators, a marginality index, and demographic indicators to assess and monitor forest conservation efforts. The pan-European network has 1967 conservation units, 2737 populations of target trees, and 86 species of target trees. We detected a poor coincidence between FGR conservation and other biodiversity conservation objectives within this network. We identified 2 complementary strategies: a species-oriented strategy in which national conservation networks are specifically designed for key target species and a site-oriented strategy in which multiple-target units include so-called secondary species conserved within a few sites. The network is highly unbalanced in terms of species representation, and 7 key target species are conserved in 60% of the conservation units. We performed specific gap analyses for 11 tree species, including assessment of ecogeographic, demographic, and genetic criteria. For each species, we identified gaps, particularly in the marginal parts of their distribution range, and found multiple redundant conservation units in other areas. The Mediterranean forests and to a lesser extent the boreal forests are underrepresented. Monitoring the conservation efficiency of each unit remains challenging; however, <2% of the conserved populations seem to be at risk of extinction. On the basis of our results, we recommend combining species-oriented and site-oriented strategies. © 2012 Society for Conservation Biology.

Family needs and involvement in the intensive care unit: a literature review.

PubMed

Al-Mutair, Abbas Saleh; Plummer, Virginia; O'Brien, Anthony; Clerehan, Rosemary

2013-07-01

To understand the needs of critically ill patient families', seeking to meet those needs and explore the process and patterns of involving family members during routine care and resuscitation and other invasive procedures. A structured literature review using Cumulative Index to Nursing and Allied Health Literature, Pubmed, Proquest, Google scholar, Meditext database and a hand search of critical care journals via identified search terms for relevant articles published between 2000 and 2010. Thirty studies were included in the review either undertaken in the Intensive Care Unit or conducted with critical care staff using different methods of inquiry. The studies were related to family needs; family involvement in routine care; and family involvement during resuscitation and other invasive procedures. The studies revealed that family members ranked both the need for assurance and the need for information as the most important. They also perceived their important needs as being unmet, and identified the nurses as the best staff to meet these needs, followed by the doctors. The studies demonstrate that both family members and healthcare providers have positive attitudes towards family involvement in routine care. However, family members and healthcare providers had significantly different views of family involvement during resuscitation and other invasive procedures. Meeting Intensive Care Unit family needs can be achieved by supporting and involving families in the care of the critically ill family member. More emphasis should be placed on identifying the family needs in relation to the influence of cultural values and religion held by the family members and the organisational climate and culture of the working area in the Intensive Care Unit. © 2013 Blackwell Publishing Ltd.

Developing nursing research in the United Arab Emirates: a narrative review.

PubMed

McCreaddie, M; Kuzemski, D; Griffiths, J; Sojka, E M; Fielding, M; Al Yateem, N; Williams, J J

2018-03-01

This article identified, critically analysed and synthesized the literature on international nursing and midwifery research capacity building and standards. The United Arab Emirates is heavily dependent up on expatriate nurses. Only 4% of nurses working within the country are Emirati. The nation is therefore committed to developing nurses and nursing as a profession. The United Arab Emirates' Nursing and Midwifery Council was formed in 2009 and initially focused on regulation, education and specialization. This review was undertaken to inform the work of the Council's newly established Scientific Research Sub-Committee. A rapid narrative review was conducted using the Cumulative Index of Nursing and Allied Health Literature database, key words, Boolean operators, parameters and a journal-specific search. An inclusion/exclusion criterion was identified. The search provided 332 articles with 45 included in the final review. The literature on nursing research 'standards' and 'capacity building' is diverse and inconsistent across continents and in approaches. Nursing research has evolved to varying degrees across the globe. Nevertheless, irrespective of the locale, there are similar problems encountered in growing research, for example nursing faculty shortage, lack of collaborative research, funding. There are also specific challenges in the Middle East and North Africa region. The review was constrained by time and access. There are specific challenges for the United Arab Emirates. However, the country is well placed to learn from the experiences of colleagues elsewhere. Time and commitment is required to build the solid foundations necessary to ensure robust, sustained growth. Identifying research capacity as both a process and outcome at the outset may also assist. Further, it may be prudent to consider initiating a Gulf Coast Countries' collaborative approach to building research capacity to harness scare resources and create a larger critical mass. © 2017 International Council of Nurses.

Pharmacogenomic biomarker information in drug labels approved by the United States food and drug administration: prevalence of related drug use.

PubMed

Frueh, Felix W; Amur, Shashi; Mummaneni, Padmaja; Epstein, Robert S; Aubert, Ronald E; DeLuca, Teresa M; Verbrugge, Robert R; Burckart, Gilbert J; Lesko, Lawrence J

2008-08-01

To review the labels of United States Food and Drug Administration (FDA)-approved drugs to identify those that contain pharmacogenomic biomarker information, and to collect prevalence information on the use of those drugs for which pharmacogenomic information is included in the drug labeling. Retrospective analysis. The Physicians' Desk Reference Web site, Drugs@FDA Web site, and manufacturers' Web sites were used to identify drug labels containing pharmacogenomic information, and the prescription claims database of a large pharmacy benefits manager (insuring > 55 million individuals in the United States) was used to obtain drug utilization data. Pharmacogenomic biomarkers were defined, FDA-approved drug labels containing this information were identified, and utilization of these drugs was determined. Of 1200 drug labels reviewed for the years 1945-2005, 121 drug labels contained pharmacogenomic information based on a key word search and follow-up screening. Of those, 69 labels referred to human genomic biomarkers, and 52 referred to microbial genomic biomarkers. Of the labels referring to human biomarkers, 43 (62%) pertained to polymorphisms in cytochrome P450 (CYP) enzyme metabolism, with CYP2D6 being most common. Of 36.1 million patients whose prescriptions were processed by a large pharmacy benefits manager in 2006, about 8.8 million (24.3%) received one or more drugs with human genomic biomarker information in the drug label. Nearly one fourth of all outpatients received one or more drugs that have pharmacogenomic information in the label for that drug. The incorporation and appropriate use of pharmacogenomic information in drug labels should be tested for its ability to improve drug use and safety in the United States.

Habitat Demonstration Unit (HDU) Pressurized Excursion Module (PEM) Systems Integration Strategy

NASA Technical Reports Server (NTRS)

Gill, Tracy; Merbitz, Jerad; Kennedy, Kriss; Tri, Terry; Toups, Larry; Howe, A. Scott

2011-01-01

The Habitat Demonstration Unit (HDU) project team constructed an analog prototype lunar surface laboratory called the Pressurized Excursion Module (PEM). The prototype unit subsystems were integrated in a short amount of time, utilizing a rapid prototyping approach that brought together over 20 habitation-related technologies from a variety of NASA centers. This paper describes the system integration strategies and lessons learned, that allowed the PEM to be brought from paper design to working field prototype using a multi-center team. The system integration process was based on a rapid prototyping approach. Tailored design review and test and integration processes facilitated that approach. The use of collaboration tools including electronic tools as well as documentation enabled a geographically distributed team take a paper concept to an operational prototype in approximately one year. One of the major tools used in the integration strategy was a coordinated effort to accurately model all the subsystems using computer aided design (CAD), so conflicts were identified before physical components came together. A deliberate effort was made following the deployment of the HDU PEM for field operations to collect lessons learned to facilitate process improvement and inform the design of future flight or analog versions of habitat systems. Significant items within those lessons learned were limitations with the CAD integration approach and the impact of shell design on flexibility of placing systems within the HDU shell.

Barriers and enablers to implementing clinical treatment protocols for fever, hyperglycaemia, and swallowing dysfunction in the Quality in Acute Stroke Care (QASC) Project--a mixed methods study.

PubMed

Dale, Simeon; Levi, Christopher; Ward, Jeanette; Grimshaw, Jeremy M; Jammali-Blasi, Asmara; D'Este, Catherine; Griffiths, Rhonda; Quinn, Clare; Evans, Malcolm; Cadilhac, Dominique; Cheung, N Wah; Middleton, Sandy

2015-02-01

The Quality in Acute Stroke Care (QASC) trial evaluated systematic implementation of clinical treatment protocols to manage fever, sugar, and swallow (FeSS protocols) in acute stroke care. This cluster-randomised controlled trial was conducted in 19 stroke units in Australia. To describe perceived barriers and enablers preimplementation to the introduction of the FeSS protocols and, postimplementation, to determine which of these barriers eventuated as actual barriers. Preimplementation: Workshops were held at the intervention stroke units (n = 10). The first workshop involved senior clinicians who identified perceived barriers and enablers to implementation of the protocols, the second workshop involved bedside clinicians. Postimplementation, an online survey with stroke champions from intervention sites was conducted. A total of 111 clinicians attended the preimplementation workshops, identifying 22 barriers covering four main themes: (a) need for new policies, (b) limited workforce (capacity), (c) lack of equipment, and (d) education and logistics of training staff. Preimplementation enablers identified were: support by clinical champions, medical staff, nursing management and allied health staff; easy adaptation of current protocols, care-plans, and local policies; and presence of specialist stroke unit staff. Postimplementation, only five of the 22 barriers identified preimplementation were reported as actual barriers to adoption of the FeSS protocols, namely, no previous use of insulin infusions; hyperglycaemic protocols could not be commenced without written orders; medical staff reluctance to use the ASSIST swallowing screening tool; poor level of engagement of medical staff; and doctors' unawareness of the trial. The process of identifying barriers and enablers preimplementation allowed staff to take ownership and to address barriers and plan for change. As only five of the 22 barriers identified preimplementation were reported to be actual barriers at completion of the trial, this suggests that barriers are often overcome whilst some are only ever perceived rather than actual barriers. © 2015 Sigma Theta Tau International.

Vertebral Fracture Assessment by dual-energy X-ray absorptiometry: insurance coverage issues in the United States. A White Paper of the International Society for Clinical Densitometry.

PubMed

Laster, Andrew J; Lewiecki, E Michael

2007-01-01

Clinical trial data and fracture risk prediction models unequivocally demonstrate the utility of identifying prevalent vertebral fractures to predict future fractures of all types. Knowledge of prevalent vertebral fractures can alter patient management decisions and result in initiation of therapy to reduce fracture risk in some patients who would not otherwise be treated. Cost-benefit analysis demonstrates that identifying and treating patients with vertebral fractures, even those with a densitometric classification of osteopenia, is cost effective. Vertebral fractures can be readily identified in the office setting using standard radiography or Vertebral Fracture Assessment (VFA), a software addition to a central dual-energy X-ray absorptiometry (DXA) machine. In the United States, VFA was assigned a Current Procedural Terminology (CPT) code in January 2005. Nevertheless, coverage of VFA has not been uniformly embraced by Medicare carriers, companies that contract with the federal government to administer Medicare coverage and process claims for a region of the United States. Unlike DXA, for which uniform national coverage of qualified Medicare beneficiaries is mandated by the Balanced Budget Act of 1997, VFA coverage policies are determined by the local Medicare carriers. Third-party insurers are also variable in their coverage of VFA. This International Society for Clinical Densitometry (ISCD) White Paper documents the role of VFA in the evaluation and treatment of women with postmenopausal osteoporosis and compares it with standard spine radiography. Arguments used by some Medicare carriers and insurers to deny coverage of VFA in the United States are analyzed and critiqued. For health care providers within the United States, this White Paper may serve as a resource to respond to insurers who deny coverage of VFA. For health care providers regardless of their country, this article underscores the value of VFA as an alternative to spine radiography in the evaluation and management of postmenopausal women with suspected osteoporosis.

Records of Triassic volcanism in Pangean Great Lakes, and implications for reconstructing the distal effects of Large Igneous Provinces

NASA Astrophysics Data System (ADS)

Whiteside, J. H.; Percival, L.; Kinney, S.; Olsen, P. E.; Mather, T. A.; Philpotts, A.

2017-12-01

Documentation of the precise timing of volcanic eruptions in sedimentary records is key for linking volcanic activity to both historical and geological episodes of environmental change. Deposition of tuffs in sediments, and sedimentary enrichment of trace metals linked to igneous processes, are both commonly used for such correlations. In particular, sedimentary mercury (Hg) enrichments have been used as a marker for volcanic activity from Large Igneous Provinces (LIPs) to support their link to episodes of major climate change and mass extinction in the geological record. However, linking such enrichments to a specific eruption or eruption products is often challenging or impossible. In this study, the mercury records from two exactly contemporaneous latest Triassic-earliest Jurassic rift lakes are presented. Both sedimentary records feature igneous units proposed to be related to the later (Early Jurassic) stages of volcanism of the Central Atlantic Magmatic Province (CAMP). These CAMP units include a small tuff unit identified by thin-section petrology and identified at 10 localities over a distance of over 200 km, and a major CAMP basalt flow overlying this tuff (and dated at 200.916±0.064 Ma) which is also known across multiple sedimentary basins in both North America and Morocco and is thought to have been emplaced about 120 kyr after the tuff. A potential stratigraphic correlation between Hg enrichments and the igneous units is considered, and compared to the established records of mercury enrichments from the latest Triassic that are thought to be coeval with the earlier stages of CAMP volcanism. Investigating the Hg records of sedimentary successions containing tuffs and basalt units is an important step for demonstrating whether the mercury emissions from specific individual volcanic eruptions in the deep past can be identified in the geological record, and are thus important tools for interpreting the causes of associated past geological events, such as mass extinctions.

Attrition due to orthopedic reasons during combat training: rates, types of injuries, and comparison between infantry and noninfantry units.

PubMed

Schwartz, Oren; Levinson, Tal; Astman, Nadav; Haim, Lavon

2014-08-01

The purpose of this study is to identify the prevalence and types of orthopedic injuries in infantry and noninfantry units responsible for attrition from combat training. 18,651 soldiers consecutively recruited to combat units (5 infantry and 4 noninfantry units) were included in this study. All recruited soldiers underwent and successfully passed a meticulous medical selection process. In all units, the soldiers participated in a suited fitness program that included marching, running, and strength training. Data were collected directly from attrite soldiers' files and detailed lists provided by the units' medical clinics. Out of 18,651 recruits, 641 (3.44%) attrite because of medical reasons. The leading cause of attrition was orthopedic diagnoses, and their overall rate was 43% (274 out of 641). Overuse injuries accounted for 90% of all orthopedic injuries. Low-back and lower extremity injuries accounted for 71.5% of all orthopedic injuries. There was high similarity in orthopedic injuries types and rates between infantry and noninfantry units. On the basis of our results, we recommend a multidisciplinary intense effort including physicians, physical training officers, physiotherapists, and commanders to significantly reduce overuse injuries, especially in the low-back and lower extremity regions. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

15 CFR 971.209 - Processing outside the United States.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 15 Commerce and Foreign Trade 3 2011-01-01 2011-01-01 false Processing outside the United States... Applications Contents § 971.209 Processing outside the United States. (a) Except as provided in this section... contravenes the overriding national interests of the United States. (b) If foreign processing is proposed, the...

15 CFR 971.209 - Processing outside the United States.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 15 Commerce and Foreign Trade 3 2014-01-01 2014-01-01 false Processing outside the United States... Applications Contents § 971.209 Processing outside the United States. (a) Except as provided in this section... contravenes the overriding national interests of the United States. (b) If foreign processing is proposed, the...

Perceptions of Risk and Safety in the ICU: A Qualitative Study of Cognitive Processes Relating to Staffing*

PubMed Central

D’Lima, Danielle M.; Brett, Stephen J.

2018-01-01

Objectives: The aims of this study were to 1) examine individual professionals’ perceptions of staffing risks and safe staffing in intensive care and 2) identify and examine the cognitive processes that underlie these perceptions. Design: Qualitative case study methodology with nurses, doctors, and physiotherapists. Setting: Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group. Subjects: Forty-four ICU team members of diverse professional backgrounds and seniority. Interventions: None. Main Results: Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an “A” team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a “dynamic balance” influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals’ risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit. Conclusions: This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals’ cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals’ perfectionist or pragmatic approach. Perfectionists’ team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived “A” team but diminished by interdisciplinary tensions. Third, counter intuitively, higher “situational” awareness for some individuals increased their stress and anxiety. Finally, our results suggest that professionals have varying concepts of where their personal responsibility to minimize risk begins and ends, which we have termed “risk horizons” and that these horizons may affect their behavior both within and beyond the unit. PMID:29077619

Perceptions of Risk and Safety in the ICU: A Qualitative Study of Cognitive Processes Relating to Staffing.

PubMed

D'Lima, Danielle M; Murray, Eleanor J; Brett, Stephen J

2018-01-01

The aims of this study were to 1) examine individual professionals' perceptions of staffing risks and safe staffing in intensive care and 2) identify and examine the cognitive processes that underlie these perceptions. Qualitative case study methodology with nurses, doctors, and physiotherapists. Three mixed medical and surgical adult ICUs, each on a separate hospital site within a 1,200-bed academic, tertiary London hospital group. Forty-four ICU team members of diverse professional backgrounds and seniority. None. Four themes (individual, team, unit, and organizational) were identified. Individual care provision was influenced by the pragmatist versus perfectionist stance of individuals and team dynamics by the concept of an "A" team and interdisciplinary tensions. Perceptions of safety hinged around the importance of achieving a "dynamic balance" influenced by the burden of prevailing circumstances and the clinical status of patients. Organizationally, professionals' risk perceptions affected their willingness to take personal responsibility for interactions beyond the unit. This study drew on cognitive research, specifically theories of cognitive dissonance, psychological safety, and situational awareness to explain how professionals' cognitive processes impacted on ICU behaviors. Our results may have implications for relationships, management, and leadership in ICU. First, patient care delivery may be affected by professionals' perfectionist or pragmatic approach. Perfectionists' team role may be compromised and they may experience cognitive dissonance and subsequent isolation/stress. Second, psychological safety in a team may be improved within the confines of a perceived "A" team but diminished by interdisciplinary tensions. Third, counter intuitively, higher "situational" awareness for some individuals increased their stress and anxiety. Finally, our results suggest that professionals have varying concepts of where their personal responsibility to minimize risk begins and ends, which we have termed "risk horizons" and that these horizons may affect their behavior both within and beyond the unit.

Patient safety challenges in a case study hospital--of relevance for transfusion processes?

PubMed

Aase, Karina; Høyland, Sindre; Olsen, Espen; Wiig, Siri; Nilsen, Stein Tore

2008-10-01

The paper reports results from a research project with the objective of studying patient safety, and relates the finding to safety issues within transfusion medicine. The background is an increased focus on undesired events related to diagnosis, medication, and patient treatment in general in the healthcare sector. The study is designed as a case study within a regional Norwegian hospital conducting specialised health care services. The study includes multiple methods such as interviews, document analysis, analysis of error reports, and a questionnaire survey. Results show that the challenges for improved patient safety, based on employees' perceptions, are hospital management support, reporting of accidents/incidents, and collaboration across hospital units. Several of these generic safety challenges are also found to be of relevance for a hospital's transfusion service. Positive patient safety factors are identified as teamwork within hospital units, a non-punitive response to errors, and unit manager's actions promoting safety.

The United Nations programme on space applications: priority thematic areas

NASA Astrophysics Data System (ADS)

Haubold, H.

The Third United Nations Conference on the Exploration and Peaceful Uses of Outer Space (UNISPACE III) was held in 1999 with efforts to identify world wide benefits of developing space science and technology, particularly in the developing nations. One of the main vehicles to implement recommendations of UNISPACE III is the United Nations Programme on Space Applications of the Office for Outer Space Affairs at UN Headquarters in Vienna. Following a process of prioritization by Member States, the Programme focus its activities on (i) knowledge-based themes as space law and basic space science, (ii) application-based themes as disaster management, natural resources management, environmental monitoring, tele-health, and (iii) enabling technologies such as remote sensing satellites, communications satellites, global navigation satellite systems, and small satellites. Current activities of the Programme will be reviewed. Further information available at http://www.oosa.unvienna.org/sapidx.html

Relative chronology of Martian volcanoes

NASA Technical Reports Server (NTRS)

Landheim, R.; Barlow, N. G.

1991-01-01

Impact cratering is one of the major geological processes that has affected the Martian surface throughout the planet's history. The frequency of craters within particular size ranges provides information about the formation ages and obliterative episodes of Martian geologic units. The Barlow chronology was extended by measuring small craters on the volcanoes and a number of standard terrain units. Inclusions of smaller craters in units previously analyzed by Barlow allowed for a more direct comparison between the size-frequency distribution data for volcanoes and established chronology. During this study, 11,486 craters were mapped and identified in the 1.5 to 8 km diameter range in selected regions of Mars. The results are summarized in this three page report and give a more precise estimate of the relative chronology of the Martian volcanoes. Also, the results of this study lend further support to the increasing evidence that volcanism has been a dominant geologic force throughout Martian history.

Improving student critical thinking skills through a root cause analysis pilot project.

PubMed

Tschannen, Dana; Aebersold, Michelle

2010-08-01

The Essentials of Baccalaureate Education for Professional Nursing Practice provides a framework for building the baccalaureate education for the twenty-first century. One of the exemplars included in the essentials toolkit includes student participation in an actual root cause analysis (RCA) or failure mode effects analysis. To align with this exemplar, faculty at the University of Michigan School of Nursing developed a pilot RCA project for the senior-level Leadership and Management course. While working collaboratively with faculty and unit liaisons at the University Health System, students completed an RCA on a nursing sensitive indicator (pain assessment or plan of care compliance). An overview of the pilot project, including the implementation process, is described. Each team of students identified root causes and recommendations for improvement on clinical and documentation practice within the context of the unit. Feedback from both the unit liaisons and the students confirmed the pilot's success.

Motor unit potential induced repetitive discharges (MIRDs): description of an unusual iterative discharge.

PubMed

So, Noel F; Rubin, Devon I; Jones, Lyell K; Litchy, William J; Sorenson, Eric J

2013-12-01

Repetitive discharges may be recorded during nerve conduction studies (NCS) or during needle electromyography in a muscle at rest. Repetitive discharges that occur during voluntary activation and are time-locked to voluntary motor unit potentials (MUP) have not been described. Retrospective review of motor unit potential induced repetitive discharges (MIRDs) identified in the EMG laboratory. Characteristics of each MIRD, patient demographics, other EMG findings in the same muscle, and electrophysiological diagnosis were analyzed. MIRDs were observed in 15 patients. The morphology and number of spikes and duration of MIRDs varied. The discharges fired at rates of 50-200 Hz. All but 2 patients had EMG findings of a chronic neurogenic disorder. MIRDs are rare iterative discharges time-locked to a voluntary MUP. The pathophysiology of MIRDs is unclear, but their presence may indicate a chronic neurogenic process. Copyright © 2013 Wiley Periodicals, Inc.

Revealing the fate of the phenylcoumaran linkage during lignin oxidation reactions.

PubMed

Lahive, Ciaran W; Lancefield, Christopher S; Codina, Anna; Kamer, Paul C J; Westwood, Nicholas J

2018-03-14

The fate of most lignin linkages, other than the β-O-4, under selective oxidation conditions is largely unknown. In this work we use advanced β-5 lignin model compounds to identify the fate of phenylcoumaran units in a softwood lignin during oxidation with DDQ. By using model compounds combined with detailed characterisation of the oxidised lignin polymer using HSQC and HMBC NMR we show that phenylcoumarones are a major product, and therefore constitute a novel non-native β-5 linkage in oxidised lignins. Additionally, the reactivity of these units in lignin led us to further investigate their connectivity in lignin, showing that they are found as both phenolic and etherified units. The findings and approach developed here will help improve the efficiency of selective oxidative lignin depolymerisation processes, particularly those aimed at the upgrading of softwood lignin in which phenylcoumarans are a major linkage.

Generation of useful energy from process fluids using the biphase turbine

NASA Astrophysics Data System (ADS)

Helgeson, N. L.

1981-01-01

The six largest energy consuming industries in the United States were surveyed to determine the energy savings that could result from applying the Biphase turbine to industrial process streams. A national potential energy savings of 58 million barrels of oil per year (technical market) was identified. This energy is recoverable from flashing gas liquid process streams and is separate and distinct from exhaust gas waste heat recovery. The industries surveyed in this program were the petroleum chemical, primary metals, paper and pulp, stone-clay-glass, and food. It was required to determine the applicability of the Biphase turbine to flashing operations connected with process streams, to determine the energy changes associated with these flashes if carried out in a Biphase turbine, and to determine the suitability (technical and economical feasibility) of applying the Biphase turbine to these processes.

Multi-Unit Considerations for Human Reliability Analysis

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

St. Germain, S.; Boring, R.; Banaseanu, G.

This paper uses the insights from the Standardized Plant Analysis Risk-Human Reliability Analysis (SPAR-H) methodology to help identify human actions currently modeled in the single unit PSA that may need to be modified to account for additional challenges imposed by a multi-unit accident as well as identify possible new human actions that might be modeled to more accurately characterize multi-unit risk. In identifying these potential human action impacts, the use of the SPAR-H strategy to include both errors in diagnosis and errors in action is considered as well as identifying characteristics of a multi-unit accident scenario that may impact themore » selection of the performance shaping factors (PSFs) used in SPAR-H. The lessons learned from the Fukushima Daiichi reactor accident will be addressed to further help identify areas where improved modeling may be required. While these multi-unit impacts may require modifications to a Level 1 PSA model, it is expected to have much more importance for Level 2 modeling. There is little currently written specifically about multi-unit HRA issues. A review of related published research will be presented. While this paper cannot answer all issues related to multi-unit HRA, it will hopefully serve as a starting point to generate discussion and spark additional ideas towards the proper treatment of HRA in a multi-unit PSA.« less

Exploring challenges in the patient's discharge process from the internal medicine service: A qualitative study of patients' and providers' perceptions.

PubMed

Pinelli, Vincent; Stuckey, Heather L; Gonzalo, Jed D

2017-09-01

In hospital-based medicine units, patients have a wide range of complex medical conditions, requiring timely and accurate communication between multiple interprofessional providers at the time of discharge. Limited work has investigated the challenges in interprofessional collaboration and communication during the patient discharge process. In this study, authors qualitatively assessed the experiences of internal medicine providers and patients about roles, challenges, and potential solutions in the discharge process, with a phenomenological focus on the process of collaboration. Authors conducted interviews with 87 providers and patients-41 providers in eight focus-groups, 39 providers in individual interviews, and seven individual patient interviews. Provider roles included physicians, nurses, therapists, pharmacists, care coordinators, and social workers. Interviews were audio-recorded and transcribed verbatim, followed by iterative review of transcripts using qualitative coding and content analysis. Participants identified several barriers related to interprofessional collaboration during the discharge process, including systems insufficiencies (e.g., medication reconciliation process, staffing challenges); lack of understanding others' roles (e.g., unclear which provider should be completing the discharge summary); information-communication breakdowns (e.g., inaccurate information communicated to the primary medical team); patient issues (e.g., patient preferences misaligned with recommendations); and poor collaboration processes (e.g., lack of structured interprofessional rounds). These results provide context for targeting improvement in interprofessional collaboration in medicine units during patient discharges. Implementing changes in care delivery processes may increase potential for accurate and timely coordination, thereby improving the quality of care transitions.

[Teamwork and negotiation with family in pediatrics].

PubMed

Ramos-Mendes, Maria Goreti; Rodrigues Araújo, Beatriz; Pereira Martins, Manuela

2016-01-01

Analyze the negotiation and interaction process within nurses' practice with mothers of hospitalized children in pediatric unit from the teamwork perspective. A qualitative approach was used in this study, based on the Grounded Theory from the symbolic interaction perspective. The study included 12 nurses of the pediatric unit and 18 mothers who stayed in the hospital with their hospitalized children. The number of participants was defined according to data saturation. Participant observation and semi-structured interviews were chosen as data collection techniques and it was analyzed using the program NVivo8. From the analysis performed, the central category identified was «weaknesses in the negotiation process», within the interactions between nurses and mothers. Nurses revealed difficulties in the communication process, they did not include roles definition with mothers in order to establish their participation in the care process and a power imbalance was also evidenced. Within the studied settings, an important lack of collaborative work with hospitalized children's mothers was observed. The weaknesses in the negotiation process and specifically the difficulties found in communication; the lack of roles and tasks clarification and the perceived power imbalance regarding relationships, prevent mothers involvement in their children care process, considered a basic component to achieve a greater mother implication, better results in terms of health and a lower impact of hospitalization in the children. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Processes of early stroke care and hospital costs.

PubMed

Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H; Ingeman, Annette; Johnsen, Søren P

2014-08-01

The relationship between processes of early stroke care and hospital costs remains unclear. We therefore examined the association in a population based cohort study. We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005 and 2010.The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance imaging (CT/MRI) scan, early physiotherapy and occupational therapy, early assessment of nutritional risk, constipation risk and of swallowing function, early mobilization,early catheterization, and early thromboembolism prophylaxis.Hospital costs were assessed for each patient based on the number of days spent in different in-hospital facilities using local hospital charges. The mean costs of hospitalization were $23 352 (standard deviation 27 827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose–response relationship. The adjusted costs were $24 566 (95% confidence interval 19 364–29 769) lower for patients who received 75–100% of the relevant processes of care compared with patients receiving 0–24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Early care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings.

Statistical modeling methods to analyze the impacts of multiunit process variability on critical quality attributes of Chinese herbal medicine tablets.

PubMed

Sun, Fei; Xu, Bing; Zhang, Yi; Dai, Shengyun; Yang, Chan; Cui, Xianglong; Shi, Xinyuan; Qiao, Yanjiang

2016-01-01

The quality of Chinese herbal medicine tablets suffers from batch-to-batch variability due to a lack of manufacturing process understanding. In this paper, the Panax notoginseng saponins (PNS) immediate release tablet was taken as the research subject. By defining the dissolution of five active pharmaceutical ingredients and the tablet tensile strength as critical quality attributes (CQAs), influences of both the manipulated process parameters introduced by an orthogonal experiment design and the intermediate granules' properties on the CQAs were fully investigated by different chemometric methods, such as the partial least squares, the orthogonal projection to latent structures, and the multiblock partial least squares (MBPLS). By analyzing the loadings plots and variable importance in the projection indexes, the granule particle sizes and the minimal punch tip separation distance in tableting were identified as critical process parameters. Additionally, the MBPLS model suggested that the lubrication time in the final blending was also important in predicting tablet quality attributes. From the calculated block importance in the projection indexes, the tableting unit was confirmed to be the critical process unit of the manufacturing line. The results demonstrated that the combinatorial use of different multivariate modeling methods could help in understanding the complex process relationships as a whole. The output of this study can then be used to define a control strategy to improve the quality of the PNS immediate release tablet.

Tracking motor units longitudinally across experimental sessions with high‐density surface electromyography

PubMed Central

Martinez‐Valdes, E.; Negro, F.; Laine, C. M.; Falla, D.; Mayer, F.

2017-01-01

Key points Classic motor unit (MU) recording and analysis methods do not allow the same MUs to be tracked across different experimental sessions, and therefore, there is limited experimental evidence on the adjustments in MU properties following training or during the progression of neuromuscular disorders.We propose a new processing method to track the same MUs across experimental sessions (separated by weeks) by using high‐density surface electromyography.The application of the proposed method in two experiments showed that individual MUs can be identified reliably in measurements separated by weeks and that changes in properties of the tracked MUs across experimental sessions can be identified with high sensitivity.These results indicate that the behaviour and properties of the same MUs can be monitored across multiple testing sessions.The proposed method opens new possibilities in the understanding of adjustments in motor unit properties due to training interventions or the progression of pathologies. Abstract A new method is proposed for tracking individual motor units (MUs) across multiple experimental sessions on different days. The technique is based on a novel decomposition approach for high‐density surface electromyography and was tested with two experimental studies for reliability and sensitivity. Experiment I (reliability): ten participants performed isometric knee extensions at 10, 30, 50 and 70% of their maximum voluntary contraction (MVC) force in three sessions, each separated by 1 week. Experiment II (sensitivity): seven participants performed 2 weeks of endurance training (cycling) and were tested pre–post intervention during isometric knee extensions at 10 and 30% MVC. The reliability (Experiment I) and sensitivity (Experiment II) of the measured MU properties were compared for the MUs tracked across sessions, with respect to all MUs identified in each session. In Experiment I, on average 38.3% and 40.1% of the identified MUs could be tracked across two sessions (1 and 2 weeks apart), for the vastus medialis and vastus lateralis, respectively. Moreover, the properties of the tracked MUs were more reliable across sessions than those of the full set of identified MUs (intra‐class correlation coefficients ranged between 0.63—0.99 and 0.39–0.95, respectively). In Experiment II, ∼40% of the MUs could be tracked before and after the training intervention and training‐induced changes in MU conduction velocity had an effect size of 2.1 (tracked MUs) and 1.5 (group of all identified motor units). These results show the possibility of monitoring MU properties longitudinally to document the effect of interventions or the progression of neuromuscular disorders. PMID:28032343

RCRA/UST, superfund, and EPCRA hotline training module. Introduction to: Solid and hazardous waste exclusions (40 CFR section 261.4) updated as of July 1995

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

NONE

1995-11-01

This module explains each waste exclusion and its scope, so one can apply this knowledge in determining wheather a given waste is or is not regulated under RCRA Subtitle C. It cites the regulatory section for exclusions and identifies materials that are not solid wastes and solid wastes that are not hazardous wastes. It locates the manufacturing process unit exclusion and identifies the sample and treatability study exclusions and their applicability. It outlines and specifies the conditions for meeting the exclusions for household wastes and mixtures of domestic sewage.

Enantiomeric composition of chiral polychlorinated biphenyl atropisomers in aquatic bed sediment

USGS Publications Warehouse

Wong, C.S.; Garrison, A.W.; Foreman, W.T.

2001-01-01

Enantiomeric ratios (ERs) for eight polychlorinated biphenyl (PCB) atropisomers were measured in aquatic sediment from selected sites throughout the United States by using chiral gas chromatography/mass spectrometry. Nonracemic ERs for PCBs 91, 95, 132, 136, 149, 174, and 176 were found in sediment cores from Lake Hartwell, SC, which confirmed previous inconclusive reports of reductive dechlorination of PCBs at these sites on the basis of achiral measurements. Nonracemic ERs for many of the atropisomers were also found in bed-sediment samples from the Hudson and Housatonic Rivers, thus indicating that some of the PCB biotransformation processes identified at these sites are enantioselective. Patterns in ERs among congeners were consistent with known reductive dechlorination patterns at both river sediment basins. The enantioselectivity of PCB 91 is reversed between the Hudson and Housatonic River sites, which implies that the two sites have different PCB biotransformation processes with different enantiomer preferences.Enantiomeric ratios (ERs) for eight polychlorinated biphenyl (PCB) atropisomers were measured in aquatic sediment from selected sites throughout the United States by using chiral gas chromatography/mass spectrometry. Nonracemic ERs for PCBs 91, 95, 132, 136, 149, 174, and 176 were found in sediment cores from Lake Hartwell, SC, which confirmed previous inconclusive reports of reductive dechlorination of PCBs at these sites on the basis of achiral measurements. Nonracemic ERs for many of the atropisomers were also found in bed-sediment samples from the Hudson and Housatonic Rivers, thus indicating that some of the PCB biotransformation processes identified at these sites are enantioselective. Patterns in ERs among congeners were consistent with known reductive dechlorination patterns at both river sediment basins. The enantioselectivity of PCB 91 is reversed between the Hudson and Housatonic River sites, which implies that the two sites have different PCB biotransformation processes with different enantiomer preferences.

EFFECT OF SITE ON BACTERIAL POPULATIONS IN THE SAPWOOD OF COARSE WOODY DEBRIS.

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

Porter, Emma, G.,; Waldrop, Thomas, A.; McElreath, Susan, D.

1998-01-01

Porter, Emma G., T.A. Waldrop, Susan D. McElreath, and Frank H. Tainter. 1998. Effect of site on bacterial populations in the sapwood of coarse woody debris. Pp. 480-484. In: Proc. 9th Bienn. South. Silv. Res. Conf. T.A. Waldrop (ed). USDA Forest Service, Southern Research Station. Gen. Tech. Rep. SRS-20. Abstract: Coarse woody debris (CWD) is an important structural component of southeastern forest ecosystems, yet little is known about its dynamics in these systems. This project identified bacterial populations associated with CWD and their dynamics across landscape ecosystem classification (LEC) units. Bolts of red oak and loblolly pine were placed onmore » plots at each of three hydric, mesic, and xeric sites at the Savannah River Station. After the controls were processed, samples were taken at four intervals over a 16-week period. Samples were ground within an anaerobe chamber using nonselective media. Aerobic and facultative anaerobic bacteria were identified using the Biolog system and the anaerobes were identified using the API 20A system. Major genera isolated were: Bacillus, Buttiauxella, Cedecea, Enterobacter, Erwinia, Escherichia, Klebsiella, Pantoea, Pseudomonas, Serratia, and Xanthomonas. The mean total isolates were determined by LEC units and sample intervals. Differences occurred between the sample intervals with total isolates of 6.67, 13.33, 10.17, and 9.50 at 3, 6, 10, and 16 weeks, respectively. No significant differences in the numbers of bacteria isolated were found between LEC units.« less

A Statistical Perspective on Highly Accelerated Testing

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

Thomas, Edward V.

Highly accelerated life testing has been heavily promoted at Sandia (and elsewhere) as a means to rapidly identify product weaknesses caused by flaws in the product's design or manufacturing process. During product development, a small number of units are forced to fail at high stress. The failed units are then examined to determine the root causes of failure. The identification of the root causes of product failures exposed by highly accelerated life testing can instigate changes to the product's design and/or manufacturing process that result in a product with increased reliability. It is widely viewed that this qualitative use ofmore » highly accelerated life testing (often associated with the acronym HALT) can be useful. However, highly accelerated life testing has also been proposed as a quantitative means for "demonstrating" the reliability of a product where unreliability is associated with loss of margin via an identified and dominating failure mechanism. It is assumed that the dominant failure mechanism can be accelerated by changing the level of a stress factor that is assumed to be related to the dominant failure mode. In extreme cases, a minimal number of units (often from a pre-production lot) are subjected to a single highly accelerated stress relative to normal use. If no (or, sufficiently few) units fail at this high stress level, some might claim that a certain level of reliability has been demonstrated (relative to normal use conditions). Underlying this claim are assumptions regarding the level of knowledge associated with the relationship between the stress level and the probability of failure. The primary purpose of this document is to discuss (from a statistical perspective) the efficacy of using accelerated life testing protocols (and, in particular, "highly accelerated" protocols) to make quantitative inferences concerning the performance of a product (e.g., reliability) when in fact there is lack-of-knowledge and uncertainty concerning the assumed relationship between the stress level and performance. In addition, this document contains recommendations for conducting more informative accelerated tests.« less

From speech to thought: the neuronal basis of cognitive units in non-experimental, real-life communication investigated using ECoG

PubMed Central

Derix, Johanna; Iljina, Olga; Weiske, Johanna; Schulze-Bonhage, Andreas; Aertsen, Ad; Ball, Tonio

2014-01-01

Exchange of thoughts by means of expressive speech is fundamental to human communication. However, the neuronal basis of real-life communication in general, and of verbal exchange of ideas in particular, has rarely been studied until now. Here, our aim was to establish an approach for exploring the neuronal processes related to cognitive “idea” units (IUs) in conditions of non-experimental speech production. We investigated whether such units corresponding to single, coherent chunks of speech with syntactically-defined borders, are useful to unravel the neuronal mechanisms underlying real-world human cognition. To this aim, we employed simultaneous electrocorticography (ECoG) and video recordings obtained in pre-neurosurgical diagnostics of epilepsy patients. We transcribed non-experimental, daily hospital conversations, identified IUs in transcriptions of the patients' speech, classified the obtained IUs according to a previously-proposed taxonomy focusing on memory content, and investigated the underlying neuronal activity. In each of our three subjects, we were able to collect a large number of IUs which could be assigned to different functional IU subclasses with a high inter-rater agreement. Robust IU-onset-related changes in spectral magnitude could be observed in high gamma frequencies (70–150 Hz) on the inferior lateral convexity and in the superior temporal cortex regardless of the IU content. A comparison of the topography of these responses with mouth motor and speech areas identified by electrocortical stimulation showed that IUs might be of use for extraoperative mapping of eloquent cortex (average sensitivity: 44.4%, average specificity: 91.1%). High gamma responses specific to memory-related IU subclasses were observed in the inferior parietal and prefrontal regions. IU-based analysis of ECoG recordings during non-experimental communication thus elicits topographically- and functionally-specific effects. We conclude that segmentation of spontaneous real-world speech in linguistically-motivated units is a promising strategy for elucidating the neuronal basis of mental processing during non-experimental communication. PMID:24982625

Built-In Diagnostics (BID) Of Equipment/Systems

NASA Technical Reports Server (NTRS)

Granieri, Michael N.; Giordano, John P.; Nolan, Mary E.

1995-01-01

Diagnostician(TM)-on-Chip (DOC) technology identifies faults and commands systems reconfiguration. Smart microcontrollers operating in conjunction with other system-control circuits, command self-correcting system/equipment actions in real time. DOC microcontroller generates commands for associated built-in test equipment to stimulate unit of equipment diagnosed, collects and processes response data obtained by built-in test equipment, and performs diagnostic reasoning on response data, using diagnostic knowledge base derived from design data.

United States Air Force Civil Engineering Additive Manufacturing Applications: Tools and Jigs

DTIC Science & Technology

2016-03-24

A faulty wheel design and tire inflation system on the Mine Resistant Ambush Protected Vehicle (MRAP) in theatre was identified, designed , and...hook (Figure 12). Walls on the four sides of the bracket would hold the sensors in place on the robot. As this was the initial design , satisfactory...be assembled prior to the printing process. Using squares placed at standardized distances across the bracket, walls were designed to slide into

Integrated Advanced Sounding Unit-A (AMSU-A). Configuration Management Plan

NASA Technical Reports Server (NTRS)

Cavanaugh, J.

1996-01-01

The purpose of this plan is to identify the baseline to be established during the development life cycle of the integrated AMSU-A, and define the methods and procedures which Aerojet will follow in the implementation of configuration control for each established baseline. Also this plan establishes the Configuration Management process to be used for the deliverable hardware, software, and firmware of the Integrated AMSU-A during development, design, fabrication, test, and delivery.

Kilogram-scale prexasertib monolactate monohydrate synthesis under continuous-flow CGMP conditions.

PubMed

Cole, Kevin P; Groh, Jennifer McClary; Johnson, Martin D; Burcham, Christopher L; Campbell, Bradley M; Diseroad, William D; Heller, Michael R; Howell, John R; Kallman, Neil J; Koenig, Thomas M; May, Scott A; Miller, Richard D; Mitchell, David; Myers, David P; Myers, Steven S; Phillips, Joseph L; Polster, Christopher S; White, Timothy D; Cashman, Jim; Hurley, Declan; Moylan, Robert; Sheehan, Paul; Spencer, Richard D; Desmond, Kenneth; Desmond, Paul; Gowran, Olivia

2017-06-16

Advances in drug potency and tailored therapeutics are promoting pharmaceutical manufacturing to transition from a traditional batch paradigm to more flexible continuous processing. Here we report the development of a multistep continuous-flow CGMP (current good manufacturing practices) process that produced 24 kilograms of prexasertib monolactate monohydrate suitable for use in human clinical trials. Eight continuous unit operations were conducted to produce the target at roughly 3 kilograms per day using small continuous reactors, extractors, evaporators, crystallizers, and filters in laboratory fume hoods. Success was enabled by advances in chemistry, engineering, analytical science, process modeling, and equipment design. Substantial technical and business drivers were identified, which merited the continuous process. The continuous process afforded improved performance and safety relative to batch processes and also improved containment of a highly potent compound. Copyright © 2017, American Association for the Advancement of Science.

Technology development for lunar base water recycling

NASA Technical Reports Server (NTRS)

Schultz, John R.; Sauer, Richard L.

1992-01-01

This paper will review previous and ongoing work in aerospace water recycling and identify research activities required to support development of a lunar base. The development of a water recycle system for use in the life support systems envisioned for a lunar base will require considerable research work. A review of previous work on aerospace water recycle systems indicates that more efficient physical and chemical processes are needed to reduce expendable and power requirements. Development work on biological processes that can be applied to microgravity and lunar environments also needs to be initiated. Biological processes are inherently more efficient than physical and chemical processes and may be used to minimize resupply and waste disposal requirements. Processes for recovering and recycling nutrients such as nitrogen, phosphorus, and sulfur also need to be developed to support plant growth units. The development of efficient water quality monitors to be used for process control and environmental monitoring also needs to be initiated.

Pre-Holocene to Modern Evolution of the Lower Delaware Estuary: Constraints from High-Resolution Chirp Subbottom Profiles

NASA Astrophysics Data System (ADS)

Daw, Julianne

Throughout the Quaternary Period, the Delaware Estuary, which is located within the Mid-Atlantic region of the United States, has undergone substantial change as a result of sea-level fluctuations. To better understand the recent (late Pleistocene to Holocene) evolution of the region, chirp subbottom profiles were analyzed within Delaware Bay near the southern end of the Delaware River Navigation Channel including the adjacent shoals and sloughs, using RoxAnn bottom classification data and available vibracores to aid in interpreting sediment types and depositional environments within the study area. Using seismic processing software (SonarWiz6), chirp profiles were processed and reflection events were identified and their positions digitized. Major reflection events were analyzed using a seismic facies approach. The identified facies were each characterized as distinct units composed of reflections with unique elements, such as configuration, amplitude, and continuity. Five seismic facies were identified and their thicknesses determined. Depths to the major reflection events were correlated with sediment boundaries as observed in the available vibracores, allowing the seismic facies to be interpreted in terms of their associated sediment types and inferred environments of deposition. The distributions of surficial and subsurface seismic and sedimentological features were visualized using three-dimensional images. The interpretations of the identified facies are as follows: Facies I is a surficial unit of the modern Holocene estuarine deposits; Facies II is a beach-berm washover zone deposition; Facies III is a deposit of a lagoonal environment; Facies IV is a deposit of an open water environment; and Facies V is a marsh deposition. The chirp data, when integrated with available information from vibracores and RoxAnn bottom sediment classification, was also used to map the position of a former major river system (paleochannel). This paleochannel, trending generally northwest to southeast, can be correlated with the southern channel that was identified in previous work by Knebel and Circe (1988). In addition to the knowledge gained by studying the geological evolution of Delaware Bay, our data can be used by decision makers and stakeholders to inform future management of the Delaware Estuary in practical applications that range from planning for maintenance dredging of the navigation channel to determining locations and thicknesses of suitable sand resources for shoreline replenishment. The surficial layer that would be most affected by such applications is mostly composed of sand & muddy sand, but in the deeper portions and along the shoals, it is composed of mixed and coarse sediments and mud & sandy mud, respectively. Furthermore, the surficial unit is thickest (between 1.5 and 4 meters) in the central and eastern regions of the study area encompassing the deeper portions, and it is thinnest (up to 1 meter) along the western and northern regions that include the shoals.

Subtypes of Patients Experiencing Exacerbations of COPD and Associations with Outcomes

PubMed Central

Arostegui, Inmaculada; Esteban, Cristobal; García-Gutierrez, Susana; Bare, Marisa; Fernández-de-Larrea, Nerea; Briones, Eduardo; Quintana, José M.

2014-01-01

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous condition characterized by occasional exacerbations. Identifying clinical subtypes among patients experiencing COPD exacerbations (ECOPD) could help better understand the pathophysiologic mechanisms involved in exacerbations, establish different strategies of treatment, and improve the process of care and patient prognosis. The objective of this study was to identify subtypes of ECOPD patients attending emergency departments using clinical variables and to validate the results using several outcomes. We evaluated data collected as part of the IRYSS-COPD prospective cohort study conducted in 16 hospitals in Spain. Variables collected from ECOPD patients attending one of the emergency departments included arterial blood gases, presence of comorbidities, previous COPD treatment, baseline severity of COPD, and previous hospitalizations for ECOPD. Patient subtypes were identified by combining results from multiple correspondence analysis and cluster analysis. Results were validated using key outcomes of ECOPD evolution. Four ECOPD subtypes were identified based on the severity of the current exacerbation and general health status (largely a function of comorbidities): subtype A (n = 934), neither high comorbidity nor severe exacerbation; subtype B (n = 682), moderate comorbidities; subtype C (n = 562), severe comorbidities related to mortality; and subtype D (n = 309), very severe process of exacerbation, significantly related to mortality and admission to an intensive care unit. Subtype D experienced the highest rate of mortality, admission to an intensive care unit and need for noninvasive mechanical ventilation, followed by subtype C. Subtypes A and B were primarily related to other serious complications. Hospitalization rate was more than 50% for all the subtypes, although significantly higher for subtypes C and D than for subtypes A and B. These results could help identify characteristics to categorize ECOPD patients for more appropriate care, and help test interventions and treatments in subgroups with poor evolution and outcomes. PMID:24892936

Geologic mapping of Europa

USGS Publications Warehouse

Greeley, R.; Figueredo, P.H.; Williams, D.A.; Chuang, F.C.; Klemaszewski, J.E.; Kadel, S.D.; Prockter, L.M.; Pappalardo, R.T.; Head, J. W.; Collins, G.C.; Spaun, N.A.; Sullivan, R.J.; Moore, Johnnie N.; Senske, D.A.; Tufts, B.R.; Johnson, T.V.; Belton, M.J.S.; Tanaka, K.L.

2000-01-01

Galileo data enable the major geological units, structures, and surface features to be identified on Europa. These include five primary units (plains, chaos, band, ridge, and crater materials) and their subunits, along with various tectonic structures such as faults. Plains units are the most widespread. Ridged plains material spans a wide range of geological ages, including the oldest recognizable features on Europa, and appears to represent a style of tectonic resurfacing, rather than cryovolcanism. Smooth plains material typically embays other terrains and units, possibly as a type of fluid emplacement, and is among the youngest material units observed. At global scales, plains are typically mapped as undifferentiated plains material, although in some areas differences can be discerned in the near infrared which might be related to differences in ice grain size. Chaos material is composed of plains and other preexisting materials that have been severely disrupted by inferred internal activity; chaos is characterized by blocks of icy material set in a hummocky matrix. Band material is arrayed in linear, curvilinear, wedge-shaped, or cuspate zones with contrasting albedo and surface textures with respect to the surrounding terrain. Bilateral symmetry observed in some bands and the relationships with the surrounding units suggest that band material forms by the lithosphere fracturing, spreading apart, and infilling with material derived from the subsurface. Ridge material is mapped as a unit on local and some regional maps but shown with symbols at global scales. Ridge material includes single ridges, doublet ridges, and ridge complexes. Ridge materials are considered to represent tectonic processes, possibly accompanied by the extrusion or intrusion of subsurface materials, such as diapirs. The tectonic processes might be related to tidal flexing of the icy lithosphere on diurnal or longer timescales. Crater materials include various interior (smooth central, rough inner, and annular massif) and exterior (continuous ejecta) subunits. Structural features and landforms are shown with conventional symbols. Type localities for the units are identified, along with suggestions for portraying the features on geological maps, including colors and letter abbreviations for material units. Implementing these suggestions by the planetary mapping community would facilitate comparisons of maps for different parts of Europa and contribute to an eventual global synthesis of its complex geology. On the basis of initial mapping results, a stratigraphic sequence is suggested in which ridged plains form the oldest unit on Europa, followed by development of band material and individual ridges. Band materials tend to be somewhat older than ridges, but in many areas the two units formed simultaneously. Similarly, the formation of most chaos follows the development of ridged plains; although chaos is among the youngest materials on Europa, some chaos units might have formed contemporaneously with ridged plains. Smooth plains generally embay all other units and are late-stage in the evolution of the surface. C1 craters are superposed on ridged plains but are crosscut by other materials, including bands and ridges. Most c2 craters postdate all other units, but a few c2 craters are cut by ridge material. C3 craters constitute the youngest recognizable material on Europa. Copyright 2000 by the American Geophysical Union.

Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses' fetal surveillance practice using theoretical domains framework.

PubMed

Patey, Andrea M; Curran, Janet A; Sprague, Ann E; Francis, Jill J; Driedger, S Michelle; Légaré, France; Lemyre, Louise; Pomey, Marie-Pascale A; Grimshaw, Jeremy M

2017-09-25

Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA. We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses' behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social influences; Behavioural regulation). We identified potential influences on birthing unit nurses' use of IA as their primary method of fetal surveillance. These beliefs suggest potential targets for behaviour change interventions to promote IA use.

Geological control of floristic composition in Amazonian forests

PubMed Central

Higgins, Mark A; Ruokolainen, Kalle; Tuomisto, Hanna; Llerena, Nelly; Cardenas, Glenda; Phillips, Oliver L; Vásquez, Rodolfo; Räsänen, Matti

2011-01-01

Aim Conservation and land-use planning require accurate maps of patterns in species composition and an understanding of the factors that control them. Substantial doubt exists, however, about the existence and determinants of large-area floristic divisions in Amazonia. Here we ask whether Amazonian forests are partitioned into broad-scale floristic units on the basis of geological formations and their edaphic properties. Location Western and central Amazonia. Methods We used Landsat imagery and Shuttle Radar Topography Mission (SRTM) digital elevation data to identify a possible floristic and geological discontinuity of over 300 km in northern Peru. We then used plant inventories and soil sampling to document changes in species composition and soil properties across this boundary. Data were obtained from 138 sites distributed along more than 450 km of road and river. On the basis of our findings, we used broad-scale Landsat and SRTM mosaics to identify similar patterns across western and central Amazonia. Results The discontinuity identified in Landsat and SRTM data corresponded to a 15-fold change in soil cation concentrations and an almost total change in plant species composition. This discontinuity appears to be caused by the widespread removal of cation-poor surface sediments by river incision to expose cation-rich sediments beneath. Examination of broad-scale Landsat and SRTM mosaics indicated that equivalent processes have generated a north–south discontinuity of over 1500 km in western Brazil. Due to similarities with our study area, we suggest that this discontinuity represents a chemical and ecological limit between western and central Amazonia. Main conclusions Our findings suggest that Amazonian forests are partitioned into large-area units on the basis of geological formations and their edaphic properties. The evolution of these units through geological time may provide a general mechanism for biotic diversification in Amazonia. These compositional units, moreover, may correspond to broad-scale functional units. The existence of large-area compositional and functional units would suggest that protected-area, carbon sequestration, and other land-use strategies in Amazonia be implemented on a region-by-region basis. The methods described here can be used to map these patterns, and thus enable effective conservation and management of Amazonian forests. PMID:22247585

The interdependence of lake ice and climate in central North America

NASA Technical Reports Server (NTRS)

Jelacic, A. J. (Principal Investigator)

1972-01-01

There are no author-identified significant results in this report. This investigation is to identify any correlations between the freeze/ thaw cycles of lakes and regional weather variations. ERTS-1 imagery of central Canada and north central United States is examined on a seasonal basis. The ice conditions of certain major study lakes are noted and recorded on magnetic tape, from which the movement of a freeze/thaw transition zone may be deduced. Weather maps and tables are used to establish any obvious correlations. The process of selecting major study lakes is discussed, and a complete lake directory is presented. Various routines of the software support library are described, accompanied by output samples. Procedures used for ERTS imagery processing are presented along with the data analysis plan. Application of these procedures to selected ERTS imagery has demonstrated their utility. Preliminary results show that the freeze/thaw transition zone can be monitored from ERTS.

[Quality assurance of hospital medical records as a risk management tool].

PubMed

Terranova, Giuseppina; Cortesi, Elisabetta; Briani, Silvia; Giannini, Raffaella

2006-01-01

A retrospective analysis of hospital medical records was performed jointly by the Medicolegal department of the Pistoia Local Health Unit N. 3 and by the management of the SS. Cosma and Damiano di Pescia Hospital. Evaluation was based on ANDEM criteria, JCAHO standards, and the 1992 discharge abstract guidelines of the Italian Health Ministry. In the first phase of the study, data were collected and processed for each hospital ward and then discussed with clinicians and audited. After auditing, appropriate actions were agreed upon for correcting identified problems. Approximately one year later a second smaller sample of medical records was evaluated and a higher compliance rate with the established corrective actions was found in all wards for all data categories. In this study the evaluation of medical records can be considered in the wider context of risk management, a multidisciplinary process directed towards identifying and monitoring risk through the use of appropriate quality indicators.

Northern Hemisphere Biome-and Process-Specific Changes in Forest Area and Gross Merchantable Volume: 1890-1990 (DB1017)

DOE Data Explorer

Auclair, A.N.D. [Science and Policy Associates, Inc., Washington, D.C. (United States; Bedford, J.A. [Science and Policy Associates, Inc., Washington, D.C. (United States); Revenga, C. [Science and Policy Associates, Inc., Washington, D.C. (United States); Brenkert, A.L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

1997-01-01

This database lists annual changes in areal extent (Ha) and gross merchantable wood volume (m3) produced by depletion and accrual processes in boreal and temperate forests in Alaska, Canada, Europe, Former Soviet Union, Non-Soviet temperate Asia, and the contiguous United States for the years 1890 through 1990. Forest depletions (source terms for atmospheric CO2) are identified as forest pests, forest dieback, forest fires, forest harvest, and land-use changes (predominantly the conversion of forest, temperate woodland, and shrubland to cropland). Forest accruals (sink terms for atmospheric CO2) are identified as fire exclusion, fire suppression, and afforestation or crop abandonment. The changes in areal extent and gross merchantable wood volume are calculated separately for each of the following biomes: forest tundra, boreal softwoods, mixed hardwoods, temperate softwoods, temperate hardwoods, and temperate wood- and shrublands.

Dissecting delays in trauma care using corporate lean six sigma methodology.

PubMed

Parks, Jennifer K; Klein, Jorie; Frankel, Heidi L; Friese, Randall S; Shafi, Shahid

2008-11-01

The Institute of Medicine has identified trauma center overcrowding as a crisis. We applied corporate Lean Six Sigma methodology to reduce overcrowding by quantifying patient dwell times in trauma resuscitation units (TRU) and to identify opportunities for reducing them. TRU dwell time of all patients treated at a Level I trauma center were measured prospectively during a 3-month period (n = 1,184). Delays were defined as TRU dwell time >6 hours. Using personnel trained in corporate Lean Six Sigma methodology, we created a detailed process map of patient flow through our TRU and measured time spent at each step prospectively during a 24/7 week-long time study (n = 43). Patients with TRU dwell time below the median (3 hours) were compared with those with longer dwell times to identify opportunities for improvement. TRU delays occurred in 183 of 1,184 trauma patients (15%), and peaked on days with >15 patients or with presence of five simultaneous patients. However, 135 delays (74%) occurred on days when

“The problem often is that we do not have a family spokesperson but a spokesgroup”: Family Member Informal Roles in End-of-Life Decision-Making in Adult ICUs

PubMed Central

Quinn, Jill R.; Schmitt, Madeline; Baggs, Judith Gedney; Norton, Sally A.; Dombeck, Mary T.; Sellers, Craig R.

2013-01-01

Background To support the process of effective family decision-making, it is important to recognize and understand informal roles various family members may play in the end-of-life decision-making process. Objective The purpose of this study was to describe some informal roles consistently enacted by family members involved in the process of end-of-life decision-making in intensive care units (ICUs). Methods Ethnographic study. Data were collected via participant observation with field notes and semi-structured interviews on four ICUs in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical ICU, a surgical ICU, a burn and trauma ICU, and a cardiovascular ICU. Participants Participants included health care clinicians, patients, and family members. Results Informal roles for family members consistently observed were:, Primary Caregiver, Primary Decision Maker, Family Spokesperson, Out-of-Towner, Patient Wishes Expert, Protector, Vulnerable Member, and Health Care Expert. The identified informal roles were part of family decision making processes, and each role was part of a potentially complicated family dynamic for end-of-life decision-making within the family system, and between the family and health care domains. Conclusions These informal roles reflect the diverse responses to demands for family decision making in what is usually a novel and stressful situation. Identification and description of these family member informal roles can assist clinicians to recognize and understand the functions of these roles in family decision making at the end-of-life, and guide development of strategies to support and facilitate increased effectiveness of family discussions and decision-making processes. PMID:22210699

Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study.

PubMed

Kristensen, Pia Kjær; Thillemann, Theis Muncholm; Søballe, Kjeld; Johnsen, Søren Paaske

2016-01-01

admission to orthogeriatric units improves clinical outcomes for patients with hip fracture; however, little is known about the underlying mechanisms. to compare quality of in-hospital care, 30-day mortality, time to surgery (TTS) and length of hospital stay (LOS) among patients with hip fracture admitted to orthogeriatric and ordinary orthopaedic units, respectively. population-based cohort study. using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 11,461 patients aged ≥65 years admitted with a hip fracture between 1 March 2010 and 30 November 2011. The patients were divided into two groups: (i) those treated at an orthogeriatric unit, where the geriatrician is an integrated part of the multidisciplinary team, and (ii) those treated at an ordinary orthopaedic unit, where geriatric or medical consultant service are available on request. Outcome measures were the quality of care as reflected by six process performance measures, 30-day mortality, the TTS and the LOS. Data were analysed using log-binomial, linear and logistic regression controlling for potential confounders. admittance to orthogeriatric units was associated with a higher chance for fulfilling five out of six process performance measures. Patients who were admitted to an orthogeriatric unit experienced a lower 30-day mortality (adjusted odds ratio (aOR) 0.69; 95% CI 0.54-0.88), whereas the LOS (adjusted relative time (aRT) of 1.18; 95% CI 0.92-1.52) and the TTS (aRT 1.06; 95% CI 0.89-1.26) were similar. admittance to an orthogeriatric unit was associated with improved quality of care and lower 30-day mortality among patients with hip fracture. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Distributed and recoverable digital control system

NASA Technical Reports Server (NTRS)

Stange, Kent (Inventor); Hess, Richard (Inventor); Kelley, Gerald B (Inventor); Rogers, Randy (Inventor)

2010-01-01

A real-time multi-tasking digital control system with rapid recovery capability is disclosed. The control system includes a plurality of computing units comprising a plurality of redundant processing units, with each of the processing units configured to generate one or more redundant control commands. One or more internal monitors are employed for detecting data errors in the control commands. One or more recovery triggers are provided for initiating rapid recovery of a processing unit if data errors are detected. The control system also includes a plurality of actuator control units each in operative communication with the computing units. The actuator control units are configured to initiate a rapid recovery if data errors are detected in one or more of the processing units. A plurality of smart actuators communicates with the actuator control units, and a plurality of redundant sensors communicates with the computing units.

Hydrological Modeling in Alaska with WRF-Hydro

NASA Astrophysics Data System (ADS)

Elmer, N. J.; Zavodsky, B.; Molthan, A.

2017-12-01

The operational National Water Model (NWM), implemented in August 2016, is an instantiation of the Weather Research and Forecasting hydrological extension package (WRF-Hydro). Currently, the NWM only covers the contiguous United States, but will be expanded to include an Alaska domain in the future. It is well known that Alaska presents several hydrological modeling challenges, including unique arctic/sub-arctic hydrological processes not observed elsewhere in the United States and a severe lack of in-situ observations for model initialization. This project sets up an experimental version of WRF-Hydro in Alaska mimicking the NWM to gauge the ability of WRF-Hydro to represent hydrological processes in Alaska and identify model calibration challenges. Recent and upcoming launches of hydrology-focused NASA satellite missions such as the Soil Moisture Active Passive (SMAP) and Surface Water Ocean Topography (SWOT) expand the spatial and temporal coverage of observations in Alaska, so this study also lays the groundwork for assimilating these NASA datasets into WRF-Hydro in the future.

Strategies for preventing group B streptococcal infections in newborns: a nation-wide survey of Italian policies.

PubMed

Tzialla, Chryssoula; Berardi, Alberto; Farina, Claudio; Clerici, Pierangelo; Borghesi, Alessandro; Viora, Elsa; Scollo, Paolo; Stronati, Mauro

2017-11-02

There are no Italian data regarding the strategies for preventing neonatal group B streptococcal (GBS) infection. We conducted a national survey in order to explore obstetrical, neonatal and microbiological practices for the GBS prevention. Three distinct questionnaires were sent to obstetricians, neonatologists and microbiologists. Questionnaires included data on prenatal GBS screening, maternal risk factors, intrapartum antibiotic prophylaxis, microbiological information concerning specimen processing and GBS antimicrobial susceptibility. All respondent obstetrical units used the culture-based screening approach to identify women who should receive intrapartum antibiotic prophylaxis, and more than half of the microbiological laboratories (58%) reported using specimen processing consistent with CDC guidelines. Most neonatal units (89 out of 107, 82%) reported using protocols for preventing GBS early-onset sepsis consistent with CDC guidelines. The screening-based strategy is largely prevalent in Italy, and most protocols for preventing GBS early-onset sepsis are consistent with CDC guidelines. However, we found discrepancies in practices among centers that may reflect the lack of Italian guidelines issued by public health organizations.

Caring for the caregiver.

PubMed

Levy, Mitchell M

2004-07-01

There are certainly many coping behaviors that may assist ICU caregivers in the process of caring for themselves. Staff support groups,regular interdisciplinary meetings to discuss difficult cases,and bringing trained personnel into the intensive care unit (ICU)environment to offer staff training in communication and conflict resolution skills have been suggested as methods for alleviating caregiver stress. Combining these as well as other tools with a deeper look at the caregiver-patient relationship are important building blocks for creating a sane, healthy environment in the ICU. Over the next years, as the population ages, and as technologic advances continue, the critical care units will play an even more prominent role in health care. Given the threat posed by the severe nursing shortage, it becomes apparent that, to prepare for this increased need for critical care services, efforts must be directed to identify the sources of distress for ICU caregivers and develop focused training programs that alleviate the inevitably strains and pressures that arise in the process of compassionate caring for the critically ill.

High-Throughput Characterization of Porous Materials Using Graphics Processing Units

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

Kim, Jihan; Martin, Richard L.; Rübel, Oliver

We have developed a high-throughput graphics processing units (GPU) code that can characterize a large database of crystalline porous materials. In our algorithm, the GPU is utilized to accelerate energy grid calculations where the grid values represent interactions (i.e., Lennard-Jones + Coulomb potentials) between gas molecules (i.e., CHmore » $$_{4}$$ and CO$$_{2}$$) and material's framework atoms. Using a parallel flood fill CPU algorithm, inaccessible regions inside the framework structures are identified and blocked based on their energy profiles. Finally, we compute the Henry coefficients and heats of adsorption through statistical Widom insertion Monte Carlo moves in the domain restricted to the accessible space. The code offers significant speedup over a single core CPU code and allows us to characterize a set of porous materials at least an order of magnitude larger than ones considered in earlier studies. For structures selected from such a prescreening algorithm, full adsorption isotherms can be calculated by conducting multiple grand canonical Monte Carlo simulations concurrently within the GPU.« less

Uniting functional network topology and oscillations in the fronto-parietal single unit network of behaving primates.

PubMed

Dann, Benjamin; Michaels, Jonathan A; Schaffelhofer, Stefan; Scherberger, Hansjörg

2016-08-15

The functional communication of neurons in cortical networks underlies higher cognitive processes. Yet, little is known about the organization of the single neuron network or its relationship to the synchronization processes that are essential for its formation. Here, we show that the functional single neuron network of three fronto-parietal areas during active behavior of macaque monkeys is highly complex. The network was closely connected (small-world) and consisted of functional modules spanning these areas. Surprisingly, the importance of different neurons to the network was highly heterogeneous with a small number of neurons contributing strongly to the network function (hubs), which were in turn strongly inter-connected (rich-club). Examination of the network synchronization revealed that the identified rich-club consisted of neurons that were synchronized in the beta or low frequency range, whereas other neurons were mostly non-oscillatory synchronized. Therefore, oscillatory synchrony may be a central communication mechanism for highly organized functional spiking networks.

Cis-dicarbonyl binding at cobalt and iron porphyrins with saddle-shape conformation.

PubMed

Seufert, Knud; Bocquet, Marie-Laure; Auwärter, Willi; Weber-Bargioni, Alexander; Reichert, Joachim; Lorente, Nicolás; Barth, Johannes V

2011-02-01

Diatomic molecules attached to complexed iron or cobalt centres are important in many biological processes. In natural systems, metallotetrapyrrole units carry respiratory gases or provide sensing and catalytic functions. Conceiving synthetic model systems strongly helps to determine the pertinent chemical foundations for such processes, with recent work highlighting the importance of the prosthetic groups' conformational flexibility as an intricate variable affecting their functional properties. Here, we present simple model systems to investigate, at the single molecule level, the interaction of carbon monoxide with saddle-shaped iron- and cobalt-porphyrin conformers, which have been stabilized as two-dimensional arrays on well-defined surfaces. Using scanning tunnelling microscopy we identified a novel bonding scheme expressed in tilted monocarbonyl and cis-dicarbonyl configurations at the functional metal-macrocycle unit. Modelling with density functional theory revealed that the weakly bonded diatomic carbonyl adduct can effectively bridge specific pyrrole groups with the metal atom as a result of the pronounced saddle-shape conformation of the porphyrin cage.

Environmental Engineering Unit Operations and Unit Processes Laboratory Manual.

ERIC Educational Resources Information Center

O'Connor, John T., Ed.

This manual was prepared for the purpose of stimulating the development of effective unit operations and unit processes laboratory courses in environmental engineering. Laboratory activities emphasizing physical operations, biological, and chemical processes are designed for various educational and equipment levels. An introductory section reviews…

Hydrologic Unit Map -- 1978, state of South Dakota

USGS Publications Warehouse

,

1978-01-01

This map and accompanying table show Hydrologic Unites that are basically hydrographic in nature. The Cataloging Unites shown supplant the Cataloging Units previously depicted n the 1974 State Hydrologic Unit Map. The boundaries as shown have been adapted from the 1974 State Hydrologic Unit Map, "The Catalog of Information on Water Data" (1972), "Water Resources Regions and Subregions for the National Assessment of Water and Related Land Resources" by the U.S. Water Resources Council (1970), "River Basin of the United States" by the U.S. Soil Conservation Service (1963, 1970), "River Basin Maps Showing Hydrologic Stations" by the Inter-Agency Committee on Water Resources, Subcommittee on Hydrology (1961), and State planning maps. The Political Subdivision has been adopted from "Counties and County Equivalents of the States if the United States" presented in Federal Information Processing Standards Publication 6-2, issued by the National Bureau of Standards (1973) in which each county or county equivalent is identified by a 2-character State code and a 3-character county code. The Regions, Subregions and Accounting Units are aggregates of the Cataloging Unites. The Regions and Sub regions are currently (1978) used by the U.S> Water Resources Council for comprehensive planning, including the National Assessment, and as a standard geographical framework for more detailed water and related land-resources planning. The Accounting Units are those currently (1978) in use by the U.S. Geological Survey for managing the National Water Data Network. This map was revised to include a boundary realinement between Cataloging Units 10140103 and 10160009.

Developing a Comprehensive Model of Intensive Care Unit Processes: Concept of Operations.

PubMed

Romig, Mark; Tropello, Steven P; Dwyer, Cindy; Wyskiel, Rhonda M; Ravitz, Alan; Benson, John; Gropper, Michael A; Pronovost, Peter J; Sapirstein, Adam

2015-04-23

This study aimed to use a systems engineering approach to improve performance and stakeholder engagement in the intensive care unit to reduce several different patient harms. We developed a conceptual framework or concept of operations (ConOps) to analyze different types of harm that included 4 steps as follows: risk assessment, appropriate therapies, monitoring and feedback, as well as patient and family communications. This framework used a transdisciplinary approach to inventory the tasks and work flows required to eliminate 7 common types of harm experienced by patients in the intensive care unit. The inventory gathered both implicit and explicit information about how the system works or should work and converted the information into a detailed specification that clinicians could understand and use. Using the ConOps document, we created highly detailed work flow models to reduce harm and offer an example of its application to deep venous thrombosis. In the deep venous thrombosis model, we identified tasks that were synergistic across different types of harm. We will use a system of systems approach to integrate the variety of subsystems and coordinate processes across multiple types of harm to reduce the duplication of tasks. Through this process, we expect to improve efficiency and demonstrate synergistic interactions that ultimately can be applied across the spectrum of potential patient harms and patient locations. Engineering health care to be highly reliable will first require an understanding of the processes and work flows that comprise patient care. The ConOps strategy provided a framework for building complex systems to reduce patient harm.

PAT: From Western solid dosage forms to Chinese materia medica preparations using NIR-CI.

PubMed

Zhou, Luwei; Xu, Manfei; Wu, Zhisheng; Shi, Xinyuan; Qiao, Yanjiang

2016-01-01

Near-infrared chemical imaging (NIR-CI) is an emerging technology that combines traditional near-infrared spectroscopy with chemical imaging. Therefore, NIR-CI can extract spectral information from pharmaceutical products and simultaneously visualize the spatial distribution of chemical components. The rapid and non-destructive features of NIR-CI make it an attractive process analytical technology (PAT) for identifying and monitoring critical control parameters during the pharmaceutical manufacturing process. This review mainly focuses on the pharmaceutical applications of NIR-CI in each unit operation during the manufacturing processes, from the Western solid dosage forms to the Chinese materia medica preparations. Finally, future applications of chemical imaging in the pharmaceutical industry are discussed. Copyright © 2015 John Wiley & Sons, Ltd.

Removal of contaminant gases from an electrolytic urine pretreatment process. [in spacecraft life support systems

NASA Technical Reports Server (NTRS)

Colombo, G. V.; Putnam, D. F.

1977-01-01

The effluent gas stream from an electrolytic urine pretreatment process was analyzed by gas chromatography-mass spectroscopy and wet chemical methods to determine its composition. The major constituents were identified as: hydrogen, carbon dioxide, oxygen, nitrogen, water vapor, and chlorine. The trace impurities were chlorinated light hydrocarbons, and a number of other organic impurities in the low ppm range. Several methods of removing all of the undesirable gases to levels acceptable for return to a space cabin atmosphere were investigated experimentally. A subsystem concept comprised of the following sequential unit processes and operations was successfully demonstrated: (1) raw urine scrubbing, (2) silica gel sorption, (3) dilution with cabin air, and (4) catalytic oxidation.

A social marketing approach to building a behavioral intervention for congenital cytomegalovirus.

PubMed

Bate, Sheri Lewis; Cannon, Michael J

2011-05-01

Congenital cytomegalovirus (CMV) is the most common congenital infection in the United States, causing permanent disabilities in more than 5,500 children born each year. In the absence of a vaccine, a promising means of prevention is through a behavioral intervention that educates women about CMV and promotes adherence to hygiene guidelines during pregnancy. Although effective behavioral interventions have been identified for other infectious diseases with similar transmission modes, current research has not yet identified an effective intervention for CMV. One way to gather evidence and identify key elements of a successful CMV intervention is through a social marketing approach. This article describes a five-step process for applying social marketing principles to the research and development, implementation, and evaluation of a CMV behavioral intervention.

[Identification and mapping of prescribed nursing actions for patients in an adult ICU].

PubMed

Salgado, Patricia Oliveira; Tannure, Meire Chucre; Oliveira, Cleydson Rodrigues; Chianca, Tânia Couto Machado

2012-01-01

Descriptive study that aimed to identify nursing actions prescribed by nurses in the medical records of patients admitted to an Intensive Care Unit (ICU) for adults, in Belo Horizonte (MG), the terms used, their frequency and map the actions to the Theory of Basic Human Needs and NIC interventions. It was obtained a sample of 44 patient records. It was identified 2,260 nursing actions. After exclusion of repetitions, it was found 124 different actions. All nursing actions have been mapped to physiological needs and also to NIC interventions. It was obtained 100% of agreement among experts in the validation of the mapping process. It is suggested that similar studies in ICUs from other locations and different contexts / specialties should be driven to identify nursing actions developed and its evolution.

USGS mineral-resource assessment of Sagebrush Focal Areas in the western United States

USGS Publications Warehouse

Frank, David G.; Frost, Thomas P.; Day, Warren C.; ,

2016-10-04

U.S. Geological Survey (USGS) scientists have completed an assessment of the mineral-resource potential of nearly 10 million acres of Federal and adjacent lands in Idaho, Montana, Nevada, Oregon, Utah, and Wyoming. The assessment of these lands, identified as Sagebrush Focal Areas, was done at the request of the Bureau of Land Management. The assessment results will be used in the decision-making process that the Department of the Interior is pursuing toward the protection of large areas of contiguous sagebrush habitat for the greater sage-grouse (Centrocercus urophasianus) in the Western United States. The detailed results of this ambitious study are published in the five volumes of USGS Scientific Investigations Report 2016–5089 and seven accompanying data releases.

Evolution of a Nursing Model for Identifying Client Needs in a Disaster Shelter: A Case Study with the American Red Cross.

PubMed

Springer, Janice; Casey-Lockyer, Mary

2016-12-01

From the time of Clara Barton, Red Cross nursing has had a key role in the care and support of persons affected by disasters in the United States. Hurricane Katrina and other events brought to light the need for a shelter model that was inclusive of the whole community, including persons with disabilities, at-risk and vulnerable populations, and children. From an intake process to a nursing model for assessment, an evidence-guided process informed a systematic approach for a registered nurse-led model of care. Copyright © 2016 Elsevier Inc. All rights reserved.

Ion propulsion cost effectivity

NASA Technical Reports Server (NTRS)

Zafran, S.; Biess, J. J.

1978-01-01

Ion propulsion modules employing 8-cm thrusters and 30-cm thrusters were studied for Multimission Modular Spacecraft (MMS) applications. Recurring and nonrecurring cost elements were generated for these modules. As a result, ion propulsion cost drivers were identified to be Shuttle charges, solar array, power processing, and thruster costs. Cost effective design approaches included short length module configurations, array power sharing, operation at reduced thruster input power, simplified power processing units, and power processor output switching. The MMS mission model employed indicated that nonrecurring costs have to be shared with other programs unless the mission model grows. Extended performance missions exhibited the greatest benefits when compared with monopropellant hydrazine propulsion.

Lexical morphology and its role in the writing process: evidence from a case of acquired dysgraphia.

PubMed

Badecker, W; Hillis, A; Caramazza, A

1990-06-01

A case of acquired dysgraphia is presented in which the deficit is attributed to an impairment at the level of the Graphemic Output Buffer. It is argued that this patient's performance can be used to identify the representational character of the processing units that are stored in the Orthographic Output Lexicon. In particular, it is argued that the distribution of spelling errors and the types of lexical items which affect error rates indicate that the lexical representations passed from the lexical output system to the Graphemic Output Buffer correspond to the productive morphemes of the language.

Analysis of the implementation of ergonomic design at the new units of an oil refinery.

PubMed

Passero, Carolina Reich Marcon; Ogasawara, Erika Lye; Baú, Lucy Mara Silva; Buso, Sandro Artur; Bianchi, Marcos Cesar

2012-01-01

Ergonomic design is the adaptation of working conditions to human limitations and skills in the physical design phase of a new installation, a new working system, or new products or tools. Based on this concept, the purpose of this work was to analyze the implementation of ergonomic design at the new industrial units of an oil refinery, using the method of Ergonomic Workplace Assessment. This study was conducted by a multidisciplinary team composed of operation, maintenance and industrial safety technicians, ergonomists, designers and engineers. The analysis involved 6 production units, 1 industrial wastewater treatment unit, and 3 utilities units, all in the design detailing phase, for which 455 ergonomic requirements were identified. An analysis and characterization of the requirements identified for 5 of the production units, involving a total of 246 items, indicated that 62% were related to difficult access and blockage operations, while 15% were related to difficulties in the circulation of employees inside the units. Based on these data, it was found that the ergonomic requirements identified in the design detailing phase of an industrial unit involve physical ergonomics, and that it is very difficult to identify requirements related to organizational or cognitive ergonomics.

Defining the Process of a Cardiovascular Risk Assessment Program: Lessons Learnt From Cardiac Assessment of Elite Soccer Players in the United Kingdom.

PubMed

Speers, Christopher; Seth, Ajai Narain; Patel, Kiran Chhaganbhai; Rakhit, Dhrubo Jyoti; Gillett, Mark James

2017-12-14

Retrospectively analyze the cardiac assessment process for elite soccer players, and provide team physicians with a systematic guide to managing longitudinal cardiac risk. Descriptive Epidemiology Study. Cardiac assessments incorporating clinical examination, 12-lead ECG, echocardiography, and health questionnaire. Soccer players at 5 professional clubs in England, the United Kingdom. Data was retrospectively collected, inspected, and analyzed to determine their clinical management and subsequent follow-up. Over 2 years, 265 soccer players, aged 13 to 37 years with 66% of white European ethnicity, were included in the cohort. Eleven percent had "not-normal" assessments, of these assessments, 83% were considered gray screens, falling into three broad categories: structural cardiac features (including valvular abnormalities), functional cardiac features, and electrocardiogram changes. After cardiology consultation, all assessments were grouped into low, enhanced and high-risk categories for ongoing longitudinal risk management. Overall clear-cut pathology was identified in 2%. Cardiovascular assessment is a vital tool in identifying athletes at risk of sudden cardiac death to mitigate their risk through surveillance, intervention, or participation restriction. The decision whether a player is fit to play or not requires a robust risk assessment followed by input from a multidisciplinary team that includes both the team physician and cardiologist. This educational article proposes a clinical management pathway to aid clinicians with this process. Sudden cardiac death is the important medical cause of death during exercise. The team physician should assume responsibility for the management of the longitudinal risk of their players' cardiac assessments in conjunction with sports cardiologist.

Development of the Vaccine Analytic Unit's research agenda for investigating potential adverse events associated with anthrax vaccine adsorbed.

PubMed

Payne, Daniel C; Franzke, Laura H; Stehr-Green, Paul A; Schwartz, Benjamin; McNeil, Michael M

2007-01-01

In 2002, the Centers for Disease Control and Prevention established the Vaccine Analytic Unit (VAU) in collaboration with the Department of Defense (DoD). The focus of this report is to describe the process by which the VAU's anthrax vaccine safety research plan was developed following a comprehensive review of these topics. Public health literature, surveillance data, and clinical sources were reviewed to create a list of adverse events hypothesized to be potentially related to anthrax vaccine adsorbed (AVA). From this list, a consensus process was used to select 11 important research topics. Adverse event background papers were written for each of these topics, addressing predetermined criteria. These were independently reviewed and ranked by a National Vaccine Advisory Committee (NVAC) workgroup. The adverse events included in the final priority list will be the subject of observational or other post marketing surveillance studies using the Defense Medical Surveillance System (DMSS) database. A review of various information sources identified over 100 potential adverse events. The review process recommended 11 topics as potentially warranting further study. The NVAC workgroup identified the following adverse event topics for study: arthritis, optic neuritis, and Stevens-Johnson syndrome/Toxic epidermal necrolysis. Two additional topics (systemic lupus erythematosus (SLE) and multiple, near-concurrent military vaccinations) were added in response to emerging public health and military concerns. The experience described, while specific for establishing the VAU's research agenda for the safety of the current anthrax vaccine, may be useful and adapted for research planning in other areas of public health research. Copyright (c) 2006 John Wiley & Sons, Ltd.

Use of Archived Information by the United States National Data Center

NASA Astrophysics Data System (ADS)

Junek, W. N.; Pope, B. M.; Roman-Nieves, J. I.; VanDeMark, T. F.; Ichinose, G. A.; Poffenberger, A.; Woods, M. T.

2012-12-01

The United States National Data Center (US NDC) is responsible for monitoring international compliance to nuclear test ban treaties, acquiring data and data products from the International Data Center (IDC), and distributing data according to established policy. The archive of automated and reviewed event solutions residing at the US NDC is a valuable resource for assessing and improving the performance of signal detection, event formation, location, and discrimination algorithms. Numerous research initiatives are currently underway that are focused on optimizing these processes using historic waveform data and alphanumeric information. Identification of optimum station processing parameters is routinely performed through the analysis of archived waveform data. Station specific detector tuning studies produce and compare receiver operating characteristics for multiple detector configurations (e.g., detector type, filter passband) to identify an optimum set of processing parameters with an acceptable false alarm rate. Large aftershock sequences can inundate automated phase association algorithms with numerous detections that are closely spaced in time, which increases the number of false and/or mixed associations in automated event solutions and increases analyst burden. Archived waveform data and alphanumeric information are being exploited to develop an aftershock processor that will construct association templates to assist the Global Association (GA) application, reduce the number of false and merged phase associations, and lessen analyst burden. Statistical models are being developed and evaluated for potential use by the GA application for identifying and rejecting unlikely preliminary event solutions. Other uses of archived data at the US NDC include: improved event locations using empirical travel time corrections and discrimination via a statistical framework known as the event classification matrix (ECM).

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

PubMed Central

2012-01-01

Background Perinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. Methods The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF), the actions to improve care, and the opinions of the participants. Results The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for ‘external cooperation’ (15%), ‘internal cooperation’ (17%), ‘practice organization’ (26%), ‘training and education’ (10%), and ‘medical performance’ (27%). Valued aspects of the audit meetings were: the multidisciplinary character (13%), the collective and non-judgmental search for substandard factors (21%), the perception of safety (13%), the motivation to reflect on one’s own professional performance (5%), and the inherent postgraduate education (10%). Conclusion Following our implementation strategy, the perinatal mortality audit has been successfully implemented in all 15 perinatal cooperation units. An important feature was our emphasis on the delicate character of the caregivers evaluating the care they provided. However, the actual implementation of the proposed actions for improving care is still a point of concern. PMID:22776712

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands.

PubMed

van Diem, Mariet Th; Timmer, Albertus; Bergman, Klasien A; Bouman, Katelijne; van Egmond, Nico; Stant, Dennis A; Ulkeman, Lida H M; Veen, Wenda B; Erwich, Jan Jaap H M

2012-07-09

Perinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF), the actions to improve care, and the opinions of the participants. The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for 'external cooperation' (15%), 'internal cooperation' (17%), 'practice organization' (26%), 'training and education' (10%), and 'medical performance' (27%). Valued aspects of the audit meetings were: the multidisciplinary character (13%), the collective and non-judgmental search for substandard factors (21%), the perception of safety (13%), the motivation to reflect on one's own professional performance (5%), and the inherent postgraduate education (10%). Following our implementation strategy, the perinatal mortality audit has been successfully implemented in all 15 perinatal cooperation units. An important feature was our emphasis on the delicate character of the caregivers evaluating the care they provided. However, the actual implementation of the proposed actions for improving care is still a point of concern.

40 CFR 63.100 - Applicability and designation of source.

Code of Federal Regulations, 2010 CFR

2010-07-01

... manufacturing process unit has two or more products that have the same maximum annual design capacity on a mass... subject to this subpart. (3) For chemical manufacturing process units that are designed and operated as... chemical manufacturing process units that are designed and operated as flexible operation units shall be...

15 CFR 971.427 - Processing outside the United States.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 15 Commerce and Foreign Trade 3 2014-01-01 2014-01-01 false Processing outside the United States... outside the United States. If appropriate TCRs will incorporate provisions to implement the decision of the Administrator regarding the return of resources processed outside the United States, in accordance...

40 CFR 63.1275 - Glycol dehydration unit process vent standards.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 12 2014-07-01 2014-07-01 false Glycol dehydration unit process vent... Storage Facilities § 63.1275 Glycol dehydration unit process vent standards. (a) This section applies to each glycol dehydration unit subject to this subpart that must be controlled for air emissions as...

40 CFR 63.1275 - Glycol dehydration unit process vent standards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 12 2013-07-01 2013-07-01 false Glycol dehydration unit process vent... Storage Facilities § 63.1275 Glycol dehydration unit process vent standards. (a) This section applies to each glycol dehydration unit subject to this subpart that must be controlled for air emissions as...

Geologic Mapping of Vesta

NASA Technical Reports Server (NTRS)

Yingst, R. A.; Mest, S. C.; Berman, D. C.; Garry, W. B.; Williams, D. A.; Buczkowski, D.; Jaumann, R.; Pieters, C. M.; De Sanctis, M. C.; Frigeri, A.;

Soil Functional Mapping: A Geospatial Framework for Scaling Soil Carbon Cycling

NASA Astrophysics Data System (ADS)

Lawrence, C. R.

2017-12-01

Climate change is dramatically altering biogeochemical cycles in most terrestrial ecosystems, particularly the cycles of water and carbon (C). These changes will affect myriad ecosystem processes of importance, including plant productivity, C exports to aquatic systems, and terrestrial C storage. Soil C storage represents a critical feedback to climate change as soils store more C than the atmosphere and aboveground plant biomass combined. While we know plant and soil C cycling are strongly coupled with soil moisture, substantial unknowns remain regarding how these relationships can be scaled up from soil profiles to ecosystems. This greatly limits our ability to build a process-based understanding of the controls on and consequences of climate change at regional scales. In an effort to address this limitation we: (1) describe an approach to classifying soils that is based on underlying differences in soil functional characteristics and (2) examine the utility of this approach as a scaling tool that honors the underlying soil processes. First, geospatial datasets are analyzed in the context of our current understanding of soil C and water cycling in order to predict soil functional units that can be mapped at the scale of ecosystems or watersheds. Next, the integrity of each soil functional unit is evaluated using available soil C data and mapping units are refined as needed. Finally, targeted sampling is conducted to further differentiate functional units or fill in any data gaps that are identified. Completion of this workflow provides new geospatial datasets that are based on specific soil functions, in this case the coupling of soil C and water cycling, and are well suited for integration with regional-scale soil models. Preliminary results from this effort highlight the advantages of a scaling approach that balances theory, measurement, and modeling.

40 CFR 264.1035 - Recordkeeping requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... management units in one recordkeeping system if the system identifies each record by each hazardous waste management unit. (b) Owners and operators must record the following information in the facility operating...., identify the hazardous waste management units on a facility plot plan). (ii) Information and data...

Trainee underperformance: a guide to achieving resolution.

PubMed

Rashid, Prem; Grills, Richard; Kuan, Melvyn; Klein, Deborah

2015-05-01

Underperformance and the disharmony it can cause are not commonly faced by trainees. However, when it occurs, a process to recognize and manage the issues compassionately must be put in place. A literature review was undertaken to outline processes and themes in addressing and resolving these types of issues. A PubMed search using 'surgical underperformance' and 'remedial teaching' was used as a broad template to find papers that illustrated key concepts. One thousand four hundred and fifteen papers were identified. In papers where the titles were in line with the stated topic, 294 abstracts were reviewed. Key papers were used to develop themes. Additional cross-referenced papers were also included where relevant. There can be a variety of reasons for trainee underperformance. The root cause is not always clear. Disharmony can result in a surgical unit during this time. The involved trainee as well as the members of the clinical unit may experience a variety of stressors. A systematic process of management can be used to evaluate the situation and bring some resolution to difficulties in working relationships. Early constructive intervention improves outcomes. There should be a process to systematically and compassionately resolve underlying issues. This paper outlines the disharmony that can result from trainee underperformance and offers guidance for resolution to those involved. © 2014 Royal Australasian College of Surgeons.

Identification of the Parameters of Menétrey -Willam Failure Surface of Calcium Silicate Units

NASA Astrophysics Data System (ADS)

Radosław, Jasiński

2017-10-01

The identification of parameters of Menétrey-Willamsurface made of concrete, masonry or autoclaved aerated concrete is not complicated. It is much more difficult to identify failure parameters of masonry units with cavities. This paper describes the concept of identifying the parameters of Menétrey-Willam failure surface (M-W-3) with reference to masonry units with vertical cavities. The M-W-3 surface is defined by uniaxial compressive strength fc, uniaxial tensile strength ft and eccentricity of elliptical function e. A test stand was built to identify surface parameters. It was used to test behaviour of masonry units under triaxial stress and conduct tests on whole masonry units in the uniaxial state. Results from tests on tens of silicate masonry units are presented in the Haigh-Westergaard (H-W) space. Statistical analyses were used to identify the shape of surface meridian, and then to determine eccentricity of the elliptical function.

Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital

PubMed Central

Hoffmeister, Louíse Viecili; de Moura, Gisela Maria Schebella Souto

2015-01-01

OBJECTIVE: to evaluate the use of identification wristbands among patients hospitalized in inpatient units. METHOD: quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. RESULTS: it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. CONCLUSION: the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process. PMID:25806629

Proposal for including what is valuable to ecosystems in environmental assessments.

PubMed

Campbell, D E

2001-07-15

Assessment scientists and managers depend on social values to identify the goals that will be used to guide environmental assessments. These goals are commonly identified by examining the vested interests of the various social groups that are stakeholders in a region. However, knowledge about what people value represents only part of the information needed to identify comprehensive assessment goals for environmental systems that include both economic and ecological components and processes. All parties also need to understand what is valuable to ecosystems because that determines the ecological patterns and processes that prevail in the long run. The competition among alternate system designs for available energy determines the viability of the choices that people make for their environment. Ecosystems that prevail in competition use the process of self-organization to create system designs that maximize the use of ever-changing sources of available energy. The efficacy of ecosystem designs can be evaluated using the maximum empower principle, which states that ecosystems evolve toward designs that maximize empower (energy use per unit time). Energy is an accounting quantity that normalizes the different kinds of energy developed in a system so that they may be compared. The counter-intuitive and sometimes controversial results that come from energy analyses are illustrated by examining three environmental problems on the interface between ecology and economics. A process for identifying and using social and ecosystem values to guide environmental assessments is proposed using a conceptual energy systems model that shows how these processes might interact within a region. The probability of realizing a given change in system empower production is suggested as a decision criterion that can be used by managers to evaluate the efficacy of alternatives.

[Feasibility of Developing Post High School Technician Programs for Emerging Energy Sources in Southwestern United States.] Policies and Manpower Needs Related to Emerging Energy Sources in Arizona and New Mexico. Final Report.

ERIC Educational Resources Information Center

Edington, Everett; And Others

The energy manpower research project was established to review the process used to identify skills needed in emerging energy sources and to discover any new occupations for which additional post-high school, vocational/technical training would be needed. A supplemental part of the project was the development of a solar energy instructional module.…

Personalizing Drug Selection Using Advanced Clinical Decision Support

PubMed Central

Pestian, John; Spencer, Malik; Matykiewicz, Pawel; Zhang, Kejian; Vinks, Alexander A.; Glauser, Tracy

2009-01-01

This article describes the process of developing an advanced pharmacogenetics clinical decision support at one of the United States’ leading pediatric academic medical centers. This system, called CHRISTINE, combines clinical and genetic data to identify the optimal drug therapy when treating patients with epilepsy or Attention Deficit Hyperactivity Disorder. In the discussion a description of clinical decision support systems is provided, along with an overview of neurocognitive computing and how it is applied in this setting. PMID:19898682

Participatory redesign of work organisation in hospital nursing: A study of the implementation process.

PubMed

Stab, Nicole; Hacker, Winfried

2018-05-01

The main goal of the study was to apply and analyse a moderated participatory small-group procedure with registered nurses, which aims at the development and implementation of measures to improve work organisation in hospital wards and nursing units. Participation in job redesign is an essential prerequisite of the successful implementation of improvement measures in nursing. The study was carried out in a public hospital of maximum care in Germany. We selected 25 wards with the most critical reported exhaustion and general health and applied a series of moderated small-group sessions in which the registered nurses jointly identified deficits in their work organisation, developed improvement measures, and then implemented and assessed them. Registered nurses of 22 wards actively took part in the small-group procedure. All nursing units jointly identified organisational deficits, developed possible improvement measures, and implemented them. The nursing teams then evaluated the implemented measures which were already assessable at the end of our research period; nearly all (99.0%) showed improvements, while 69.4% actually attained the desired goals. Participatory small-group activities may be successfully applied in hospital nursing in order to improve work organisation. Participatory assessment and redesign of nurses' work organisation should be integrated into regular team meetings. The nursing management should actively support the implementation process. © 2018 John Wiley & Sons Ltd.

Automating multistep flow synthesis: approach and challenges in integrating chemistry, machines and logic

PubMed Central

Shukla, Chinmay A

2017-01-01

The implementation of automation in the multistep flow synthesis is essential for transforming laboratory-scale chemistry into a reliable industrial process. In this review, we briefly introduce the role of automation based on its application in synthesis viz. auto sampling and inline monitoring, optimization and process control. Subsequently, we have critically reviewed a few multistep flow synthesis and suggested a possible control strategy to be implemented so that it helps to reliably transfer the laboratory-scale synthesis strategy to a pilot scale at its optimum conditions. Due to the vast literature in multistep synthesis, we have classified the literature and have identified the case studies based on few criteria viz. type of reaction, heating methods, processes involving in-line separation units, telescopic synthesis, processes involving in-line quenching and process with the smallest time scale of operation. This classification will cover the broader range in the multistep synthesis literature. PMID:28684977

An efficient process for lactic acid production from wheat straw by a newly isolated Bacillus coagulans strain IPE22.

PubMed

Zhang, Yuming; Chen, Xiangrong; Luo, Jianquan; Qi, Benkun; Wan, Yinhua

2014-04-01

A thermophilic lactic acid (LA) producer was isolated and identified as Bacillus coagulans strain IPE22. The strain showed remarkable capability to ferment pentose, hexose and cellobiose, and was also resistant to inhibitors from lignocellulosic hydrolysates. Based on the strain's promising features, an efficient process was developed to produce LA from wheat straw. The process consisted of biomass pretreatment by dilute sulfuric acid and subsequent SSCF (simultaneous saccharification and co-fermentation), while the operations of solid-liquid separation and detoxification were avoided. Using this process, 46.12 g LA could be produced from 100g dry wheat straw with a supplement of 10 g/L corn steep liquid powder at the cellulase loading of 20 FPU (filter paper activity units)/g cellulose. The process by B. coagulans IPE22 provides an economical route to produce LA from lignocellulose. Copyright © 2014 Elsevier Ltd. All rights reserved.

Motivation for health information seeking and processing about clinical trial enrollment.

PubMed

Yang, Z Janet; McComas, Katherine; Gay, Geri; Leonard, John P; Dannenberg, Andrew J; Dillon, Hildy

2010-07-01

Low patient accrual in clinical trials poses serious concerns for the advancement of medical science in the United States. Past research has identified health communication as a crucial step in overcoming barriers to enrollment. However, few communication scholars have studied this problem from a sociopsychological perspective to understand what motivates people to look for or pay attention to information about clinical trial enrollment. This study applies the model of Risk Information Seeking and Processing (RISP) to this context of health decision making. By recognizing the uncertainties embedded in clinical trials, we view clinical trial enrollment as a case study of risk. With data from a random-digit-dial telephone survey of 500 adults living in the United States, we used structural equation modeling to test the central part of the RISP model. In particular, we examined the role of optimistic feelings, as a type of positive affect, in motivating information seeking and processing. Our results indicated that rather than exerting an indirect influence on information seeking through motivating a psychological need for more information, optimistic feelings have more direct relationships with information seeking and processing. Similarly, informational subjective norms also exhibit a more direct relationship with information seeking and processing. These results suggest merit in applying the RISP model to study health decision making related to clinical trial enrollment. Our findings also render practical implications on how to improve communication about clinical trial enrollment.

Learning and feedback from the Danish patient safety incident reporting system can be improved.

PubMed

Moeller, Anders Damgaard; Rasmussen, Kurt; Nielsen, Kent Jacob

2016-06-01

The perceived usefulness of incident reporting systems is an important motivational factor for reporting. The usefulness may be facilitated by well-established feedback mechanisms and by learning processes. The aim of this study was to investigate how feedback mechanisms and learning processes were implemented at four Danish hospital units all located in one of the five Danish regions. Based on the concepts of feedback and learning from incident processes, a questionnaire was developed and distributed to 335 patient safety representatives from 200 departments at four Danish hospital units in one of the five Danish regions. The study showed that external reporters were rarely contacted for dialogue, grouped front-line staff were sparsely involved in the learning process, few evaluated the effectiveness of implemented interventions and personal factors were frequently perceived as a primary contributory factor to these incidents. In contrast, the patient safety representatives perceived their competencies as sufficient for the job, internal reporters were often contacted for dialogue, evaluation was widely used and management supported the work with incident reports. The results of the study identified several shortcomings in the implementation of learning processes and feedback mechanisms. The apparent existence of a person-focused approach stands out as an element of notice. The insufficient implementation we observed indicates that there is room for improvement in the efforts made to maximise learning from incidents in the investigated population. not relevant. not relevant.

Conducting an Efficient Proactive Risk Assessment Prior to CPOE Implementation in an Intensive Care Unit

PubMed Central

Hundt, Ann Schoofs; Adams, Jean A.; Schmid, J. Andrew; Musser, Linda M.; Walker, James M.; Wetterneck, Tosha B; Douglas, Stephen V.; Paris, Bonnie L.; Carayon, Pascale

2012-01-01

Purpose To develop, conduct, and evaluate a proactive risk assessment (PRA) of the design and implementation of CPOE in an ICU. Methods We developed a PRA method based on issues identified from documented experience with conventional PRA methods and the constraints of an organization about to implement CPOE in an intensive care unit. The PRA method consists of three phases: planning (three months), team (one five-hour meeting), and evaluation (short- and long-term). Results Sixteen unique relevant vulnerabilities were identified as a result of the PRA team’s efforts. Negative consequences resulting from the vulnerabilities included potential patient safety and quality of care issues, non-compliance with regulatory requirements, increases in cognitive burden on CPOE users, and/or worker inconvenience or distress. Actions taken to address the vulnerabilities included redesign of the technology, process (workflow) redesign, user training, and/or ongoing monitoring. Verbal and written evaluation by the team members indicated that the PRA method was useful and that participants were willing to participate in future PRAs. Long-term evaluation was accomplished by monitoring an ongoing “issues list” of CPOE problems identified by or reported to IT staff. Vulnerabilities identified by the team were either resolved prior to CPOE implementation (n = 7) or shortly thereafter (n = 9). No other issues were identified beside those identified by the team. Conclusions Generally positive results from the various evaluations including a long-term evaluation demonstrate the value of developing an efficient PRA method that meets organizational and contextual requirements and constraints. PMID:22608242

Career Education Resource Units: Grade 3.

ERIC Educational Resources Information Center

Newark School District, DE.

The units contained in this guide are intended primarily as resource materials to assist grade 3 teachers in identifying units into which career awareness concepts can be infused and also in identifying instructional activities that correlate basic skills and career education objectives. Introductory information includes a definition of career…

Career Education Resource Units: Grades 4.

ERIC Educational Resources Information Center

Newark School District, DE.

The units contained in this guide are intended primarily as resource materials to assist grade 4 teachers in identifying units into which career awareness concepts can be infused and also in identifying instructional activities that correlate basic skills and career education objectives. Introductory information includes a definition of career…

Infrared Spectral Signatures for Io's Dark and Green Spots

NASA Technical Reports Server (NTRS)

Granahan, J. C.; Fanale, F. P.; Carlson, R.; Smythe, W. D.

2001-01-01

This spectral study of Io identifies the infrared components of the visible spectral units (green and dark) as identified by Galileo. The green units possess sulfur dioxide and the dark units are associated with infrared thermal signatures. Additional information is contained in the original extended abstract.

On the use of Cox regression to examine the temporal clustering of flooding and heavy precipitation across the central United States

NASA Astrophysics Data System (ADS)

Mallakpour, Iman; Villarini, Gabriele; Jones, Michael P.; Smith, James A.

2017-08-01

The central United States is plagued by frequent catastrophic flooding, such as the flood events of 1993, 2008, 2011, 2013, 2014 and 2016. The goal of this study is to examine whether it is possible to describe the occurrence of flood and heavy precipitation events at the sub-seasonal scale in terms of variations in the climate system. Daily streamflow and precipitation time series over the central United States (defined here to include North Dakota, South Dakota, Nebraska, Kansas, Missouri, Iowa, Minnesota, Wisconsin, Illinois, West Virginia, Kentucky, Ohio, Indiana, and Michigan) are used in this study. We model the occurrence/non-occurrence of a flood and heavy precipitation event over time using regression models based on Cox processes, which can be viewed as a generalization of Poisson processes. Rather than assuming that an event (i.e., flooding or precipitation) occurs independently of the occurrence of the previous one (as in Poisson processes), Cox processes allow us to account for the potential presence of temporal clustering, which manifests itself in an alternation of quiet and active periods. Here we model the occurrence/non-occurrence of flood and heavy precipitation events using two climate indices as time-varying covariates: the Arctic Oscillation (AO) and the Pacific-North American pattern (PNA). We find that AO and/or PNA are important predictors in explaining the temporal clustering in flood occurrences in over 78% of the stream gages we considered. Similar results are obtained when working with heavy precipitation events. Analyses of the sensitivity of the results to different thresholds used to identify events lead to the same conclusions. The findings of this work highlight that variations in the climate system play a critical role in explaining the occurrence of flood and heavy precipitation events at the sub-seasonal scale over the central United States.

Sustainability of protocolized handover of pediatric cardiac surgery patients to the intensive care unit.

PubMed

Chenault, Kristin; Moga, Michael-Alice; Shin, Minah; Petersen, Emily; Backer, Carl; De Oliveira, Gildasio S; Suresh, Santhanam

2016-05-01

Transfer of patient care among clinicians (handovers) is a common source of medical errors. While the immediate efficacy of these initiatives is well documented, sustainability of practice changes that results in better processes of care is largely understudied. The objective of the current investigation was to evaluate the sustainability of a protocolized handover process in pediatric patients from the operating room after cardiac surgery to the intensive care unit. This was a prospective study with direct observation assessment of handover performance conducted in the cardiac ICU (CICU) of a free-standing, tertiary care children's hospital in the United States. Patient transitions from the operating room to the CICU, including the verbal handoff, were directly observed by a single independent observer in all phases of the study. A checklist of key elements identified errors classified as: (1) technical, (2) information omissions, and (3) realized errors. Total number of errors was compared across the different times of the study (preintervention, postintervention, and the current sustainability phase). A total of 119 handovers were studied: 41 preintervention, 38 postintervention, and 40 in the current sustainability phase. The median [Interquartile range (IQR)] number of technical errors was significantly reduced in the sustainability phase compared to the preintervention and postintervention phase, 2 (1-3), 6 (5-7), and 2.5 (2-4), respectively P = 0.0001. Similarly, the median (IQR) number of verbal information omissions was also significantly reduced in the sustainability phase compared to the preintervention and postintervention phases, 1 (1-1), 4 (3-5) and 2 (1-3), respectively. We demonstrate sustainability of an improved handover process using a checklist in children being transferred to the intensive care unit after cardiac surgery. Standardized handover processes can be a sustainable strategy to improve patient safety after pediatric cardiac surgery. © 2016 John Wiley & Sons Ltd.

Envisioning successful teamwork: An exploratory qualitative study of team processes used by nursing teams in a paediatric hospital unit.

PubMed

Whitehair, Leeann; Hurley, John; Provost, Steve

2018-06-12

To explore how team processes support nursing teams in hospital units during every day work. Due to their close proximity to patients, nurses are central to the process of maintaining patient safety. Globally, changes in models of care delivery by nurses, inclusive of team nursing are being considered. This qualitative study used purposive sampling in a single hospital and participants were nurses employed to work on a paediatric unit. Data was collected using non-participant observation. Thematic analysis was used to analyse and code data to create themes. Three clear themes emerged. Theme 1:"We are a close knit team"; Behaviours building a successful team"- outlines expectations regarding how members are to behave when establishing, nurturing and managing a team. Theme 2: "Onto it"; Ways of interacting with each other" - Identifies the expected pattern of relating within the team which contribute to shared understanding and actions. Theme 3: "No point in second guessing"; Maintaining a global view of the unit" - focuses on the processes for monitoring and reporting signals that team performance is on course or breaking down and includes accepting responsibility to lead the team and team members having a widespread sensitivity to what needs to happen. Essential to successful teamwork is the interplay and mutuality of team members and team leaders. Leadership behaviours exhibited in this study provide useful insights to how informal and shared or distributed leadership of teams may be achieved. Without buy-in from team members, teams may not achieve successful desired outcomes. It is not sufficient for teams to rely on current successful outcomes, as they need to be on the look-out for new ways to ensure that they can anticipate possible risks or threats to the team before harm is done. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.