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Sample records for improve patient understanding

  1. Improving Health Care by Understanding Patient Preferences

    PubMed Central

    Brennan, Patricia Flatley; Strombom, Indiana

    1998-01-01

    If nurses, physicians, and health care planners knew more about patients' health-related preferences, care would most likely be cheaper, more effective, and closer to the individuals' desires. In order for patient preferences to be effectively used in the delivery of health care, it is important that patients be able to formulate and express preferences, that these judgments be made known to the clinician at the time of care, and that these statements meaningfully inform care activities. Decision theory and health informatics offer promising strategies for eliciting subjective values and making them accessible in a clinical encounter in a manner that drives health choices. Computer-based elicitation and reporting tools are proving acceptable to patients and clinicians alike. It is time for the informatics community to turn their attention toward building computer-based applications that support clinicians in the complex cognitive process of integrating patient preferences with scientific knowledge, clinical practice guidelines, and the realities of contemporary health care. PMID:9609495

  2. Tablets in trauma: using mobile computing platforms to improve patient understanding and experience.

    PubMed

    Furness, Nicholas D; Bradford, Oliver J; Paterson, Maurice P

    2013-03-01

    Tablets are becoming commonplace in the health care setting. Patients often request to view their radiographs after sustaining trauma. This can be challenging, especially if patients are immobile. The authors performed a prospective, questionnaire-based study to assess inpatient desire to view radiographs on tablets and whether viewing images affected patient-rated outcomes of understanding and satisfaction. Enabling trauma patients to view their images on a tablet is a worthwhile practice because it improves patient involvement in decision making, satisfaction, perceived understanding, and overall experience.

  3. Knowledge is Power. A quality improvement project to increase patient understanding of their hospital stay

    PubMed Central

    Nicholson Thomas, Eleanor; Edwards, Lloyd; McArdle, Paul

    2017-01-01

    Patients frequently leave hospital uninformed about the details of their hospital stay with studies showing that only 59.9% of patients are able to accurately state their diagnosis and ongoing management after discharge. 1 2 This places patients at a higher risk of complications. Educating patients by providing them with accurate and understandable information enables them to take greater control, potentially reducing readmission rates, and unplanned visits to secondary services whilst providing safer care and improving patient satisfaction. 3 4 We wished to investigate whether through a simple intervention, we could improve the understanding and retention of key pieces of clinical information in those patients recently admitted to hospital. A leaflet was designed to trigger patients to ask questions about key aspects of their stay. This was then given to inpatients who were interviewed two weeks later using telephone follow up to assess their understanding of their hospital admission. Patients were asked about their diagnosis, new medications, likely complications, follow up arrangements and recommended points of contact in case of difficulty. Sequential modifications were made using PDSA cycles to maximise the impact and benefit of the process. Baseline data revealed that only 77% of patients could describe their diagnosis and only 27% of patients knew details about their new medications. After the leaflet intervention these figures improved to 100% and 71% respectively. Too often patients are unaware about what happens to them whilst in hospital and are discharged unsafely and dissatisfied as a result. A simple intervention such as a leaflet prompting patients to ask questions and take responsibility for their health can make a difference in potentially increasing patient understanding and thereby reducing risk. PMID:28321297

  4. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

    PubMed

    Montano, Maria F; Mehdi, Harshal; Nash, David B

    2016-11-01

    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.

  5. Understanding patients' perspective in the use of generic antiepileptic drugs: compelling lessons for physicians to improve physician/patient communication

    PubMed Central

    Liow, Kore

    2009-01-01

    Background Epilepsy is a condition in which consistency of treatment is paramount to successful management and for most patients, effective seizure control can be achieved. Given the severe consequences of even a single breakthrough seizure, patients should be afforded every opportunity to succeed on their given regimens. Discussion Some experts argue that global policy on generic antiepileptic drug substitution in epilepsy should be limited – occurring at the discretion of and with careful monitoring by the physician. While the debate continues, physicians still have daily responsibilities to their patients to help them best manage their epilepsy within the context of the current environment – the reality of which may involve switching to a generic antiepileptic drug or navigating various formulations between generics. Summary To provide context, this paper first reviews the main "hot button" issues fueling the ongoing generic debate, including a broad overview of the current state of the literature. The main goal however is to provide physicians with a patient perspective on generic antiepileptic drug use in epilepsy as a source of clinically useful, everyday advice to improve communication and increase patient self-advocacy, both of which are necessary for optimal patient outcome. PMID:19292903

  6. Understanding the needs of relatives of patients within a special hospital for mentally disordered offenders: a basis for improved services.

    PubMed

    McCann, G; McKeown, M; Porter, I

    1996-02-01

    This paper outlines one component of a major research study, which will form the basis for a new service for relatives of schizophrenia sufferers within a special hospital. The aim of this initial component has been twofold: firstly to identify and understand the needs of relatives in terms of their present knowledge and understanding of schizophrenia; and secondly to establish what stress the relatives are presently experiencing in maintaining contact with patients and whether this stress may have an impact on the management of schizophrenia at the hospital. A purposive sample of 17 relatives were interviewed using two semi-structured interview protocols. All interviews were audio-taped and later transcribed for analysis. The data have provided an illuminating insight into the thoughts and feelings of relatives and indicate many ways in which a service for relatives could be tailored. It is apparent that many relatives are currently not being supported, involved or allowed to contribute to the care of their family member at Ashworth Hospital. This present situation is stressful for relatives and is likely to have a detrimental effect on the course of schizophrenia in patients at Ashworth Hospital.

  7. Improving Understanding of and Adherence to Pulmonary Rehabilitation in Patients with COPD: A Qualitative Inquiry of Patient and Health Professional Perspectives

    PubMed Central

    Guo, Su-Er; Bruce, Anne

    2014-01-01

    Objectives Although patients with Chronic Obstructive Pulmonary Disease (COPD) who adhere to a pulmonary rehabilitation program are better able to manage their illness and experience a better health-related quality of life, pulmonary rehabilitation remains underused. This study aims to describe the experiences of patients who are in a pulmonary rehabilitation program, and explore the perceptions of both patients and health professionals about what improves effective pulmonary rehabilitation. Methods A qualitative research design, including focus groups and individual interviews with 25 patients and 7 program health professionals, was used to obtain combined perspectives about the factors underpinning the COPD patient's reasons for participation in a rehabilitation program. Results Three themes were derived from the descriptive content analysis: (1) building confidence, (2) a perception of immediate tangible results, and (3) being ready and having access to the program. Conclusions and Practical Implications Qualitative findings from this study suggest that a patient's adherence to a COPD rehabilitation program can be improved by quickly building up the participant's confidence, promoting tangible results, and by timely recognizing and responding to the issues of readiness and access. Based on these findings, health care providers could develop strategies to better serve COPD patients who face multiple barriers to access and successfully complete a pulmonary rehabilitation program. PMID:25357128

  8. A first step toward understanding patient safety

    PubMed Central

    2016-01-01

    Patient safety has become an important policy agenda in healthcare systems since publication of the 1999 report entitled "To Err Is Human." The paradigm has changed from blaming the individual for the error to identifying the weakness in the system that led to the adverse events. Anesthesia is one of the first healthcare specialties to adopt techniques and lessons from the aviation industry. The widespread use of simulation programs and the application of human factors engineering to clinical practice are the influences of the aviation industry. Despite holding relatively advanced medical technology and comparable safety records, the Korean health industry has little understanding of the systems approach to patient safety. Because implementation of the existing system and program requires time, dedication, and financial support, the Korean healthcare industry is in urgent need of developing patient safety policies and putting them into practice to improve patient safety before it is too late. PMID:27703622

  9. Improving Student Understanding of Spatial Ecology Statistics

    ERIC Educational Resources Information Center

    Hopkins, Robert, II; Alberts, Halley

    2015-01-01

    This activity is designed as a primer to teaching population dispersion analysis. The aim is to help improve students' spatial thinking and their understanding of how spatial statistic equations work. Students use simulated data to develop their own statistic and apply that equation to experimental behavioral data for Gambusia affinis (western…

  10. Improving Students' Understanding of Quantum Measurement

    SciTech Connect

    Zhu Guangtian; Singh, Chandralekha

    2010-10-24

    We describe the difficulties advanced undergraduate and graduate students have with quantum measurement. To reduce these difficulties, we have developed research-based learning tools such as the Quantum Interactive Learning Tutorial (QuILT) and peer instruction tools. A preliminary evaluation shows that these learning tools are effective in improving students' understanding of concepts related to quantum measurement.

  11. Improving Students' Understanding of Quantum Measurement

    NASA Astrophysics Data System (ADS)

    Zhu, Guangtian; Singh, Chandralekha

    2010-10-01

    We describe the difficulties advanced undergraduate and graduate students have with quantum measurement. To reduce these difficulties, we have developed research-based learning tools such as the Quantum Interactive Learning Tutorial (QuILT) and peer instruction tools. A preliminary evaluation shows that these learning tools are effective in improving students' understanding of concepts related to quantum measurement.

  12. Understanding Millennials to Improve Recruiting Efficiency

    DTIC Science & Technology

    2011-03-24

    ABSTRACT The Millennial generation , born between 1982 and 2003, has been influenced by numerous events in their developmental years such as the 9/11...characteristics of the Millennial generation and the interrelationship with other generations in an effort to improve U.S. Army recruiting efficiencies... Millennials . Recruiting is a “people” business and the more USAREC leaders and recruiters understand generational interrelationships, influences, and

  13. Do Patients Understand Written Health Information?

    ERIC Educational Resources Information Center

    Dixon, Elizabeth; Park, Rosemarie

    1990-01-01

    Long sentences, medical terms, and small print make hospital information brochures and consent forms difficult for many patients to understand. Nurses can help patients by simplifying language, highlighting important information, and using lists. (JOW)

  14. Improving student understanding of quantum mechanics

    NASA Astrophysics Data System (ADS)

    Singh, Chandralekha

    2015-04-01

    Learning quantum mechanics is challenging for many students. We are investigating the difficulties that upper-level students have in learning quantum mechanics. To help improve student understanding of quantum concepts, we are developing quantum interactive learning tutorials (QuILTs) and tools for peer-instruction. Many of the QuILTs employ computer simulations to help students visualize and develop better intuition about quantum phenomena. We will discuss the common students' difficulties and research-based tools we are developing to bridge the gap between quantitative and conceptual aspects of quantum mechanics and help students develop a solid grasp of quantum concepts. Support from the National Science Foundation is gratefully acknowledged.

  15. Teleophthalmology: improving patient outcomes?

    PubMed Central

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  16. Understanding nursing 'nous' in the context of service improvements.

    PubMed

    Price, Bob

    2013-07-01

    Nurse managers face the challenges of how best to improve healthcare services in ways that can be evaluated readily by patients and that engage nurses. They also need to demonstrate how staff resource has been successfully deployed. This article ventures that a better understanding of 'nous' - the organisational ability of nurses to combine skills to clear purpose and patient benefit - may assist nurse managers to achieve these aims. It explores what staff nous consists of and examines critically more traditional modes of thinking about staff as intellectual capital. The reader is shown how staff nous might feature in new patient evaluations of care, nursing staff appraisals and the design of care initiatives.

  17. Improving students' understanding of quantum mechanics

    NASA Astrophysics Data System (ADS)

    Zhu, Guangtian

    2011-12-01

    Learning physics is challenging at all levels. Students' difficulties in the introductory level physics courses have been widely studied and many instructional strategies have been developed to help students learn introductory physics. However, research shows that there is a large diversity in students' preparation and skills in the upper-level physics courses and it is necessary to provide scaffolding support to help students learn advanced physics. This thesis explores issues related to students' common difficulties in learning upper-level undergraduate quantum mechanics and how these difficulties can be reduced by research-based learning tutorials and peer instruction tools. We investigated students' difficulties in learning quantum mechanics by administering written tests and surveys to many classes and conducting individual interviews with a subset of students. Based on these investigations, we developed Quantum Interactive Learning Tutorials (QuILTs) and peer instruction tools to help students build a hierarchical knowledge structure of quantum mechanics through a guided approach. Preliminary assessments indicate that students' understanding of quantum mechanics is improved after using the research-based learning tools in the junior-senior level quantum mechanics courses. We also designed a standardized conceptual survey that can help instructors better probe students' understanding of quantum mechanics concepts in one spatial dimension. The validity and reliability of this quantum mechanics survey is discussed.

  18. Understanding Empathy Training with Virtual Patients.

    PubMed

    Kleinsmith, Andrea; Rivera-Gutierrez, Diego; Finney, Glen; Cendan, Juan; Lok, Benjamin

    2015-11-01

    While the use of virtual characters in medical education is becoming more and more commonplace, an understanding of the role they can play in empathetic communication skills training is still lacking. This paper presents a study aimed at building this understanding by determining if students can respond to a virtual patient's statement of concern with an empathetic response. A user study was conducted at the [blinded] College of Medicine in which early stage medical students interacted with virtual patients in one session and real humans trained to portray real patients (i.e., standardized patients) in a separate session about a week apart. During the interactions, the virtual and 'real' patients presented the students with empathetic opportunities which were later rated by outside observers. The results of pairwise comparisons indicate that empathetic responses made to virtual patients were rated as significantly more empathetic than responses made to standardized patients. Even though virtual patients may be perceived as artificial, the educational benefit of employing them for training medical students' empathetic communications skills is that virtual patients offer a low pressure interaction which allows students to reflect on their responses.

  19. Understanding Empathy Training with Virtual Patients

    PubMed Central

    Kleinsmith, Andrea; Rivera-Gutierrez, Diego; Finney, Glen; Cendan, Juan; Lok, Benjamin

    2015-01-01

    While the use of virtual characters in medical education is becoming more and more commonplace, an understanding of the role they can play in empathetic communication skills training is still lacking. This paper presents a study aimed at building this understanding by determining if students can respond to a virtual patient's statement of concern with an empathetic response. A user study was conducted at the [blinded] College of Medicine in which early stage medical students interacted with virtual patients in one session and real humans trained to portray real patients (i.e., standardized patients) in a separate session about a week apart. During the interactions, the virtual and ‘real' patients presented the students with empathetic opportunities which were later rated by outside observers. The results of pairwise comparisons indicate that empathetic responses made to virtual patients were rated as significantly more empathetic than responses made to standardized patients. Even though virtual patients may be perceived as artificial, the educational benefit of employing them for training medical students' empathetic communications skills is that virtual patients offer a low pressure interaction which allows students to reflect on their responses. PMID:26166942

  20. Understanding Patient Satisfaction Ratings for Radiology Services

    PubMed Central

    Lang, Elvira V.; Yuh, William T.C.; Kelly, Ronda; Macadam, Luke; Potts, Richard; Mayr, Nina A.

    2015-01-01

    Under the Hospital Value-Based Purchasing Program of the Centers for Medicare & Medicaid Services patient satisfaction accounts for 30% of the measures of and payments for quality of care. Understanding what drives satisfaction data, how it is obtained, converted into scores, and formulated into rankings, is increasingly critical for imaging departments. PMID:24261356

  1. [Understanding my patient from the personalist bioethics].

    PubMed

    Cardona Vélez, Jonathan

    2014-01-01

    The role of ethics in our everyday life responds to the need to understand a decisive reality, especially for us as physicians, a reality that we know as the human person. So, a personalized bioethical approach plays an important role against the accelerated dehumanization that we are experiencing, because every one of our actions has a direct impact on our patients.

  2. Understanding the role of physician attire on patient perceptions: a systematic review of the literature— targeting attire to improve likelihood of rapport (TAILOR) investigators

    PubMed Central

    Petrilli, Christopher Michael; Mack, Megan; Petrilli, Jennifer Janowitz; Hickner, Andy; Saint, Sanjay; Chopra, Vineet

    2015-01-01

    Objectives Despite a growing body of literature, uncertainty regarding the influence of physician dress on patients’ perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence. Setting, participants, interventions and outcomes We searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted. Results Of 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions. Conclusions

  3. Understanding basic carbohydrate counting, glycemic index, and glycemic load for improved glycemic control in Hispanic patients with type 2 diabetes mellitus.

    PubMed

    Ortiz, Lidia Guadalupe Compeán; Berry, Diane C; Ruiz, Octelina Castillo; González, Eunice Reséndiz; Pérez, Paulina Aguilera; Rivas, Elva Del Ángel

    2014-01-01

    Hispanic patients with type 2 diabetes mellitus generally have poor glycemic control. Constant hyperglycemia in individuals with type 2 diabetes can cause microvascular and macrovascular complications that lead to early morbidity and mortality. Good glycemic control requires a balance between diet, exercise, and medication, but dietary balance is difficult to achieve for many patients. Of the macronutrients, carbohydrates mostly affect blood glucose levels. Basic carbohydrate counting, glycemic index, and glycemic load are important tools for patients to master to control their blood glucose levels.

  4. Improving semantic scene understanding using prior information

    NASA Astrophysics Data System (ADS)

    Laddha, Ankit; Hebert, Martial

    2016-05-01

    Perception for ground robot mobility requires automatic generation of descriptions of the robot's surroundings from sensor input (cameras, LADARs, etc.). Effective techniques for scene understanding have been developed, but they are generally purely bottom-up in that they rely entirely on classifying features from the input data based on learned models. In fact, perception systems for ground robots have a lot of information at their disposal from knowledge about the domain and the task. For example, a robot in urban environments might have access to approximate maps that can guide the scene interpretation process. In this paper, we explore practical ways to combine such prior information with state of the art scene understanding approaches.

  5. Understanding challenging behaviour in patients with dementia.

    PubMed

    Cunningham, C

    The fifth and final article in the series on patients with dementia in acute care examines challenging behaviour. Hospital admission, combined with unfamiliar surroundings and memory problems, can be frightening and disorientating for those with dementia. This can lead to behaviour which is perceived as 'disruptive' or 'difficult'. Aspects of the hospital environment or care practice can contribute to problems that may be misinterpreted and lead to challenging behaviour. Staff should seek to understand the cause of challenging behaviour, assess the possible causes and use strategies to reinforce familiarity and minimise distress for these patients.

  6. Understanding pharmacokinetics to improve tuberculosis treatment outcome

    PubMed Central

    Reynolds, Jonathan; Heysell, Scott K

    2014-01-01

    Introduction Tuberculosis (TB) remains the leading cause of death from a curable infectious disease; drug-resistant TB threatens to dismantle all prior gains in global control. Suboptimal circulating anti-TB drug concentrations can lead to lack of cure and acquired drug resistance. Areas covered This review will introduce pharmacokinetic parameters for key anti-TB drugs, as well as the indications and limitations of measuring these parameters in clinical practice. Current and novel methodologies for delivering anti-TB pharmacokinetic-pharmacodynamic data are highlighted and gaps in operational research described. Expert opinion Individual pharmacokinetic variability is commonplace, underappreciated and difficult to predict without therapeutic drug monitoring (TDM). Pharmacokinetic thresholds associated with poor TB treatment outcome in drug-susceptible TB have recently been described and may now guide the application of TDM, but require validation in a variety of settings and comorbidities. Dried blood spots for TDM and prepackaged multidrug plates for minimum inhibitory concentration testing will overcome barriers of accessibility and represent areas for innovation. Operationalizing pharmacokinetics has the potential to improve TB outcomes in the most difficult-to-treat forms of the disease such as multidrug resistance. Clinical studies in these areas are eagerly anticipated and we expect will better define the rational introduction of novel therapeutics. PMID:24597717

  7. Strategies for improving patient compliance.

    PubMed

    Strand, J

    1994-01-01

    Achieving patient compliance in taking prescribed medications is a formidable challenge for all clinicians. As PAs, we have daily opportunities to communicate with patients and improve their compliance. An office-based compliance program, combining patient education and behavior-modification components, can be beneficial in this regard. Strategies for improving compliance include giving clear, concise, and logical instructions in familiar language, adapting drug regimens to daily routines, eliciting patient participation through self-monitoring, and providing educational materials that promote overall good health in connection with medical treatment.

  8. Improving emergency department patient flow.

    PubMed

    Jarvis, Paul Richard Edwin

    2016-06-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  9. Improving emergency department patient flow

    PubMed Central

    Jarvis, Paul Richard Edwin

    2016-01-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED’s capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED. PMID:27752619

  10. What constitutes our understanding of a patient?

    PubMed

    Chessick, R D

    1993-01-01

    A number of approaches to the search for methodology in the human sciences are reviewed. Heidegger's use of Husserl's phenomenology led to his exploration of the background practices on which he believed all our understanding is based. This use of phenomenology was adopted by Sartre and R. D. Laing, and existential psychiatrists and psychoanalysts in their emphasis on the here-and-now encounter between the patient and the therapist, along with various embellishments and emendations on Heidegger's notion of what it meant to live authentically or inauthentically. Foucault maintained that there is a politics embedded in all the human sciences such as psychiatry and psychoanalysis, and this politics revolves around the use of power and its operations, including the actual use of the human sciences in the culture and what the different theories imply in the way of an ideology. Lacan emphasized this when he challenged the prevailing ideology of United States psychoanalysis, in which adaptation was seen as the crucial task of the ego. The existence of background practices and outer horizons required for any understanding in the human sciences leads to a situation that questions the use of empirical methods to establish what is accepted as "truth" in the human sciences. A predominant alternative, that of hermeneutics, has gained acceptance by eminent analysts such as Gill and certain interpersonal theorists. But the term hermeneutics is used in many ways by many authors and runs the danger of a relativism and a nihilism. This leads to a discussion of the value of various philosophical positions in throwing light on our search for a methodology in the human sciences. A review of arguments invoking the "end of philosophy" such as those of Rorty reveals that they are paradoxical and based on premises which in turn represent a philosophy. This debate remains unresolved. In general the postmodern view sees "truth" as more relative and emphasizes the role of social and cultural

  11. Memorandum of Understanding for Improving Environmental Management of Electronic Assets

    EPA Pesticide Factsheets

    This is a memorandum of understanding between the U.S. Postal Service, Department of Defense, Department of Energy, Department of Interior and EPA to improve the environmental management of the government's electronic assets.

  12. Improving Students' Understanding of Electricity and Magnetism

    ERIC Educational Resources Information Center

    Li, Jing

    2012-01-01

    Electricity and magnetism are important topics in physics. Research shows that students have many common difficulties in understanding concepts related to electricity and magnetism. However, research to improve students' understanding of electricity and magnetism is limited compared to introductory mechanics. This thesis explores issues…

  13. Orthogeriatric care: improving patient outcomes

    PubMed Central

    Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

    2016-01-01

    Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

  14. A model for improving cancer patient education.

    PubMed

    Fredette, S L

    1990-08-01

    Adjustment to cancer requires modification of behavior that may be aided through patient education. Numerous programs have been developed to meet this need; however, studies show that even after being taught, patients are not well informed. It seems that the process of educating cancer patients needs to be improved. Authors suggest a progression of psychosocial stages of adjustment to serious illness during which specific behaviors are exhibited and coping mechanisms utilized. Understanding the nature of this process forms the basis for effective patient education since theories of adaptation describe behaviors that impact on motivation to learn, information required, and teaching methodology. Failure to attend to this variable of emotional response to the disease can prevent learning. This article integrates the theories of Weisman, Crate, Engle, and Kubler-Ross into an educational model for the cancer patient consisting of six periods. The model suggests nursing approaches, educational topics, and teaching strategies based on the patient's behavioral responses. Use of this model can improve teaching effectiveness in clinical practice by ensuring that the patient is ready to learn prior to teaching and by utilizing teaching strategies appropriate to the educational period. It can further be used as a tool to teach students of nursing how to use the stages of adjustment to chronic illness when planning patient teaching.

  15. Toward understanding the patient's perception of quality.

    PubMed

    Carson, P P; Carson, K D; Roe, C W

    1998-03-01

    Patients often don't have the technical competence to judge the quality of medical care. Therefore, they rely on different criteria than do professionals in assessing quality. They perceive quality as a gestalt of experiences influenced by such issues as empathy, integrity, and appearance of competency. Patients do not complain about service quality when it is appropriately provided. But to satisfy the consumer, providers must go beyond being reliable, polite, and honest. They must provide prompt services, be approachable, and provide individualized attention. To ultimately delight consumers, however, providers must meet the unarticulated needs of the patient.

  16. Understanding and managing patients with chronic pain.

    PubMed

    Szumita, Richard P; Szumita, Paul M; Just, Nancy

    2010-11-01

    The specialty of oral and maxillofacial surgery has had at its core the foundations of anesthesia and pain and anxiety control. This article attempts to refamiliarize the reader with clinical pearls helpful in the management of patients with chronic pain conditions. The authors also hope to highlight the interplay of chronic pain and psychology as it relates to the oral and maxillofacial surgery patient. To that end, the article outlines and reviews the neurophysiology of pain, the definitions of pain, conditions encountered by the oral and maxillofacial surgeon that produce chronic pain, the psychological impact and comorbidities associated with patients experiencing chronic pain conditions, and concepts of multimodal treatment for patients experiencing chronic pain conditions.

  17. Understanding taste dysfunction in patients with cancer.

    PubMed

    McLaughlin, Laura; Mahon, Suzanne M

    2012-04-01

    Taste dysfunction is a significant but underestimated issue for patients with cancer. Impaired taste results in changes in diet and appetite, early satiety, and impaired social interactions. Nurses can play a key role in educating patients and families on the pathophysiology of taste dysfunction by suggesting interventions to treat the consequences of taste dysfunction, when available, and offering psychosocial support as patients cope with this often devastating consequence of treatment. Taste recognition helps humans identify the nutritional quality of food and signals the digestive tract to begin secreting enzymes. Spoiled or tainted foods typically are recognized by their bad taste. Along with the other sensory systems, taste is crucial for helping patients treated for cancer feel normal. This article will review the anatomy and physiology of taste; define the different types of taste dysfunction, including the underlying pathophysiologic basis related to cancer treatment; and discuss potential nursing interventions to manage the consequences of taste dysfunction.

  18. Improving At-Risk Learners' Understanding of Fractions

    ERIC Educational Resources Information Center

    Fuchs, Lynn S.; Schumacher, Robin F.; Long, Jessica; Namkung, Jessica; Hamlett, Carol L.; Cirino, Paul T.; Jordan, Nancy C.; Siegler, Robert; Gersten, Russell; Changas, Paul

    2013-01-01

    The purposes of this study were to investigate the effects of an intervention designed to improve at-risk 4th graders' understanding of fractions and to examine the processes by which effects occurred. The intervention focused more on the measurement interpretation of fractions; the control condition focused more on the part-whole interpretation…

  19. Can an understanding of transactional analysis improve postgraduate clinical supervision?

    PubMed

    Sivan, Manoj; McKimm, Judy; Held, Sam

    2011-01-01

    Clinical supervision in postgraduate medical training is vital in producing competent and safe health-care practitioners. Effective communication between supervisors and trainees at an interpersonal and professional level determines the quality of the supervision process. Transactional analysis, a theory of personality, can be used to enhance understanding of interpersonal interactions and improve the outcomes of clinical training.

  20. Improving the public understanding of science: New initiatives.

    PubMed

    Scotchmoor, Judy; Thanukos, Anastasia; Potter, Sheri

    2009-10-01

    The United States may be on the brink of losing its global edge in science. Many American students are underprepared for and uninterested in the scientific and technical careers they may be asked to take on. Furthermore, these students, their teachers, and the broader public lack basic understandings of what science is and how it works, which may negatively impact their ability to make reasoned and informed decisions about science-related issues. We describe two unique and recently developed projects designed to help tackle these problems by improving public understanding of and interest in science. The Coalition on the Public Understanding of Science is a grassroots effort to lower the barriers between the scientific community and the public. It aims to inspire broad appreciation of science, inform the public about the nature and process of science, and make science accessible to everyone. Understanding Science is a web-based project that aims to improve teacher understanding of the nature of the scientific enterprise, to provide resources that encourage and enable kindergarten through undergraduate (K-16) teachers to reinforce the nature of science throughout their teaching, and to serve as a clear and accessible reference that accurately portrays the scientific endeavor. The botanical and broader scientific communities are invited to participate in these efforts.

  1. Understanding motivation to enhance patient compliance.

    PubMed

    Wilkinson, J

    Motivation as a psychological concept is important in health care because frequently good care is dependent on the motivation of the patient, his/her family and the practitioners within the healthcare team. In addition, nurses need to be motivated to keep up to date with professional developments. This article describes George Kelly's framework of motivation and suggests recommendations to enhance practice in this area. The main conclusion is that although external determinants can encourage a person to engage in a particular activity the most effective kind of motivation is that which is internally mediated.

  2. Understanding and Improving Knowledge Transactions in Command and Control

    DTIC Science & Technology

    2003-06-01

    6310 Greenwich Dr., Suite 200, San Diego, CA 92122 Fax: (858) 535-1665 ramoore@pacific-science.com hors: ald A. Moore1, Janel H. Schermerhorn ...Understanding and Improving K ald A. Moore, Janel H. Schermerhorn , Heath 6310 Greenwich Dr., Suite 200, San Diego, CA 92 Phone: (858) 535 , jscherm@pacific...Naval Research (ONR Introduction For example, sources must ions must be quickly and fully support als and teams produced and ent tasks and

  3. Understanding cognition in older patients with cancer

    PubMed Central

    Karuturi, Meghan; Wong, Melisa L.; Hsu, Tina; Kimmick, Gretchen G.; Lichtman, Stuart M.; Holmes, Holly M.; Inouye, Sharon K.; Dale, William; Loh, Kah P.; Whitehead, Mary I.; Magnuson, Allison; Hurria, Arti; Janelsins, Michelle C.; Mohile, Supriya

    2016-01-01

    Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps. PMID:27282296

  4. Improving patient safety in haemodialysis

    PubMed Central

    Bray, Benjamin D.; Metcalfe, Wendy

    2015-01-01

    Thomas Inman (1820–76) wrote ‘Practice two things in your dealings with disease: either help or do not harm the patient’, echoing writings from the Hippocratic school. The challenge of practicing safely with the avoidance of complications or harm is perhaps only heightened in the context of modern medical settings such as the haemodialysis unit where complex interventions and treatment are routine. The current issue of CKJ reports two studies aimed at improving the care of haemodialysis patients targeting early use of arteriovenous grafts as access for haemodialysis and the implementation of a dialysis checklist to ensure the prescribed dialysis treatment is delivered. The further challenge of ensuring that such evidence-based tools are used appropriately and consistently falls to all members of the clinical team. PMID:26034585

  5. Examining patient comprehension of emergency department discharge instructions: Who says they understand when they do not?

    PubMed

    Lin, Margaret Jane; Tirosh, Adva Gutman; Landry, Alden

    2015-12-01

    Patient comprehension of emergency department (ED) discharge instructions is important for ensuring that patients understand their diagnosis, recommendations for treatment, appropriate follow-up, and reasons to return. However, many patients may not fully understand their instructions. Furthermore, some patients may state they understand their instructions even when they do not. We surveyed 75 patients on their perception of their understanding of their ED discharge instructions, and asked them specific questions about the instructions. We also performed a chart review, and examined patients' answers for correlation with the written instructions and medical chart. We then performed a statistical analysis evaluating which patients claimed understanding but who were found to have poor understanding on chart review. Overall, there was no significant correlation between patient self-reported understanding and physician evaluation of their understanding (ρ = 0.221, p = 0.08). However, among female patients and patients with less than 4 years of college, there was significant positive correlation between self-report and physician evaluation of comprehension (ρ = 0.326, p = 0.04 and ρ = 0.344, p = 0.04, respectively), whereas there was no correlation for male patients and those with more than 16 years of education (ρ = 0.008, p = 0.9, ρ = -0.041, p = 0.84, respectively). Patients' perception of their understanding may not be accurate, especially among men, and those with greater than college education. Identifying which patients say they understand their discharge instructions, but may actually have poor comprehension could help focus future interventions on improving comprehension.

  6. Improvements in Professional Development Program Participants' Understandings about Inclusive Teaching

    NASA Astrophysics Data System (ADS)

    Metevier, A. J.; Hunter, L.; Goza, B. K.; Raschke, L. M.; Seagroves, S.

    2010-12-01

    A major emphasis of the Center for Adaptive Optics Professional Development Program (PDP) is training early-career scientists and engineers to teach more inclusively as well as more effectively. To this end, the PDP includes workshops on diversity and equity, and PDP participants are explicitly encouraged to weave inclusive instructional strategies into the inquiry laboratory activities they design and teach. In an initial effort to gauge the effectiveness of the PDP's diversity and equity training, we have analyzed 2008 and 2009 PDP participants' responses to a survey knowledge question that asks them to briefly describe how they would engage a diverse undergraduate student population through their teaching and research. Each participant answered the survey question before any PDP training, as well as after a series of intensive PDP workshops. We developed a rubric to score and analyze participants' pre- and post-workshop responses, and have found that their response scores improve significantly after PDP training. This indicates that PDP training does improve participants' understandings about how to teach inclusively. Furthermore, survey respondents who participated in the PDP in both 2008 and 2009 showed little decrease in response scores between years, but continued increases with continued training. In this paper, we detail our rubric development, survey response scoring, analysis, and results, as well as the implications our results have had for refining our goals for PDP participants and for further improving PDP workshops.

  7. Nurses' understanding influences comprehension of patients admitted in the observation unit.

    PubMed

    Desme, Aline; Mendes, Nathalie; Perruche, Franck; Veillard, Elsa; Elie, Caroline; Moulinet, Françoise; Sanson, Fabienne; Georget, Jean-Michel; Tissier, Anne; Pourriat, Jean-Louis; Claessens, Yann-Erick

    2013-01-01

    Comprehension is poor in patients admitted in the emergency observation unit. Teamwork communication gaps could contribute to patients' misunderstanding of their health condition. To determine in patients admitted in the emergency observation unit whether comprehension of diagnosis, prognosis, and management depended on nurses' comprehension, the authors conducted a prospective observational study in a busy adult emergency department of a tertiary teaching hospital in Paris over 2 months. Consecutive patients admitted in the emergency observation unit were included. Patients' and nurses' comprehension of diagnosis, prognosis, and management was compared with the statements of the emergency department attending physicians for these items. The authors observed whether patients' misunderstanding was associated with nurses' misunderstanding. A total of 544 patients were evaluated. For each patient, nurses' and patients' comprehension was available. Patients understood severity in 40%, organ involved in 69%, medical wording in 57%, reason for admission in 48%, and discharge instruction in 67%. In comparison with patients, nurses better understood each item except for discharge instruction. The authors observed that patients' comprehension was better when nurses understood diagnosis (p <.0001), reasons for admission (p =.032) and discharge instructions (p =.002). Nurses' understanding of severity did not modify patients' comprehension. These results support the conclusions that communication gaps in teamwork alter patients' comprehension and that nurses' and patients' misunderstandings are associated. Therefore, improving communication by nurses and physicians to patients may improve patients' understanding.

  8. Improving Students' Understanding of Lock-In Amplifiers

    NASA Astrophysics Data System (ADS)

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Chandralekha, Singh

    2014-03-01

    A lock-in amplifier is a versatile instrument frequently used in physics research. However, many students struggle with the basic operating principles of a lock-in amplifier which can lead to a variety of difficulties. To improve students' understanding, we have been developing and evaluating a research-based tutorial which makes use of a computer simulation of a lock-in amplifier. The tutorial is based on a field-tested approach in which students realize their difficulties after predicting the outcome of simulated experiments involving a lock-in amplifier and check their predictions using the simulated lock-in amplifier. Then, the tutorial guides and helps students develop a coherent understanding of the basics of a lock-in amplifier. The tutorial development involved interviews with physics faculty members and graduate students and iteration of many versions of the tutorial with professors and graduate students. The student difficulties and the development and assessment of the research-based tutorial are discussed. We thank National Science Foundation for award NSF-1124131.

  9. How community ecology can improve our understanding of cholera dynamics

    PubMed Central

    Constantin de Magny, Guillaume; Hasan, Nur A.; Roche, Benjamin

    2013-01-01

    Understanding the seasonal emergence and reemergence of cholera is challenging due to the complex dynamics of different protagonists. The abundance of Vibrio cholerae, the causative agent of cholera and a natural inhabitant of aquatic environments, fluctuates according to abiotic, and biotic factors. Among the biotic factors, the zooplankton community dynamics has been suggested to play a pivotal role in the survival, persistence, and natural competence of V. cholerae. However, factors regulating V. cholerae population structure and seasonal dynamics are still not fully understood. Investigation of the temporal shifts and variability in aquatic community composition in relation to the occurrence or abundance of V. cholerae appears very promising yet remained underexplored. Recent advances in metagenomics, facilitated by high-throughput ultra deep sequencing, have greatly improved our ability for a broader and deeper exploration of microbial communities including an understanding of community structure, function, as well as inter- and intra-specific competitions. Here, we discuss possible areas of research focusing how combination of community ecology and metagenomic approaches could be applied to study the cholera system. PMID:24765090

  10. Self-care instructions: do patients understand educational materials?

    PubMed

    Wong, M

    1992-02-01

    As health care providers we are not in a position to teach reading. We do, however, have a legal and an ethical obligation to provide patients with self-care instructions they can understand. Because the methods presented for enhancing patient understanding of self-care instructions are relatively new, and because nurses are just beginning to be aware of the need for such interventions, it will be a while before the ideal situation exists. Ideally, each pamphlet or set of instructions would be coded with the reading grade level needed to understand it and each patient's reading level would be recorded in the chart. Under such "perfect" circumstances it would be easy for nurses to provide patients with instructions at the appropriate reading level. For now, any step that nurses take toward making self-care a reality for patients who read poorly is a step in the right direction. People with poor reading skills are less adept at formulating questions than good readers because they lack vocabulary and the ability to analyze written material. Rather than be regarded as stupid, many choose not to verbalize their lack of understanding. This phenomenon puts a large group of patients at risk for health complications related to inadequate understanding of self-care directions.

  11. Combinatorial mutagenesis and selection to understand and improve yeast promoters.

    PubMed

    Berg, Laila; Strand, Trine Aakvik; Valla, Svein; Brautaset, Trygve

    2013-01-01

    Microbial promoters are important targets both for understanding the global gene expression and developing genetic tools for heterologous expression of proteins and complex biosynthetic pathways. Previously, we have developed and used combinatorial mutagenesis methods to analyse and improve bacterial expression systems. Here, we present for the first time an analogous strategy for yeast. Our model promoter is the strong and inducible P AOX1 promoter in methylotrophic Pichia pastoris. The Zeocin resistance gene was applied as a valuable reporter for mutant P AOX1 promoter activity, and we used an episomal plasmid vector to ensure a constant reporter gene dosage in the yeast host cells. This novel design enabled direct selection for colonies of recombinant cells with altered Zeocin tolerance levels originating solely from randomly introduced point mutations in the P AOX1 promoter DNA sequence. We demonstrate that this approach can be used to select for P AOX1 promoter variants with abolished glucose repression in large mutant libraries. We also selected P AOX1 promoter variants with elevated expression level under induced conditions. The properties of the selected P AOX1 promoter variants were confirmed by expressing luciferase as an alternative reporter gene. The tools developed here should be useful for effective screening, characterization, and improvement of any yeast promoters.

  12. Improving oral hygiene for patients.

    PubMed

    Bonetti, Debbie; Hampson, Victoria; Queen, Kerry; Kirk, Donna; Clarkson, Jan; Young, Linda

    2015-01-13

    Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care.

  13. Improving Spiritual Well-Being in Patients with Lung Cancers

    PubMed Central

    Piderman, Katherine M.; Euerle, Terin T.; Frost, Marlene H.; Novotny, Paul J.; Rausch Osian, Sarah M.; Nes, Lise Solberg; Patten, Christi A.; Sloan, Jeff A.; Rummans, Teresa A.; Bronars, Carrie A.; Yang, Ping; Clark, Matthew M.

    2016-01-01

    Patients with lung cancer report more disease burden and lower spiritual well-being (SWB) compared with other cancer patients. Understanding variables that lessen disease burden and improve SWB is essential. The aim of this study was to explore the relationship between motivational level for physical activity and SWB in patients with lung cancer. Linear regression showed increased SWB as stage of change for physical activity increased (p<0.0001), even after adjusting for multiple demographic variables. PMID:26463853

  14. Giving Doctors' Daily Progress Notes to Hospitalized Patients and Families to Improve Patient Experience.

    PubMed

    Weinert, Craig

    Hospital quality includes excellent physician-patient communication. The objective was to determine effects of distributing physicians' notes to patients. Hospitalized patients or family members on 6 wards at a university hospital received daily a printed copy of their medical team's progress note. Surveys were completed about the benefits and adverse effects of reading the physician notes. In all, 74% to 86% of patients or family members responded favorably that receiving doctors' notes improved understanding of their health condition or gave them more control over their hospital course. Patient concerns about privacy or offense were uncommon, although 16% thought notes were confusing or caused worry. Note distribution had minor effects on physician note writing practice. Having patients and family members read their physicians' progress notes is feasible and enhances patients' understanding of their diagnostic and treatment plan. Notes supplement traditional physician-patient verbal communication practice and have the potential to improve the hospitalized patient experience.

  15. Toward an Improved Understanding of the Global Fresh Water Budget

    NASA Technical Reports Server (NTRS)

    Hildebrand, Peter H.

    2005-01-01

    priorities for future improvements in global fresh water budget monitoring. The priorities are based on the potential of new approaches to provide improved measurement and modeling systems, and on the need to measure and understand the potential for a speed-up of the global water cycle under the effects of climate change.

  16. Understanding and Improving High Voltage Vacuum Insulators for Microsecond Pulses

    SciTech Connect

    Javedani, J B; Goerz, D A; Houck, T L; Lauer, E J; Speer, R D; Tully, L K; Vogtlin, G E; White, A D

    2007-03-05

    High voltage insulation is one of the main areas of pulsed power research and development, and dielectric breakdown is usually the limiting factor in attaining the highest possible performance in pulsed power devices. For many applications the delivery of pulsed power into a vacuum region is the most critical aspect of operation. The surface of an insulator exposed to vacuum can fail electrically at an applied field more than an order or magnitude below the bulk dielectric strength of the insulator. This mode of breakdown, called surface flashover, imposes serious limitations on the power flow into a vacuum region. This is especially troublesome for applications where high voltage conditioning of the insulator and electrodes is not practical and for applications where relatively long pulses, on the order of several microseconds, are required. The goal of this project is to establish a sound fundamental understanding of the mechanisms that lead to surface flashover, and then evaluate the most promising techniques to improve vacuum insulators and enable high voltage operation at stress levels near the intrinsic bulk breakdown limits of the material. The approach we proposed and followed was to develop this understanding through a combination of theoretical and computation methods coupled with experiments to validate and quantify expected behaviors. In this report we summarize our modeling and simulation efforts, theoretical studies, and experimental investigations. The computational work began by exploring the limits of commercially available codes and demonstrating methods to examine field enhancements and defect mechanisms at microscopic levels. Plasma simulations with particle codes used in conjunction with circuit models of the experimental apparatus enabled comparisons with experimental measurements. The large scale plasma (LSP) particle-in-cell (PIC) code was run on multiprocessor platforms and used to simulate expanding plasma conditions in vacuum gap regions

  17. Understanding and projecting sea level change: improvements and uncertainties (Invited)

    NASA Astrophysics Data System (ADS)

    Church, J. A.; Clark, P. U.; Cazenave, A. A.; Gregory, J. M.; Jevrejeva, S.; Merrifield, M. A.; Milne, G. A.; Nerem, R.; Payne, A. J.; Pfeffer, W. T.; Stammer, D.; Levermann, A.; Nunn, P.; Unnikrishnan, A. S.

    2013-12-01

    The rate of global mean sea level rise (GMSLR) has accelerated during the last two centuries, from a rate of order tenths of mm yr-1 during the late Holocene, to about 1.7 mm yr-1 since 1901. Ocean thermal expansion and glacier melting were the dominant contributors to 20th century GMSLR, with relatively small contributions from the Greenland and Antarctic ice sheets. Process-based models suggest that the larger rate of rise since 1990 results from increased radiative forcing (both natural and anthropogenic) and increased ice-sheet outflow, induced by warming of the immediately adjacent ocean. Confidence in projections of global mean sea level rise has increased since the AR4 because of improved physical process-based understanding of observed sea level change, especially in recent decades, and the inclusion of future rapid ice-sheet dynamical changes, for which a quantitative assessment could not be made on the basis of scientific knowledge available at the time of the AR4. By 2100, the rate of GMSLR for a scenario of high emissions (RCP8.5) could approach the average rates that occurred during the last deglaciation, whereas for a strong emissions mitigation scenario (RCP2.6) it could stabilise at rates similar to those of the early 21st century. In either case, GMSLR will continue for many subsequent centuries. Although there has been much recent progress, projections of ice-sheet change are still uncertain, especially beyond 2100. Future sea level change will not be globally uniform, but models still exhibit substantial disagreement in projections of ice mass loss and ocean dynamics, which are the main influences on the pattern. Uncertainty in projections of future storminess is a further obstacle to confident projection of changes in sea level extremes.

  18. Improving predictive certainty and system understanding with watershed hydrology models

    NASA Astrophysics Data System (ADS)

    Kelleher, C.; McGlynn, B. L.; Wagener, T.

    2015-12-01

    Modeling at the intersection of climate variability and hydrology is complicated by uncertainties that make predicting physical behavior a challenge. Environmental models used to simulate how climate will impact hydrology are typically complex, demand many spatial and temporal data inputs, contain numerous parameters, and can be computationally expensive. Distributed models in particular complicate the assessment of how uncertainty in the model framework, inputs, parameters, and observations impact predictive uncertainty. In addition, future climate perturbations may alter the magnitude of these uncertainties. Here, we focus on model parameters as a key source of uncertainty. Identifying those model parameters that most influence the predictions at a particular place can reduce a complex, multidimensional problem to a simpler form. We demonstrate how sensitivity analysis in the absence of observational streamflow can be used to identify sensitive model parameters by conditioning a model on climate data and a priori parameter ranges. We apply this approach to five headwater catchments in the Tenderfoot Creek Experimental Forest located in central Montana using the Distributed Hydrology-Soil-Vegetation Model. Across these five sub-catchments, climate clearly organizes parameter sensitivities. To further explore the relationship between parameter sensitivities and climate, we assess how parameter sensitivities change when meteorological forcing data is perturbed to reflect natural variability at the site. This general approach can support uncertainty reduction. However, parameter equifinality will still impact finer scale predictions of any environmental variable in space and time. As such, improving our certainty in environmental predictions should evaluate point predictions as well as simulations of internal catchment behavior, and must not only rely on our use of computational methods but on our basic understanding of system functioning.

  19. Understanding patients' preferences for treatment: the need for innovative methodologies

    PubMed Central

    Frewer, L; Salter, B; Lambert, N

    2001-01-01

    Treatment selection is now much more consumer driven than in the past. However, there is a need to develop investigative methodological approaches that are sensitive to differences in patient preferences if full account is to be taken of what the patient sees as the best option in terms of different possible treatments available for a particular condition. Previous attitude research has been criticised because it does not provide insight into reasons why people hold different preferences or beliefs. A methodology is described which allows people to describe their concerns and values associated with different treatment options in their own words. This is the repertory grid method of eliciting personal constructs used in conjunction with generalised Procrustes analysis (GPA). An example of the use of this methodology is provided, drawn from research directed towards understanding people's beliefs about genetic technologies. A possible application of the method to understanding treatment preferences related to type 2 diabetes is also discussed. It is concluded that the use of innovative methodologies is essential if our understanding of patient preferences regarding treatment options is to have a significant impact on patient quality of life. Key Words: patient preference; repertory grid method; diabetes PMID:11533439

  20. Communicating with Parents: Understanding the Process, Improving Your Skills

    ERIC Educational Resources Information Center

    American Federation of Teachers (NJ), 2007

    2007-01-01

    Communication is the exchange of information, ideas and/or feelings from one person to another. The goal of communication is understanding. Without understanding, there is no communication. The communication process consists of verbal and nonverbal communication and listening. The spoken word is self-explanatory. Communication problems between…

  1. Understanding the influence of educational attainment on kidney health and opportunities for improved care.

    PubMed

    Green, Jamie A; Cavanaugh, Kerri L

    2015-01-01

    Educational attainment is an important but often overlooked contributor to health outcomes in patients with kidney disease. Those with lower levels of education have an increased risk of ESRD, complications of peritoneal dialysis, worse transplant outcomes, and mortality. Mediators of these associations are poorly understood but involve a complex interplay between health knowledge, behaviors, and socioeconomic and psychosocial factors. Interventions targeting these aspects of care have the potential to reduce disparities related to educational attainment; however, few programs have been described that specifically address this issue. Future research efforts should not only systematically assess level of educational attainment but also report the differential impact of interventions across educational strata. In addition, routine measurement of health literacy may be useful to identify high-risk patients independent of years of schooling. A better understanding of the influence of educational attainment on kidney health provides an opportunity to improve the care and outcomes of vulnerable patients with kidney disease.

  2. Changing the Conversation: Messages for Improving Public Understanding of Engineering

    ERIC Educational Resources Information Center

    National Academies Press, 2008

    2008-01-01

    Can the United States continue to lead the world in innovation? The answer may hinge in part on how well the public understands engineering, a key component of the "innovation engine." A related concern is how to encourage young people--particularly girls and under-represented minorities--to consider engineering as a career option.…

  3. Standing in the Hallway Improves Students' Understanding of Conformity

    ERIC Educational Resources Information Center

    Lawson, Timothy J.; Haubner, Richard R.; Bodle, James H.

    2013-01-01

    To help beginning psychology students understand how they are influenced by social pressures to conform, we developed a demonstration designed to elicit their conformity to a small group of students standing in the hallway before class. Results showed the demonstration increased students' recognition of their own tendency to conform, knowledge of…

  4. Lectures and Simulation Laboratories to Improve Learners' Conceptual Understanding

    ERIC Educational Resources Information Center

    Brophy, Sean P.; Magana, Alejandra J.; Strachan, Alejandro

    2013-01-01

    We studied the use of online molecular dynamics simulations (MD) to enhance student abilities to understand the atomic processes governing plastic deformation in materials. The target population included a second-year undergraduate engineering course in the School of Materials Engineering at Purdue University. The objectives of the study were to…

  5. Understanding the advances in biology of orthodontic tooth movement for improved ortho-perio interdisciplinary approach

    PubMed Central

    Patil, Anand K.; Shetty, Adarsh S.; Setty, Swati; Thakur, Srinath

    2013-01-01

    This article provides an insight on detailed current advances in molecular understandings of periodontal ligament cells and the influence of orthodontic force on them in the light of recent advances in molecular and genetic sciences. It sequentially unfolds the cellular events beginning from the mechanical force initiated events of cellular responses to bone remodeling. It also highlights the risks and limitations of orthodontic treatment in certain periodontal conditions, the important areas of team work, orthodontic expectations from periodontal treatment and the possibility of much more future combined research to improve the best possible periodontal health and esthetic outcome of the patient. PMID:24049330

  6. [Improved treatment options for a short bowel syndrome patient].

    PubMed

    Pakarinen, Mikko

    2014-01-01

    Short bowel syndrome necessitates long-term parenteral nutrition, which exposes to decreased quality of life and increased morbidity. In recent years the understanding of short bowel pathophysiology and related complications has expanded, forming the basis for improved treatment options. In addition to evolving nutritional therapy, new pharmacological and surgical therapies have emerged, enhancing the patients' possibilities to achieve intestinal autonomy. Increasingly efficient prevention of intestinal failure-associated liver disease and central line-associated septic episodes improves patient survival. Bowel function can be restored by intestinal transplantation in those developing life-threatening complications.

  7. Understanding Leadership Paradigms for Improvement in Higher Education

    ERIC Educational Resources Information Center

    Flumerfelt, Shannon; Banachowski, Michael

    2011-01-01

    Purpose: This research article is based on the Baldrige National Quality Program Education Criteria for Performance Excellence's conceptualization of improvement as a dual cycle/three element initiative of examining and bettering inputs, processes, and outputs as driven by measurement, analysis and knowledge management work. This study isolates a…

  8. Improving Access to and Understanding of Regulations through Taxonomies

    ERIC Educational Resources Information Center

    Cheng, Chin Pang; Lau. Gloria T.; Law, Kincho H.; Pan, Jiayi; Jones, Albert

    2009-01-01

    Industrial taxonomies have the potential to automate information retrieval, facilitate interoperability and, most importantly, improve decision making - decisions that must comply with existing government regulations and codes of practice. However, it is difficult to find those regulations and codes most relevant to a particular decision, even…

  9. Quality of life and disease understanding: impact of attending a patient-centered cancer symposium.

    PubMed

    Padrnos, Leslie; Dueck, Amylou C; Scherber, Robyn; Glassley, Pamela; Stigge, Rachel; Northfelt, Donald; Mikhael, Joseph; Aguirre, Annette; Bennett, Robert M; Mesa, Ruben A

    2015-06-01

    To evaluate the impact of a patient-centered symposium as an educational intervention on a broad population of cancer patients. We developed a comprehensive patient symposium. Through voluntary questionnaires, we studied the impact of this cancer symposium on quality of life, cancer-specific knowledge, and symptom management among cancer patients. Symposium attendees were provided surveys prior to and 3 months following the educational intervention. Surveys included (1) EORTC-QLQ-C30; (2) disease understanding tool developed for this conference; (3) validated disease-specific questionnaires. Changes over time were assessed using McNemar's tests and paired t-tests for categorical and continuous variables, respectively. A total of 158 attendees completed the pre-convention survey. Most respondents reported at least "quite a bit" of understanding regarding treatment options, screening modalities, symptomatology, and cancer-related side effects. Attendees endorsed the least understanding of disease-related stress, risk factors, fatigue management, and legal issues related to disease/treatment. At 3 months, there was improvement in understanding (12 of 14 areas of self-reported knowledge especially regarding nutrition, and stress/fatigue management). However, no significant change was seen in QLQ-C30 functioning, fatigue, pain, or insomnia. A patient symposium, as an educational intervention improves a solid knowledge base amongst attendees regarding their disease, increases knowledge in symptom management, but may be insufficient to impact QoL as a single intervention.

  10. Patient care simulations: role playing to enhance clinical understanding.

    PubMed

    Comer, Shirley K

    2005-01-01

    Role-play techniques can serve as an effective substitute for, and supplement to, simulation technology when teaching clinical nursing skills. They provide risk-free opportunities to practice clinical skills and develop clinical judgment. A two-phase patient care simulation, performed in real time, is described. Students are presented with a scenario and work cooperatively in role-playing appropriate care, with one student using a prepared script to assume the role of patient. The class functions as a resource for four students who assume the nursing role. Students reported increased understanding of course material as a result of participation in the clinical simulation scenario. Faculty observed a decreased failure rate on the corresponding course examination.

  11. Measuring and improving ambulatory surgery patients' satisfaction.

    PubMed

    Farber, Janice

    2010-09-01

    The pressure on perioperative services to improve quality for health care consumers creates both challenges and opportunities. To make positive changes, many health care organizations contract with Press Ganey (PG), which processes an extensive database of more than 9.5 million surveys annually and provides benchmark reports to same-type organizations. To measure and improve ambulatory surgery patient satisfaction at one health care network in northeastern Pennsylvania, the nursing leaders in the ambulatory surgery center and OR undertook a quality improvement project focused on educating perioperative nurses on the use of PG reports. After we reviewed the PG reports and implemented changes with nursing staff members in perioperative areas, PG patient satisfaction scores improved regarding information about delays (4.1%) and center attractiveness (0.2%).

  12. Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records.

    PubMed

    Ryan, James; Hendler, James; Bennett, Kristin P

    2015-12-01

    Electronic Healthcare Records (EHRs) have the potential to improve healthcare quality and to decrease costs by providing quality metrics, discovering actionable insights, and supporting decision-making to improve future outcomes. Within the United States Medicaid Program, rates of recidivism among emergency department (ED) patients serve as metrics of hospital performance that help ensure efficient and effective treatment within the ED. We analyze ED Medicaid patient data from 1,149,738 EHRs provided by a hospital over a 2-year period to understand the characteristics of the ED return visits within a 72-hour time frame. Frequent flyer patients with multiple revisits account for 47% of Medicaid patient revisits over this period. ED encounters by frequent flyer patients with prior 72-hour revisits in the last 6 months are thrice more likely to result in a readmit than those of infrequent patients. Statistical L1-logistic regression and random forest analyses reveal distinct patterns of ED usage and patient diagnoses between frequent and infrequent patient encounters, suggesting distinct opportunities for interventions to improve efficacy of care and streamline ED workflow. This work forms a foundation for future development of predictive models, which could flag patients at high risk of revisiting.

  13. Melatonin improves sleep quality in hemodialysis patients

    PubMed Central

    Edalat-Nejad, M.; Haqhverdi, F.; Hossein-Tabar, T.; Ahmadian, M.

    2013-01-01

    Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoietin (EPO) are also reported as secondary outcomes. In a 6-week randomized, double-blind cross-over clinical trial, 3 mg melatonin or placebo was administered to 68 patients at bedtime. A 72-h washout preceded the switch from melatonin to placebo, or vice versa. SQ was assessed by the Pittsburgh sleep quality index (PSQI). Sixty-eight patients completed the study protocol and were included in the final analysis. Melatonin treatment significantly improved the global PSQI scores (P < 0.001), particularly subjective SQ (P < 0.001), sleep efficiency (P = 0.005) and sleep duration (P < 0.001). No differences in sleep latency and daytime sleepiness were observed. Melatonin also increased the high-density lipoprotein (HDL) cholesterol (P = 0.003). The need for EPO prescription decreased after melatonin treatment (P < 0.001). We conclude that melatonin can improve sleep in ESRD. The modest increase in HDL cholesterol and decrease in the EPO requirement are other benefits associated with this treatment PMID:23960341

  14. Improved performance of polybenzoxazines through a mechanistic understanding of polymerization

    NASA Astrophysics Data System (ADS)

    Wang, Yong-Xia

    A class of phenolic resins, polybenzoxazines, is described. Benzoxazine resins have a wide range of mechanical and physical properties that can be tailored to various needs. Good thermal, chemical, electrical, mechanical, and physical properties make polybenzoxazines attractive alternatives to existing materials. Effective initiators/catalysts aimed at lowering the polymerization temperature and reducing the product cycle time have been examined. The benzoxazine-initiator systems exhibit new polymerization mechanisms and kinetics, leading to polybenzoxazines with highly improved properties. By tailoring the benzoxazine chemistry and utilizing a new synthetic route, both hydrophilic and hydrophobic thermoplastic polybenzoxazines with high molecular weight are synthesized for the first time. A novel type of low cost yet high performance benzoxazine resins, mono-oxazine-based low viscosity benzoxazines, has been developed. Various characterization techniques including proton (1H) and carbon (13C) nuclear magnetic resonance spectroscopy (NMR), Fourier transform infrared spectroscopy (FT-IR), pyrolytic gas chromatography/mass spectrometry (GC/MS), size exclusion chromatography (SEC), static light scattering (SLS), wide angle X-ray diffraction (WAXD), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and dynamic mechanical analysis (DMA) have been used to determine the polymer structures and demonstrate their improved properties.

  15. NCCN: 20 Years of Improving Patients' Lives.

    PubMed

    Carlson, Robert W

    2015-05-01

    In his Keynote Address at the NCCN 20th Annual Conference, Robert W. Carlson, MD, reflected on the achievements of NCCN and described how the organization will continue to grow under his leadership. Recognizing that the founding of NCCN was by a group of visionary leaders who came together 20 years ago to assure access of patients to high-quality cancer care, Dr. Carlson said "All our efforts within NCCN are focused on improving the quality, effectiveness, and efficiency of patient care, so that our patients can live better lives."

  16. Concepts first, jargon second improves student articulation of understanding.

    PubMed

    McDonnell, Lisa; Barker, Megan K; Wieman, Carl

    2016-01-01

    In this experiment, students in a large undergraduate biology course were first exposed to the concepts without new technical vocabulary ("jargon") in a pre-class reading assignment. Their learning of the concepts and jargon was compared with that of an equivalent group of students in another section of the same course, whose pre-class reading presented both the jargon and concepts together in the traditional manner. Both groups had the same active-learning classes with the same instructor, and then completed the same post-test. Although the two groups performed the same on the multiple choice questions of the post-test, the group exposed to concepts first and jargon second included 1.5 times and 2.5 times more correct arguments on two free-response questions about the concepts. The correct use of jargon between the two groups was similar, with the exception of one jargon term that the control group used more often. These results suggest that modest instructional changes whereby new concepts are introduced in a concepts-first, jargon-second manner can increase student learning, as demonstrated by their ability to articulate their understanding of new concepts.

  17. Understanding the role of opinion leaders in improving clinical effectiveness.

    PubMed

    Locock, L; Dopson, S; Chambers, D; Gabbay, J

    2001-09-01

    We present findings from evaluations of two government-funded initiatives exploring the transfer of research evidence into clinical practice--the PACE Programme (Promoting Action on Clinical Effectiveness), and the Welsh Clinical Effectiveness Initiative National Demonstration Projects. We situate the findings within the context of available research evidence from healthcare and other settings on the role of opinion leaders or product champions in innovation and change--evidence which leaves a number of problems and unanswered questions. A major concern is the difficulty of achieving a single replicable description of what opinion leaders are and what they do--subjective understandings of their role differ from one setting to another, and we identify a range of very different types of opinion leadership. What makes someone a credible and influential authority is derived not just from their own personality and skills and the dynamic of their relationship with other individuals, but also from other context-specific factors. We examine the question of expert versus peer opinion leaders, and the potential for these different categories to be more or less influential at different stages in the innovation process. An often neglected area is the impact of opinion leaders who are ambivalent or hostile to an innovation. Finally, we note that the interaction between individual opinion leaders and the collective process of negotiating a change and reorienting professional norms remains poorly understood. This raises a number of methodological concerns which need to be considered in further research in this area.

  18. Improving management of patients with advanced cancer

    PubMed Central

    Drudge-Coates, Lawrence

    2010-01-01

    Development of bone metastases in patients with advanced cancer is associated with skeletal-related events (SREs) such as pathologic fractures, spinal cord compression, the requirement for surgery or palliative radiotherapy to bone, and hypercalcemia of malignancy. Skeletal morbidity may reduce patient mobility, limit functional independence, and impair quality of life (QOL). Proactive management of new or worsening bone pain or motor impairment is crucial because of the potential for rapid progression of symptoms. Administration of bisphosphonate therapy as a monthly infusion to patients with bone metastases prevents or delays the onset and reduces the frequency of SREs and provides clinically meaningful improvements in bone pain and QOL. In addition to administration of therapy, the monthly infusion visit allows a dedicated team of healthcare professionals to regularly assess SREs, response to therapy, adverse events (AEs), QOL, and adherence to oral medications and supplements. The continuity of care that occurs during the monthly infusion visit provides oncology nurses with an opportunity to educate patients about effective strategies to manage SREs and AEs. In addition, regular interaction provides oncology nurses with an opportunity to recognize and proactively address subtle changes in the patients’ medical condition. Using a multidisciplinary medical team also eliminates barriers between the various healthcare professionals involved in patient management. Consequently, the monthly infusion visit can result in effective patient management and improved clinical outcomes in patients with malignant bone disease. PMID:21206517

  19. Mechanistic Understanding of Microbial Plugging for Improved Sweep Efficiency

    SciTech Connect

    Steven Bryant; Larry Britton

    2008-09-30

    Microbial plugging has been proposed as an effective low cost method of permeability reduction. Yet there is a dearth of information on the fundamental processes of microbial growth in porous media, and there are no suitable data to model the process of microbial plugging as it relates to sweep efficiency. To optimize the field implementation, better mechanistic and volumetric understanding of biofilm growth within a porous medium is needed. In particular, the engineering design hinges upon a quantitative relationship between amount of nutrient consumption, amount of growth, and degree of permeability reduction. In this project experiments were conducted to obtain new data to elucidate this relationship. Experiments in heterogeneous (layered) beadpacks showed that microbes could grow preferentially in the high permeability layer. Ultimately this caused flow to be equally divided between high and low permeability layers, precisely the behavior needed for MEOR. Remarkably, classical models of microbial nutrient uptake in batch experiments do not explain the nutrient consumption by the same microbes in flow experiments. We propose a simple extension of classical kinetics to account for the self-limiting consumption of nutrient observed in our experiments, and we outline a modeling approach based on architecture and behavior of biofilms. Such a model would account for the changing trend of nutrient consumption by bacteria with the increasing biomass and the onset of biofilm formation. However no existing model can explain the microbial preference for growth in high permeability regions, nor is there any obvious extension of the model for this observation. An attractive conjecture is that quorum sensing is involved in the heterogeneous bead packs.

  20. Medical Interpreting: Improving Communication with Your Patients.

    ERIC Educational Resources Information Center

    Tebble, Helen

    The guide is designed for physicians and other medical practitioners who need to work with medical interpreters to improve communication with patients. Special attention is given to the Australian context. An introductory section discusses the need for medical interpreters and explains the guide's organization. Subsequent sections address these…

  1. Understanding improved osteoblast behavior on select nanoporous anodic alumina

    PubMed Central

    Ni, Siyu; Li, Changyan; Ni, Shirong; Chen, Ting; Webster, Thomas J

    2014-01-01

    The aim of this study was to prepare different sized porous anodic alumina (PAA) and examine preosteoblast (MC3T3-E1) attachment and proliferation on such nanoporous surfaces. In this study, PAA with tunable pore sizes (25 nm, 50 nm, and 75 nm) were fabricated by a two-step anodizing procedure in oxalic acid. The surface morphology and elemental composition of PAA were characterized by field emission scanning electron microscopy and X-ray photoelectron spectroscopy analysis. The nanopore arrays on all of the PAA samples were highly regular. X-ray photoelectron spectroscopy analysis suggested that the chemistry of PAA and flat aluminum surfaces were similar. However, contact angles were significantly greater on all of the PAA compared to flat aluminum substrates, which consequently altered protein adsorption profiles. The attachment and proliferation of preosteoblasts were determined for up to 7 days in culture using field emission scanning electron microscopy and a Cell Counting Kit-8. Results showed that nanoporous surfaces did not enhance initial preosteoblast attachment, whereas preosteoblast proliferation dramatically increased when the PAA pore size was either 50 nm or 75 nm compared to all other samples (P<0.05). Thus, this study showed that one can alter surface energy of aluminum by modifying surface nano-roughness alone (and not changing chemistry) through an anodization process to improve osteoblast density, and, thus, should be further studied as a bioactive interface for orthopedic applications. PMID:25045263

  2. Improving animal and human health through understanding liver fluke immunology.

    PubMed

    Piedrafita, D; Spithill, T W; Smith, R E; Raadsma, H W

    2010-08-01

    Sheep, goats and cattle represent the most numerous and economically important agricultural species worldwide used as sources for milk, fibre and red meat. In addition, in the developing world, these species often represent the sole asset base for small-holder livestock farmers and cattle/buffaloes often provide the majority of draught power for crop production. Production losses caused by helminth diseases of these animals are a major factor in extending the cycle of poverty in developing countries and a major food security issue for developed economies. Fasciola spp. are one of the most important zoonotic diseases with a global economic impact in livestock production systems and a poorly defined but direct effect on human health. Improvements in human and animal health will require a concerted research effort into the development of new accurate and simple diagnostic tests and increased vaccine and drug development against Fasciola infections. Here, the use of definitive natural host breeds with contrasting resistance to Fasciola infections is discussed as a resource to contrast parasite-host interactions and identify parasite immune evasion strategies. Such studies are likely to boost the discovery of new vaccine, drug and diagnostic candidates and provide the foundation for future genetic selection of resistant animals.

  3. Changing education to improve patient care

    PubMed Central

    Leach, D

    2001-01-01

    Health professionals need competencies in improvement skills if they are to contribute usefully to improving patient care. Medical education programmes in the USA have not systematically taught improvement skills to residents (registrars in the UK). The Accreditation Council for Graduate Medical Education (ACGME) has recently developed and begun to deploy a competency based model for accreditation that may encourage the development of improvement skills by the 100 000 residents in accredited programmes. Six competencies have been identified for all physicians, independent of specialty, and measurement tools for these competencies have been described. This model may be applicable to other healthcare professions. This paper explores patterns that inhibit efforts to change practice and proposes an educational model to provide changes in management skills based on trainees' analysis of their own work. Key Words: physician education; improvement skills; accreditation; competency PMID:11700380

  4. Increasing Patient Activation Could Improve Outcomes for Patients with Inflammatory Bowel Disease.

    PubMed

    Shah, Shawn L; Siegel, Corey A

    2015-12-01

    Inflammatory bowel disease (IBD) is a complex disease process that often requires the integration of skills from various health care providers to adequately meet the needs of patients with IBD. The medical and surgical treatment options for IBD have become more complicated and are frequently a source of angst for both the patient and provider. However, it has become more important than ever to engage patients in navigating the treatment algorithm. Although novel in the IBD world, the concept of patients' becoming more active and effective managers of their care has been well studied in other disease processes such as diabetes mellitus and mental illness. This idea of patient activation refers to a patient understanding his or her role in the care process and having the skill sets and self-reliance necessary to manage his or her own health care. Over the past decade, evidence supporting the role of patient activation in chronic illness has grown, revealing improved health outcomes, enhanced patient experiences, and lower overall costs. Patient activation can be measured, and interventions have been shown to improve levels of activation over time and influence outcomes. A focus on patient activation is very appropriate for patients with IBD because this may potentially serve as a tool for IBD providers to not only improve patient outcomes and experience but also reduce health care costs.

  5. Understanding

    ERIC Educational Resources Information Center

    Buxkemper, Andra C.; Hartfiel, D. J.

    2003-01-01

    There is no common agreement on the meaning of the word "understand". However, there is agreement on what students should be able to do with material they understand. Bloom et al. discuss kinds of tasks a student should be able to do, provided that the student understands. In a similar way, Biggs and Collis provide a taxonomy intended to evaluate…

  6. The patient with cold hands: understanding Raynaud's disease.

    PubMed

    Jackson, Carol Mackenzie

    2006-11-01

    The availability of new treatments for Raynaud's disease, as with any medical condition, depends on how convincing the results of clinical research prove to be. The validity and reliability of research in Raynaud's disease is subject to two major constraints: the seasonal and intermittent nature of the condition limits the amount of time patients can be studied continuously, and researchers have failed to agree on objective outcome measures. Vascular physiology is, and no doubt is destined to remain, a dynamic and technology-driven clinical realm. Despite the wide array of promising treatments, the best and most basic management of Raynaud's disease seems to be behavioral and at least partly pharmaceutical. The two biggest behavioral factors are nicotine use and exposure to cold environments. Giving up nicotine can be a daunting challenge for long-term smokers and chewing-tobacco users. Avoiding cold environments may be easier said than done, especially for patients who work outdoors or in air-conditioned spaces. Perhaps the best treatment for Raynaud's disease is a reliable diagnosis and the positive prognosis that comes with it. Most patients have a stable course, and nearly half will actually improve with time and steady reassurance.

  7. Hearing the patient's voice? Factors affecting the use of patient survey data in quality improvement

    PubMed Central

    Davies, E; Cleary, P

    2005-01-01

    Objective: To develop a framework for understanding factors affecting the use of patient survey data in quality improvement. Design: Qualitative interviews with senior health professionals and managers and a review of the literature. Setting: A quality improvement collaborative in Minnesota, USA involving teams from eight medical groups, focusing on how to use patient survey data to improve patient centred care. Participants: Eight team leaders (medical, clinical improvement or service quality directors) and six team members (clinical improvement coordinators and managers). Results: Respondents reported three types of barriers before the collaborative: organisational, professional and data related. Organisational barriers included lack of supporting values for patient centred care, competing priorities, and lack of an effective quality improvement infrastructure. Professional barriers included clinicians and staff not being used to focusing on patient interaction as a quality issue, individuals not necessarily having been selected, trained or supported to provide patient centred care, and scepticism, defensiveness or resistance to change following feedback. Data related barriers included lack of expertise with survey data, lack of timely and specific results, uncertainty over the effective interventions or time frames for improvement, and consequent risk of perceived low cost effectiveness of data collection. Factors that appeared to have promoted data use included board led strategies to change culture and create quality improvement forums, leadership from senior physicians and managers, and the persistence of quality improvement staff over several years in demonstrating change in other areas. Conclusion: Using patient survey data may require a more concerted effort than for other clinical data. Organisations may need to develop cultures that support patient centred care, quality improvement capacity, and to align professional receptiveness and leadership with

  8. Lynch Syndrome Limbo: Patient Understanding of Variants of Uncertain Significance.

    PubMed

    Solomon, Ilana; Harrington, Elizabeth; Hooker, Gillian; Erby, Lori; Axilbund, Jennifer; Hampel, Heather; Semotiuk, Kara; Blanco, Amie; Klein, William M P; Giardiello, Francis; Leonard, Lori

    2017-01-26

    Providers and patients encounter challenges related to the management of Variants of Unknown Significance (VUS). A VUS introduces new counseling dilemmas for the understanding and psychosocial impact of uncertain genetic test results. This descriptive study uses Mishel's theory of uncertainty in illness to explore the experience of individuals who have received a VUS as part of the genetic testing process. Semi-structured interviews were conducted with 27 adult individuals who received a VUS for Lynch syndrome mismatch repair genes between 2002 and 2013. The interviews were transcribed and analyzed. Most individuals recalled their result and perceived various types of uncertainty associated with their VUS. Half of the participants appraised their variant as a danger and implemented coping strategies to reduce the threat of developing cancer. Mobilizing strategies to reduce their risk included vigilant cancer surveillance, information seeking and notifying relatives. The majority of participants were unaware of the possibility of a VUS before receiving their result and expected reclassification over time. These results provide insight into the ways healthcare providers can support patients who receive VUS for Lynch syndrome. Findings also provide direction for future work that can further explicate the impact of receiving a VUS.

  9. Creating effective leadership for improving patient safety.

    PubMed

    Mohr, Julie J; Abelson, Herbert T; Barach, Paul

    2002-01-01

    Leadership has emerged as a key theme in the rapidly growing movement to improve patient safety. Leading an organization that is committed to providing safer care requires overcoming the common traps in thinking about error, such as blaming individuals, ignoring the underlying systems factors, and blaming the bureaucracy of the organization. Leaders must address the system issues that are at work within their organizations to allow individual and organizational learning to occur.

  10. Improving adherence and outcomes in diabetic patients

    PubMed Central

    Joshi, Renu; Joshi, Disha; Cheriyath, Pramil

    2017-01-01

    Objective Nonadherence in diabetes is a problem leading to wasted resources and preventable deaths each year. Remedies for diminishing nonadherence are many but marginally effective, and outcomes remain suboptimal. Aim The aim of this study was to test a new iOS “app”, PatientPartner. Derived from complexity theory, this novel technology has been extensively used in other fields; this is the first trial in a patient population. Methods Physicians referred patients who were “severely non-adherent” with HbA1c levels >8. After consent and random assignment (n=107), subjects in the intervention group were immersed in the 12-min PatientPartner game, which assesses and trains subjects on parameters of thinking that are critical for good decision making in health care: information management, stress coping, and health strategies. The control group did not play PatientPartner. All subjects were called each week for 3 weeks and self-reported on their medication adherence, diet, and exercise. Baseline and 3-month post-intervention HbA1c levels were recorded for the intervention group. Results Although the control group showed no difference on any measures at 3 weeks, the intervention group reported significant mean percentage improvements on all measures: medication adherence (57%, standard deviation [SD] 18%–96%, SD 9), diet (50%, SD 33%–75%, SD 28), and exercise (29%, SD 31%–43%, SD 33). At 3 months, the mean HbA1c levels in the intervention group were significantly lower (9.6) than baseline (10.7). Conclusion Many programs to improve adherence have been proved to be expensive and marginally effective. Therefore, improvements from the single use of a 12-min-long “app” are noteworthy. This is the first ever randomized, controlled trial to demonstrate that an “app” can impact the gold standard biological marker, HbA1c, in diabetes. PMID:28243070

  11. [Improving patient safety through voluntary peer review].

    PubMed

    Kluge, S; Bause, H

    2015-01-01

    The intensive care unit (ICU) is one area of the hospital in which processes and communication are of primary importance. Errors in intensive care units can lead to serious adverse events with significant consequences for patients. Therefore quality and risk-management are important measures when treating critically ill patients. A pragmatic approach to support quality and safety in intensive care is peer review. This approach has gained significant acceptance over the past years. It consists of mutual visits by colleagues who conduct standardised peer reviews. These reviews focus on the systematic evaluation of the quality of an ICU's structure, its processes and outcome. Together with different associations, the State Chambers of Physicians and the German Medical Association have developed peer review as a standardized tool for quality improvement. The common goal of all stakeholders is the continuous and sustainable improvement in intensive care with peer reviews significantly increasing and improving communication between professions and disciplines. Peer reviews secure the sustainability of planned change processes and consequently lead the way to an improved culture of quality and safety.

  12. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    PubMed

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment.

  13. Improving patient safety by instructional systems design

    PubMed Central

    Battles, J B

    2006-01-01

    Education and training are important elements in patient safety, both as a potential contributing factor to risks and hazards of healthcare associated injury or harm and as an intervention to be used in eliminating or preventing such harm. All too often we have relied on training as the only interventions for patient safety without examining other alternatives or realizing that, in some cases, the training systems themselves are part of the problem. One way to ensure safety by design is to apply established design principles to education and training. Instructional systems design (ISD) is a systematic method of development of education and training programs for improved learner performance. The ISD process involves five integrated steps: analysis, development, design, implementation, and evaluation (ADDIE). The application of ISD using the ADDIE approach can eliminate or prevent education and training from being a contributing factor of health associated injury or harm, and can also be effective in preventing injury or harm. PMID:17142604

  14. An Evaluation of Understandability of Patient Journey Models in Mental Health

    PubMed Central

    2016-01-01

    Background There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. Objectives This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. Method Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. Results The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. Conclusions The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot

  15. Herceptin resistance database for understanding mechanism of resistance in breast cancer patients.

    PubMed

    Ahmad, Sahil; Gupta, Sudheer; Kumar, Rahul; Varshney, Grish C; Raghava, Gajendra P S

    2014-03-27

    Monoclonal antibody Trastuzumab/Herceptin is considered as frontline therapy for Her2-positive breast cancer patients. However, it is not effective against several patients due to acquired or de novo resistance. In last one decade, several assays have been performed to understand the mechanism of Herceptin resistance with/without supplementary drugs. This manuscript describes a database HerceptinR, developed for understanding the mechanism of resistance at genetic level. HerceptinR maintains information about 2500 assays performed against various breast cancer cell lines (BCCs), for improving sensitivity of Herceptin with or without supplementary drugs. In order to understand Herceptin resistance at genetic level, we integrated genomic data of BCCs that include expression, mutations and copy number variations in different cell lines. HerceptinR will play a vital role in i) designing biomarkers to identify patients eligible for Herceptin treatment and ii) identification of appropriate supplementary drug for a particular patient. HerceptinR is available at http://crdd.osdd.net/raghava/herceptinr/.

  16. Consent for biobanking: assessing the understanding and views of cancer patients.

    PubMed

    Mancini, Julien; Pellegrini, Isabelle; Viret, Frédéric; Vey, Norbert; Daufresne, Lise-Marie; Chabannon, Christian; Julian-Reynier, Claire

    2011-01-19

    Cancer patients were questioned about the consent process in a context in which they were routinely requested to donate tumor samples to research. After in-depth interviews of 19 patients, a 12-page questionnaire was designed and mailed to 745 patients who had been recently treated for colorectal cancer, breast cancer, or a hematological malignancy at a French Regional Cancer Center at which an opt-in biobanking system has existed since 2002. The response rate was 77.0% (N = 574). Among responding patients, 349 (60.8%) of the 574 were in favor of a formal and signed consent. Concordance was low (kappa = 0.23) between the number of patients who declared in the survey that they had given consent (213 of 574 [37.1%]) vs the number for whom registered consent had been recorded (267 of 574 [46.5%]). Only 2 (0.3%) of the 574 patients stated that they had signed a refusal, and only 88 (41.3%) of the 213 patients who remembered giving consent understood that their consent for biobanking also covered authorization to use their clinical data. We conclude that the opt-in consent procedure is positively perceived by most patients but should be improved for a better understanding and possibly an even better adherence to the consent process.

  17. Improving clinical care for patients with irritable bowel syndrome.

    PubMed

    Thompson, Julie

    2017-01-26

    Progress has been made in the past year in the guidance available for health professionals caring for patients with irritable bowel syndrome (IBS). In April 2016, the first National Institute for Health and Care Excellence (NICE) quality standard on IBS in adults was published and new dietary guidelines were developed. Nurses are at the forefront of caring for people with IBS across all healthcare sectors and may have more time to understand the patient's perspective and advise on lifestyle changes than a general practitioner in the average 10-minute consultation. Rapid diagnosis and evidence-based treatments using treatment pathways significantly reduces healthcare costs in primary care and improves quality of life. First-line treatment modalities remain a combination of lifestyle factors, diet and medications, but for persistent refractory symptoms, referral to specialist practitioners should be considered. This article aims to update nurses on new practice guidance and provide information on when it is appropriate to refer patients for specialist care.

  18. Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information.

    PubMed

    Champlin, Sara; Mackert, Michael; Glowacki, Elizabeth M; Donovan, Erin E

    2016-05-12

    While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low (n = 13) and adequate (n = 14) health literacy patients, and health professionals (n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

  19. Health innovation for patient safety improvement.

    PubMed

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

  20. Listening to patients with cancer: using a literary-based research method to understand patient-focused care

    PubMed Central

    Begley, Amanda; Pritchard-Jones, Kathy; Biriotti, Maurice; Kydd, Anna; Burdsey, Tim; Townsley, Emma

    2014-01-01

    Objective In spite of considerable attention, patients diagnosed with cancer continue to report poor experiences of care. The root causes of this remain unclear. This exploratory study aimed to investigate new ways of understanding the experience of patients with cancer, using a literary-based research approach. Design Interviews were undertaken with four patients diagnosed with high-grade brain cancers at least 6 months from diagnosis and with people (n=5) identified by the patients as important in their care pathway. Interview transcripts were analysed by humanities academics as pieces of literature, where each patient's story was told from more than one person's perspective. The academics then came together in a facilitated workshop to agree major themes within the patient experiences. The themes were presented at a patient and carer event involving 70 participants to test the validity of the insights. Results Insights into the key issues for patients with cancer could be grouped into six themes: accountability; identity; life context; time; language; rigour and emotion. Patients often held a different perspective to the traditionally held medical views of what constitutes good care. For example, patients did not see any conflict between a doctor having scientific rigour and portraying emotion. Conclusions One key feature of the approach was its comparative nature: patients often held different views from those traditionally held by physicians of what constitutes health and good outcomes. This revealed aspects that may be considered by healthcare professionals when designing improvements. Proposals for further testing are discussed, with a particular emphasis on the need for sensitivity to individual differences in experiences. PMID:25324319

  1. Functional dysphonia: strategies to improve patient outcomes

    PubMed Central

    Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele

    2015-01-01

    Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for

  2. Understanding patient satisfaction, trust, and loyalty to primary care physicians.

    PubMed

    Platonova, Elena A; Kennedy, Karen Norman; Shewchuk, Richard M

    2008-12-01

    The authors developed and empirically tested a model reflecting a system of interrelations among patient loyalty, trust, and satisfaction as they are related to patients' intentions to stay with a primary care physician (PCP) and recommend the doctor to other people. They used a structural equation modeling approach. The fit statistics indicate a well-fitting model: root mean square error of approximation = .022, goodness-of-fit index = .99, adjusted goodness-of-fit index = .96, and comparative fit index = 1.00. The authors found that patient trust and good interpersonal relationships with the PCP are major predictors of patient satisfaction and loyalty to the physician. Patients need to trust the PCP to be satisfied and loyal to the physician. The authors also found that patient trust, satisfaction, and loyalty are strong and significant predictors of patients' intentions to stay with the doctor and to recommend the PCP to others.

  3. Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine

    PubMed Central

    Ciechanowski, Paul S; Worley, Linda LM; Russo, Joan E; Katon, Wayne J

    2006-01-01

    Background Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty. Methods We determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1) relationship style and specialty choice factors; 2) specialty choice factors and specialty match, and 3) relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty. Results Prevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6). There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness. Conclusion Assessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice. PMID:16405723

  4. Improving management of patients with hyperemesis

    PubMed Central

    Lloyd, Jilly; Ramskill, Nikki; Sharma, Bhavna

    2014-01-01

    Hyperemesis gravidarum (HG), defined as severe nausea and vomiting resulting in dehydration, is a common reason for emergency admission in gynaecology (1). The management of HG is supportive, including the correction of dehydration and electrolyte disturbances and use of antiemetics. An audit in our unit identified that women with HG were not receiving appropriate fluid resuscitation and in particular inadequate potassium replacement. A proforma was developed by a multidiscplinary team to prompt appropriate investigations, medications, and fluid resuscitation. The proforma was introduced in paper format and electronically, accompanied by an education programme for junior doctors. This intervention has improved prescribing practice and fluid resuscitation for these patients. Length of admission has reduced. Efforts have been made to ensure this change is sustainable in the long term, through involvement of the junior doctors using the proforma at all stages of the project. PMID:26734219

  5. Understanding the factors that influence patient satisfaction with ambulance services.

    PubMed

    Bogomolova, Svetlana; Tan, P J; Dunn, S P; Bizjak-Mikic, M

    2016-01-01

    The quality of ambulance services has an immense impact on patients' future well-being and quality of life. Patient satisfaction is one of the key metrics for evaluating the quality of this service. Yet, the patient satisfaction measurement may be limited in its ability to accurately reflect this service quality, and even reflect factors beyond the patient experiences. We analyze 10 years of survey data to reveal a number of factors that systematically bias ambulance satisfaction ratings. Taking into account these biases provides more robust comparison of ambulance performance over time or across different jurisdictions.

  6. Understanding the Transformation of Compassion in Nurses Who Become Patients

    ERIC Educational Resources Information Center

    Pucino, Carrie L.

    2013-01-01

    The purpose of this study was to examine how nurses who become patients learn compassion toward patients in their professional practice, and examine the role of empathy in the process of learning compassion. The process of learning compassion represents a significant change in the way nurses perceive this aspect of practice. Therefore,…

  7. Understanding diabetes in patients with HIV/AIDS

    PubMed Central

    2011-01-01

    This paper reviews the incidence, pathogenetic mechanisms and management strategies of diabetes mellitus in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). It classifies patients based on the aetiopathogenetic mechanisms, and proposes rational methods of management of the condition, based on aetiopathogenesis and concomitant pharmacotherapy. PMID:21232158

  8. Improved informed consent documents for biomedical research do not increase patients’ understanding but reduce enrolment: a study in real settings

    PubMed Central

    Paris, Adeline; Deygas, Béatrice; Cornu, Catherine; Thalamas, Claire; Maison, Patrick; Duale, Christian; Kane, Maty; Hodaj, Enkelejda; Cracowski, Jean-Luc

    2015-01-01

    Aims The aim was to evaluate the comprehension of participants of an improved informed consent document (ICD). Method This was a randomized controlled French multicentre study performed in real conditions. Participants were adult patients undergoing screening for enrolment in biomedical research studies, who agreed to answer a validated questionnaire evaluating objective and subjective comprehension scored from 0 (no comprehension) to 100 (excellent comprehension). Patients were provided either the original ICD or an ICD modified in terms of structure and readability. The primary end point was the score of objective comprehension. The secondary end-points were the enrolment rate in the clinical study and patient characteristics associated with the score of objective comprehension. Results Four hundred and eighty-one patients were included, 241 patients in the original ICD group and 240 patients in the modified ICD group. There was no difference between the two groups for the score of objective comprehension (original ICD 72.7 (95% CI 71.3, 74.1) vs. modified ICD 72.5 (95% CI 71.0, 74.0); P = 0.81). However, the rate of enrolment in the clinical study was lower in the group who received the modified ICD (64.4% (95% CI 58.3, 70.5)) than for the original ICD (73.0% (95% CI 67.4, 78.7)) (P = 0.042). Only female gender and high educational level were associated with a better objective comprehension. Conclusions Improving ICDs had no effect on participants’ understanding, whereas the rate of enrolment was lower in this group. In attempts at improving potential participants’ understanding of clinical research information, efforts and future trials should focus on other ways to improve comprehension. PMID:26147763

  9. Conferences, tablecloths and cupboards: how to understand the situatedness of quality improvements in long-term care.

    PubMed

    Stoopendaal, Annemiek; Bal, Roland

    2013-02-01

    Long term care needs improvement, but still little is known how quality improvement works in practice. A better, in-depth, understanding of the content and complexities of quality improvement is necessary because of the still limited theoretical and empirical grounds underlying its approach. This article draws on empirical material from Care for Better, a national quality improvement collaborative (QIC) for the long-term care sector in the Netherlands that took place from 2005 until 2012. Following a project on prevention of malnutrition, we analyzed the complex and ongoing processes of embedding improvements. The guiding question for our research was: what must be accomplished to enable and sustain improvements to occur in the everyday life of care organizations? In our analysis, we linked ethnographic findings to Actor Network Theory. We found that different kinds of work had to be done by both human and non-human actors to displace improvements into specific organizational situations. We conceptualized this work as the activity of translation. Moreover, the concept of inscription offers a perspective to reveal how improvements are made durable. Inscriptions are translations of values into texts, behavior or materialities that steer action in a specific way. We analyzed three different modes of inscription: gathering, materializing and training. We analyzed how one specific value, patient choice, became inscribed in different ways, configuring the actors in specific ways, with diverging consequences for how patient choice comes about.

  10. Understanding Facial Expressions of Pain in Patients With Depression.

    PubMed

    Lautenbacher, Stefan; Bär, Karl-Juergen; Eisold, Patricia; Kunz, Miriam

    2016-12-02

    Although depression is associated with more clinical pain complaints, psychophysical data sometimes point to hypoalgesic alterations. Studying the more reflex-like facial expression of pain in patients with depression may offer a new perspective. Facial and psychophysical responses to nonpainful and painful heat stimuli were studied in 23 patients with major depressive disorder (MDD) and 23 matched control participants. As psychophysical data, pain thresholds, tolerance thresholds, and self-report were assessed. Facial responses were videotaped and subjected offline to Facial Action Coding System analysis. One of the key facial responses of pain, which is a known facial signal of negative affect (contraction of the eyebrows), was significantly increased in MDD patients. Moreover, facial expressions and pain ratings were strongly correlated in MDD patients, whereas these 2 response systems were-in line with established findings-only weakly related in healthy participants. Pain psychophysics was unaltered in MDD patients compared with healthy control participants. In conclusion, the facial expression of pain in MDD patients indicates rather hyper- than hypoalgesia, with enhanced affective pain processing. Moreover, the linkage between subjective and facial responses was much stronger in MDD patients, which may be due to a reduced influence of social display rules, which normally complicate this relationship.

  11. Educating patients: understanding barriers, learning styles, and teaching techniques.

    PubMed

    Beagley, Linda

    2011-10-01

    Health care delivery and education has become a challenge for providers. Nurses and other professionals are challenged daily to assure that the patient has the necessary information to make informed decisions. Patients and their families are given a multitude of information about their health and commonly must make important decisions from these facts. Obstacles that prevent easy delivery of health care information include literacy, culture, language, and physiological barriers. It is up to the nurse to assess and evaluate the patient's learning needs and readiness to learn because everyone learns differently. This article will examine how each of these barriers impact care delivery along with teaching and learning strategies will be examined.

  12. Negative communication in psychosis: understanding pathways to poorer patient outcomes.

    PubMed

    Finnegan, Deirdre; Onwumere, Juliana; Green, Catherine; Freeman, Daniel; Garety, Philippa; Kuipers, Elizabeth

    2014-11-01

    High expressed emotion (EE) is a robust predictor of elevated rates of relapse and readmission in schizophrenia. However, far less is known about how high EE leads to poorer patient outcomes. This study was designed to examine links between high EE (criticism), affect, and multidimensional aspects of positive symptoms in patients with psychosis. Thirty-eight individuals with nonaffective psychosis were randomly exposed to proxy high-EE or neutral speech samples and completed self-report measures of affect and psychosis symptoms. Patients reported significant increases in anxiety, anger, and distress after exposure to the proxy high-EE speech sample as well as increases in their appraisals of psychosis symptoms: voice controllability, delusional preoccupation, and conviction. These findings offer further evidence of the potential deleterious impact of a negative interpersonal environment on patient symptoms in psychosis.

  13. Understanding cultural difference in caring for dying patients.

    PubMed Central

    Koenig, B A; Gates-Williams, J

    1995-01-01

    Experiences of illness and death, as well as beliefs about the appropriate role of healers, are profoundly influenced by patients' cultural background. As the United States becomes increasingly diverse, cultural difference is a central feature of many clinical interactions. Knowledge about how patients experience and express pain, maintain hope in the face of a poor prognosis, and respond to grief and loss will aid health care professionals. Many patients' or families' beliefs about appropriate end-of-life care are easily accommodated in routine clinical practice. Desires about the care of the body after death, for example, generally do not threaten deeply held values of medical science. Because expected deaths are increasingly the result of explicit negotiation about limiting or discontinuing therapies, however, the likelihood of serious moral disputes and overt conflict increases. We suggest a way to assess cultural variation in end-of-life care, arguing that culture is only meaningful when interpreted in the context of a patient's unique history, family constellation, and socioeconomic status. Efforts to use racial or ethnic background as simplistic, straightforward predictors of beliefs or behavior will lead to harmful stereotyping of patients and culturally insensitive care for the dying. PMID:7571587

  14. Understanding and coping with binge eating disorder: the patient's perspective.

    PubMed

    McElroy, Susan L; Guerdjikova, Anna I

    2015-08-01

    Binge eating disorder (BED) is the most common of the 6 feeding and eating disorders recognized by the DSM-5 and a significant public health problem that can be successfully managed with appropriate help. Many patients, however, are hesitant to discuss the symptoms of BED with their providers because of embarrassment or because they simply do not recognize the behavior as a problem behavior. Clinicians need to increase their awareness of BED, its warning signs, and how and why patients might try to hide it leading to increased BED recognition and timely diagnosis. Then, given the right tools, clinicians can help patients to not only accept the diagnosis and look into various treatment options but also to move beyond it to recognize if any comorbid disorders are present and in need of treatment.

  15. Understanding the will to live in patients nearing death.

    PubMed

    Chochinov, Harvey Max; Hack, Thomas; Hassard, Thomas; Kristjanson, Linda J; McClement, Susan; Harlos, Mike

    2005-01-01

    This study examined concurrent influences on the will to live in 189 patients with end-stage cancer The authors found significant correlations between the will to live and existential, psychological, social, and, to a lesser degree, physical sources of distress. Existential variables proved to have the most influence, with hopelessness, burden to others, and dignity entering into the final model. Health care providers must learn to appreciate the importance of existential issues and their ability to influence the will to live among patients nearing death.

  16. Understanding plant response to nitrogen limitation for the improvement of crop nitrogen use efficiency.

    PubMed

    Kant, Surya; Bi, Yong-Mei; Rothstein, Steven J

    2011-02-01

    Development of genetic varieties with improved nitrogen use efficiency (NUE) is essential for sustainable agriculture. Generally, NUE can be divided into two parts. First, assimilation efficiency involves nitrogen (N) uptake and assimilation and second utilization efficiency involves N remobilization. Understanding the mechanisms regulating these processes is crucial for the improvement of NUE in crop plants. One important approach is to develop an understanding of the plant response to different N regimes, especially to N limitation, using various methods including transcription profiling, analysing mutants defective in their normal response to N limitation, and studying plants that show better growth under N-limiting conditions. One can then attempt to improve NUE in crop plants using the knowledge gained from these studies. There are several potential genetic and molecular approaches for the improvement of crop NUE discussed in this review. Increased knowledge of how plants respond to different N levels as well as to other environmental conditions is required to achieve this.

  17. Using Digital Multimedia to Improve Parents’ and Children’s Understanding of Clinical Trials

    PubMed Central

    Tait, Alan R.; Voepel-Lewis, Terri; Levine, Robert

    2015-01-01

    Objective Data show that many research subjects have difficulty understanding study information using traditional paper consent documents. This study, therefore, was designed to evaluate the effect of an interactive multimedia program on improving parents’ and children’s understanding of clinical trial concepts and participation. Methods Parents (n = 148) and children (n = 135) were each randomized to receive information regarding clinical trials using either a traditional paper format (TF) or an interactive iPad program (IP) with in-line exercises. Participants’ understanding of the information was assessed using semi-structured interviews prior to (pre-test) and after (post-test) receiving the information. Participants also completed a short survey to assess their perceptions of the information delivery and satisfaction with the process. Results Regardless of the mode of information delivery, all participants demonstrated improved pre- to post-test understanding. While there were no statistical differences in parents’ post-test understanding between the TF and IP groups, children in the IP group had significantly greater post-test understanding compared with children in the TF group (11.65(4.1) vs 8.85(4.1) [2.8, 1.4,4.2] 0–18 scale where 18 = complete understanding). Furthermore, the IP was found to be significantly “easier to follow” and “more effective” in presenting information compared with the TF. Conclusions Results demonstrated the importance of providing information regarding clinical trial concepts to parents and children. Importantly, the ability of interactive multimedia to improve understanding of clinical trial concepts and satisfaction with information delivery, particularly among children, supports this approach as a novel and effective vehicle for enhancing the informed consent process. PMID:25829422

  18. Understanding situation awareness and its importance in patient safety.

    PubMed

    Gluyas, Heather; Harris, Sarah-Jane

    2016-04-20

    Situation awareness describes an individual's perception, comprehension and subsequent projection of what is going on in the environment around them. The concept of situation awareness sits within the group of non-technical skills that include teamwork, communication and managing hierarchical lines of communication. The importance of non-technical skills has been recognised in safety-critical industries such as aviation, the military, nuclear, and oil and gas. However, health care has been slow to embrace the role of non-technical skills such as situation awareness in improving outcomes and minimising the risk of error. This article explores the concept of situation awareness and the cognitive processes involved in maintaining it. In addition, factors that lead to a loss of situation awareness and strategies to improve situation awareness are discussed.

  19. A survey of patients with haemophilia to understand how they track product used at home.

    PubMed

    Sholapur, N S; Barty, R; Wang, G; Almonte, T; Heddle, N M

    2013-09-01

    Record keeping among individuals who manage haemophilia at home is an essential tool of communication between patient and Haemophilia Treatment Center (HTC). Complete records help HTCs monitor patients, their use of factor and ensure treatment is optimal. HTCs provide patients with a number of methods to track infusion practices. The study objectives were to: [1] determine the current methods of record keeping; [2] identify previous methods of record keeping; [3] understand the strengths and weaknesses associated with each method; and [4] gather suggestions for improvement. Survey methods were used to address the research objectives. Of the 83 patients in the Hamilton-Niagara region who received the survey distributed through the local HTC, 51 returned surveys were included into the analysis. Descriptive statistics were used. Results indicate individuals with haemophilia record infusion practices using: paper diaries, excel spreadsheets, hand-held PDAs and/or the online EZ-Log Web Client. The most popular method of record keeping was EZ-Log (45.1%) followed by paper diaries (35.2%). Advantages to using paper methods include the visual tracking of information and retaining hardcopies. The disadvantage was the inconvenience of physically submitting the records monthly. Advantages to using the online EZ-Log Web Client included ease of use and improved accuracy. The primary disadvantage was technical errors that were difficult to troubleshoot. Record keeping practices among individuals with haemophilia seem to vary according to personal preference and convenience. Respondents suggested that saving infusion history, incorporating barcode scanners or a copy and paste function could improve electronic methods.

  20. Improving physician-patient interactions: a review.

    PubMed

    Strecher, V J

    1983-01-01

    The interaction between physician and patient comprises aspects of communication common to any two human beings and other aspects peculiar to the roles exclusively adopted by physicians and patients. In this review, nonverbal and verbal elements of general communication are discussed, detailing important aspects of vocal tone, body postures, appearance, and verbal cues that may influence attributions made of physicians by patients. Role-related elements of physician-patient interactions are discussed in light of findings from research on interactions between physicians and patients. Developmental elements of general communication are discussed, relating stages tht evolve in interactions to physician-patient interactions. Finally, an examination is made of how interpersonal skills are taught to physicians and medical students. Discussion of what skills are specified for teaching, whether they are effectively taught, and whether the learning of these skills produces desired patient health-related outcomes is presented.

  1. Rapid response teams: a proactive strategy for improving patient care.

    PubMed

    Garretson, Sharon; Rauzi, Mary Beth; Meister, Janice; Schuster, Janet

    Cardiopulmonary resuscitation success rates have not changed in 30 years. Patient outcomes may improve if changes in a patient's condition are addressed at the onset of subtle deteriorations, rather than at the point of cardiac arrest. The rapid response team involves early intervention that demonstrates the ability to decrease cardiac arrest rates and improve patient mortality.

  2. Development and Evaluation of a Tutorial to Improve Students' Understanding of a Lock-in Amplifier

    ERIC Educational Resources Information Center

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Singh, Chandralekha

    2016-01-01

    A lock-in amplifier is a versatile instrument frequently used in physics research. However, many students struggle with the basic operating principles of a lock-in amplifier which can lead to a variety of difficulties. To improve students' understanding, we have been developing and evaluating a research-based tutorial which makes use of a computer…

  3. Improving Economic Understanding of Students in Junior College Economic Principles Courses.

    ERIC Educational Resources Information Center

    Barr, Saul Zusman; Carr, Glenna D.

    1980-01-01

    Describes a study comparing a conventional textbook/lecture teaching method and a teaching method based on current event readings with lectures and class discussions. The study sought to show whether improvement in students' understanding of economics was influenced by teaching method and selected characteristics of students and teachers. (AYC)

  4. Social and Economic Benefits of Improved Adult Literacy: Towards a Better Understanding: Support Document

    ERIC Educational Resources Information Center

    Hartley, Robyn; Horne, Jackie

    2005-01-01

    This document was produced by the authors based on their research for the report, "Social and Economic Benefits of Improved Adult Literacy: Towards a Better Understanding," and is an added resource for further information. The original document is a feasibility study which explores the frameworks and methodologies available for…

  5. Improving the Conceptual Understanding in Kinematics Subject Matter with Hypertext Media Learning and Formal Thinking

    ERIC Educational Resources Information Center

    Manurung, Sondang R.; Mihardi, Satria

    2016-01-01

    The purpose of this study was to determine the effectiveness of hypertext media based kinematic learning and formal thinking ability to improve the conceptual understanding of physic prospective students. The research design used is the one-group pretest-posttest experimental design is carried out in the research by taking 36 students on from…

  6. Improving Food Safety by Understanding the Evolution of Egg-contaminating Salmonella Enteritidis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Improving Food Safety by Understanding the Evolution of Egg-contaminating Salmonella Enteritidis Jean Guard, Veterinary Medical Officer U. S. Department of Agriculture, Athens, GA USA (jean.guard@ars.usda.gov) The curious case of egg contamination by Salmonella enterica serovar Enteritidis S. ...

  7. Scaffolded Instruction Improves Student Understanding of the Scientific Method & Experimental Design

    ERIC Educational Resources Information Center

    D'Costa, Allison R.; Schlueter, Mark A.

    2013-01-01

    Implementation of a guided-inquiry lab in introductory biology classes, along with scaffolded instruction, improved students' understanding of the scientific method, their ability to design an experiment, and their identification of experimental variables. Pre- and postassessments from experimental versus control sections over three semesters…

  8. Improving the Quality and Scientific Understanding of Trophic Magnification Factors (TMFs)

    EPA Science Inventory

    This short 1000 word report presents a series of research needs for improving the measurement and understanding of trophic magnification factors (TMFs). TMFs are useful measures of trophic magnification and represent the diet-weighted average biomagnification factor (BMF) of che...

  9. Managing Resources and Relations in Higher Education Institutions: A Framework for Understanding Performance Improvement

    ERIC Educational Resources Information Center

    Ho, Sophia Shi-Huei; Peng, Michael Yao-Ping

    2016-01-01

    Changes in social systems demonstrate that various structural disadvantages have jointly led to increasing competition among higher education institutions (HEIs) in many countries, especially Taiwan. Institutional administrators must recognize the need to understand how to improve performance and consistently outperform other institutions.…

  10. Water Literacy in College Freshmen: Could a Cognitive Imagery Strategy Improve Understanding?

    ERIC Educational Resources Information Center

    Ewing, Margaret S.; Mills, Terence J.

    1994-01-01

    Presents a study designed to determine whether levels of water literacy differed between (n=83) college freshman nonscience majors having one versus two years of high school science coursework, visual imagery exercises could improve understanding of the water cycle, and patterns exist in the concept of the water cycle. (Contains 23 references.)…

  11. A Hands-On Exercise Improves Understanding of the Standard Error of the Mean

    ERIC Educational Resources Information Center

    Ryan, Robert S.

    2006-01-01

    One of the most difficult concepts for statistics students is the standard error of the mean. To improve understanding of this concept, 1 group of students used a hands-on procedure to sample from small populations representing either a true or false null hypothesis. The distribution of 120 sample means (n = 3) from each population had standard…

  12. Improving the revenue cycle by taking the patient's perspective.

    PubMed

    Langford, April; Dye, Lyda; Moresco, Jessica; Riefner, Donald C

    2010-09-01

    UPMC revenue cycle operations analyzed front-end processes to improve them, thereby also improving the patient experience. UPMC focused on scheduling, eligibility/insurance verification, and financial counseling to develop an integrated work flow ensuring data integrity and expediting account resolution. Automating the processes increased efficiency and reduced errors, while improving patient satisfaction.

  13. Sitting at patients' bedsides may improve patients' perceptions of physician communication skills.

    PubMed

    Merel, Susan E; McKinney, Christy M; Ufkes, Patrick; Kwan, Alan C; White, Andrew A

    2016-12-01

    Sitting at a patient's bedside in the inpatient setting is recommended as a best practice but has not been widely adopted. Previous studies suggest that a physician's seated posture may increase the patient's perception of time spent in the room but have not included hospitalists. We performed a cluster-randomized trial of seated versus standing physician posture during inpatient rounds on a hospitalist service at an academic medical center. Patients whose physician sat were significantly more likely to rate their physician highly on measures of listening carefully and explaining things in a way that was easy to understand. The average time spent in the patient's room was approximately 12 minutes and was not affected by physician posture. Patients' perception of the time their physician spent in their room was not affected by physician posture. Sitting at the bedside during rounds does not increase the amount of time spent with the patient but may improve patient-physician communication. Journal of Hospital Medicine 2015;11:865-868. © 2015 Society of Hospital Medicine.

  14. Improving patient care after stoma reversal.

    PubMed

    Taylor, Claire

    This article will examine the current service provision for patients who have had a temporary stoma reversal. Findings of a patient survey will be presented, highlighting the support and information received by 27 patients following a stoma reversal operation. Associated literature (Camilleri-Brennan and Steele, 2000; Sailer at al, 2000; Desnoo and Faithfull, 2006; Siassi et al, 2008; Chow et al, 2009) has confirmed a high likelihood of altered bowel function after stoma reversal, but makes less reference to the care that these patients require during the follow-up period. It is recommended that colorectal teams discuss the care implications for patients requiring stoma reversal, and appraise their care delivery to ensure patient needs are met.

  15. Improving the quality of patient handover on a surgical ward.

    PubMed

    Bradley, Alison

    2014-01-01

    The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

  16. Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer

    PubMed Central

    Voznesensky, Maria; Annam, Kiran

    2016-01-01

    Cancer can cause sexual adverse effects by direct and indirect pathways. It can involve sexual organs, indirectly affect body image, or cause fatigue or depression with subsequent effects on libido. Erectile dysfunction (ED), the inability to obtain or maintain an erection firm enough for sexual intercourse, can also result from adverse effects of cancer treatment, such as fatigue, pain, or anxiety about therapy. In addition, depressed feelings about having cancer can affect sexuality, causing a range of signs and symptoms that can lead to ED. Chemotherapy, hormone therapy, surgery, and radiation can all cause sexual adverse effects. Additional factors that play a role include patient age and degree of ED before starting cancer treatment. In this article, we discuss how chemotherapy, hormone therapy, surgery, and radiation affect erectile function as well as possible treatment options for ED. PMID:27072383

  17. "Hello, hello--it's English I speak!": a qualitative exploration of patients' understanding of the science of clinical trials.

    PubMed

    Stead, M; Eadie, D; Gordon, D; Angus, K

    2005-11-01

    Informed consent may be seriously compromised if patients fail to understand the experimental nature of the trial in which they are participating. Using focus groups, the authors explored how prospective trial participants interpret and understand the science of clinical trials by using patient information sheets relative to their medical condition. An opportunity was provided to hear in the patients' own words how they interpret the information and why there is variable understanding. Respondents struggled to comprehend the meaning and purpose of concepts such as randomisation and double blinding, and found them threatening to their ideas of medical care. Suggestions are made about how to improve the national guidelines on written information for trial participants and pretesting of the information sheets is advocated.

  18. Understanding and Managing Pregnancy in Patients with Lupus

    PubMed Central

    de Jesus, Guilherme Ramires; Mendoza-Pinto, Claudia; de Jesus, Nilson Ramires; dos Santos, Flávia Cunha; Klumb, Evandro Mendes; Carrasco, Mario García; Levy, Roger Abramino

    2015-01-01

    Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6–12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies. PMID:26246905

  19. Can cone-beam computed tomography superimposition help orthodontists better understand relapse in surgical patients?

    PubMed

    Porciúncula, Guilherme Machado; Koerich, Leonardo; Eidson, Lindsey; Gandini Junior, Luiz Gonzaga; Gonçalves, João Roberto

    2014-11-01

    This case report describes the interdisciplinary treatment of a 19-year-old Brazilian man with a Class I malocclusion, a hyperdivergent profile, an anterior open bite, and signs of temporomandibular joint internal derangement. The treatment plan included evaluation with a temporomandibular joint specialist and a rheumatologist, orthodontic appliances, and maxillomandibular surgical advancement with counterclockwise rotation. Cone-beam computed tomography images were taken before and after surgery at different times and superimposed at the cranial base to assess the changes after orthognathic surgery and to monitor quantitatively the internal derangement of the temporomandibular joints and surgical relapse. Our protocol can improve the orthodontist's understanding of surgical instability, demonstrate the clinical value of cone-beam computed tomography analysis beyond the multiplanar reconstruction, and guide patient management for the best outcome possible.

  20. "What We Breathe Impacts Our Health: Improving Understanding of the Link between Air Pollution and Health".

    PubMed

    West, J Jason; Cohen, Aaron; Dentener, Frank; Brunekreef, Bert; Zhu, Tong; Armstrong, Ben; Bell, Michelle L; Brauer, Michael; Carmichael, Gregory; Costa, Dan L; Dockery, Douglas W; Kleeman, Michael; Krzyzanowski, Michal; Künzli, Nino; Liousse, Catherine; Lung, Shih-Chun Candice; Martin, Randall V; Pöschl, Ulrich; Pope, C Arden; Roberts, James M; Russell, Armistead G; Wiedinmyer, Christine

    2016-05-17

    Air pollution contributes to the premature deaths of millions of people each year around the world, and air quality problems are growing in many developing nations. While past policy efforts have succeeded in reducing particulate matter and trace gases in North America and Europe, adverse health effects are found at even these lower levels of air pollution. Future policy actions will benefit from improved understanding of the interactions and health effects of different chemical species and source categories. Achieving this new understanding requires air pollution scientists and engineers to work increasingly closely with health scientists. In particular, research is needed to better understand the chemical and physical properties of complex air pollutant mixtures, and to use new observations provided by satellites, advanced in situ measurement techniques, and distributed micro monitoring networks, coupled with models, to better characterize air pollution exposure for epidemiological and toxicological research, and to better quantify the effects of specific source sectors and mitigation strategies.

  1. Understanding the purpose of treatment and expectations in patients with inoperable lung cancer treated with palliative chemotherapy

    PubMed Central

    Woźniak, Karolina; Krajnik, Małgorzata

    2015-01-01

    Aim of the study Informing cancer patients about various types of treatment and their adverse effects and communicating negative information is an important element of diagnostic and therapeutic procedures. Understanding the purpose of treatment and expectations, and socio-demographic factors in patients undergoing palliative chemotherapy because of lung cancer. Material and methods The study included 100 patients with lung cancer at the age of 40–80 years (mean 63.1) in the Oncology Center in Bydgoszcz in 2013–2014. The diagnostic survey method with the author's questionnaire was used. Results Forty-one percent of patients were convinced that the purpose of chemotherapy is to cure the disease. Both inhabitants of small towns (population below 50 thousand) and large villages (p = 0.09) were similarly convinced about the effectiveness of chemotherapy. Seventy-three percent of inhabitants of small towns and 79% of country dwellers (p = 0.005) thought that chemotherapy is aimed at improving the quality of life. Patients with very good economic conditions responded that chemotherapy is designed to improve the quality of life more often than those with good and bad economic conditions, 90%, 88% and 60%, respectively (p = 0.001). With the increase in population the number of people who claimed that palliative chemotherapy prolongs their life increased, 71%, 77% and 90%, respectively (p = 0.03). Conclusions The knowledge of patients with lung cancer about palliative chemotherapy is insufficient. Almost half of them do not understand the purpose of treatment and hope that chemotherapy will cure them of the disease. Most patients know that the aim of chemotherapy is to alleviate symptoms and improve quality of life and prolong their life. Half of the patients want to obtain information on treatment and half of them about life expectancy. Almost half of the patients feel stress and anxiety towards chemotherapy. Most patients do not use the help of a psychologist and do

  2. Recent advances in improvement of forecast skill and understanding climate processes using AIRS Version-5 products

    NASA Astrophysics Data System (ADS)

    Susskind, Joel; Molnar, Gyula; Iredell, Lena; Rosenberg, Robert

    2012-10-01

    The NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC) generates products derived from AIRS/AMSU-A observations, starting from September 2002 when the AIRS instrument became stable, using the AIRS Science Team Version-5 retrieval algorithm. This paper shows results of some of our research using Version-5 products from the points of view of improving forecast skill as well as aiding in the understanding of climate processes.

  3. Confirming delivery: understanding the role of the hospitalized patient in medication administration safety.

    PubMed

    Macdonald, Marilyn T; Heilemann, MarySue V; MacKinnon, Neil J; Lang, Ariella; Gregory, David; Gurnham, Mary Ellen; Fillatre, Theresa

    2014-04-01

    The purpose of our study was to gain an understanding of current patient involvement in medication administration safety from the perspectives of both patients and nursing staff members. Administering medication is taken for granted and therefore suited to the development of theory to enhance its understanding. We conducted a constructivist, grounded theory study involving 24 patients and 26 nursing staff members and found that patients had the role of confirming delivery in the administration of medication. Confirming delivery was characterized by three interdependent subprocesses: engaging in the medication administration process, being "half out of it" (patient mental status), and perceiving time. We believe that ours is one of the first qualitative studies on the role of hospitalized patients in administering medication. Medication administration and nursing care systems, as well as patient mental status, impose limitations on patient involvement in safe medication administration.

  4. Expectancy-Reality Descrepancy and Patient Improvement.

    ERIC Educational Resources Information Center

    Webb, Lynn E.; Lamb, Douglas H.

    Fifty-four admissions to the psychiatric unit of a general hospital were asked to predict their length of hospitalization. The difference between their predicted and actual length of hospitalization was calculated (expectancy-reality discrepancy-ERD). Patient ERD scores were compared with self-report, ward, and therapist measures of patient…

  5. The National Kidney Disease Education Program: improving understanding, detection, and management of CKD.

    PubMed

    Narva, Andrew S; Briggs, Michael

    2009-03-01

    The National Kidney Disease Education Program (NKDEP), an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases, works to reduce the morbidity and mortality caused by chronic kidney disease (CKD) and its complications. Established in 2000, the NKDEP initially focused on increasing awareness in at-risk populations and helping the laboratory community recalibrate serum creatinine measurement methods and begin using a revised equation to estimate glomerular filtration rate. Expanding its focus in recent years, the NKDEP now works to improve provider practices by collaborating with health systems, community health centers, and professional associations to encourage testing and treatment of patients. Among its top priorities is to develop such resources as clinical encounter tools, patient education aids, and training programs that help primary care professionals better identify and care for patients with CKD. Other priorities include improving the coordination of federal responses to CKD and addressing the standardization of measurement and reporting of urine albumin. Improving CKD detection and management is an important challenge. To succeed, the NKDEP must work in close partnership with the renal community, public health agencies, professional associations, and voluntary organizations that serve at-risk and patient communities.

  6. Application of Bow-tie methodology to improve patient safety.

    PubMed

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh

    2016-05-09

    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

  7. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    PubMed

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

  8. Saskatchewan: improving patient, nursing and organizational outcomes utilizing formal nurse-patient ratios.

    PubMed

    Rozdilsky, Janlyn; Alecxe, Amber

    2012-03-01

    The issue of nurse-to-patient ratios has been of significant interest to nurses in Saskatchewan. A commitment to a nurse-to-patient pilot project was articulated in a letter of understanding in the 2005 to 2008 contract between the Saskatchewan Union of Nurses (SUN) and the Saskatchewan Association of Health Organizations. The SUN, the Saskatoon Health Region and the Saskatchewan Ministry of Health formed a partnership to engage in the pilot project, which lasted from November 2008 to March 2011. The project involved the creation of a flexible, dynamic and real-time staffing tool to inform day-to-day nurse staffing decisions on a hospital unit and was based on an adaptation of Curley's Synergy Model. A medical unit at St. Paul's Hospital in Saskatoon was selected for implementation, and all front-line nursing staff as well as unit nursing leaders were involved. A project working group adapted the Synergy-based Patient Scoring Tool (PST), which had been utilized for a recent project in British Columbia, to its own patient population. In April 2010, nurses began assessing each patient on every shift with the goal of determining the most suitable care provider. Patient assignment became based on the holistic assessment of patient needs according to the PST results rather than "geography" (for example, one nurse assigned to a multi-bed unit regardless of the acuity/capability of patients in the unit). Whenever possible, staffing on the unit was increased according to tool calculations.Positive impacts in patient outcomes began to be noted during the final data collection period for the project – nosocomial infection rates showed improvement, and the number of falls per patient-days decreased. As well, patient needs were made more visible through use of the PST, which created non-threatening opportunities for dialogue related to legislated scopes of practice. While longer timelines and larger sample size are needed to measure impacts on retention and recruitment of

  9. Understanding latent tuberculosis: the key to improved diagnostic and novel treatment strategies

    PubMed Central

    Esmail, Hanif; Barry, Clifton E; Wilkinson, Robert J

    2012-01-01

    Treatment of latent tuberculosis (LTBI) is a vital component of tuberculosis elimination but is not efficiently implemented with available diagnostics and therapeutics. The tuberculin skin test and interferon gamma release assays can inform that infection has occurred but do not prove that it persists. Treatment of LTBI with isoniazid targets actively replicating bacilli but not non-replicating populations, prolonging treatment duration. Developing more predictive diagnostic tests and treatments of shorter duration requires a greater understanding of the biology of latent tuberculosis, from both host and bacillary perspectives. In this article we discuss the basis of current diagnosis and treatment of LTBI and review recent developments in understanding the biology of latency that may enable future improved diagnostic and treatment strategies. PMID:22198298

  10. Applying Transactional Analysis and Personality Assessment to Improve Patient Counseling and Communication Skills

    PubMed Central

    Lawrence, Lesa

    2007-01-01

    Objective To teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling to improve communication. Design A lecture series for a required pharmacy communications class was developed to teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling. Students were asked to apply these techniques and to report their experiences. A personality self-assessment was also conducted. Assessment After attending the lecture series, students were able to apply the techniques and demonstrated an understanding of the psychological factors that may affect patient communication, an appreciation for the diversity created by different personality types, the ability to engage patients based on adult-to-adult interaction cues, and the ability to adapt the interactive patient counseling model to different personality traits. Conclusion Students gained a greater awareness of transactional analysis and personality assessment by applying these concepts. This understanding will help students communicate more effectively with patients. PMID:17786269

  11. Reducing PICC migrations and improving patient outcomes.

    PubMed

    Elen Hughes, Meinir

    Inadvertent migration of central venous catheters can lead to several issues including delayed therapy and clinical morbidities such as thrombosis. Peripherally inserted central catheters (PICCs) are particularly at risk of movement. An innovative new device which allows anchorage of the catheter has proved very successful in the minimisation of catheter migration. The SecurAcath device incorporates a small blunt anchor which lies beneath the skin in order to secure the catheter in place and prevent inadvertent movement. An evaluation of 31 patients with a SecurAcath device in situ to secure a PICC found only one case of insignificant catheter migration. Some initial problems with infection and pain were encountered and interventions were put in place to minimise their incidence. SecurAcath removal proved to be the most significant challenge but this can be overcome with suitable guidance and training.

  12. Understanding of definition and safety of oral health products among patients, physicians and pharmacists.

    PubMed

    Asahina, Yasuko; Hori, Satoko; Sawada, Yasufumi

    2010-07-01

    Our objective was to clarify the current understanding of the definition and safety of oral health products among patients and health professionals, and patients' perception about their communication with physicians and pharmacists regarding those products. Self-administered questionnaires were completed by patients at 17 community pharmacies in 14 prefectures of Japan. For health professionals, we sent a questionnaire to pharmacists and physicians who were registered as members of the Internet-based Medical Doctor's and Pharmacist's Information-Sharing System. The respondents were 242 patients, 158 physicians and 407 pharmacists. Some patients did not categorize dietary supplements as health products, while they did so categorize conventional foods (e.g., fermented soybeans, yogurt). Their understanding of the definition of health products was different from that of health professionals. Less than half of the patients considered that health products might potentiate or attenuate the effects of concomitant drugs, and this view was especially common among the elderly. The percentage of patients who reported that they rarely or never asked for advice from a pharmacist about their use of health products was significantly higher among those who had an incorrect understanding about health products. In conclusion, some patients' recognition of oral health products was different from that of health professionals, and most patients do not discuss their use of such products unless they are asked. Therefore, it is important for health professionals to check a patient's use of health products and be sure what he or she means when using the term 'health product'.

  13. A Cognitive Framework for Understanding and Improving Interference Resolution in the Brain

    PubMed Central

    Mishra, Jyoti; Anguera, Joaquin A.; Ziegler, David A.; Gazzaley, Adam

    2014-01-01

    All of us are familiar with the negative impact of interference on achieving our task goals. We are referring to interference by information, which either impinges on our senses from an external environmental source or is internally generated by our thoughts. Informed by more than a decade of research on the cognitive and neural processing of interference, we have developed a framework for understanding how interference impacts our neural systems and especially how it is regulated and suppressed during efficient on-task performance. Importantly, externally and internally generated interferences have distinct neural signatures, and further, distinct neural processing emerges depending on whether individuals must ignore and suppress the interference, as for distractions, or engage with them in a secondary task, as during multitasking. Here, we elaborate on this cognitive framework and how it changes throughout the human lifespan, focusing mostly on research evidence from younger adults and comparing these findings to data from older adults, children, and cognitively impaired populations. With insights gleaned from our growing understanding, we then describe three novel translational efforts in our lab directed at improving distinct aspects of interference resolution using cognitive training. Critically, these training approaches were specifically developed to target improved interference resolution based on neuroplasticity principles and have shown much success in randomized controlled first version evaluations in healthy aging. Our results show not only on-task training improvements but also robust generalization of benefit to other cognitive control abilities. This research showcases how an in-depth understanding of neural mechanisms can then inform the development of effective deficit-targeted interventions, which can in turn benefit both healthy and cognitively impaired populations. PMID:24309262

  14. Understanding the Dreyfus model of skill acquisition to improve ultrasound training for obstetrics and gynaecology trainees.

    PubMed

    Field, Alexander

    2014-05-01

    There have been significant problems in ultrasound training since the introduction of the new postgraduate curriculum for obstetrics and gynaecology. It is therefore important to understand how the skill of ultrasound is acquired in order to be able to improve the training program. Here, the potential application of the Dreyfus model of skill acquisition has been analysed to map the progression from novice to master and the progressions between each stage analysed. Although the Dreyfus model is not a perfect match for ultrasound scanning, it provides us with a theoretical framework on which to underpin educational practice in this field.

  15. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    PubMed

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  16. The CONVEX project - Using Observational Evidence and Process Understanding to Improve Predictions of Extreme Rainfall Change

    NASA Astrophysics Data System (ADS)

    Fowler, Hayley; Kendon, Elizabeth; Blenkinsop, Stephen; Chan, Steven; Ferro, Christopher; Roberts, Nigel; Stephenson, David; Jones, Richard; Sessford, Pat

    2013-04-01

    During the last decade, widespread major flood events in the UK and across the rest of Europe have focussed attention on perceived increases in rainfall intensities. Whilst Regional Climate Models (RCMs) are able to simulate the magnitude and spatial pattern of observed daily extreme rainfall events more reliably than Global Circulation Models (GCMs), they still underestimate extreme rainfall in relation to observations. Particularly during the summer a large proportion of the precipitation comes from convective storms that are typically too small to be explicitly represented by climate models. Instead, convection parameterisation schemes are necessary to represent the larger-scale effect of unresolved convective cells. Given the deficiencies in the simulation of extreme rainfall by climate models, even in the current generation of high-resolution RCMs, the CONVEX project (CONVective EXtremes) argues that an integrated approach is needed that brings together observations, basic understanding and models. This should go hand in hand with a change from a focus on traditional validation exercises (comparing modelled and observed extremes) to an understanding and quantification of the causes of model deficiencies in the simulation of extreme rainfall processes on different spatial and temporal scales. It is particularly true for localised intense summer convection. CONVEX therefore aims to contribute to the goals of enabling society to respond to global climate change and predicting the regional and local impacts of environmental change. In addition to an improved understanding of the spatial-temporal characteristics of extreme rainfall processes (principally in the UK) the project is also assessing the influence of model parameterisations and resolution on the simulation of extreme rainfall events and processes. This includes the running of new RCM simulations undertaken by the UK Meteorological Office at 50km and 12km resolutions (parameterised convection) and

  17. Jatropha curcas, a biofuel crop: functional genomics for understanding metabolic pathways and genetic improvement.

    PubMed

    Maghuly, Fatemeh; Laimer, Margit

    2013-10-01

    Jatropha curcas is currently attracting much attention as an oilseed crop for biofuel, as Jatropha can grow under climate and soil conditions that are unsuitable for food production. However, little is known about Jatropha, and there are a number of challenges to be overcome. In fact, Jatropha has not really been domesticated; most of the Jatropha accessions are toxic, which renders the seedcake unsuitable for use as animal feed. The seeds of Jatropha contain high levels of polyunsaturated fatty acids, which negatively impact the biofuel quality. Fruiting of Jatropha is fairly continuous, thus increasing costs of harvesting. Therefore, before starting any improvement program using conventional or molecular breeding techniques, understanding gene function and the genome scale of Jatropha are prerequisites. This review presents currently available and relevant information on the latest technologies (genomics, transcriptomics, proteomics and metabolomics) to decipher important metabolic pathways within Jatropha, such as oil and toxin synthesis. Further, it discusses future directions for biotechnological approaches in Jatropha breeding and improvement.

  18. Identifying patients at high risk of breast cancer recurrence: strategies to improve patient outcomes

    PubMed Central

    Martei, Yehoda M; Matro, Jennifer M

    2015-01-01

    Identifying patients at high risk of breast cancer recurrence has important implications not only for enabling the ability to provide accurate information to patients but also the potential to improve patient outcomes. Patients at high recurrence risk can be offered appropriate treatment to improve the overall survival. However, the major challenge is identifying patients with early-stage breast cancer at lower risk who may be spared potentially toxic therapy. The successful integration of molecular assays into clinical practice may address the problem of overtreatment and improve overall patient outcomes. PMID:26504408

  19. Improving the uptake of pulmonary rehabilitation in patients with COPD:

    PubMed Central

    Harris, David; Hayter, Mark; Allender, Steven

    2008-01-01

    Background Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status. Aim To identify a strategy for improving the uptake of pulmonary rehabilitation. Design of study Qualitative interviews with patients. Setting Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK. Method In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory. Results Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating. Conclusion A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake. PMID:18826782

  20. Combining Chemotherapy with Bevacizumab Improves Outcomes for Ovarian Cancer Patients

    Cancer.gov

    Results from two phase III randomized clinical trials suggest that, at least for some patients with ovarian cancer, adding the antiangiogenesis agent bevacizumab to chemotherapy increases the time to disease progression and may improve survival.

  1. Inhaler Reminders Significantly Improve Asthma Patients' Use of Controller Medications

    MedlinePlus

    ... of controller medications Share | Inhaler reminders significantly improve asthma patients’ use of controller medications Published Online: July ... effective in reducing the burden and risk of asthma, but many patients do not use them regularly. ...

  2. Learning from Our Evolving Understanding of Biophysical Interactions to Improve River Restoration Practice.

    NASA Astrophysics Data System (ADS)

    Sear, D. A.

    2014-12-01

    Restoration of riverine habitats has largely proceeded on the assumption that by improving physical habitat, and more latterly processes, biophysical interactions will reassemble to a state similar to that prior to the disturbance event. Whilst there had been little monitoring to support this view, there is increasing evidence that the complexity of ecological systems demands a greater understanding of these biophysical interactions before we can state that a restoration has succeeded. In this paper I will draw on two examples to demonstrate the importance of understanding the spatial as well as the temporal scale of biophysical interactions. In the first example, field and modelling was used to demonstrate how different location of large wood and forest restoration can result in different hydrological outcomes. Similarly, as the forest matures it is possible to see change in restoration outcomes, extending beyond the lifetime of the project. In the second example I demonstrate how climate and land use drive the biophysical interactions within spawning salmonid habitats, research that questions accepted models used in the restoration of salmonid spawning habitat. Finally the paper reflects on the problems of restoring complex ecosystems; and points towards the need for improvements in how we research and communicate with stakeholders who ultimately live by the streams we restore.

  3. Development and evaluation of a tutorial to improve students' understanding of a lock-in amplifier

    NASA Astrophysics Data System (ADS)

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Singh, Chandralekha

    2016-12-01

    A lock-in amplifier is a versatile instrument frequently used in physics research. However, many students struggle with the basic operating principles of a lock-in amplifier which can lead to a variety of difficulties. To improve students' understanding, we have been developing and evaluating a research-based tutorial which makes use of a computer simulation of a lock-in amplifier. The tutorial is based on a field-tested approach in which students realize their difficulties after predicting the outcome of simulated experiments involving a lock-in amplifier and check their predictions using the simulated lock-in amplifier. Then, the tutorial provides guidance and strives to help students develop a coherent understanding of the basics of a lock-in amplifier. The tutorial development involved interviews with physics faculty members and graduate students and iteration of many versions of the tutorial with professors and graduate students. The student difficulties with lock-in amplifiers and the development and evaluation of the research-based tutorial to help students develop a functional understanding of this device are discussed.

  4. Taking your medicine: relational steps to improving patient compliance.

    PubMed

    Hausman, A

    2001-01-01

    Patient non-compliance with physicians' instructions is a major problem that costs billions of dollars each year. This study supports a significant role for communication, both as a form of information exchange and social support, and participative decision-making in improving patient compliance. These results, based on structural equation modeling, also support the interaction of communication and participative decision-making positively affecting compliance. Results suggest that one-way communication from physician to patient and patient education will not solve compliance problems by themselves. Instead the solution revolves around open, bi-directional information exchange, active listening by both parties, and truly informed consent on the part of patients.

  5. Partnering With a Patient and Family Advisory Council to Improve Patient Care Experiences With Pain Management.

    PubMed

    Bookout, Michelle L; Staffileno, Beth A; Budzinsky, Christine M

    2016-04-01

    Patient-centered care is a key driver for the nation's health system, yet patient experience surveys indicate that hospitals are far from achieving favorable outcomes. Partnering with patients and families through a patient and family advisory council (PFAC) advances the practice of patient-centered care to improve outcomes and experiences. This article describes the process of implementing a PFAC and presents outcomes related to patients' perception of pain management in the acute care hospital setting.

  6. Improving documentation of clinical care within a clinical information network: an essential initial step in efforts to understand and improve care in Kenyan hospitals

    PubMed Central

    Tuti, Timothy; Bitok, Michael; Malla, Lucas; Paton, Chris; Muinga, Naomi; Gathara, David; Gachau, Susan; Mbevi, George; Nyachiro, Wycliffe; Ogero, Morris; Julius, Thomas; Irimu, Grace; English, Mike

    2016-01-01

    In many low income countries health information systems are poorly equipped to provide detailed information on hospital care and outcomes. Information is thus rarely used to support practice improvement. We describe efforts to tackle this challenge and to foster learning concerning collection and use of information. This could improve hospital services in Kenya. We are developing a Clinical Information Network, a collaboration spanning 14 hospitals, policy makers and researchers with the goal of improving information available on the quality of inpatient paediatric care across common childhood illnesses in Kenya. Standardised data from hospitals’ paediatric wards are collected using non-commercial and open source tools. We have implemented procedures for promoting data quality which are performed prior to a process of semi-automated analysis and routine report generation for hospitals in the network. In the first phase of the Clinical Information Network, we collected data on over 65 000 admission episodes. Despite clinicians’ initial unfamiliarity with routine performance reporting, we found that, as an initial focus, both engaging with each hospital and providing them information helped improve the quality of data and therefore reports. The process has involved mutual learning and building of trust in the data and should provide the basis for collaborative efforts to improve care, to understand patient outcome, and to evaluate interventions through shared learning. We have found that hospitals are willing to support the development of a clinically focused but geographically dispersed Clinical Information Network in a low-income setting. Such networks show considerable promise as platforms for collaborative efforts to improve care, to provide better information for decision making, and to enable locally relevant research. PMID:27398232

  7. Ecosystem function in waste stabilisation ponds: Improving water quality through a better understanding of biophysical coupling

    NASA Astrophysics Data System (ADS)

    Ghadouani, Anas; Reichwaldt, Elke S.; Coggins, Liah X.; Ivey, Gregory N.; Ghisalberti, Marco; Zhou, Wenxu; Laurion, Isabelle; Chua, Andrew

    2014-05-01

    Wastewater stabilisation ponds (WSPs) are highly productive systems designed to treat wastewater using only natural biological and chemical processes. Phytoplankton, microbial communities and hydraulics play important roles for ecosystem functionality of these pond systems. Although WSPs have been used for many decades, they are still considered as 'black box' systems as very little is known about the fundamental ecological processes which occur within them. However, a better understanding of how these highly productive ecosystems function is particularly important for hydrological processes, as treated wastewater is commonly discharged into streams, rivers, and oceans, and subject to strict water quality guidelines. WSPs are known to operate at different levels of efficiency, and treatment efficiency of WSPs is dependent on physical (flow characteristics and sludge accumulation and distribution) and biological (microbial and phytoplankton communities) characteristics. Thus, it is important to gain a better understanding of the role and influence of pond hydraulics and vital microbial communities on pond performance and WSP functional stability. The main aim of this study is to investigate the processes leading to differences in treatment performance of WSPs. This study uses a novel and innovative approach to understand these factors by combining flow cytometry and metabolomics to investigate various biochemical characteristics, including the metabolite composition and microbial community within WSPs. The results of these analyses will then be combined with results from the characterisation of pond hydrodynamics and hydraulic performance, which will be performed using advanced hydrodynamic modelling and advanced sludge profiling technology. By understanding how hydrodynamic and biological processes influence each other and ecosystem function and stability in WSPs, we will be able to propose ways to improve the quality of the treatment using natural processes, with

  8. Practice improvement, part II: update on patient communication technologies.

    PubMed

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support.

  9. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  10. Beneficent persuasion: techniques and ethical guidelines to improve patients' decisions.

    PubMed

    Swindell, J S; McGuire, Amy L; Halpern, Scott D

    2010-01-01

    Physicians frequently encounter patients who make decisions that contravene their long-term goals. Behavioral economists have shown that irrationalities and self-thwarting tendencies pervade human decision making, and they have identified a number of specific heuristics (rules of thumb) and biases that help explain why patients sometimes make such counterproductive decisions. In this essay, we use clinical examples to describe the many ways in which these heuristics and biases influence patients' decisions. We argue that physicians should develop their understanding of these potentially counterproductive decisional biases and, in many cases, use this knowledge to rebias their patients in ways that promote patients' health or other values. Using knowledge of decision-making psychology to persuade patients to engage in healthy behaviors or to make treatment decisions that foster their long-term goals is ethically justified by physicians' duties to promote their patients' interests and will often enhance, rather than limit, their patients' autonomy. We describe techniques that physicians may use to frame health decisions to patients in ways that are more likely to motivate patients to make choices that are less biased and more conducive to their long-term goals. Marketers have been using these methods for decades to get patients to engage in unhealthy behaviors; employers and policy makers are beginning to consider the use of similar approaches to influence healthy choices. It is time for clinicians also to make use of behavioral psychology in their interactions with patients.

  11. Understanding and Improving CRM and GCM Simulations of Cloud Systems with ARM Observations

    SciTech Connect

    Wu, Xiaoqing

    2014-02-25

    The works supported by this ASR project lay the solid foundation for improving the parameterization of convection and clouds in the NCAR CCSM and the climate simulations. We have made a significant use of CRM simulations and ARM observations to produce thermodynamically and dynamically consistent multi-year cloud and radiative properties; improve the GCM simulations of convection, clouds and radiative heating rate and fluxes using the ARM observations and CRM simulations; and understand the seasonal and annual variation of cloud systems and their impacts on climate mean state and variability. We conducted multi-year simulations over the ARM SGP site using the CRM with multi-year ARM forcing data. The statistics of cloud and radiative properties from the long-term CRM simulations were compared and validated with the ARM measurements and value added products (VAP). We evaluated the multi-year climate simulations produced by the GCM with the modified convection scheme. We used multi-year ARM observations and CRM simulations to validate and further improve the trigger condition and revised closure assumption in NCAR GCM simulations that demonstrate the improvement of climate mean state and variability. We combined the improved convection scheme with the mosaic treatment of subgrid cloud distributions in the radiation scheme of the GCM. The mosaic treatment of cloud distributions has been implemented in the GCM with the original convection scheme and enables the use of more realistic cloud amounts as well as cloud water contents in producing net radiative fluxes closer to observations. A physics-based latent heat (LH) retrieval algorithm was developed by parameterizing the physical linkages of observed hydrometeor profiles of cloud and precipitation to the major processes related to the phase change of atmospheric water.

  12. Patient safety and quality improvement in rehabilitation medicine.

    PubMed

    Cristian, Adrian; Green, Jonah

    2012-05-01

    Patient safety in medical settings has become a major concern. As more and more individuals seek rehabilitative care for their medical conditions or are referred to rehabilitation specialists with increasingly complex medical conditions, the issue of patient safety in the rehabilitation setting takes on added importance. This article introduces the concepts of patient safety, cognitive biases, systems thinking, and quality improvement as they apply to the rehabilitation medicine.

  13. Understanding and Improving the Quality of Inter-Layer Interfaces in FDM 3-D Printing

    NASA Astrophysics Data System (ADS)

    Duranty, Edward; Spradlin, Brandon; Stark, Madeline; Dadmun, Mark

    We have studied the effect of thermal history and material diffusion on inter-filament bonding in FDM 3D printed parts and developed methods to improve interlayer adhesion in 3D printed samples. The available thermal energy during the FDM print environment was determined quantitatively by tracking the temperature of the bottom most printed layer using a thermocouple attached to the print bed. The role of the thermal history of the filaments during the deposition process on the quality of inter-layer bonding in an FDM ABS part was monitored using a T-peel test and an innovative sample design. Additionally, the interfacial adhesion between 3D printed layers was improved by the addition of a chemical cross-linking agent 4,4 '-diaminodiphenylmethane (DADPM). These studies have increased our understanding of the importance of the complex thermal history of a filament in the 3D printing process and its impact on the interfaces that form during the fused deposition modeling print process. Furthermore, the chemical crosslinking process demonstrates a potential method to covalently link layers in FDM printed parts, improving the bulk strength of the part. The insight provided in this work may aid in the development of techniques that can produce FDM parts that could be used as replacement parts in structural applications, or as completely standalone products.

  14. Understanding and improving lithium ion batteries through mathematical modeling and experiments

    NASA Astrophysics Data System (ADS)

    Deshpande, Rutooj D.

    There is an intense, worldwide effort to develop durable lithium ion batteries with high energy and power densities for a wide range of applications, including electric and hybrid electric vehicles. For improvement of battery technology understanding the capacity fading mechanism in batteries is of utmost importance. Novel electrode material and improved electrode designs are needed for high energy- high power batteries with less capacity fading. Furthermore, for applications such as automotive applications, precise cycle-life prediction of batteries is necessary. One of the critical challenges in advancing lithium ion battery technologies is fracture and decrepitation of the electrodes as a result of lithium diffusion during charging and discharging operations. When lithium is inserted in either the positive or negative electrode, there is a volume change associated with insertion or de-insertion. Diffusion-induced stresses (DISs) can therefore cause the nucleation and growth of cracks, leading to mechanical degradation of the batteries. With different mathematical models we studied the behavior of diffusion induces stresses and effects of electrode shape, size, concentration dependent material properties, pre-existing cracks, phase transformations, operating conditions etc. on the diffusion induced stresses. Thus we develop tools to guide the design of the electrode material with better mechanical stability for durable batteries. Along with mechanical degradation, chemical degradation of batteries also plays an important role in deciding battery cycle life. The instability of commonly employed electrolytes results in solid electrolyte interphase (SEI) formation. Although SEI formation contributes to irreversible capacity loss, the SEI layer is necessary, as it passivates the electrode-electrolyte interface from further solvent decomposition. SEI layer and diffusion induced stresses are inter-dependent and affect each-other. We study coupled chemical

  15. The Alberta Cardiac Access Collaborative: improving the cardiac patient journey.

    PubMed

    Blackadar, Robyn; Houle, Mishaela

    2009-01-01

    The Alberta Cardiac Access Collaborative (ACAC) is a joint initiative of Alberta's health system to improve access to adult cardiac services across the patient journey. ACAC has created new care delivery models and implemented best practices across Alberta in four streams across the continuum: heart attack, patient navigation, heart failure and arrhythmia. Emergency medical providers, nurses, primary care physicians, hospitals, cardiac specialists and clinicians are all working together to integrate services, bridge jurisdictions and geography with one aim--improving the patient journey for adults in need of cardiac care.

  16. Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.

    PubMed

    Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, Jonathan

    2016-05-01

    Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.

  17. Using Informatics to Improve the Care of Patients Susceptible to Malignant Hyperthermia.

    PubMed

    Denholm, Bonnie G

    2016-04-01

    Perioperative nurses and nurse leaders should understand how to apply a nursing informatics framework and informatics concepts to strengthen data interpretation, transitions in care, and engagement with patients susceptible to malignant hyperthermia (MH) and their family members. Patient outcomes can be improved when informatics solutions facilitate identifying risks, clinical decision making in a crisis situation, retrieving priority information during transitions of care, and involving patients in planning care. Incorporating informatics solutions into existing quality improvement processes can help evaluate knowledge and preparedness related to managing care for a patient in an MH crisis. Informatics solutions can also help enhance interoperability by evaluating workflow related to transitions in care. Perioperative nurses and nurse leaders should advocate for diligence in submitting reports of MH-suspected events to databases. Improved data collection and data sharing enhance aggregated standardized data sets, which can advance research and increase the quality of evidence available with which to guide practice.

  18. Use of a simplified consent form to facilitate patient understanding of informed consent for laparoscopic cholecystectomy

    PubMed Central

    Borello, Alessandro; Passera, Roberto; Surace, Alessandra; Marola, Silvia; Buccelli, Claudio; Niola, Massimo; Di Lorenzo, Pierpaolo; Amato, Maurizio; Di Domenico, Lorenza; Solej, Mario; Martino, Valter

    2016-01-01

    Abstract Background Surgical informed consent forms can be complicated for patients to read and understand. We created a consent form with key information presented in bulleted texts and diagrams combined in a graphical format to facilitate the understanding of information during the verbal consent discussion. Methods This prospective, randomized study involved 70 adult patients awaiting cholecystectomy for gallstones. Consent was obtained after standard verbal explanation using either a graphically formatted (study group, n=33) or a standard text document (control group, n=37). Comprehension was evaluated with a 9-item multiple-choice questionnaire administered before surgery and factors affecting comprehension were analyzed. Results Comparison of questionnaire scores showed no effect of age, sex, time between consent and surgery, or document format on understanding of informed consent. Educational level was the only predictor of comprehension. Conclusions Simplified surgical consent documents meet the goals of health literacy and informed consent. Educational level appears to be a strong predictor of understanding. PMID:28352847

  19. Smoking cessation strategies for patients with asthma: improving patient outcomes

    PubMed Central

    Perret, Jennifer L; Bonevski, Billie; McDonald, Christine F; Abramson, Michael J

    2016-01-01

    Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as “lung age” should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. PMID:27445499

  20. POST-TRAUMATIC OSTEOARTHRITIS: IMPROVED UNDERSTANDING AND OPPORTUNITIES FOR EARLY INTERVENTION†

    PubMed Central

    Anderson, Donald D.; Chubinskaya, Susan; Guilak, Farshid; Martin, James A.; Oegema, Theodore R.; Olson, Steven A.; Buckwalter, Joseph A.

    2011-01-01

    Even with current treatments of acute joint injuries, more than 40% of people who suffer significant ligament or meniscus tears, or articular surface injuries, will develop osteoarthritis. Correspondingly, 12% or more of all patients with lower extremity osteoarthritis have a history of joint injury. Recent research suggests that acute joint damage that occurs at the time of an injury initiates a sequence of events that can lead to progressive articular surface damage. New molecular interventions, combined with evolving surgical methods, aim to minimize or prevent progressive tissue damage triggered by joint injury. Seizing the potential for progress in the treatment of joint injuries to forestall OA will depend on advances in: (1) quantitative methods of assessing the injury severity, including both structural damage and biologic responses, (2) understanding of the pathogenesis of post-traumatic OA, taking into account potential interactions among the different tissues and the role of post-traumatic incongruity and instability, and (3) application of engineering and molecular research to develop new methods of treating injured joints. This paper highlights recent advances in understanding of the structural damage and the acute biological response following joint injury, and it identifies important directions for future research. PMID:21520254

  1. The CONVEX project - Using Observational Evidence and Process Understanding to Improve Projections of Extreme Rainfall Change

    NASA Astrophysics Data System (ADS)

    Blenkinsop, Stephen; Fowler, Hayley; Kendon, Elizabeth; Chan, Steven; Ferro, Chris; Roberts, Nigel; Sessford, Pat

    2014-05-01

    During the last decade, widespread major flood events in the UK and across Europe have focussed attention on perceived increases in rainfall intensities. Whilst Regional Climate Models (RCMs) are able to simulate the magnitude and spatial pattern of observed daily extreme rainfall events more reliably than Global Circulation Models (GCMs), they still underestimate extreme rainfall in relation to observations and do not capture the properties of sub-daily events that may lead to flooding in urban areas. In the UK and Europe, particularly during the summer, a large proportion of precipitation comes from convective storms that are typically too small to be explicitly represented by climate models. Instead, convection parameterisation schemes are necessary to represent the larger-scale effect of unresolved convective cells. The CONVEX project (CONVective EXtremes) argues that an integrated approach is needed to provide improvements in estimates of change in extreme rainfall, particularly for summer convective events. As usable predictions require the synthesis of observations, understanding of atmospheric processes and models, a change in focus from traditional validation exercises (comparing modelled and observed extremes) to an understanding and quantification of the causes for model deficiencies in the simulation of extreme rainfall processes on different spatial and temporal scales is needed. By adopting this new focus CONVEX aims to contribute to the goals of enabling society to respond to global climate change and predicting the regional and local impacts of environmental change on timescales from days to decades. In addition to an improved understanding of the spatial-temporal characteristics of extreme rainfall processes (principally in the UK) the project is also assessing the influence of model parameterisations and resolution on the simulation of extreme rainfall events and processes. Under the project the UK Meteorological Office has run new RCM simulations

  2. How Patients Can Improve the Accuracy of their Medical Records

    PubMed Central

    Dullabh, Prashila M.; Sondheimer, Norman K.; Katsh, Ethan; Evans, Michael A.

    2014-01-01

    Objectives: Assess (1) if patients can improve their medical records’ accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback’s impact on medical record accuracy. Background: Improving medical record’ accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records’ accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists’ accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. Methods: The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists’ medication reconciliation logs. Findings/Discussion: (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency—or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms

  3. Understanding and Improving High-Temperature Structural Properties of Metal-Silicide Intermetallics

    SciTech Connect

    Bruce S. Kang

    2005-10-10

    The objective of this project was to understand and improve high-temperature structural properties of metal-silicide intermetallic alloys. Through research collaboration between the research team at West Virginia University (WVU) and Dr. J.H. Schneibel at Oak Ridge National Laboratory (ORNL), molybdenum silicide alloys were developed at ORNL and evaluated at WVU through atomistic modeling analyses, thermo-mechanical tests, and metallurgical studies. In this study, molybdenum-based alloys were ductilized by dispersing MgAl2O4 or MgO spinel particles. The addition of spinel particles is hypothesized to getter impurities such as oxygen and nitrogen from the alloy matrix with the result of ductility improvement. The introduction of fine dispersions has also been postulated to improve ductility by acting as a dislocation source or reducing dislocation pile-ups at grain boundaries. The spinel particles, on the other hand, can also act as local notches or crack initiation sites, which is detrimental to the alloy mechanical properties. Optimization of material processing condition is important to develop the desirable molybdenum alloys with sufficient room-temperature ductility. Atomistic analyses were conducted to further understand the mechanism of ductility improvement of the molybdenum alloys and the results showed that trace amount of residual oxygen may be responsible for the brittle behavior of the as-cast Mo alloys. For the alloys studied, uniaxial tensile tests were conducted at different loading rates, and at room and elevated temperatures. Thermal cycling effect on the mechanical properties was also studied. Tensile tests for specimens subjected to either ten or twenty thermal cycles were conducted. For each test, a follow-up detailed fractography and microstructural analysis were carried out. The test results were correlated to the size, density, distribution of the spinel particles and processing time. Thermal expansion tests were carried out using thermo

  4. Improved understanding of geologic CO{sub 2} storage processes requires risk-driven field experiments

    SciTech Connect

    Oldenburg, C.M.

    2011-06-01

    The need for risk-driven field experiments for CO{sub 2} geologic storage processes to complement ongoing pilot-scale demonstrations is discussed. These risk-driven field experiments would be aimed at understanding the circumstances under which things can go wrong with a CO{sub 2} capture and storage (CCS) project and cause it to fail, as distinguished from accomplishing this end using demonstration and industrial scale sites. Such risk-driven tests would complement risk-assessment efforts that have already been carried out by providing opportunities to validate risk models. In addition to experimenting with high-risk scenarios, these controlled field experiments could help validate monitoring approaches to improve performance assessment and guide development of mitigation strategies.

  5. Sexual dimorphism in immunity: improving our understanding of vaccine immune responses in men.

    PubMed

    Furman, David

    2015-03-01

    Weaker immune responses are often observed in males compared to females. Since female hormones have proinflammatory properties and androgens have potent immunomodulatory effects, this sexual dimorphism in the immune response seems to be hormone dependent. Despite our current knowledge about the effect of sex hormones on immune cells, definition of the factors driving the sex differences in immunoclinical outcomes, such as the diminished response to infection and vaccination observed in men or the higher rates of autoimmunity observed in females, remains elusive. Recently, systems approaches to immune function have started to suggest a way toward establishing this connection. Such studies promise to improve our understanding of the mechanisms underlying the sexual dimorphism observed in the human immune system.

  6. Animal virus discovery: improving animal health, understanding zoonoses, and opportunities for vaccine development

    PubMed Central

    Delwart, Eric

    2012-01-01

    The characterization of viral genomes has accelerated due to improvement in DNA sequencing technology. Sources of animal samples and molecular methods for the identification of novel viral pathogens and steps to determine their pathogenicity are listed. The difficulties for predicting future cross-species transmissions are highlighted by the wide diversity of known viral zoonoses. Recent surveys of viruses in wild and domesticated animals have characterized numerous viruses including some closely related to those infecting humans. The detection of multiple genetic lineages within viral families infecting a single host species, phylogenetically interspersed with viruses found in other host species, reflects frequent past cross-species transmissions. Numerous opportunities for the generation of novel vaccines will arise from a better understanding of animal viromes. PMID:22463981

  7. Cross-Functional Team Processes and Patient Functional Improvement

    PubMed Central

    Alexander, Jeffrey A; Lichtenstein, Richard; Jinnett, Kimberly; Wells, Rebecca; Zazzali, James; Liu, Dawei

    2005-01-01

    Objective To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. Data Sources/Study Setting Primary data were collected during the period 1992–1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. Study Design A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. Data Collection Methods Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. Principal Findings Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. Conclusions Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the

  8. [Methods used in the hospital for patients' sleep improvement].

    PubMed

    Ryhänen, A; Kuivalainen, L; Meriläinen, P; Isola, A

    1998-01-01

    The purpose of this article is to describe methods used in the hospital for sleep improvement. The article is based on a study of patients' sleep in a Finnish hospital's medical or surgical ward. The patients of the Central Hospital of Northern Carelia's two medical and two surgical wards took part in the research. The data were collected by a structured questionnaire in May-June 1996. Of the replies of 181 patients, the results of 177 were taken to the final analysis. The data were analysed by statistical methods. The data and the results are presented in frequency and percent distributions. The most common method used by the patients to improve their sleep was to choose a good sleeping position. Other methods, which were often used, were reading, watching TV, having a snack, taking a warm shower or praying. The nurses were versatile in using the available methods of nursing for helping the patients to sleep. They informed the patients about their illnesses, nursing regime and the forthcoming operations, consoling and giving support to them. The nurses also organised sleep-supporting environment and gave painkillers and sleeping pills. About 60% of the researched patients were of the opinion, that sleeping tablets were prescribed too often. The patients themselves regarded the information and knowledge about their own treatment as the best way to improve their sleep.

  9. An improved conceptual understanding of snowmelt and groundwater dynamics in the semi-arid Andes

    NASA Astrophysics Data System (ADS)

    Sproles, Eric; Hevia, Andres; Soulsby, Chris; Tetzlaff, Doerthe

    2016-04-01

    The contribution of snowmelt to groundwater has long been recognized as an important component of the hydrological cycle in semi-arid northern central Chile (29°-32°S). Despite its importance as a water resource, this transition to groundwater remains poorly understood. Climatically, the High Cordillera in northern central Chile receives approximately 10 times as much annual precipitation as the valley bottoms, falling almost exclusively as snow above 3500 m during the winter months. Geologically, the High Cordillera is characterized by steep topography and a highly dissected landscape underlain by bedrock. Groundwater stores in the mountain headwaters are assumed to be constrained to the valley bottoms. The current working hypothesis of watershed processes in the High Cordillera describes fluxes of spring melt moving through the hillslope via local flowpaths to valley aquifers that recharge streams throughout the headwater reaches. Previous studies in the region indicate Pre-Cordilleran aquifers, located in lower elevation dry ephemeral valleys, are hydrologically disconnected from the High Cordillera. These watersheds have no seasonal snowpack, and recharge occurs primarily during infrequent rain events. These isolated Pre-Cordilleran aquifers serve as an important water resource for rural residents and infrastructure. We present stable isotope, geochemical, and groundwater level data from the wet El Niño winter of 2015 that suggests a topographically disconnected aquifer in the Pre-Cordillera received considerable recharge from High Cordillera snowmelt. These novel findings are indicative of deep groundwater flow paths between the Pre- and High Cordillera during the wet winter and spring of 2015, and improve the conceptual understanding of hydrological processes in the region. Additionally, these results will directly benefit groundwater management in the Pre-Cordillera and better inform modeling efforts in the High Cordillera. While this study is limited to

  10. Cognitive Predictors of Understanding Treatment Decisions in Patients with Newly Diagnosed Brain Metastases

    PubMed Central

    Gerstenecker, Adam; Meneses, Karen; Duff, Kevin; Fiveash, John B.; Marson, Daniel C.; Triebel, Kristen L.

    2015-01-01

    Background Medical decision-making capacity is a higher-order functional skill that refers to a patient’s ability to make informed, sound decisions related to care and treatment. In a medical context, understanding is the most cognitively demanding consent standard and refers to a patient’s ability to comprehend information to the extent that informed decisions can be made. Methods The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically-matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (i.e., intact or impaired). Results Results indicate that measures of simple attention, verbal fluency, verbal memory, processing speed, and executive functioning were all associated with understanding, and that verbal memory and phonemic fluency were the primary cognitive predictors. Using these two primary predictors, equations can be constructed to predict the ability to understand treatment decisions in patients with brain metastasis. Conclusions Although preliminary, these data demonstrate how cognitive measures can estimate understanding as it relates to medical decision-making capacities in these patients. Clinically, these findings suggest that poor verbal memory and expressive language function could serve as “red flags” for reduced consent capacity in this patient population, and, thus, signal that a more comprehensive medical decision-making capacity evaluation is warranted. PMID:25735262

  11. Engaging Students Through Classroom Connection Webinars to Improve Their Understanding of the Mars Science Laboratory Mission

    NASA Technical Reports Server (NTRS)

    Graff, Paige V.; Achilles, Cherie

    2013-01-01

    Planetary exploration missions to other worlds, like Mars, can generate a lot of excitement and wonder for the public. The Mars Science Laboratory Mission is one of the latest planetary missions that has intrigued the public perhaps more than most. How can scientists and educational specialists capitalize on the allure of this mission and involve students and teachers in a way that not only shares the story of the mission, but actively engages classrooms with scientists and improves their understanding of the science? The Expedition Earth and Beyond (EEAB) Program [1], facilitated by the Astromaterials Research and Exploration Science (ARES) Directorate Education Program at the NASA Johnson Space Center achieves this by facilitating MSL mission focused classroom connection webinars. Five MSL-focused webinars facilitated through EEAB during the 2012 fall semester engaged almost 3000 students and teachers. Involved STEM experts/role models helped translate the science behind the Mars Science Laboratory mission in a comprehensive, exciting, and engaging manner. These virtual events captured participants attention while increasing their science awareness and understanding of the MSL mission.

  12. Active learning to understand infectious disease models and improve policy making.

    PubMed

    Willem, Lander; Stijven, Sean; Vladislavleva, Ekaterina; Broeckhove, Jan; Beutels, Philippe; Hens, Niel

    2014-04-01

    Modeling plays a major role in policy making, especially for infectious disease interventions but such models can be complex and computationally intensive. A more systematic exploration is needed to gain a thorough systems understanding. We present an active learning approach based on machine learning techniques as iterative surrogate modeling and model-guided experimentation to systematically analyze both common and edge manifestations of complex model runs. Symbolic regression is used for nonlinear response surface modeling with automatic feature selection. First, we illustrate our approach using an individual-based model for influenza vaccination. After optimizing the parameter space, we observe an inverse relationship between vaccination coverage and cumulative attack rate reinforced by herd immunity. Second, we demonstrate the use of surrogate modeling techniques on input-response data from a deterministic dynamic model, which was designed to explore the cost-effectiveness of varicella-zoster virus vaccination. We use symbolic regression to handle high dimensionality and correlated inputs and to identify the most influential variables. Provided insight is used to focus research, reduce dimensionality and decrease decision uncertainty. We conclude that active learning is needed to fully understand complex systems behavior. Surrogate models can be readily explored at no computational expense, and can also be used as emulator to improve rapid policy making in various settings.

  13. How does sport psychology actually improve athletic performance? A framework to facilitate athletes' and coaches' understanding.

    PubMed

    Gee, Chris J

    2010-09-01

    The popularity of sport psychology, both as an academic discipline and an applied practice, has grown substantially over the past two decades. Few within the realm of competitive athletics would argue with the importance of being mentally prepared prior to an athletic competition as well as the need to maintain that particular mindset during a competitive contest. Nevertheless, recent research has shown that many athletes, coaches, and sporting administrators are still quite reluctant to seek out the services of a qualified sport psychologist, even if they believe it could help. One of the primary reasons for this hesitation appears to be a lack of understanding about the process and the mechanisms by which these mental skills affect performance. Unlike the "harder sciences" of sport physiology and biochemistry where athletes can see the tangible results in themselves or other athletes (e.g., he or she lifted weights, developed larger muscles, and is now stronger/faster as a result), the unfamiliar and often esoteric nature of sport psychology appears to be impeding a large number of athletes from soliciting these important services. As such, the purpose of this article is to provide the reader with a simple framework depicting how mental skills training translates into improved within-competition performance. This framework is intended to help bridge the general "understanding gap" that is currently being reported by a large number of athletes and coaches, while also helping sport psychology practitioners sell their valuable services to individual athletes and teams.

  14. Active Learning to Understand Infectious Disease Models and Improve Policy Making

    PubMed Central

    Vladislavleva, Ekaterina; Broeckhove, Jan; Beutels, Philippe; Hens, Niel

    2014-01-01

    Modeling plays a major role in policy making, especially for infectious disease interventions but such models can be complex and computationally intensive. A more systematic exploration is needed to gain a thorough systems understanding. We present an active learning approach based on machine learning techniques as iterative surrogate modeling and model-guided experimentation to systematically analyze both common and edge manifestations of complex model runs. Symbolic regression is used for nonlinear response surface modeling with automatic feature selection. First, we illustrate our approach using an individual-based model for influenza vaccination. After optimizing the parameter space, we observe an inverse relationship between vaccination coverage and cumulative attack rate reinforced by herd immunity. Second, we demonstrate the use of surrogate modeling techniques on input-response data from a deterministic dynamic model, which was designed to explore the cost-effectiveness of varicella-zoster virus vaccination. We use symbolic regression to handle high dimensionality and correlated inputs and to identify the most influential variables. Provided insight is used to focus research, reduce dimensionality and decrease decision uncertainty. We conclude that active learning is needed to fully understand complex systems behavior. Surrogate models can be readily explored at no computational expense, and can also be used as emulator to improve rapid policy making in various settings. PMID:24743387

  15. Improving conservation outcomes with a new paradigm for understanding species’ fundamental and realized adaptive capacity

    USGS Publications Warehouse

    Beever, Erik; O’Leary, John; Mengelt, Claudia; West, Jordan M.; Julius, Susan; Green, Nancy; Magness, Dawn; Petes, Laura E.; Stein, Bruce A.; Nicotra, Adrienne B; Hellmann, Jessica J; Robertson, Amanda L; Staudinger, Michelle D.; Rosenberg, Andrew A.; Babij, Eleanora; Brennan, Jean; Schuurman, Gregor W; Hofmann, Gretchen E

    2016-01-01

    Worldwide, many species are responding to ongoing climate change with shifts in distribution, abundance, phenology, or behavior. Consequently, natural-resource managers face increasingly urgent conservation questions related to biodiversity loss, expansion of invasive species, and deteriorating ecosystem services. We argue that our ability to address these questions is hampered by the lack of explicit consideration of species’ adaptive capacity (AC). AC is the ability of a species or population to cope with climatic changes and is characterized by three fundamental components: phenotypic plasticity, dispersal ability, and genetic diversity. However, few studies simultaneously address all elements; often, AC is confused with sensitivity or omitted altogether from climate-change vulnerability assessments. Improved understanding, consistent definition, and comprehensive evaluations of AC are needed. Using classic ecological-niche theory as an analogy, we propose a new paradigm that considers fundamental and realized AC: the former reflects aspects inherent to species, whereas the latter denotes how extrinsic factors constrain AC to what is actually expressed or observed. Through this conceptualization, we identify ecological attributes contributing to AC, outline areas of research necessary to advance understanding of AC, and provide examples demonstrating how the inclusion of AC can better inform conservation and natural-resource management.

  16. Redefining fine roots improves understanding of below-ground contributions to terrestrial biosphere processes.

    PubMed

    McCormack, M Luke; Dickie, Ian A; Eissenstat, David M; Fahey, Timothy J; Fernandez, Christopher W; Guo, Dali; Helmisaari, Heljä-Sisko; Hobbie, Erik A; Iversen, Colleen M; Jackson, Robert B; Leppälammi-Kujansuu, Jaana; Norby, Richard J; Phillips, Richard P; Pregitzer, Kurt S; Pritchard, Seth G; Rewald, Boris; Zadworny, Marcin

    2015-08-01

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain because of the challenges of consistently measuring and interpreting fine-root systems. Traditionally, fine roots have been defined as all roots ≤ 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. Here, we demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, fine roots are either separated into individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine-root pool. Using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally - a c. 30% reduction from previous estimates assuming a single fine-root pool. Future work developing tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi into fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand below-ground processes in the terrestrial biosphere.

  17. Redefining fine roots improves understanding of belowground contributions to terrestrial biosphere processes

    SciTech Connect

    McCormack, M. Luke; Dickie, Ian A.; Eissenstat, David M.; Fahey, Timothy J.; Fernandez, Christopher W.; Guo, Dali; Helmisaari, Helja -Sisko; Hobbie, Erik A.; Iversen, Colleen M.; Jackson, Robert B.; Leppälammi-Kujansuu, Jaana; Norby, Richard J.; Phillips, Richard P.; Pregitzer, Kurt S.; Pritchard, Seth G.; Rewald, Boris; Zadworny, Marcin

    2015-03-10

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain due to challenges in consistent measurement and interpretation of fine-root systems. We define fine roots as all roots less than or equal to 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. We demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, fine roots are separated into either individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine root pool. Furthermore, using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally a ca. 30% reduction from previous estimates assuming a single fine-root pool. In the future we hope to develop tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi in fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand belowground processes in the terrestrial biosphere.

  18. Redefining fine roots improves understanding of belowground contributions to terrestrial biosphere processes

    DOE PAGES

    McCormack, M. Luke; Dickie, Ian A.; Eissenstat, David M.; ...

    2015-03-10

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain due to challenges in consistent measurement and interpretation of fine-root systems. We define fine roots as all roots less than or equal to 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. We demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, finemore » roots are separated into either individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine root pool. Furthermore, using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally a ca. 30% reduction from previous estimates assuming a single fine-root pool. In the future we hope to develop tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi in fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand belowground processes in the terrestrial biosphere.« less

  19. Using Computer-Based Visualization Strategies to Improve Students' Understanding of Molecular Polarity and Miscibility

    NASA Astrophysics Data System (ADS)

    Sanger, Michael J.; Badger, Steven M., II

    2001-10-01

    This study reports how instruction including visualization strategies associated with computer animations and electron density plots affected students' conceptual understanding of two chemistry topics. Two sets of students responded to several conceptual questions about molecular polarities and miscibilities and these responses were compared. One group received instruction including the use of wooden model kits and physical demonstrations; the other received similar instruction with the additional use of computer animations and electron-density plots. Students who viewed electron-density plots were more likely to identify symmetric molecules with polar bonds as being nonpolar and provided more complete descriptions of how soap molecules help remove grease from an object. Students who viewed computer animations and electron density plots were also more likely to explain that the intermolecular attractions among water molecules are responsible for the immiscibility of oil and water, and were more likely to recognize that water molecules are attracted to each other and to sodium and chloride ions but are not strongly attracted to hydrogen molecules. Although other studies have shown that computer animations can improve students' conceptual understanding of chemistry, this is the first to demonstrate that electron-density plots mapped with electrostatic potentials can also be an effective visualization strategy.

  20. Understanding motivations to participate in an observational research study: Why do patients enroll?

    PubMed

    Soule, Michael C; Beale, Eleanor E; Suarez, Laura; Beach, Scott R; Mastromauro, Carol A; Celano, Christopher M; Moore, Shannon V; Huffman, Jeff C

    2016-01-01

    By understanding common motivations for participating in observational research studies, clinicians may better understand the perceived benefits of research participation from their clients' perspective. We enrolled 164 cardiac patients in a study about the effects of gratitude and optimism. Two weeks post-enrollment, participants completed a four-item questionnaire regarding motivations for study enrollment. Altruistic motivation ranked highest, while intellectual, health-related, and financial motivations rated lower. Four subgroups of participants emerged, each with distinct characteristics and different priorities for participating. These findings may help front-line clinicians to understand which motivations for participation apply to their clients who enroll in non-treatment-based research projects.

  1. Understanding Motivations to Participate in an Observational Research Study: Why do Patients Enroll?

    PubMed Central

    Soule, Michael C.; Beale, Eleanor E.; Suarez, Laura; Beach, Scott R.; Mastromauro, Carol A.; Celano, Christopher M; Moore, Shannon V; Huffman, Jeff C.

    2016-01-01

    By understanding common motivations for participating in observational research studies, clinicians may better understand the perceived benefits of research participation from their clients’ perspective. We enrolled 164 cardiac patients in a study about the effects of gratitude and optimism. Two weeks post-enrollment, participants completed a four-item questionnaire regarding motivations for study enrollment. Altruistic motivation ranked highest, while intellectual, health-related, and financial motivations rated lower. Four subgroups of participants emerged, each with distinct characteristics and different priorities for participating. These findings may help front-line clinicians to understand which motivations for participation apply to their clients who enroll in non-treatment-based research projects. PMID:26933943

  2. Informed consent in trauma: does written information improve patient recall of risks? A prospective randomised study.

    PubMed

    Smith, Hannah K; Manjaly, Joseph G; Yousri, Taher; Upadhyay, Neil; Taylor, Hazel; Nicol, Stephen G; Livingstone, James A

    2012-09-01

    Informed consent is vital to good surgical practice. Pain, sedative medication and psychological distress resulting from trauma are likely to adversely affect a patient's ability to understand and retain information thus impairing the quality of the consent process. This study aims to assess whether provision of written information improves trauma patient's recall of the risks associated with their surgery. 121 consecutive trauma patients were randomised to receive structured verbal information or structured verbal information with the addition of supplementary written information at the time of obtaining consent for their surgery. Patients were followed up post-operatively (mean 3.2 days) with a questionnaire to assess recall of risks discussed during the consent interview and satisfaction with the consent process. Recall of risks discussed in the consent interview was found to be significantly improved in the group receiving written and verbal information compared to verbal information alone (mean questionnaire score 41% vs. 64%), p=0.0014 using the Mann-Whitney U test. Patient satisfaction with the consent process was improved in the group receiving written and verbal information and 90% of patients in both groups expressed a preference for both written and verbal information compared to verbal information alone. Patients awaiting surgery following trauma can pose a challenge to adequately inform about benefits conferred, the likely post operative course and potential risks. Written information is a simple and cost-effective means to improve the consent process and was popular with patients.

  3. Bovine brucellosis in wildlife: using adaptive management to improve understanding, technology and suppression.

    PubMed

    White, P J; Treanor, J J; Geremia, C; Wallen, R L; Blanton, D W; Hallac, D E

    2013-04-01

    Eradication of brucellosis from bison (Bison bison) and elk (Cervus elaphus) populations in the Greater Yellowstone Area is not possible with current technology. There are considerable uncertainties regarding the effectiveness of management techniques and unintended effects on wildlife behaviour and demography. However, adaptive management provides a framework for learning about the disease, improving suppression techniques, and lowering brucellosis transmission among wildlife and to cattle. Since it takes approximately three years after birth for female bison to become reproductively active and contribute to brucellosis transmission, there is an opportunity to implement actions such as vaccination and the selective removal of infectious bison based on age and assay results to reduce the potential for transmission. Older adult bison that have been exposed to the bacteria, but recovered from acute infection, could be retained in the population to provide some immunity (resistance) against future transmission. Through careful predictions, research, and monitoring, our understanding and technology will be improved and management actions can be adjusted to better achieve desired outcomes.

  4. Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds.

    PubMed

    Robinson, Lisa A; Hammitt, James K; Chang, Angela Y; Resch, Stephen

    2017-02-01

    Researchers and policymakers have long been interested in developing simple decision rules to aid in determining whether an intervention is, or is not, cost-effective. In global health, interventions that impose costs per disability-adjusted life year averted less than three and one times gross domestic product per capita are often considered cost-effective and very cost-effective, respectively. This article explores the conceptual foundation and derivation of these thresholds. Its goal is to promote understanding of how these thresholds were derived and their implications, as well as to suggest options for improvement. These thresholds are intended to reflect the monetary value of the benefits to affected individuals, based on their preferences for spending on health vs spending on other goods and services. However, the current values were not rigorously derived, which means that their application may lead to inappropriate conclusions regarding which interventions should be adopted as well as misallocation of resources across health and other investments. Improving the basis for these cost-effectiveness thresholds is of particular importance in low- and middle-income countries, given the limited resources available and the significant needs of their populations.

  5. Air pollution and public health: emerging hazards and improved understanding of risk.

    PubMed

    Kelly, Frank J; Fussell, Julia C

    2015-08-01

    Despite past improvements in air quality, very large parts of the population in urban areas breathe air that does not meet European standards let alone the health-based World Health Organisation Air Quality Guidelines. Over the last 10 years, there has been a substantial increase in findings that particulate matter (PM) air pollution is not only exerting a greater impact on established health endpoints, but is also associated with a broader number of disease outcomes. Data strongly suggest that effects have no threshold within the studied range of ambient concentrations, can occur at levels close to PM2.5 background concentrations and that they follow a mostly linear concentration-response function. Having firmly established this significant public health problem, there has been an enormous effort to identify what it is in ambient PM that affects health and to understand the underlying biological basis of toxicity by identifying mechanistic pathways-information that in turn will inform policy makers how best to legislate for cleaner air. Another intervention in moving towards a healthier environment depends upon the achieving the right public attitude and behaviour by the use of optimal air pollution monitoring, forecasting and reporting that exploits increasingly sophisticated information systems. Improving air quality is a considerable but not an intractable challenge. Translating the correct scientific evidence into bold, realistic and effective policies undisputedly has the potential to reduce air pollution so that it no longer poses a damaging and costly toll on public health.

  6. Progress in Understanding Degradation Mechanisms and Improving Stability in Organic Photovoltaics.

    PubMed

    Mateker, William R; McGehee, Michael D

    2017-03-01

    Understanding the degradation mechanisms of organic photovoltaics is particularly important, as they tend to degrade faster than their inorganic counterparts, such as silicon and cadmium telluride. An overview is provided here of the main degradation mechanisms that researchers have identified so far that cause extrinsic degradation from oxygen and water, intrinsic degradation in the dark, and photo-induced burn-in. In addition, it provides methods for researchers to identify these mechanisms in new materials and device structures to screen them more quickly for promising long-term performance. These general strategies will likely be helpful in other photovoltaic technologies that suffer from insufficient stability, such as perovskite solar cells. Finally, the most promising lifetime results are highlighted and recommendations to improve long-term performance are made. To prevent degradation from oxygen and water for sufficiently long time periods, OPVs will likely need to be encapsulated by barrier materials with lower permeation rates of oxygen and water than typical flexible substrate materials. To improve stability at operating temperatures, materials will likely require glass transition temperatures above 100 °C. Methods to prevent photo-induced burn-in are least understood, but recent research indicates that using pure materials with dense and ordered film morphologies can reduce the burn-in effect.

  7. Jatropha curcas, a biofuel crop: Functional genomics for understanding metabolic pathways and genetic improvement

    PubMed Central

    Maghuly, Fatemeh; Laimer, Margit

    2013-01-01

    Jatropha curcas is currently attracting much attention as an oilseed crop for biofuel, as Jatropha can grow under climate and soil conditions that are unsuitable for food production. However, little is known about Jatropha, and there are a number of challenges to be overcome. In fact, Jatropha has not really been domesticated; most of the Jatropha accessions are toxic, which renders the seedcake unsuitable for use as animal feed. The seeds of Jatropha contain high levels of polyunsaturated fatty acids, which negatively impact the biofuel quality. Fruiting of Jatropha is fairly continuous, thus increasing costs of harvesting. Therefore, before starting any improvement program using conventional or molecular breeding techniques, understanding gene function and the genome scale of Jatropha are prerequisites. This review presents currently available and relevant information on the latest technologies (genomics, transcriptomics, proteomics and metabolomics) to decipher important metabolic pathways within Jatropha, such as oil and toxin synthesis. Further, it discusses future directions for biotechnological approaches in Jatropha breeding and improvement. PMID:24092674

  8. Patient Understanding of Pelvic Floor Disorders: What Women Want to Know

    PubMed Central

    Kiyosaki, Krista; Ackerman, A. Lenore; Histed, Stephanie; Sevilla, Claudia; Eilber, Karyn; Maliski, Sally; Anger, Jennifer

    2013-01-01

    Objective To assess the effect of initial visit with a specialist on disease understanding in women with pelvic floor disorders. Methods Women with referrals or chief complaints suggestive of urinary incontinence (UI) or pelvic organ prolapse (POP) were recruited from an academic urology clinic. Patients completed a Test of Functional Health Literacy in Adults (TOFHLA) and scripted interview sessions before and after the physician encounter. Physician treatment plans were standardized based on diagnosis and were explained using models. Interview transcripts were analyzed using qualitative grounded theory methodology. Results Twenty women with pelvic floor disorders (UI or POP) were recruited and enrolled in this pilot study. The mean age was 60.5 years (range 31–87 years) and the majority of women were Caucasian with a college degree or beyond. TOFHLA scores indicated adequate to high levels of health literacy. Preliminary themes before and after the physician encounter were extracted from interviews, and two main concepts emerged: 1) After the initial physician visit, knowledge of their diagnosis and the ability to treat their symptoms relieved patient concerns related to misunderstandings of the severity of their disease 2) Patients tended to focus on treatment and had difficulty grasping certain diagnostic terms. This resulted in good understanding of treatment plans despite an inconsistent understanding of diagnosis. Conclusion Our findings demonstrated a significant effect of the initial physician visit on patient understanding of her pelvic floor disorder. Despite the variation in diagnostic recall after the physician encounter, patients had good understanding of treatment plans. This served to increase perceived control and adequately relieve patient fears. PMID:22543763

  9. Improving learning outcomes: integration of standardized patients & telemedicine technology.

    PubMed

    Seibert, Diane C; Guthrie, John T; Adamo, Graceanne

    2004-01-01

    Innovative use of standardized patients (SPs) in a telemedicine environment can improve learning outcomes and clinical competencies. This randomized, cross-over study examined the relationship of technology-based strategies and the improvement of knowledge outcomes and competencies. Results showed that the innovative use of SPs and telemedicine, compared to a traditional distance learning teaching methodology, significantly improved learning outcomes. In addition, there was a significant increase in performance motivation and an interesting decrease in student satisfaction that may be linked to the pressure of performance-based learning. This article addresses knowledge improvement only.

  10. Implementing practice management strategies to improve patient care: the EPIC project.

    PubMed

    Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

    2012-01-01

    Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

  11. Leveraging information technology to drive improvement in patient satisfaction.

    PubMed

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

    2010-01-01

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

  12. Patient-centered outcomes research to improve asthma outcomes.

    PubMed

    Anise, Ayodola; Hasnain-Wynia, Romana

    2016-12-01

    The Patient-Centered Outcomes Research Institute is funding 8 comparative effectiveness research projects to improve patient-centered outcomes for African American and Hispanic/Latino patients with uncontrolled asthma. These projects aim to compare multilevel interventions with known efficacy at the community, home, and health system levels to enhance patient and clinician uptake of the National Heart, Lung, and Blood Institute's National Asthma Education Prevention Program guidelines and improve outcomes. The National Asthma Education Prevention Program guidelines provide clinicians with a range of acceptable approaches for the diagnosis and management of asthma and define general practices that meet the needs of most patients. Yet disparities in asthma care and outcomes remain pervasive for African Americans and Hispanics/Latinos. The National Heart, Lung, and Blood Institute AsthmaNet consortium has identified several top research priorities for pediatric and adult populations, including a recommendation to examine tailored approaches based on race/ethnicity. In addition, the guidelines emphasize the need for studies that focus on multicomponent interventions recognizing that single interventions are generally ineffective. This article will describe the Patient-Centered Outcomes Research Institute-funded asthma projects and how they are individually and collectively addressing evidence gaps in asthma care by focusing on multicomponent and tailored approaches for improving outcomes and reducing disparities for African American and Hispanic/Latino patients.

  13. Understanding unexpected courses of multiple sclerosis among patients using complementary and alternative medicine: A travel from recipient to explorer

    PubMed Central

    Salamonsen, Anita; Launsø, Laila; Kruse, Tove E.; Eriksen, Sissel H.

    2010-01-01

    Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients’ redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients’ position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM. PMID:20616888

  14. Does pharmacotherapy improve cardiovascular outcomes in hemodialysis patients?

    PubMed

    Mittal, Mayank; Aggarwal, Kul; Littrell, Rachel L; Agrawal, Harsh; Alpert, Martin A

    2015-10-01

    Cardiovascular disease (CVD) occurs commonly in patients with chronic kidney disease (CKD) including those treated with hemodialysis (HD), and is associated with poor outcomes in this population. Pharmacologic management of hypertension, dyslipidemia, acute and chronic coronary artery disease, and atrial fibrillation in the general population is supported by the results of high-quality, randomized, controlled clinical trials. Pharmacotherapy of these disorders in the general population is effective in improving clinical outcomes. In contrast, information concerning the effect of pharmacotherapy on mortality and cardiovascular outcomes in patients with CKD, and particularly in HD patients, is limited. Available data suggest that, in general, pharmacotherapy of hypertension and dyslipidemia, anti-platelet therapy of CVD, and anticoagulant therapy in patients with atrial fibrillation are less effective in HD patients than in the general population or even in patients with early stage of CKD.

  15. Improving outcomes for patients receiving transarterial chemoembolization for hepatocellular carcinoma.

    PubMed

    McCurdy, Heather M

    2013-01-01

    Hepatocellular carcinoma is a cancer with increasing incidence in the veteran population. This type of cancer can be treated with transarterial chemoembolization, an invasive procedure performed by specially trained interventional radiologists. The most common serious complications are liver failure, sepsis secondary to ischemic cholecystitis or liver abscess, gastrointestinal bleeding, and death. However, nursing staff and physicians often have little or no experience in caring for patients in the hospital who have had this procedure. Patient safety can be threatened by this lack of knowledge. Sources of threat to patient safety are described by the Institute of Medicine as falling into 4 categories: management, workforce, work processes, and organizational culture. To promote patient safety, defenses need to be deployed to address each category. In this article, the author provides a case example, describes threats to the patient's safety, and describes a plan to improve the care of all patients undergoing this procedure.

  16. [Understanding and reducing the risk of adverse drug reactions in pediatric patients].

    PubMed

    Gotta, Verena; van den Anker, Johannes; Pfister, Marc

    2015-12-01

    Developmental pharmacology influences the safety profile of drugs in pediatrics. Altered pharmacokinetics and/ or pharmacodynamics of drugs make pediatric patients susceptible to adverse drug reactions (ADRs), especially infants and newborns. Since the efficacy/ safety balance of most available drugs has not been formally evaluated in pediatric clinical trials, optimal dosing is rarely known in pediatrics. Suboptimal pediatric drug formulations make dose optimization even more difficult exposing pediatric patients to medication errors like overdosing and associated ADRs. We provide an overview of pediatric ADRs and discuss recent regulatory and pharmacological measures to understand and reduce risk of ADRs in pediatric patients.

  17. Different Approaches to Understanding Patients in General Practice in Denmark: A Qualitative Study

    ERIC Educational Resources Information Center

    Davidsen, Annette Sofie; Reventlow, Susanne

    2011-01-01

    General practitioners (GPs) treat more than 90% of common mental disorders. Their approaches to psychological interventions have been little studied and their process of understanding patients remains unexplored. This qualitative interview and observation study aimed to explore Danish GPs' approaches to emotional problems and mental disorders in…

  18. Improving patient access at a movement disorder clinic by participating in a Process Improvement Program

    PubMed Central

    Goodridge, Alan; Woodhouse, Douglas; Barbour, Janet

    2013-01-01

    Our multi-disciplinary neurology team were dissatisfied with long access times for consultation for new referrals. We participated in a rapid process improvement workshop and a structured improvement process. Over a six-month period we were able to reduce our access time for initial appointment for patients with suspected movement disorders from 133 to 20 days. We implemented a ‘carousel’ multi-disciplinary appointment and a standardised clinic form that improved the flow of patients and that we estimate will save 150 hours of physician time and 320 hours of administrative time per year. PMID:26734164

  19. Commentary: quality improvement projects: how do we protect patients' rights?

    PubMed

    Diamond, Louis H; Kliger, Alan S; Goldman, Richard S; Palevsky, Paul M

    2004-01-01

    A recent ruling by the Office of Human Research Protection (OHRP) has renewed an ongoing debate over whether Institutional Review Boards (IRBs) should have oversight not only over clinical research but also over quality improvement projects (QIPs). The authors discussed the similarities and differences among clinical practice, QIPs, and clinical research, pointing out issues to consider when identifying the most appropriate method for QIP oversight and accountability. They note that potential solutions must address ethical issues (eg, patient safety, privacy, and self-determination) and weigh the effect of the underlying QIP goal (administrative versus clinical improvement) on an individual patient and patient populations. They conclude that because QIPs are an extension of clinical practice and have elements of clinical research, it too should have an oversight system. Institutional or regional quality improvement boards, operating parallel to current IRBs, are suggested as 1 means of ensuring that QIP participants are offered the same protections as those who take part in clinical research.

  20. What Is in a Name? How Biomedical Language May Derail Patient Understanding of Hypertension.

    PubMed

    Bokhour, Barbara G; Kressin, Nancy R

    2015-07-01

    Despite major advances in treating hypertension, >50% of all individuals diagnosed with the condition remain in poor control. A fundamental issue may be that patients may not fully understand the meaning of the term hypertension or its cause, leading to poor adherence to medications and limiting other effective self-management behaviors. We posit that the word hypertension itself may contribute to these misunderstandings, particularly in regards to the role of stress in causing hypertension, which thus suggests stress management as a primary strategy for control. The word hypertension is often interpreted by patients to mean too much tension. In conjunction with cultural framings of stress causing high blood pressure, many patients turn to stress management to control their hypertension. The word hypertension can thus cause patients to think of it as more of a psychological than physiological condition, thus discounting the value of antihypertensive medications and interfering with medication adherence. We therefore suggest that clinicians reconsider the use of the term hypertension and the ways in which they explain the condition to patients. Reorienting the language to the more patient-centered term of high blood pressure may help patients better understand the condition and to more readily embrace the available efficacious therapies.

  1. Using patient stories to inspire quality improvement within the NHS Modernization Agency collaborative programmes.

    PubMed

    Wilcock, Peter Michael; Brown, Geraint Ceri Stewart; Bateson, John; Carver, Jonathon; Machin, Sheelagh

    2003-05-01

    The importance of obtaining the opinions of service users has long been recognized and, traditionally, most contact has focused on measuring their satisfaction with the services they receive. However, there is little evidence that this has had much impact on improving care. The Discovery Interview Process, a technique for listening to patients and carers and using their narratives to improve care, is discussed in this article. This approach has been used in the pilot phases of the UK Coronary Heart Disease Collaborative and Critical Care Collaborative. These narratives develop understanding grounded in experience. Those delivering care can interpret the narratives using their own clinical and professional knowledge and experience to create better or new ways of meeting patients' and carers' needs. Using their own expert knowledge they can identify needs within the narratives, including those that patients and carers did not know they had. The principal techniques for gathering these narratives are outlined, and ways of using such data to inform patient-focused service improvements are discussed. Various locally sensitive methods for presenting the narratives to expert interprofessional teams are also described along with emerging experience of this feedback. We consider the Discovery Interview technique for gathering patient and carer narratives to be a potentially powerful method for informing quality improvements, discovering what really matters to patients and their carers. This pragmatic approach could prove manageable within local quality improvement projects.

  2. Improving outcomes for ESRD patients: shifting the quality paradigm.

    PubMed

    Nissenson, Allen R

    2014-02-01

    The availability of life-saving dialysis therapy has been one of the great successes of medicine in the past four decades. Over this time period, despite treatment of hundreds of thousands of patients, the overall quality of life for patients with ESRD has not substantially improved. A narrow focus by clinicians and regulators on basic indicators of care, like dialysis adequacy and anemia, has consumed time and resources but not resulted in significantly improved survival; also, frequent hospitalizations and dissatisfaction with the care experience continue to be seen. A new quality paradigm is needed to help guide clinicians, providers, and regulators to ensure that patients' lives are improved by the technically complex and costly therapy that they are receiving. This paradigm can be envisioned as a quality pyramid: the foundation is the basic indicators (outstanding performance on these indicators is necessary but not sufficient to drive the primary outcomes). Overall, these basics are being well managed currently, but there remains an excessive focus on them, largely because of publically reported data and regulatory requirements. With a strong foundation, it is now time to focus on the more complex intermediate clinical outcomes-fluid management, infection control, diabetes management, medication management, and end-of-life care among others. Successfully addressing these intermediate outcomes will drive improvements in the primary outcomes, better survival, fewer hospitalizations, better patient experience with the treatment, and ultimately, improved quality of life. By articulating this view of quality in the ESRD program (pushing up the quality pyramid), the discussion about quality is reframed, and also, clinicians can better target their facilities in the direction of regulatory oversight and requirements about quality. Clinicians owe it to their patients, as the ESRD program celebrates its 40th anniversary, to rekindle the aspirations of the creators of

  3. Using patient flow simulation to improve access at a multidisciplinary sleep centre.

    PubMed

    Pendharkar, Sachin R; Bischak, Diane P; Rogers, Paul; Flemons, Ward; Noseworthy, Tom W

    2015-06-01

    The lack of timely access to diagnosis and treatment for sleep disorders is well described, but little attention has been paid to understanding how multiple system constraints contribute to long waiting times. The objectives of this study were to identify system constraints leading to long waiting times at a multidisciplinary sleep centre, and to use patient flow simulation modelling to test solutions that could improve access. Discrete-event simulation models of patient flow were constructed using historical data from 150 patients referred to the sleep centre, and used to both examine reasons for access delays and to test alternative system configurations that were predicted by administrators to reduce waiting times. Four possible solutions were modelled and compared with baseline, including addition of capacity to different areas at the sleep centre and elimination of prioritization by urgency. Within the model, adding physician capacity improved time from patient referral to initial physician appointment, but worsened time from polysomnography requisition to test completion, and had no effect on time from patient referral to treatment initiation. Adding respiratory therapist did not improve model performance compared with baseline. Eliminating triage prioritization worsened time to physician assessment and treatment initiation for urgent patients without improving waiting times overall. This study demonstrates that discrete-event simulation can identify multiple constraints in access-limited healthcare systems and allow suggested solutions to be tested before implementation. The model of this sleep centre predicted that investments in capacity expansion proposed by administrators would not reduce the time to a clinically meaningful patient outcome.

  4. Improving our understanding of flood forecasting using earlier hydro-meteorological intelligence

    NASA Astrophysics Data System (ADS)

    Shih, Dong-Sin; Chen, Cheng-Hsin; Yeh, Gour-Tsyh

    2014-05-01

    In recent decades, Taiwan has suffered from severe bouts of torrential rain, and typhoon induced floods have become the major natural threat to Taiwan. In order to warn the public of potential risks, authorities are considering establishing an early warning system derived from an integrated hydro-meteorological estimation process. This study aims at the development and accuracy of such a warning system. So it is first necessary to understand the distinctive features of flood forecasting in integrated rainfall-runoff simulations. Additionally the adequacies of a warning system that is based on extracting useful intelligence from earlier, possibly faulty numerical simulation results are discussed. In order to precisely model flooding, hydrological simulations based upon spot measured rainfall data have been utilized in prior studies to calibrate model parameters. Here, precipitation inputs from an ensemble of almost 20 different realizations of rainfall fields have been used to derive flood forecasts. The flood warning system therefore integrates rainfall-runoff calculations, field observations and data assimilations. Simulation results indicate that the ensemble precipitation estimates generated by a Weather Research Forecasting (WRF) mesoscale model produce divergent estimates. Considerable flooding is often shown in the simulated hydrographs, but the results as to the peak time and peak stage are not always in agreement with the observations. In brief, such forecasts can be good for warning against potential damaging floods in the near future, but the meteorological inputs are not good enough to forecast the time and magnitude of the peaks. The key for such warning system is not to expect highly accurate rainfall predictions, but to improve our understanding from individual ensemble flood forecasts.

  5. Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach.

    PubMed

    Courtney-Pratt, Helen; Ford, Karen; Marlow, Annette

    2015-11-01

    Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders.

  6. Improving organizational climate for excellence in patient care.

    PubMed

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  7. Improving pain assessment and managment in stroke patients.

    PubMed

    Nesbitt, Julian; Moxham, Sian; Ramadurai, Gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief.

  8. Improving pain assessment and managment in stroke patients

    PubMed Central

    Nesbitt, Julian; Moxham, Sian; ramadurai, gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief. PMID:26732690

  9. Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

    PubMed Central

    2011-01-01

    Background In the last few years there seems to be an emerging interest for including the patients' perspective in assessing methadone maintenance treatment (MMT), with treatment satisfaction surveys being the most commonly-used method of incorporating this point of view. The present study considers the perspective of patients on MMT when assessing the outcomes of this treatment, acknowledging the validity of this approach as an indicator. The primary aim of this study is to evaluate the concordance between improvement assessment performed by two members of the clinical staff (a psychiatrist and a nurse) and assessment carried out by MMT patients themselves. Method Patients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively. Results The global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001). Conclusions MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves. PMID:21871064

  10. Informed consent in clinical research; Do patients understand what they have signed?

    PubMed

    Villamañán, Elena; Ruano, Margarita; Fernández-de Uzquiano, Enma; Lavilla, Paz; González, Diana; Freire, Mercedes; Sobrino, Carmen; Herrero, Alicia

    2016-05-01

    Informed consent is an essential element of research, and signing this document is required to conduct most clinical trials. Its aim is to inform patients what their participation in the study will involve. However, increasingly, their complexity and length are making them difficult to understand, which might lead patients to give their authorization without having read them previously or without having understood what is stated. In this sense, the Ethics Committees for Clinical Research, and Pharmacists specialized in Hospital Pharmacy and Primary Care in their capacity as members of said committees, play an important and difficult role in defending the rights of patients. These Committees will review thoroughly these documents to guarantee that all legal requirements have been met and, at the same time, that they are easy to understand by the potential participants in a clinical trial.

  11. [Does simulator-based team training improve patient safety?].

    PubMed

    Trentzsch, H; Urban, B; Sandmeyer, B; Hammer, T; Strohm, P C; Lazarovici, M

    2013-10-01

    Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.

  12. Patient-Provider Communication: Understanding the Role of Patient Activation for Latinos in Mental Health Treatment

    ERIC Educational Resources Information Center

    Cortes, Dharma E.; Mulvaney-Day, Norah; Fortuna, Lisa; Reinfeld, Sarah; Alegria, Margarita

    2009-01-01

    This article highlights results from the Right Question Project-Mental Health (RQP-MH), an intervention designed to teach skills in question formulation and to increase patients' participation in decisions about mental health treatment. Of participants in the RQP-MH intervention, 83% were from a Latino background, and 75% of the interviews were…

  13. Toward an improved understanding of the role of transpiration in critical zone dynamics

    NASA Astrophysics Data System (ADS)

    Mitra, B.; Papuga, S. A.

    2012-12-01

    Evapotranspiration (ET) is an important component of the total water balance across any ecosystem. In subalpine mixed-conifer ecosystems, transpiration (T) often dominates the total water flux and therefore improved understanding of T is critical for accurate assessment of catchment water balance and for understanding of the processes that governs the complex dynamics across critical zone (CZ). The interaction between T and plant vegetation not only modulates soil water balance but also influences water transit time and hydrochemical flux - key factors in our understanding of how the CZ evolves and responds. Unlike an eddy covariance system which provides only an integrated ET flux from an ecosystem, a sap flow system can provide an estimate of the T flux from the ecosystem. By isolating T, the ecohydrological drivers of this major water loss from the CZ can be identified. Still, the species composition of mixed-conifer ecosystems vary and the drivers of T associated with each species are expected to be different. Therefore, accurate quantification of T from a mixed-conifer requires knowledge of the unique transpiration dynamics of each of the tree species. Here, we installed a sap flow system within two mixed-conifer study sites of the Jemez River Basin - Santa Catalina Mountains Critical Zone Observatory (JRB - SCM CZO). At both sites, we identified the dominant tree species and installed sap flow sensors on healthy representatives for each of those species. At the JRB CZO site, sap sensors were installed in fir (4) and spruce (4) trees; at the SCM CZO site, sap sensors were installed at white fir (4) and maple (4) and one dead tree. Meteorological data as well as soil temperature (Ts) and soil moisture (θ) at multiple depths were also collected from each of the two sites. Preliminary analysis of two years of sap flux rate at JRB - SCM CZO shows that the environmental drivers of fir, spruce, and maple are different and also vary throughout the year. For JRB fir

  14. Improving Hypertension Control and Patient Engagement Using Digital Tools.

    PubMed

    Milani, Richard V; Lavie, Carl J; Bober, Robert M; Milani, Alexander R; Ventura, Hector O

    2017-01-01

    Hypertension is present in 30% of the adult US population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. We evaluated blood pressure control in 156 patients with uncontrolled hypertension enrolled into a home-based digital-medicine blood pressure program and compared them with 400 patients (matched to age, sex, body mass index, and blood pressure) in a usual-care group after 90 days. Digital-medicine patients completed questionnaires online, were asked to submit at least one blood pressure reading/week, and received medication management and lifestyle recommendations via a clinical pharmacist and a health coach. Blood pressure units were commercially available that transmitted data directly to the electronic medical record. Digital-medicine patients averaged 4.2 blood pressure readings per week. At 90 days, 71% of digital-medicine vs 31% of usual-care patients had achieved target blood pressure control. Mean decrease in systolic/diastolic blood pressure was 14/5 mm Hg in digital medicine, vs 4/2 mm Hg in usual care (P < .001). Excess sodium consumption decreased from 32% to 8% in the digital-medicine group (P = .004). Mean patient activation increased from 41.9 to 44.1 (P = .008), and the percentage of patients with low patient activation decreased from 15% to 6% (P = .03) in the digital-medicine group. A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change. Utilization of a virtual health intervention using connected devices improves patient activation and is well accepted by patients.

  15. Development and Evaluation of an Intervention to Improve Further Education Students' Understanding of Higher Education Assessment Criteria: Three Studies

    ERIC Educational Resources Information Center

    Jessen, Anna; Elander, James

    2009-01-01

    This paper reports three studies about preparing Further Education (FE) students for the transition to Higher Education (HE) by improving their understanding of HE assessment criteria. In study 1, students and tutors in both FE and HE were interviewed for a qualitative analysis of their understandings and expectations about assessment criteria. In…

  16. Current multiple sclerosis treatments have improved our understanding of MS autoimmune pathogenesis.

    PubMed

    Martin, Roland; Sospedra, Mireia; Rosito, Maria; Engelhardt, Britta

    2016-09-01

    Multiple sclerosis (MS) is the most common inflammatory disorder of the central nervous system (CNS) in young adults. When MS is not treated, it leads to irreversible and severe disability. The etiology of MS and its pathogenesis are not fully understood. The recent discovery that MS-associated genetic variants code for molecules related to the function of specific immune cell subsets is consistent with the concept of MS as a prototypic, T-cell-mediated autoimmune disease targeting the CNS. While the therapeutic efficacy of the currently available immunomodulatory therapies further strengthen this concept, differences observed in responses to MS treatment as well as additional clinical and imaging observations have also shown that the autoimmune pathogenesis underlying MS is much more complex than previously thought. There is therefore an unmet need for continued detailed phenotypic and functional analysis of disease-relevant adaptive immune cells and tissues directly derived from MS patients to unravel the immune etiology of MS in its entire complexity. In this review, we will discuss the currently available MS treatment options and approved drugs, including how they have contributed to the understanding of the immune pathology of this autoimmune disease.

  17. Understanding Variability in Beach Slope to Improve Forecasts of Storm-induced Water Levels

    NASA Astrophysics Data System (ADS)

    Doran, K. S.; Stockdon, H. F.; Long, J.

    2014-12-01

    The National Assessment of Hurricane-Induced Coastal Erosion Hazards combines measurements of beach morphology with storm hydrodynamics to produce forecasts of coastal change during storms for the Gulf of Mexico and Atlantic coastlines of the United States. Wave-induced water levels are estimated using modeled offshore wave height and period and measured beach slope (from dune toe to shoreline) through the empirical parameterization of Stockdon et al. (2006). Spatial and temporal variability in beach slope leads to corresponding variability in predicted wave setup and swash. Seasonal and storm-induced changes in beach slope can lead to differences on the order of a meter in wave runup elevation, making accurate specification of this parameter essential to skillful forecasts of coastal change. Spatial variation in beach slope is accounted for through alongshore averaging, but temporal variability in beach slope is not included in the final computation of the likelihood of coastal change. Additionally, input morphology may be years old and potentially very different than the conditions present during forecast storm. In order to improve our forecasts of hurricane-induced coastal erosion hazards, the temporal variability of beach slope must be included in the final uncertainty of modeled wave-induced water levels. Frequently collected field measurements of lidar-based beach morphology are examined for study sites in Duck, North Carolina, Treasure Island, Florida, Assateague Island, Virginia, and Dauphin Island, Alabama, with some records extending over a period of 15 years. Understanding the variability of slopes at these sites will help provide estimates of associated water level uncertainty which can then be applied to other areas where lidar observations are infrequent, and improve the overall skill of future forecasts of storm-induced coastal change. Stockdon, H. F., Holman, R. A., Howd, P. A., and Sallenger Jr, A. H. (2006). Empirical parameterization of setup

  18. Improved radiographic outcomes with patient-specific total knee arthroplasty.

    PubMed

    Ivie, Conrad B; Probst, Patrick J; Bal, Amrit K; Stannard, James T; Crist, Brett D; Sonny Bal, B

    2014-11-01

    Patient-specific guides can improve limb alignment and implant positioning in total knee arthroplasty, although not all studies have supported this benefit. We compared the radiographs of 100 consecutively-performed patient-specific total knees to a similar group that was implanted with conventional instruments instead. The patient-specific group showed more accurate reproduction of the theoretically ideal mechanical axis, with fewer outliers, but implant positioning was comparable between groups. Our odds ratio comparison showed that the patient-specific group was 1.8 times more likely to be within the desired +3° from the neutral mechanical axis when compared to the standard control group. Our data suggest that reliable reproduction of the limb mechanical axis may accrue from patient-specific guides in total knee arthroplasty when compared to standard, intramedullary instrumentation.

  19. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  20. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed Central

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers’ income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  1. Looking beyond historical patient outcomes to improve clinical models.

    PubMed

    Chia, Chih-Chun; Rubinfeld, Ilan; Scirica, Benjamin M; McMillan, Sean; Gurm, Hitinder S; Syed, Zeeshan

    2012-04-25

    Conventional algorithms for modeling clinical events focus on characterizing the differences between patients with varying outcomes in historical data sets used for the model derivation. For many clinical conditions with low prevalence and where small data sets are available, this approach to developing models is challenging due to the limited number of positive (that is, event) examples available for model training. Here, we investigate how the approach of developing clinical models might be improved across three distinct patient populations (patients with acute coronary syndrome enrolled in the DISPERSE2-TIMI33 and MERLIN-TIMI36 trials, patients undergoing inpatient surgery in the National Surgical Quality Improvement Program registry, and patients undergoing percutaneous coronary intervention in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry). For each of these cases, we supplement an incomplete characterization of patient outcomes in the derivation data set (uncensored view of the data) with an additional characterization of the extent to which patients differ from the statistical support of their clinical characteristics (censored view of the data). Our approach exploits the same training data within the derivation cohort in multiple ways to improve the accuracy of prediction. We position this approach within the context of traditional supervised (2-class) and unsupervised (1-class) learning methods and present a 1.5-class approach for clinical decision-making. We describe a 1.5-class support vector machine (SVM) classification algorithm that implements this approach, and report on its performance relative to logistic regression and 2-class SVM classification with cost-sensitive weighting and oversampling. The 1.5-class SVM algorithm improved prediction accuracy relative to other approaches and may have value in predicting clinical events both at the bedside and for risk-adjusted quality of care assessment.

  2. Improvements to the Interpretation and Understanding of SXR Tomography Measurements on MST

    NASA Astrophysics Data System (ADS)

    Vanmeter, Patrick; Franz, Paolo; Reusch, Lisa; Goetz, John; den Hartog, Daniel

    2016-10-01

    The soft x-ray (SXR) tomography system on MST uses four cameras in a double foil configuration to determine the emissivity and temperature structures of the plasma. The emissivity is due to a combination of bremsstrahlung, recombination, and line radiation due to impurities in the plasma. At higher energies recombination steps and line radiation are no longer present and can therefore be removed using thick filters. However, this limits the range of measurements to high temperature, high performance plasmas. Recent analysis focuses on including these additional sources of radiation in order to extend the effective range of SXR measurements and to explore the agreement of SXR measurements with other diagnostics like the external magnetic sensing coils. The SXR emissivity structure should directly correspond to the structure of the magnetic field; however, there is a discrepancy between the phase of the emissivity reconstructions and magnetic field reconstructions when using a cylindrical approximation to interpret the magnetic signals. This discrepancy was measured for each SXR camera viewing angle and for two distinct plasma conditions, with results supporting the interpretation that it emerges from physical effects of the toroidal geometry. Improving the understanding of these toroidal effects and the effects of radiation from impurity ions will aid in the interpretation of all SXR measurements. Supported by the US DOE.

  3. The Promise and Limitations of Using Analogies to Improve Decision-Relevant Understanding of Climate Change

    PubMed Central

    Stern, Paul C.; Maki, Alexander

    2017-01-01

    To make informed choices about how to address climate change, members of the public must develop ways to consider established facts of climate science and the uncertainties about its future trajectories, in addition to the risks attendant to various responses, including non-response, to climate change. One method suggested for educating the public about these issues is the use of simple mental models, or analogies comparing climate change to familiar domains such as medical decision making, disaster preparedness, or courtroom trials. Two studies were conducted using online participants in the U.S.A. to test the use of analogies to highlight seven key decision-relevant elements of climate change, including uncertainties about when and where serious damage may occur, its unprecedented and progressive nature, and tradeoffs in limiting climate change. An internal meta-analysis was then conducted to estimate overall effect sizes across the two studies. Analogies were not found to inform knowledge about climate literacy facts. However, results suggested that people found the medical analogy helpful and that it led people—especially political conservatives—to better recognize several decision-relevant attributes of climate change. These effects were weak, perhaps reflecting a well-documented and overwhelming effect of political ideology on climate change communication and education efforts in the U.S.A. The potential of analogies and similar education tools to improve understanding and communication in a polarized political environment are discussed. PMID:28135337

  4. A belowground perspective on the drought sensitivity of forests: Towards improved understanding and simulation

    DOE PAGES

    Phillips, Richard P.; Ibanez, Ines; D’Orangeville, Loic; ...

    2016-09-13

    Predicted increases in the frequency and intensity of droughts across the temperate biome have highlighted the need to examine the extent to which forests may differ in their sensitivity to water stress. At present, a rich body of literature exists on how leaf- and stem-level physiology influence tree drought responses; however, less is known regarding the dynamic interactions that occur below ground between roots and soil physical and biological factors. Hence, there is a need to better understand how and why processes occurring below ground influence forest sensitivity to drought. Here, we review what is known about tree species’ belowmore » ground strategies for dealing with drought, and how physical and biological characteristics of soils interact with rooting strategies to influence forest sensitivity to drought. Then, we highlight how a below ground perspective of drought can be used in models to reduce uncertainty in predicting the ecosystem consequences of droughts in forests. Lastly, we describe the challenges and opportunities associated with managing forests under conditions of increasing drought frequency and intensity, and explain how a below ground perspective on drought may facilitate improved forest management.« less

  5. A belowground perspective on the drought sensitivity of forests: Towards improved understanding and simulation

    SciTech Connect

    Phillips, Richard P.; Ibanez, Ines; D’Orangeville, Loic; Hanson, Paul J.; Ryan, Michael G.; McDowell, Nathan G.

    2016-09-13

    Predicted increases in the frequency and intensity of droughts across the temperate biome have highlighted the need to examine the extent to which forests may differ in their sensitivity to water stress. At present, a rich body of literature exists on how leaf- and stem-level physiology influence tree drought responses; however, less is known regarding the dynamic interactions that occur below ground between roots and soil physical and biological factors. Hence, there is a need to better understand how and why processes occurring below ground influence forest sensitivity to drought. Here, we review what is known about tree species’ below ground strategies for dealing with drought, and how physical and biological characteristics of soils interact with rooting strategies to influence forest sensitivity to drought. Then, we highlight how a below ground perspective of drought can be used in models to reduce uncertainty in predicting the ecosystem consequences of droughts in forests. Lastly, we describe the challenges and opportunities associated with managing forests under conditions of increasing drought frequency and intensity, and explain how a below ground perspective on drought may facilitate improved forest management.

  6. The Promise and Limitations of Using Analogies to Improve Decision-Relevant Understanding of Climate Change.

    PubMed

    Raimi, Kaitlin T; Stern, Paul C; Maki, Alexander

    2017-01-01

    To make informed choices about how to address climate change, members of the public must develop ways to consider established facts of climate science and the uncertainties about its future trajectories, in addition to the risks attendant to various responses, including non-response, to climate change. One method suggested for educating the public about these issues is the use of simple mental models, or analogies comparing climate change to familiar domains such as medical decision making, disaster preparedness, or courtroom trials. Two studies were conducted using online participants in the U.S.A. to test the use of analogies to highlight seven key decision-relevant elements of climate change, including uncertainties about when and where serious damage may occur, its unprecedented and progressive nature, and tradeoffs in limiting climate change. An internal meta-analysis was then conducted to estimate overall effect sizes across the two studies. Analogies were not found to inform knowledge about climate literacy facts. However, results suggested that people found the medical analogy helpful and that it led people-especially political conservatives-to better recognize several decision-relevant attributes of climate change. These effects were weak, perhaps reflecting a well-documented and overwhelming effect of political ideology on climate change communication and education efforts in the U.S.A. The potential of analogies and similar education tools to improve understanding and communication in a polarized political environment are discussed.

  7. Long-range correlations improve understanding of the influence of network structure on contact dynamics.

    PubMed

    Peyrard, N; Dieckmann, U; Franc, A

    2008-05-01

    Models of infectious diseases are characterized by a phase transition between extinction and persistence. A challenge in contemporary epidemiology is to understand how the geometry of a host's interaction network influences disease dynamics close to the critical point of such a transition. Here we address this challenge with the help of moment closures. Traditional moment closures, however, do not provide satisfactory predictions close to such critical points. We therefore introduce a new method for incorporating longer-range correlations into existing closures. Our method is technically simple, remains computationally tractable and significantly improves the approximation's performance. Our extended closures thus provide an innovative tool for quantifying the influence of interaction networks on spatially or socially structured disease dynamics. In particular, we examine the effects of a network's clustering coefficient, as well as of new geometrical measures, such as a network's square clustering coefficients. We compare the relative performance of different closures from the literature, with or without our long-range extension. In this way, we demonstrate that the normalized version of the Bethe approximation-extended to incorporate long-range correlations according to our method-is an especially good candidate for studying influences of network structure. Our numerical results highlight the importance of the clustering coefficient and the square clustering coefficient for predicting disease dynamics at low and intermediate values of transmission rate, and demonstrate the significance of path redundancy for disease persistence.

  8. Concurrent Chemoradiotherapy Improves Survival in Patients With Hypopharyngeal Cancer

    SciTech Connect

    Paximadis, Peter; Yoo, George; Lin, Ho-Sheng; Jacobs, John; Sukari, Ammar; Dyson, Greg; Christensen, Michael; Kim, Harold

    2012-03-15

    Purpose: To retrospectively review our institutional experience with hypopharyngeal carcinoma with respect to treatment modality. Methods and Materials: A total of 70 patients with hypopharyngeal cancer treated between 1999 and 2009 were analyzed for functional and survival outcomes. The treatments included surgery alone (n = 5), surgery followed by radiotherapy (RT) (n = 3), surgery followed by chemoradiotherapy (CRT) (n = 13), RT alone (n = 2), CRT alone (n = 22), induction chemotherapy followed by RT (n = 3), and induction chemotherapy followed by CRT (n = 22). Results: The median follow-up was 18 months. The median overall survival and disease-free survival for all patients was 28.3 and 17.6 months, respectively. The 1- and 2-year local control rate for all patients was 87.1% and 80%. CRT, given either as primary therapy or in the adjuvant setting, improved overall survival and disease-free survival compared with patients not receiving CRT. The median overall survival and disease-free survival for patients treated with CRT was 36.7 and 17.6 months vs. 14.0 and 8.0 months, respectively (p < .01). Of the patients initially treated with an organ-preserving approach, 4 (8.2%) required salvage laryngectomy for local recurrence or persistent disease; 8 (16.3%) and 12 (24.5%) patients were dependent on a percutaneous gastrostomy and tracheostomy tube, respectively. The 2-year laryngoesophageal dysfunction-free survival rate for patients treated with an organ-preserving approach was estimated at 31.7%. Conclusions: Concurrent CRT improves survival in patients with hypopharyngeal cancer. CRT given with conventional radiation techniques yields poor functional outcomes, and future efforts should be directed at determining the feasibility of pharyngeal-sparing intensity-modulated radiotherapy in patients with hypopharyngeal tumors.

  9. Improved understanding and control of magnesium-doped gallium nitride by plasma assisted molecular beam epitaxy

    NASA Astrophysics Data System (ADS)

    Burnham, Shawn D.

    By an improved understanding of Mg-doped GaN through an exhaustive review of current limitations, increased control over the material was achieved by addressing several of these issues. To address the issues of the memory effect, low sticking coefficient and high vapor pressure of Mg, a new Mg dopant source was implemented, characterized and modeled for p-type doping of GaN. The device enhanced the sticking coefficient of Mg by energizing the outgoing Mg flux, and also allowed the first reported demonstration of an abrupt junction between two non-zero Mg concentrations and a graded Mg-doped GaN film. The significant compensation of Mg acceptors at high dopant concentrations was used advantageously to develop a new ex situ resistivity analysis technique using the energy distributions of SIMS to characterize doping of buried layers. The new technique was used to identify the barrier between conductive and resistive Mg doping for increased Mg concentration, which was then used to optimize Mg-doped GaN. Because Mg doping exhibits a dependence upon the growth regime, a new growth and regime characterization technique was developed using specific RHEED intensity responses to repeat growth conditions. During the development of this technique, a new surface kinetics growth model for III-nitrides was discovered based on DMS observations, which suggests preferential buildup of the metal bilayer before growth begins with an unfamiliar cation-anion exchange process initially upon metal shutter opening. Using the new RHEED growth and regime characterization technique, a new growth technique called metal modulated epitaxy (MME) was developed to increase repeatability, uniformity and smoothness. The MME technique was enhanced with a closed-loop control using real-time feedback from RHEED transients to control shutter transitions. This enhancement, called "smart shuttering," led to improved growth rate and further improvement of surface roughness and grain size, which were

  10. Applicability and importance of Caraka's concept of Aaturaparijnana Hetawah in understanding a patient.

    PubMed

    Wadher, Rupesh; Dwivedi, Rambabu R

    2012-04-01

    Many concepts in Ayurveda are untouched or unexplored till date. One of such concepts to understand the healthy and unhealthy persons is that of the Aaturaparijnana Hetawah (APH), which is only mentioned in Caraka Samhita. The descriptions about Dushya, Desha, Bala, Kala, Prakriti, etc. are mentioned very briefly in all the classics. But no standard figure or pattern is maintained while considering them. It is only in the description of Aaturaparijnana Hetawah mentioned in Vimana Sthana that all the factors are pre-arranged in a chronological order to understand an individual according to one's Desha as from birth till grown up stage, and also to understand about the illness and most common disorders. In this article, it is aimed at presenting an in-depth evaluation about description of Aaturaparijnana Hetawah in Ayurveda. For this study, the references of Aturaparijnana Hetu have been collected through the Ayurvedic texts along with their commentaries. By making use of 14 factors described in Aaturaparijnana Hetawah, it is possible to have an in depth understanding about the patient's nature and factors that may be contributing to his health and illness. Aaturaparijnana Hetawah helps in an in-depth understanding of a patient's disease and heath status. More in-depth evaluation studies and application in the modern medical science should be done in order to avail the benefits of this approach.

  11. Amantadine improves gait in PD patients with STN stimulation.

    PubMed

    Chan, Hiu-Fai; Kukkle, Prashanth L; Merello, Marcelo; Lim, Shen-Yang; Poon, Yu-Yan; Moro, Elena

    2013-03-01

    In advanced Parkinson's disease (PD), axial symptoms such as speech, gait, and balance impairment often become levodopa-unresponsive and they are difficult to manage, even in patients with subthalamic nucleus deep brain stimulation (STN-DBS). We anecdotally observed that oral administration of amantadine was very effective in treating both residual and stimulation-induced axial symptoms after bilateral STN-DBS in one PD patient. Therefore, we conducted a prospective multicenter observational study to evaluate the effects of amantadine on speech, gait and balance in PD patients with STN-DBS and incomplete axial benefit. Primary outcomes were changes in speech (UPDRS III, item 18), gait (item 29) and postural stability (item 30) with amantadine treatment compared to baseline. Secondary outcome was the patients' subjective scoring of axial symptoms with amantadine compared to baseline. Forty-six PD patients with STN-DBS were enrolled in the study and followed for 10.35 ± 8.21 months (median: 9.00; range: 1-31). The mean daily dose of amantadine was 273.44 ± 47.49 mg. Gait scores significantly improved (from 1.51 ± 0.89 to 1.11 ± 0.92, P = 0.015) with amantadine treatment, whereas postural stability and speech scores were similar before and after treatment. Thirty-five (76.1%) patients reported subjective improvement in speech, gait or balance with amantadine, whereas thirty (65.2%) patients reported improvement in gait and balance. In conclusion, our data suggest that amantadine may have new beneficial effects on axial symptoms in PD patients with STN-DBS.

  12. Polymer Solar Cells: Understanding Solvent Interactions and Morphology, and Strategies for Efficiency Improvements

    NASA Astrophysics Data System (ADS)

    Chang, Lilian

    Organic solar cells have the potential to be unrivaled in terms of processing cost, speed, and simplicity. The simplest of such devices consists of a single bulk-heterojunction (BHJ) active layer, in which the electron donor (conjugated polymer) and electron acceptor (fullerene) are deposited from a common solvent. The performance of BHJ solar cells is strongly correlated with the nanoscale structure of the active layer. Various processing techniques have been explored to improve the nanoscale morphology of the BHJ layer, e.g. by varying the casting solvent, thermal annealing, solvent annealing, and solvent additives. An understanding of the role of residual solvent in the BHJ layer is imperative in order to develop strategies for morphology stabilization and preserve the longevity of the device. This work highlights the effect of residual solvents on acceptor, (6,6)-phenyl-C61-butyric acid methyl ester (PCBM) diffusion and ultimately the stability of the morphology. We first show that solvent is retained within the BHJ film despite prolonged heat treatment, leading to extensive phase separation between poly(3-hexylthiophene) (P3HT) and PCBM. We then show that the addition of a small volume fraction of nitrobenzene to the casting solution inhibits the diffusion of PCBM in the film and improves the fill factor of the BHJ device without further tempering. Other commonly used additives for morphology improvement were also investigated, i.e. 1,8-diiodooctane and 1-chloronaphthalene. We show that the choice of solvent additives has direct implications on morphological evolution, i.e. P3HT:PCBM BHJ films processed with a small amount of 1,8-diiodooctane or 1-chloronaphthalene have more crystalline PCBM domains compared to crystalline P3HT domains, while the opposite is true for films cast with nitrobenzene additive and films cast purely from chlorobenzene. The BHJ film cross-links when annealed at 300°C in the presence of 1,8-diiodooctane. Cross-linking is found to

  13. Can pegylated interferon improve the outcome of polycythemia vera patients?

    PubMed

    Crisà, Elena; Cerrano, Marco; Beggiato, Eloise; Benevolo, Giulia; Lanzarone, Giuseppe; Manzini, Paola Maria; Borchiellini, Alessandra; Riera, Ludovica; Boccadoro, Mario; Ferrero, Dario

    2017-01-13

    Pegylated interferon (peg-IFN) was proven by phase II trials to be effective in polycythemia vera (PV); however, it is not clear whether it could improve patient outcome compared to hydroxyurea (HU). Here, we present an observational study on 65 PV patients aged 65 years or younger, who received either peg-IFN (30) or HU (35) according to the physician choice. Median follow-up was 75 months. The two cohorts were comparable for patient and disease characteristics. Eighty-seven percent of the patients treated with peg-INF responded, with a CR rate of 70% as compared to 100 and 49% with HU, respectively. Discontinuation rate was similar in the two groups (20% in peg-IFN vs 17% in HU). JAK2 allele burden was monitored in peg-INF arm only, and a reduction was observed in 88% of the patients. No thrombotic events were observed during peg-IFN treatment compared to three on HU. Disease progression to myelofibrosis or acute myeloid leukemia occurred to a patient only in peg-INF, compared to three in HU. Overall, three second malignancies were observed during the study, two in patients who received HU only, and one in a patient largely treated HU who received also peg-IFN for 3 months. Overall survival was significantly better for peg-IFN patients compared to HU, p = 0.027. Our study, albeit limited by small patient and event number and lack of randomization, confirms the efficacy of peg-INF in PV and shows a significant survival advantage for peg-INF-treated patients. Waiting for confirming data from the ongoing phase III trials, our study can support peg-INF as a first-line treatment option for PV, at least for younger patients.

  14. Do endobronchial valves improve outcomes in patients with emphysema?

    PubMed

    Barua, Anupama; Vaughan, Paul; Wotton, Robin; Naidu, Babu

    2012-12-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether endobronchial valves improve outcomes in patients with severe emphysema. Eighty-seven papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Endobronchial Valve for Emphysema Palliation Trial demonstrated that endobronchial valve increased forced expiratory volume in one second by 4.3% (95% confidence interval 1.4-7.2) and decreased by 2.5% in the control group (95% confidence interval -5.4 to 0.4) at a 6-month interval. This benefit is more marked in patients who do not have collateral ventilation into the area of lung being isolated as mapped by bronchoscopic physiological mapping (Chartis) or by computed tomography imaging documenting intact fissures. This evidence is reflected in the Endobronchial Valve for Emphysema Palliation Trial. Patients treated with endobronchial valve with high heterogeneity and complete fissures had greater improvement in forced expiratory volume in one second at 6- and 12-month intervals. We conclude that endobronchial valve placement improves lung function, exercise capacity and quality of life in selected patients with emphysematous diseases.

  15. Understanding recurrent herpes labialis management and impact on patients' quality of life: the HERPESCOPE study.

    PubMed

    Dreno, Brigitte; Malkin, Jean-Elie; Saiag, Philippe

    2013-01-01

    Herpes labialis (HL) is a common and benign disease. However, frequent episodes can impair quality of life (QoL) and impact healthcare consumption. The aim of this survey was to understand patients' profiles, behavior, treatment and quality of life, using web-based questionnaires administered in the USA and in France. A total of 1002 and 1005 patients completed it, respectively. Self-diagnosis of HL is usually made at the very start of the prodromal phase. In the USA, 41% of patients seek medical advice at some point and they are often prescribed a topical antiviral drug (AVD) associated with an over-the-counter drug. Those who treat HL by themselves purchase mainly non-antiviral topical drugs. In France, the treatment is almost identical (topical AVD) whether patients seek medical advice (32%) or not. In both countries, patients with 6 or more annual episodes often go to the doctor and use systemic AVD. Continuous treatment is prescribed to 55% and 35% of patients with at least 4 annual episodes, in the USA and France respectively. Sick leaves are delivered to 33% and 14% of patients, respectively. QoL is significantly impaired in a majority of patients, all the more so when HL episodes are more frequent.

  16. Understanding “revolving door” patients in general practice: a qualitative study

    PubMed Central

    2014-01-01

    Background ‘Revolving door’ patients in general practice are repeatedly removed from general practitioners’ (GP) lists. This paper reports a qualitative portion of the first mixed methods study of these marginalised patients. Methods We conducted qualitative semi-structured interviews with six practitioner services staff and six GPs in Scotland, utilizing Charmazian grounded theory to characterise ‘revolving door’ patients and their impact from professionals’ perspectives. Results ‘Revolving door’ patients were reported as having three necessary characteristics; they had unreasonable expectations, exhibited inappropriate behaviours and had unmet health needs. A range of boundary breaches were reported too when ‘revolving door’ patients interacted with NHS staff. Conclusions We utilise the ‘sensitising concepts’ of legitimacy by drawing on literature about ‘good and bad’ patients and ‘dirty work designations.’ We relate these to the core work of general practice and explore the role that medical and moral schemas have in how health service professionals understand and work with ‘revolving door’ patients. We suggest this may have wider relevance for the problem doctor patient relationship literature. PMID:24524363

  17. [Understanding the seriously ill patient and his family at the domiciliary reality].

    PubMed

    Freire, Geruza Diogo; de Campos, Débora Rebollo; Boemer, Magali Roseira

    2004-12-01

    The purpose of this study is to understand the reality of living with a seriously ill patient, from the point of view of the carer family member. We have contacted families who cared for seriously ill family members at home. Our intent was to understand the essence of the meaning of this situation for the carer family member. This was a qualitative study that relied on the theoretical and methodological framework of phenomenology. Thematic categories emerged from the careful analysis of testimonies of the carer family member, pointing to the essence of the day-to-day experience of providing this care.

  18. Understanding Teacher Effectiveness: Significant State Data Capacity Is Required to Measure and Improve Teacher Effectiveness. Data for Action 2012

    ERIC Educational Resources Information Center

    Data Quality Campaign, 2012

    2012-01-01

    States are increasingly focused on understanding and improving teacher effectiveness. There are several funding opportunities that incentivize states to use data to inform measurements of teacher effectiveness. Local, state, and federal efforts support using data to improve teacher preparation programs. Preparation programs seek "access to data…

  19. Faster Cancer Treatment: Using timestamp data to improve patient journeys.

    PubMed

    Walker, C G; O'Sullivan, M J; Ziedins, I; Furian, N

    2016-12-01

    This paper presents a case study of research conducted to improve the delivery of treatment to high priority cancer patients. The authors present a modelling framework that uses time-stamp data collected by the North Shore Hospital IT systems as "business as usual", to describe the patient journey through the cancer-care process. A simulation process is developed that uses this data to estimate the service's performance under current operating practices, and enables "what-if" analysis to identify where changes to current practice can most effectively be applied, ensuring the investment of additional resource can be targeted at the steps of the patient pathway where it can result in the greatest improvement. The process is illustrated using the Breast Cancer stream as a case-study, for the initial study period (July 2013 to June 2014), with a follow-up analysis presented briefly for the 3 months from July to the end of September 2014.

  20. A threat to the understanding of oneself: Intensive care patients' experiences of dependency

    PubMed Central

    Lykkegaard, Kristina; Delmar, Charlotte

    2013-01-01

    This study examines the meaning of dependency on care as experienced by intensive care patients. Literature on the subject is sparse, but research from nonintensive settings shows that dependency is often experienced negatively. The study is based on in-depth qualitative semistructured interviews with three former patients characterized as narratives. The analysis is inspired by a phenomenological hermeneutical method. The study has found that dependency is experienced as difficult and that the experience seems to be attached to the relationship to oneself. Patients feel powerless and experience shame, their understanding of self is threatened, and they fight for independence in the course after intensive care. The findings might be influenced by the study being conducted in a Western country setting, where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation. PMID:23809023

  1. A threat to the understanding of oneself: intensive care patients' experiences of dependency.

    PubMed

    Lykkegaard, Kristina; Delmar, Charlotte

    2013-06-28

    This study examines the meaning of dependency on care as experienced by intensive care patients. Literature on the subject is sparse, but research from nonintensive settings shows that dependency is often experienced negatively. The study is based on in-depth qualitative semistructured interviews with three former patients characterized as narratives. The analysis is inspired by a phenomenological hermeneutical method. The study has found that dependency is experienced as difficult and that the experience seems to be attached to the relationship to oneself. Patients feel powerless and experience shame, their understanding of self is threatened, and they fight for independence in the course after intensive care. The findings might be influenced by the study being conducted in a Western country setting, where independence is valued. They can be used as means of reflection on nursing practice and matters such as communication and patient participation.

  2. Heliophysics 2009 Roadmap and Global Change: Possibilities for Improved Understanding of the Connection

    NASA Technical Reports Server (NTRS)

    Spann, Jim

    2010-01-01

    Heliophysics is the science that includes all aspects of the research needed to understand the Sun and its effects on the Earth and the solar system. Six science targets: 1. Origins of Near-Earth Plasma - to understand the origin and transport of terrestrial plasma from its source to the magnetosphere and solar wind. 2. Solar Energetic Particle Acceleration and Transport - to understand how and where solar eruptions accelerate energetic particles that reach Earth. 3. Ion-Neutral Coupling in the Atmosphere - to understand how neutral winds control ionospheric variability. 4. Climate Impacts of Space Radiation - to understand our atmosphere s response to auroral, radiation belt, and solar energetic particles, and the associated effects on nitric oxide (NO) and ozone. 5. Dynamic Geospace Coupling - to understand how magnetospheric dynamics provides energy into the coupled ionosphere-magnetosphere system. 6. Heliospheric Magnetics - to understand the flow and dynamics of transient magnetic structures form the solar interior to Earth.

  3. Understanding and improving the mechanical stability of semiconducting polymers for flexible and stretchable electronics

    NASA Astrophysics Data System (ADS)

    Printz, Adam David

    Polymeric semiconductors offer the promise of low-cost, printable, and mechanically robust electronic devices for use in outdoor, portable, and wearable applications such as organic photovoltaics, biosensors, and electronic skins. However, many organic semiconductors are unable to accommodate the mechanical stresses these applications require, and it is therefore important to understand the factors and parameters that govern the mechanical stability of these materials. Chapter 1 provides a gentle introduction to the electronic and mechanical properties relevant to flexible and stretchable organic semiconductor devices. The idea of inherent competition between electronic performance and mechanical robustness is explored. Chapter 2 investigates the inherent competition between good electronic performance and mechanical robustness in poly(3-alkylthiophene)s. A key finding is a critical alkyl side-chain length that allows for good electronic performance and mechanical compliance. Chapter 3 and Appendix A are further studies on the properties of poly(3-alkylthiophene)s with side-chains close to the critical length to gain better understanding of the transition from good electronic properties and poor mechanical properties to poor electronic properties and good mechanical properties. Chapter 4 and Appendix B detail the effects on mechanical and electronic properties of statistical incorporation of unlike monomer into a low-bandgap polymer backbone in an effort to disrupt aggregation and improve mechanical compliance. Chapter 5 explores how the extent of molecular mixing of polythiophenes and fullerenes---materials common in organic photovoltaics---affects their mechanical properties. Chapter 6 describes the invention of a new technique to determine the yield point of thin films. A dependence on the alkyl-side chain length is observed, as well as a critical film thickness below which the yield point increases substantially. In Chapter 7, the weakly interacting H

  4. Periglacial process research for improved understanding of climate change in periglacial environments

    NASA Astrophysics Data System (ADS)

    Hvidtfeldt Christiansen, Hanne

    2010-05-01

    Periglacial landscapes extend widely outside the glaciated areas and the areas underlain by permafrost and with seasonal frost. Yet recently significant attention has in cryosphere research, related to periglacial geomorphology, been given to a direct climate permafrost relationship. The focus is on the permafrost thermal state including the thickness of the active layer, and often simplifying how these two key conditions are directly climatically controlled. There has been less focus on the understanding and quantification of the different periglacial processes, which largely control the consequences of changing climatic conditions on the permafrost and on seasonal frost all over the periglacial environments. It is the complex relationship between climate, micro-climate and local geomorphological, geological and ecological conditions, which controls periglacial processes. In several cases local erosion or deposition will affect the rates of landform change significantly more than any climate change. Thus detailed periglacial process studies will sophisticate the predictions of how periglacial landscapes can be expected to respond to climatic changes, and be built into Earth System Modelling. Particularly combining direct field observations and measurements with remote sensing and geochronological studies of periglacial landforms, enables a significantly improved understanding of periglacial process rates. An overview of the state of research in key periglacial processes are given focusing on ice-wedges and solifluction landforms, and seasonal ground thermal dynamics, all with examples from the high Arctic in Svalbard. Thermal contraction cracking and its seasonal meteorological control is presented, and potential thermal erosion of ice-wedges leading to development of thermokarst is discussed. Local and meteorological controls on solifluction rates are presented and their climatic control indicated. Seasonal ground thermal processes and their dependence on local

  5. Patients' complaints as a management tool for continuous quality improvement.

    PubMed

    Javetz, R; Stern, Z

    1996-01-01

    Continuous quality improvement focuses on the customer and, therefore, requires attention to customers' feedback as a vital input. Customers' feedback in general hospitals includes utilization statistics of various services, patient satisfaction surveys and patients' complaints. The role of complaint data as a management tool, and particularly as applied to quality improvement, has received little attention in the literature. As a quality control tool, complaints are investigated on the individual, unit and organizational levels. Repeated complaints about the same units, procedures or individuals, are especially important for quality review. The role of the hospital administration is to draw on the human, technological and procedural resources at its disposal, along a solution time interval (immediate, short and long term), in designing its policy for quality improvement. Presents three examples of policy changes. The aggregate of complaint data serves, in addition, for follow-up of the effect of changes introduced by policy decisions.

  6. Cardiac rehabilitation improves the blood plasma properties of cardiac patients.

    PubMed

    Gwoździński, Krzysztof; Pieniążek, Anna; Czepas, Jan; Brzeszczyńska, Joanna; Jegier, Anna; Pawlicki, Lucjan

    2016-11-01

    Cardiac rehabilitation (CR) improves exercise tolerance and general function. However, its effects on blood plasma in cardiac patients remain uncertain. Our aim was to examine the effect of comprehensive CR on the oxidative stress parameters and antioxidant plasma status in patients with coronary artery disease (CAD) after cardiac interventions. Exercise-based rehabilitation was established as ergometer training, adjusted for individual patients' physical efficiency. Training was repeated three times a week for two months. The standard biochemical (total cholesterol, HDL, LDL, triglycerides and erythrocyte sedimentation rate) and metabolic parameters (peak oxygen uptake [VO2] and peak workload) were determined. We assessed plasma viscosity, lipid peroxidation, carbonyl compounds levels, glutathione (GSH) and ascorbate (ASC) levels and the non-enzymatic antioxidant capacity of plasma in 12 patients with CAD before and after CR. Parameters were examined before exercise, immediately after exercise, and 1 h later. We also compared morphological and biochemical parameters of blood, as well as other parameters such as heart rate and blood pressure (resting and exercise), VO2max and peak workload (W) before and after CR. Before CR, a significant decrease in GSH concentration was observed 1 h after exercise. Conversely, after CR, GSH, and ASC levels remained unchanged immediately after exercise. However, ASC increased after CR after exercise and 1 h later in comparison to before CR. There was a significant increase in ferric reduction ability of plasma immediately after exercise after CR, when compared with before CR. CR improved several blood biochemical parameters, peak VO2, induced an increase in systolic blood pressure peak, and patients' peak workload. After CR, improvements were detected in oxidative stress parameters, except in the level of carbonyls. These changes may contribute to the increased functional heart capacity and better tolerance to exercise and

  7. Understanding and responding to severe and enduring patient distress resulting from episodes of healthcare.

    PubMed

    Kenward, Linda

    2017-03-29

    This article focuses on the severe, long-term and debilitating distress that may be experienced by patients as a result of their interactions with healthcare professionals and services. It is essential for healthcare professionals to be able to respond effectively to severe patient distress resulting from episodes of healthcare. Severe and enduring patient distress can occur in response to neglect - even when unintentional, misdiagnosis, surgical errors and/or deficits in the quality of care. Severe and enduring distress experienced by patients may go unacknowledged; the long-term consequences may not be recognised, or resolution may be presumed following formal apologies or receipt of compensation. An emphasis on the duty of candour has increased awareness of the importance of honesty and acknowledgement of adverse events or 'near misses' in the healthcare setting, in improving the relationship between patients and healthcare professionals.

  8. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

    PubMed Central

    2014-01-01

    Background In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding – and sometimes preventing – disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment. Discussion As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization. Summary Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts. PMID:24969758

  9. Accurate Accumulation of Dose for Improved Understanding of Radiation Effects in Normal Tissue

    SciTech Connect

    Jaffray, David A.; Lindsay, Patricia E.; Brock, Kristy K.; Deasy, Joseph O.; Tome, W.A.

    2010-03-01

    The actual distribution of radiation dose accumulated in normal tissues over the complete course of radiation therapy is, in general, poorly quantified. Differences in the patient anatomy between planning and treatment can occur gradually (e.g., tumor regression, resolution of edema) or relatively rapidly (e.g., bladder filling, breathing motion) and these undermine the accuracy of the planned dose distribution. Current efforts to maximize the therapeutic ratio require models that relate the true accumulated dose to clinical outcome. The needed accuracy can only be achieved through the development of robust methods that track the accumulation of dose within the various tissues in the body. Specific needs include the development of segmentation methods, tissue-mapping algorithms, uncertainty estimation, optimal schedules for image-based monitoring, and the development of informatics tools to support subsequent analysis. These developments will not only improve radiation outcomes modeling but will address the technical demands of the adaptive radiotherapy paradigm. The next 5 years need to see academia and industry bring these tools into the hands of the clinician and the clinical scientist.

  10. Improving human health through understanding the complex structure of glucose polymers.

    PubMed

    Gilbert, Robert G; Wu, Alex C; Sullivan, Mitchell A; Sumarriva, Gonzalo E; Ersch, Natascha; Hasjim, Jovin

    2013-11-01

    Two highly branched glucose polymers with similar structures--starch and glycogen--have important relations to human health. Slowly digestible and resistant starches have desirable health benefits, including the prevention and alleviation of metabolic diseases and prevention of colon cancer. Glycogen is important in regulating the use of glucose in the body, and diabetic subjects have an anomaly in their glycogen structure compared with that in healthy subjects. This paper reviews the biosynthesis-structure-property relations of these polymers, showing that polymer characterization produces knowledge which can be useful in producing healthier foods and new drug targets aimed at improving glucose storage in diabetic patients. Examples include mathematical modeling to design starch with better nutritional values, the effects of amylose fine structures on starch digestibility, the structure of slowly digested starch collected from in vitro and in vivo digestion, and the mechanism of the formation of glycogen α particles from β particles in healthy subjects. A new method to overcome a current problem in the structural characterization of these polymers using field-flow fractionation is also given, through a technique to calibrate evaporative light scattering detection with starch.

  11. How to improve patient satisfaction when patients are already satisfied: a continuous process-improvement approach.

    PubMed

    Friesner, Dan; Neufelder, Donna; Raisor, Janet; Bozman, Carl S

    2009-01-01

    The authors present a methodology that measures improvement in customer satisfaction scores when those scores are already high and the production process is slow and thus does not generate a large amount of useful data in any given time period. The authors used these techniques with data from a midsized rehabilitation institute affiliated with a regional, nonprofit medical center. Thus, this article functions as a case study, the findings of which may be applicable to a large number of other healthcare providers that share both the mission and challenges faced by this facility. The methodology focused on 2 factors: use of the unique characteristics of panel data to overcome the paucity of observations and a dynamic benchmarking approach to track process variability over time. By focusing on these factors, the authors identify some additional areas for process improvement despite the institute's past operational success.

  12. The low level of understanding of depression among patients treated with antidepressants: a survey of 424 outpatients in Japan

    PubMed Central

    Kudo, Shuhei; Tomita, Tetsu; Sugawara, Norio; Sato, Yasushi; Ishioka, Masamichi; Tsuruga, Koji; Nakagami, Taku; Nakamura, Kazuhiko; Yasui-Furukori, Norio

    2015-01-01

    Background We used self-administered questionnaires to investigate the level of understanding of depression among outpatients who were administered antidepressants. Methods A total of 424 outpatients were enrolled in this study. We used an original self-administered questionnaire that consisted of eight categories: (A) depressive symptoms, (B) the course of depression, (C) the cause of depression, (D) the treatment plan, (E) the duration of taking antidepressants, (F) how to discontinue antidepressants, (G) the side effects of the antidepressants, and (H) psychotherapy. Each category consisted of the following two questions: “Have you received an explanation from the doctor in charge?” and “How much do you understand about it?” The level of understanding was rated on a scale of 0–10 (11 anchor points). The Quick Inventory of Depressive Symptomatology Japanese version, Global Assessment of Functioning, and Clinical Global Impression – Severity scale were administered, and clinical characteristics were investigated. Results The percentages of participants who received explanations were as follows: 61.8% for (A), 49.2% for (B), 50.8% for (C), 57.2% for (D), 46.3% for (E), 28.5% for (F), 50.6% for (G), and 36.1% for (H). The level of understanding in participants who received explanations from their physicians was significantly higher compared with patients who did not receive explanations for all evaluated categories. Patient age, age at disease onset, and Global Assessment of Functioning scores were significantly associated with more items compared with the other variables. Conclusion Psychoeducation is not sufficiently performed. According to the study results, it is possible for patients to receive better psychoeducation and improve their clinical outcomes. PMID:26604765

  13. Towards an Enhanced Understanding of Plant–Microbiome Interactions to Improve Phytoremediation: Engineering the Metaorganism

    PubMed Central

    Thijs, Sofie; Sillen, Wouter; Rineau, Francois; Weyens, Nele; Vangronsveld, Jaco

    2016-01-01

    Phytoremediation is a promising technology to clean-up contaminated soils based on the synergistic actions of plants and microorganisms. However, to become a widely accepted, and predictable remediation alternative, a deeper understanding of the plant–microbe interactions is needed. A number of studies link the success of phytoremediation to the plant-associated microbiome functioning, though whether the microbiome can exist in alternative, functional states for soil remediation, is incompletely understood. Moreover, current approaches that target the plant host, and environment separately to improve phytoremediation, potentially overlook microbial functions and properties that are part of the multiscale complexity of the plant-environment wherein biodegradation takes place. In contrast, in situ studies of phytoremediation research at the metaorganism level (host and microbiome together) are lacking. Here, we discuss a competition-driven model, based on recent evidence from the metagenomics level, and hypotheses generated by microbial community ecology, to explain the establishment of a catabolic rhizosphere microbiome in a contaminated soil. There is evidence to ground that if the host provides the right level and mix of resources (exudates) over which the microbes can compete, then a competitive catabolic and plant-growth promoting (PGP) microbiome can be selected for as long as it provides a competitive superiority in the niche. The competition-driven model indicates four strategies to interfere with the microbiome. Specifically, the rhizosphere microbiome community can be shifted using treatments that alter the host, resources, environment, and that take advantage of prioritization in inoculation. Our model and suggestions, considering the metaorganism in its natural context, would allow to gain further knowledge on the plant–microbial functions, and facilitate translation to more effective, and predictable phytotechnologies. PMID:27014254

  14. The Geophysical Kitchen Sink Approach to Improving our Understanding of Volcano-Tectonic Interactions

    NASA Astrophysics Data System (ADS)

    George, Ophelia A.

    A multi-prong approach was taken in this dissertation to understand volcanic processes from both a long-term and more immediate hazard perspective. In the long-term, magma sources within the crust may produce measurable surficial response and long-wavelength gravity anomalies that provide information about the extent and depth of this magma. Long-term volcanic hazard forecasting is also improved by developing as complete a record as possible of past events. In the short-term, a long-standing question has been on the casting of precursory volcanic activity in terms of future volcanic hazards. Three studies are presented in this dissertation to address these issues. Inversion of high-resolution ground magnetic data in Amargosa Valley, NV indicates that anomaly B could be generated by a buried shield volcano. This new information changes the event count in this region which in turn affects the overall volcanic hazard estimation. Through the use of Finite Element Models (FEM) an in-depth characterization of the surficial response to magma underplating is provided for the Tohoku Volcanic Arc, Japan. These models indicate that surficial uplift was dominantly driven by mid-crustal intrusions and the magnitude and wavelength of this uplift was mainly controlled by the elastic layer thickness. In Dominica, seismic data were used as weights in spatial intensity maps to generate dynamic volcanic hazard maps influenced by changes in seismicity. These maps show an increasing trend in the north that may be indicative of an increase in earthquake and volcanic hazards.

  15. Towards an Enhanced Understanding of Plant-Microbiome Interactions to Improve Phytoremediation: Engineering the Metaorganism.

    PubMed

    Thijs, Sofie; Sillen, Wouter; Rineau, Francois; Weyens, Nele; Vangronsveld, Jaco

    2016-01-01

    Phytoremediation is a promising technology to clean-up contaminated soils based on the synergistic actions of plants and microorganisms. However, to become a widely accepted, and predictable remediation alternative, a deeper understanding of the plant-microbe interactions is needed. A number of studies link the success of phytoremediation to the plant-associated microbiome functioning, though whether the microbiome can exist in alternative, functional states for soil remediation, is incompletely understood. Moreover, current approaches that target the plant host, and environment separately to improve phytoremediation, potentially overlook microbial functions and properties that are part of the multiscale complexity of the plant-environment wherein biodegradation takes place. In contrast, in situ studies of phytoremediation research at the metaorganism level (host and microbiome together) are lacking. Here, we discuss a competition-driven model, based on recent evidence from the metagenomics level, and hypotheses generated by microbial community ecology, to explain the establishment of a catabolic rhizosphere microbiome in a contaminated soil. There is evidence to ground that if the host provides the right level and mix of resources (exudates) over which the microbes can compete, then a competitive catabolic and plant-growth promoting (PGP) microbiome can be selected for as long as it provides a competitive superiority in the niche. The competition-driven model indicates four strategies to interfere with the microbiome. Specifically, the rhizosphere microbiome community can be shifted using treatments that alter the host, resources, environment, and that take advantage of prioritization in inoculation. Our model and suggestions, considering the metaorganism in its natural context, would allow to gain further knowledge on the plant-microbial functions, and facilitate translation to more effective, and predictable phytotechnologies.

  16. Improved hepatitis B vaccination rates in ESRD patients in California.

    PubMed

    Brown, J; Peters, V

    2000-10-01

    According to the Centers for Disease Control (CDC) Survey of Dialysis Associated Diseases, California, which includes Network 17 and 18, had one of the lowest hepatitis B vaccination rates in the country for 1994, 1995, and 1996. With 3 outbreaks of hepatitis B (HBV) in California in 1994, hepatitis B vaccination was chosen as a quality improvement project in both Network 17 and 18. With input from both Medical Review Boards and HCFA Region X, a project was formulated which focused on the improvement of the number of facilities which had hepatitis B vaccination rates which are greater than 50%. The overall purpose of both projects was to: (1) achieve access to preventative services for end-stage renal disease (ESRD) Medicare beneficiaries; (2) increase the number of ESRD patients in California who are vaccinated for HBV; (3) eliminate dialysis in California as an independent risk factor for contracting HBV; (4) decrease the number of ESRD facilities with HBV vaccination rates of 0%; and (5) increase the number of ESRD facilities with HBV vaccination rates greater than 50%. In 1998, both Network 17 and 18 denominators were adjusted to reflect the population which is eligible for vaccination. Because of historically low vaccination rate in California, the 1998 data collection sought to ascertain precise numbers for the ESRD patient population. Data were used from the 1996 and 1997 CDC Survey of Dialysis Associated Diseases from baseline measurements of HBV vaccination rates for all facilities in both Network 17 and 18. The CDC did not conduct a survey in 1998, however, Network 17 and 18 conducted a survey of dialysis associated diseases for all of California ESRD facilities. A data collection tool was designed to gather information on processes and outcomes in each facility. This allowed a continuous quality improvement (CQI)-based approach to analyze the problem, where tools like cause/effect and Pareto diagrams provided information on factors and issues affecting

  17. Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey

    PubMed Central

    2014-01-01

    Background The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients. Methods A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions Understanding use and factors predicting use can increase adoption and utilization of social media for health care–related purposes among underserved patients in community health centers. PMID:25427823

  18. Improving patient care through student leadership in team quality improvement projects.

    PubMed

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  19. Commentary on the article 'Understanding Muslim patients: cross-sectional dental hygiene care'.

    PubMed

    Musrati, Ahmed Ali

    2015-08-01

    I have read with interest the article ''Understanding Muslim patients: cross-sectional dental hygiene care'' by ML Sirois et al. In the time that I see their article as a faithful, unbiased image showing a Muslim's religious life and conduct from the oral and systemic health perspective, I still have two main concerns about certain facts which were denoted with imprecise connotations. These are related to food and Ramadan fasting.

  20. Virtual Patient Technology: Engaging Primary Care in Quality Improvement Innovations

    PubMed Central

    May, Christine N; Sadasivam, Rajani S; Houston, Thomas K

    2017-01-01

    Background Engaging health care staff in new quality improvement programs is challenging. Objective We developed 2 virtual patient (VP) avatars in the context of a clinic-level quality improvement program. We sought to determine differences in preferences for VPs and the perceived influence of interacting with the VP on clinical staff engagement with the quality improvement program. Methods Using a participatory design approach, we developed an older male smoker VP and a younger female smoker VP. The older male smoker was described as a patient with cardiovascular disease and was ethnically ambiguous. The female patient was younger and was worried about the impact of smoking on her pregnancy. Clinical staff were allowed to choose the VP they preferred, and the more they engaged with the VP, the more likely the VP was to quit smoking and become healthier. We deployed the VP within the context of a quality improvement program designed to encourage clinical staff to refer their patients who smoke to a patient-centered Web-assisted tobacco intervention. To evaluate the VPs, we used quantitative analyses using multivariate models of provider and practice characteristics and VP characteristic preference and analyses of a brief survey of positive deviants (clinical staff in practices with high rates of encouraging patients to use the quit smoking innovation). Results A total of 146 clinical staff from 76 primary care practices interacted with the VPs. Clinic staff included medical providers (35/146, 24.0%), nurse professionals (19/146, 13.0%), primary care technicians (5/146, 3.4%), managerial staff (67/146, 45.9%), and receptionists (20/146, 13.7%). Medical staff were mostly male, and other roles were mostly female. Medical providers (OR 0.031; CI 0.003-0.281; P=.002) and younger staff (OR 0.411; CI 0.177-0.952; P=.038) were less likely to choose the younger, female VP when controlling for all other characteristics. VP preference did not influence online patient

  1. Physician in triage improves emergency department patient throughput.

    PubMed

    Imperato, Jason; Morris, Darren Scott; Binder, David; Fischer, Christopher; Patrick, John; Sanchez, Leon Dahomey; Setnik, Gary

    2012-10-01

    To determine if a physician in triage (PIT) improves Emergency Department (ED) patient flow in a community teaching hospital. This is an interventional study comparing patient flow parameters for the 3-month periods before and after implementation of a PIT model. During the interventional time an additional attending physician was assigned to triage from 1 p.m. to 9 p.m. daily. Outcome measures were median time to attending physician evaluation, median length of stay (LOS), number of patients who left without being seen (LWBS), and total time and number of days on ambulance diversion. Non-normally distributed values were compared with the Wilcoxon rank sum test. Proportions were compared with Chi-square test. Outcome measures were available for 17,631 patients, of whom 8,620 were seen before the initiation of PIT, and 9,011 were seen after PIT was implemented. For all patients, the median time from registration to attending physician evaluation was reduced by 36 min (1:41 to 1:05, p < 0.01) while the median LOS for all patients was reduced by 12 min (3:51 to 3:39, p < 0.01) after the intervention. Both the number of days on diversion (24 vs. 9 days) and total time on diversion (68 h 25 min vs. 26 h 7 min) were decreased, p < 0.01. Finally, there was a slight reduction in the number of patients who LWBS from 1.5 to 1.3 %, but this was not statistically significant (p = 0.36). Patient flow parameters in a community teaching hospital were modestly improved as a result of PIT implementation.

  2. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis

    PubMed Central

    Santos, Roberto Sávio Silva; Coelho, Fernando Morgadinho Santos; da Silva, Bruno Caldin; Graciolli, Fabiana Giorgeti; Dominguez, Wagner Velasquez; de Menezes Montenegro, Fabio Luiz; Jorgetti, Vanda; Moysés, Rosa Maria Affonso; Elias, Rosilene Motta

    2016-01-01

    Background Restless leg syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied. Methods this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years) with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography. Results At baseline, RLS was present in 10 patients (52.6%), and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008) that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14–46.3, p = 0.035). After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH)-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04), which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep. Conclusion RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation. PMID:27196740

  3. Improving Emergency Providers’ Attitudes Towards Sickle Cell Patients in Pain

    PubMed Central

    Puri, Aditi; Haywood, Carlton; Beach, Mary Catherine; Guidera, Mark; Lanzkron, Sophie; Valenzuela-Araujo, Doris; Rothman, Richard E.; Dugas, Andrea Freyer

    2015-01-01

    Background Provider biases and negative attitudes are recognized barriers to optimal pain management in sickle cell disease, particularly in the emergency department (ED). Measures This prospective cohort measures pre- and post-intervention provider attitudes towards patients with sickle pain crises using a validated survey instrument. Intervention ED providers viewed an eight-minute online video that illustrated challenges in sickle cell pain management, perspectives of patients and providers as well as misconceptions and stereotypes of which to be wary. Outcomes Ninety-six ED providers were enrolled. Negative attitude scoring decreased, with a mean difference -11.5 from baseline, and positive attitudes improved, with a mean difference +10. Endorsement of red-flag behaviors similarly decreased (mean difference -12.8). Results were statistically significant and sustained on repeat testing three months post-intervention. Conclusions/Lessons Learned Brief video-based educational interventions can improve emergency provider attitudes towards patients with sickle pain crises, potentially curtailing pain crises early, improving health outcomes and patient satisfaction scores. PMID:26596878

  4. The CCLM contribution to improvements in quality and patient safety.

    PubMed

    Plebani, Mario

    2013-01-01

    Clinical laboratories play an important role in improving patient care. The past decades have seen unbelievable, often unpredictable improvements in analytical performance. Although the seminal concept of the brain-to-brain laboratory loop has been described more than four decades ago, there is now a growing awareness about the importance of extra-analytical aspects in laboratory quality. According to this concept, all phases and activities of the testing cycle should be assessed, monitored and improved in order to decrease the total error rates thereby improving patients' safety. Clinical Chemistry and Laboratory Medicine (CCLM) not only has followed the shift in perception of quality in the discipline, but has been the catalyst for promoting a large debate on this topic, underlining the value of papers dealing with errors in clinical laboratories and possible remedies, as well as new approaches to the definition of quality in pre-, intra-, and post-analytical steps. The celebration of the 50th anniversary of the CCLM journal offers the opportunity to recall and mention some milestones in the approach to quality and patient safety and to inform our readers, as well as laboratory professionals, clinicians and all the stakeholders of the willingness of the journal to maintain quality issues as central to its interest even in the future.

  5. Measuring and improving the patient experience in radiology.

    PubMed

    Brook, Olga R; Siewert, Bettina; Weinstein, Jeffrey; Ahmed, Muneeb; Kruskal, Jonathan

    2017-04-01

    Recently enacted healthcare legislation and the associated payment reforms have shifted the focus from traditional fee for service models to adding measurable and appreciable value to the patient experience. The value equation links quality to costs, and quality metrics are now directly related to patient outcomes and the patient experience. To participate effectively in this new paradigm requires not only that we provide excellent, timely and appropriate patient-centric care at all times, but that we are able to measure and manage the feedback we obtain from our patients. Of course, in order to provide value-added care, we must know not only who our customers are, but what they value. In this review, we explore factors that impact patient perception and experience with imaging services. We further illustrate different ways that patient feedback can be elicited and provide pros and cons of each approach. Collecting appropriate data is insufficient by itself; such data must be carefully analyzed, and opportunities for improvement must be identified, introduced, and monitored ahead of future surveys.

  6. Patient counseling: the key to improving success with OCs.

    PubMed

    1995-07-01

    The most important step in counseling patients about the use of oral contraceptives (OCs) is to uncover patient fears because patients will not use a product if they believe it is not good for them. Clinicians can ask patients what negative stories they have heard about OCs, and clinicians should also introduce such stories in the conversation. Clinicians can then provide accurate information about the risks of OCs and warn patients about the dangers of cigarette smoking. Then, clinicians should provide information on the health benefits of OC use. Some women can cite menstrual cycle benefits of OC use, but few US women know that OCs can protect against ovarian and endometrial cancer, anemia, ectopic pregnancy, pelvic inflammatory diseases, or benign breast disease. Health benefit counseling may improve patient continuation as well as compliance. Patients also need specific information on how to take the OC, what to do about a missed pill, how to handle common nuisance side effects, and who to call with questions. More frequent follow-up visits should be scheduled for teenagers.

  7. Use of patient and hospital variables in interpreting patient satisfaction data for performance improvement purposes.

    PubMed

    Lessing, Elise E; Beech, Robert P

    2004-07-01

    Satisfaction scores of 349 patients being discharged from a state psychiatric hospital were examined in relation to available norms for the instrument used and selected patient and hospital variables. Mean item scores fell within the less-than-satisfied category on both total and factor scores. Regression analyses indicated minimal effects of patient attributes. Two hospital factors (restraint rate on patient's unit and accessibility of psychosocial groups) significantly predicted satisfaction, with the former having an unexpected positive relationship to satisfaction. Clinicians were able to use the survey data to improve care, but patients' tendency toward undifferentiated positive or negative responding hindered the prioritizing of change efforts.

  8. Understanding Patient Preference for Integrative Medical Care: Results from Patient Focus Groups

    PubMed Central

    Pugh, Guy F.; O’Connor, Bonnie B.

    2007-01-01

    Background Integrative medicine (IM), a combination of conventional and complementary and alternative medicine (CAM), has become a popular source of medical care, yet little is known about its use. Objective To identify the motivations of people who choose IM for their primary care needs. Design Qualitative study from focus group data of regular users of IM. Participants Six focus groups that include a total of 37 regular users of IM who consented to participate in a study of IM use. Approach Focus group meetings were audiotaped and transcribed verbatim. Qualitative analysis using grounded theory was used to derive the motivations for use of IM. Results Participants beliefs include the following: the combination of CAM and conventional medicine is better than either alone; health is a combination of physical, emotional, and spiritual well being; nutrition and lifestyle play a role in wellness; and pharmaceuticals should be avoided except as a last resort. Participants suffer from health problems that are not well treated by conventional medicine. Participants want to discuss CAM with physicians and obtain guidance on its use. Participants want time with their providers, to feel listened to and to have the opportunity for shared decision-making. Conclusion Much of what patients are seeking in integrative medical care is likely universally shared: a strong therapeutic relationship with providers who listen and provide time and knowledgeable advice. Users believe a combined approach of CAM and conventional medicine is better than either alone and want to be able to discuss CAM use with their providers. PMID:17846846

  9. Concept mapping: a tool for improving patient care.

    PubMed

    Aberdeen, Suzanne

    2015-07-29

    This article reviews the use of concept mapping as a person-centred problem-solving aid to assessment, risk management, care evaluation and care planning for nurses. Concept maps are diagrams that are used to organise, represent and create knowledge, and provide a useful framework for critical analysis and problem solving. Concept mapping is discussed and demonstrated in relation to improving the quality of care for patients and as a tool for clinical leadership and teamwork. The benefits of concept mapping for patients' wellbeing and safety, staff satisfaction and team learning are evidenced.

  10. [Patient education and treatment documentation - Law to Improve the Rights of Patients].

    PubMed

    Meltendorf, G; Meltendorf, C

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the (German) Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should themselves acquaint with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation.

  11. [Patient education and treatment documentation - law to improve the rights of patients].

    PubMed

    Meltendorf, Gerhard; Meltendorf, Christian

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the German Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should acquaint themselves with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation.

  12. Improving Students' Understanding of Waves by Plotting a Displacement-Time Graph in Class

    ERIC Educational Resources Information Center

    Wei, Yajun

    2012-01-01

    The topic of waves is one that many high school physics students find difficult to understand. This is especially true when using some A-level textbooks used in the U.K., where the concept of waves is introduced prior to the concept of simple harmonic oscillations. One of the challenges my students encounter is understanding the difference between…

  13. Improving Students' Understanding of, and Ability to Identify Independent and Dependent Variables

    ERIC Educational Resources Information Center

    Aldrich, Rosalie S.

    2015-01-01

    Students need to have a basic understanding of research methods before obtaining a communication degree in order to become an intelligent consumer of research--someone who is able to read, understand, explain, and critically evaluate communication and other research reported in scholarly journals as well as in the popular press. These skills are…

  14. Toward a Research Agenda for Understanding and Improving the Use of Research Evidence

    ERIC Educational Resources Information Center

    Nelson, Steven R.; Leffler, James C.; Hansen, Barbara A.

    2009-01-01

    Many researchers and research funders want their work to be influential in educational policy and practice, but there is little systematic understanding of how policymakers and practitioners use research evidence, much less how they acquire or interpret it. By understanding what does shape policymakers' and practitioners' decision making and the…

  15. Improvements in Understanding Exposure and Toxicity Issues Associated with RDX: Recent Updates

    DTIC Science & Technology

    2009-05-01

    testing activities will be adversely affected, adversely affecting military readiness.  If these values are artificially low, significant resources...results for:  Ames assays (bacterial mutagenicity)  Mammalian in vitro assays (mouse lymphoma & CHO)  Mammalian in vivo assays (mouse micronucleus ...reduction of uncertainty:  Understanding target of toxicity.  Understanding absorption, distribution, metabolism, excretion and mechanism in test animals

  16. End-of-Life Discussion, Patient Understanding and Determinants of Preferences in Very Severe COPD Patients: A Multicentric Study.

    PubMed

    Carlucci, Annalisa; Vitacca, Michele; Malovini, Alberto; Pierucci, Paola; Guerrieri, Aldo; Barbano, Luca; Ceriana, Piero; Balestrino, Antonella; Santoro, Carmen; Pisani, Lara; Corcione, Nadia; Nava, Stefano

    2016-10-01

    Discussion about patients' end-of-life (E-o-L) preferences should be part of the routine practice. Using a semi-structured interview with a scenario-based decision, we performed a prospective multicentre study to elicit the patients' E-o-L preferences in very severe chronic obstructive pulmonary disease (COPD). We also checked their ability to retain this information and the respect of their decisions when they die. Forty-three out of ninety-one of the eligible patients completed the study. The choice of E-o-L practice was equally distributed among the three proposed options: endotracheal intubation (ETI), 'ceiling' non-invasive ventilation (NIV), and palliation of symptoms with oxygen and morphine. NIV and ETI were more frequently chosen by patients who already experienced them. ETI preference was also associated with the use of anti-depressant drugs and a low educational level, while a higher educational level and a previous discussion with a pneumologist significantly correlated with the preference for oxygen and morphine. Less than 50% of the patients retained a full comprehension of the options at 24 hours. About half of the patients who died in the follow-up period were not treated according to their wishes. In conclusion, in end-stage COPD more efforts are needed to improve communication, patients' knowledge of the disease and E-o-L practice.

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

    PubMed

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

    2007-02-01

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

  18. Triheptanoin improves brain energy metabolism in patients with Huntington disease

    PubMed Central

    Adanyeguh, Isaac Mawusi; Rinaldi, Daisy; Henry, Pierre-Gilles; Caillet, Samantha; Valabregue, Romain; Durr, Alexandra

    2015-01-01

    Objective: Based on our previous work in Huntington disease (HD) showing improved energy metabolism in muscle by providing substrates to the Krebs cycle, we wished to obtain a proof-of-concept of the therapeutic benefit of triheptanoin using a functional biomarker of brain energy metabolism validated in HD. Methods: We performed an open-label study using 31P brain magnetic resonance spectroscopy (MRS) to measure the levels of phosphocreatine (PCr) and inorganic phosphate (Pi) before (rest), during (activation), and after (recovery) a visual stimulus. We performed 31P brain MRS in 10 patients at an early stage of HD and 13 controls. Patients with HD were then treated for 1 month with triheptanoin after which they returned for follow-up including 31P brain MRS scan. Results: At baseline, we confirmed an increase in Pi/PCr ratio during brain activation in controls—reflecting increased adenosine triphosphate synthesis—followed by a return to baseline levels during recovery (p = 0.013). In patients with HD, we validated the existence of an abnormal brain energy profile as previously reported. After 1 month, this profile remained abnormal in patients with HD who did not receive treatment. Conversely, the MRS profile was improved in patients with HD treated with triheptanoin for 1 month with the restoration of an increased Pi/PCr ratio during visual stimulation (p = 0.005). Conclusion: This study suggests that triheptanoin is able to correct the bioenergetic profile in the brain of patients with HD at an early stage of the disease. Classification of evidence: This study provides Class III evidence that, for patients with HD, treatment with triheptanoin for 1 month restores an increased MRS Pi/PCr ratio during visual stimulation. PMID:25568297

  19. Understanding the perceived treatment needs of patients with psychogenic nonepileptic seizures.

    PubMed

    Fairclough, Gillian; Fox, John; Mercer, Gemma; Reuber, Markus; Brown, Richard James

    2014-02-01

    Psychological therapy is generally considered the treatment of choice for psychogenic nonepileptic seizures (PNES), but there is a paucity of research on patients' attitudes towards psychological referral. We conducted semistructured interviews with twelve patients with PNES awaiting psychological treatment in order to understand their perceived treatment needs. Data were analyzed inductively according to the principles of thematic analysis. The results indicated that our patients had clear ideas about their treatment needs and a desire to recover by 'returning to normality'. Many participants felt 'caught in limbo' following their PNES diagnosis, however, because of uncertainties about their condition and a lack of support from professionals. This linked with participants feeling unsure whether psychological treatment would meet their needs; there was also apprehension for some participants about the potential negative consequences of therapy. The clinical implications of these findings are discussed, and recommendations for future research are made.

  20. Understanding patients' health and technology attitudes for tailoring self-management interventions.

    PubMed

    O'Leary, Katie; Vizer, Lisa; Eschler, Jordan; Ralston, James; Pratt, Wanda

    2015-01-01

    Healthcare providers are moving towards tailoring self-management interventions to include the communication technologies patients use in daily life. Accurate understanding of patients' attitudes towards both technology and involvement in managing chronic conditions will be critical for informing effective self-management strategies. The tailoring of these interventions, however, could be undermined by providers' implicit biases based on patient age, race, and education level that have been shown to negatively affect care. To inform the design and tailoring of self-management interventions, we elicited attitudes toward technology use and participation in care of 40 participants in a maximum variation sample. The analysis revealed three participant clusters-"Proactive Techies," "Indie Self-Managers," and "Remind Me! Non-Techies"-that represent varying attitudes toward health behaviors and technologies that were independent of race, education level, and age. Our approach provides insight into how people prioritize important values related to health participation and technology.

  1. Understanding the suffering of a patient with an illness: signs, context and strategies.

    PubMed

    Hueso Montoro, César; Siles González, José; Amezcua, Manuel; Bonill de Las Nieves, Candela; Pastor Montero, Sonia; Celdrán Mañas, Miriam

    2012-01-01

    The aim of this study is to understand the suffering of a patient with an illness, by using a secondary research method, that is, a qualitative meta-study. The primary data source of the meta-study includes "biographical reports". This project is based on a case study, in which the first-hand experiences of a patient with an illness were collected. The findings of the reports were compiled using the Archivos de la Memoria collection of the Index Foundation (Granada, Spain) and journals specialized in editing these materials. A selection of 20 biographical reports was targeted. The results of the meta-study show that suffering is a multidimensional process within a framework of ambiguous feelings. The suffering involves family and social network participation. Patients develop a range of strategies to overcome the illness. One of the effects is the fear of illness relapse or worsening.

  2. Improving Patient Safety in Anesthesia: A Success Story?

    SciTech Connect

    Botney, Richard

    2008-05-01

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety.

  3. [Geriatric fracture centers. Improved patient care and economic benefits].

    PubMed

    Kates, S L

    2016-01-01

    The world's population is aging resulting in changes in the way we manage geriatric care. Furthermore, this population has a considerable risk of fragility fractures, most notably hip fractures. Hip fractures are associated with significant morbidity and mortality and have large economic consequences. It is due to these factors that the concept of an elderly trauma center was developed. These trauma centers utilize the expertise in orthopedic and geriatric disciplines to provide coordinated care to the elderly hip fracture patient. As a result, studies have demonstrated improvements in clinical outcomes within the hospital stay, a reduction in iatrogenic complications, and improvements in 1-year mortality rates compared to the usual care given at a similar facility. Furthermore, economic models have demonstrated that there is a role for regionalized hip fracture centers that can be both profitable and provide more efficient care to these patients.

  4. Improved understanding of Diatom stratigraphy in a varved sediment through lake monitoring and sediment trap data

    NASA Astrophysics Data System (ADS)

    Maier, Dominique Beatrice; Bigler, Christian

    2016-04-01

    Biological remains in lake sediments reflect past conditions in the lake itself and within its catchment. However, it is difficult to disentangle to which extent the environmental drivers are natural (e.g. population dynamics, climate) or human-induced (e.g. agriculture, forestry). Therefore, comprehensive lake monitoring is crucial to understand taphonomy and sediment formation, and enhances the value of the paleolimnological archive. In this study, we analyze survey data of a varved lake in northern Sweden (Nylandssjön, Nordingrå) with special focus on the diatom record. Different monitoring components are combined, i.e. (1) bi-weekly data of chemical parameters (chlorophyll a, nutrients) covering the period from 2012 to 2015, (2) physical parameters (temperature, oxygen, ice-cover) covering the period from 2000-2015, (3) high-resolution data from a sequential sediment trap covering the period from 2000-2015 and (4) annually resolved diatom data from the sediment varves. Early and intense spring mixing in 2012 translates into a short but vertically pervasive chlorophyll a band which is simultaneously recorded in the sequential trap with a high diatom peak (500 000 valves cm2 d-1). The years 2013 and 2014 show higher chlorophyll a concentrations in the water column, but diatoms do not form a peak flux (>100 000 diatoms cm2 d-1) at any time in the sediment trap, probably due to stratification patterns. The trap record from 2012 indicates a spring bloom dominating the sediment signal, but this is not repeated in 2013 and 2014. Future analyses will be directed towards linking the monitored in-lake processes to annually or even seasonally resolved environmental characteristics. The multiplicity of potential ecological and environmental drivers led us to reverse our analytical view by starting with the diatom stratigraphy in the varved sediment, continuing through the data from sediment trap and water column into the lake catchment to identify deviations (timing

  5. Metoprolol Improves Endothelial Function in Patients with Cardiac Syndrome X

    PubMed Central

    Majidinia, Maryam; Rasmi, Yousef; Khadem Ansari, Mohammad Hassan; Seyed-Mohammadzad, MirHossein; Saboory, Ehsan; Shirpoor, Alireza

    2016-01-01

    Endothelial dysfunction which is manifested by the loss of nitric oxide bioavailability, is an increasingly recognized cause of cardiac syndrome X (CSX) and beta blockers are used for the treatment of this syndrome. Thus, the aim of this study was to investigate effects of metoprolol, as a beta blocker, on endothelial function in CSX patients. The study included 25 CSX patients (20 female/ 5 male, mean age: 55.36±10.31 years) who received metoprolol (50 mg BID) for one month. In addition, 25 healthy controls (20 female/ 5 male, mean age: 54.32 ±9.27 years) were enrolled. Levels of endothelin-1, E-selectin, and vascular cell adhesion molecule-1 (VCAM-1) in controls and CSX patients were measured, both at the baseline and after the treatment, by the enzyme-linked immunosorbent assay. In CSX patients, at the baseline, levels of E-selectin and VCAM-1 were significantly higher than those of the controls. In addition, levels of these biomarkers in CSX patients after the treatment significantly decreased compared to the baseline. In spite of similar tendency, these differences were not significant for endothelin-1. In conclusion, metoprolol therapy improves endothelial function. Thus, it may be a suggested choice for CSX treatment. However, further studies are needed to confirm the clinical significance of metoprolol therapy for CSX patients. PMID:27980592

  6. Studying large-scale programmes to improve patient safety in whole care systems: challenges for research.

    PubMed

    Benn, Jonathan; Burnett, Susan; Parand, Anam; Pinto, Anna; Iskander, Sandra; Vincent, Charles

    2009-12-01

    Large-scale national and multi-institutional patient safety improvement programmes are being developed in the health care systems of several countries to address problems in the reliability of care delivered to patients. Drawing upon popular collaborative improvement models, these campaigns are ambitious in their aims to improve patient safety in macro-level systems such as whole health care organisations. This article considers the methodological issues involved in conducting research and evaluation of these programmes. Several specific research challenges are outlined, which result from the complexity of longitudinal, multi-level intervention programmes and the variable, highly sociotechnical care systems, with which they interact. Organisational-level improvement programmes are often underspecified due to local variations in context and organisational readiness for improvement work. The result is variable implementation patterns and local adaptations. Programme effects span levels and other boundaries within a system, vary dynamically or are cumulative over time and are problematic to understand in terms of cause and effect, where concurrent external influences exist and the impact upon study endpoints may be mediated by a range of organisational and social factors. We outline the methodological approach to research in the United Kingdom Safer Patients Initiative, to exemplify how some of the challenges for research in this area can be met through a multi-method, longitudinal research design. Specifically, effective research designs must be sensitive to complex variation, through employing multiple qualitative and quantitative measures, collect data over time to understand change and utilise descriptive techniques to capture specific interactions between programme and context for implementation. When considering the long-term, sustained impact of an improvement programme, researchers must consider how to define and measure the capability for continuous safe and

  7. Nurse Practitioner Care Improves Renal Outcome in Patients with CKD

    PubMed Central

    van Zuilen, Arjan D.; van den Brand, Jan A.J.G.; Bots, Michiel L.; van Buren, Marjolijn; ten Dam, Marc A.G.J.; Kaasjager, Karin A.H.; Ligtenberg, Gerry; Sijpkens, Yvo W.J.; Sluiter, Henk E.; van de Ven, Peter J.G.; Vervoort, Gerald; Vleming, Louis-Jean; Blankestijn, Peter J.; Wetzels, Jack F.M.

    2014-01-01

    Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m2 per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD. PMID:24158983

  8. Motor imagery training improves upper extremity performance in stroke patients

    PubMed Central

    Kim, Seong-Sik; Lee, Byoung-Hee

    2015-01-01

    [Purpose] The purpose of this study was to investigate whether motor imagery training has a positive influence on upper extremity performance in stroke patients. [Subjects and Methods] Twenty-four patients were randomly assigned to one of the following two groups: motor imagery (n = 12) or control (n = 12). Over the course of 4 weeks, the motor imagery group participated in 30 minutes of motor imagery training on each of the 18 tasks (9 hours total) related to their daily living activities. After the 4-week intervention period, the Fugl-Meyer Assessment-Upper Extremity outcomes and Wolf Motor Function Test outcomes were compared. [Results] The post-test score of the motor imagery group on the Fugl-Meyer Assessment-Upper Extremity outcomes was significantly higher than that of the control group. In particular, the shoulder and wrist sub-items demonstrated improvement in the motor imagery group. [Conclusion] Motor imagery training has a positive influence on upper extremity performance by improving functional mobility during stroke rehabilitation. These results suggest that motor imagery training is feasible and beneficial for improving upper extremity function in stroke patients. PMID:26311968

  9. How patients understand physicians' solicitations of additional concerns: implications for up-front agenda setting in primary care.

    PubMed

    Robinson, Jeffrey D; Heritage, John

    2016-01-01

    In the more than 1 billion primary-care visits each year in the United States, the majority of patients bring more than one distinct concern, yet many leave with "unmet" concerns (i.e., ones not addressed during visits). Unmet concerns have potentially negative consequences for patients' health, and may pose utilization-based financial burdens to health care systems if patients return to deal with such concerns. One solution to the problem of unmet concerns is the communication skill known as up-front agenda setting, where physicians (after soliciting patients' chief concerns) continue to solicit patients' concerns to "exhaustion" with questions such as "Are there some other issues you'd like to address?" Although this skill is trainable and efficacious, it is not yet a panacea. This article uses conversation analysis to demonstrate that patients understand up-front agenda-setting questions in ways that hamper their effectiveness. Specifically, we demonstrate that up-front agenda-setting questions are understood as making relevant "new problems" (i.e., concerns that are either totally new or "new since last visit," and in need of diagnosis), and consequently bias answers away from "non-new problems" (i.e., issues related to previously diagnosed concerns, including much of chronic care). Suggestions are made for why this might be so, and for improving up-front agenda setting. Data are 144 videotapes of community-based, acute, primary-care, outpatient visits collected in the United States between adult patients and 20 family-practice physicians.

  10. Improved Survival with the Patients with Variceal Bleed

    PubMed Central

    Sharma, Praveen; Sarin, Shiv K.

    2011-01-01

    Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB) and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin) and endoscopic variceal ligation has become the first line treatment in the management of AVB. Short-term antibiotic prophylaxis, early use of lactulose for prevention of hepatic encephalopathy, application of early transjugular intrahepatic portasystemic shunts (TIPS), fully covered self-expandable metallic stent in patients for AVB may be useful in those cases where balloon tamponade is considered. Early and wide availability of liver transplantation has changed the armamentarium of the clinician for patients with AVB. High hepatic venous pressure gradient (HVPG) >20 mmHg in AVB has become a useful predictor of outcomes and more aggressive therapies with early TIPS based on HVPG measurement may be the treatment of choice to reduce mortality further. PMID:21994853

  11. Improved survival with the patients with variceal bleed.

    PubMed

    Sharma, Praveen; Sarin, Shiv K

    2011-01-01

    Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB) and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin) and endoscopic variceal ligation has become the first line treatment in the management of AVB. Short-term antibiotic prophylaxis, early use of lactulose for prevention of hepatic encephalopathy, application of early transjugular intrahepatic portasystemic shunts (TIPS), fully covered self-expandable metallic stent in patients for AVB may be useful in those cases where balloon tamponade is considered. Early and wide availability of liver transplantation has changed the armamentarium of the clinician for patients with AVB. High hepatic venous pressure gradient (HVPG) >20 mmHg in AVB has become a useful predictor of outcomes and more aggressive therapies with early TIPS based on HVPG measurement may be the treatment of choice to reduce mortality further.

  12. Early recognition of patient problems: a hermeneutic journey into understanding expert thinking in nursing.

    PubMed

    Peden-McAlpine, C

    2000-01-01

    The purpose of this study was to explicate the unconscious activity of early recognition of patient problems to better understand the thinking of expert critical care nurses. Multiple interviews were done with 15 peer-nominated expert critical care nurses. These nurses met specific inclusion criteria for expertise and the interviews were conducted over 9 months. Narrative accounts of critical incidents where early recognition of patient problems occurred were audiotaped and transcribed. The transcribed interviews were shared with the participants after each interview to stimulate reflection on their practice. Reflection on practice enriched subsequent interviews. A text comprising interview data was compiled and an interpretive approach based on the philosophy of human action developed by the author was used to interpret the activity of thinking behind the nurses' actions in the text. Interpretation of action revealed three common subplots or characteristics embedded in the nurses' thinking. The subplots included different types of information used in thinking, a mode of understanding situational meaning, and a temporal component of thinking in practice. The findings demonstrate an integrated model of situational understanding and informed action, thinking-in-action, similar to Aristotle's notion of practical wisdom.

  13. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  14. Talking about your health to strangers: understanding the use of online social networks by patients

    NASA Astrophysics Data System (ADS)

    Colineau, Nathalie; Paris, Cécile

    2010-04-01

    The internet has become a participatory place where everyone can contribute and interact with others. In health in particular, social media have changed traditional patient-physician relationships. Patients are organising themselves in groups, sharing observations and helping each other, although there is still little evidence of the effectiveness of these online communities on people's health. To understand why and how people use health-related sites, we studied these sites and identified three dimensions characterising most of them: informational/supportive; general/focused; and new relationships/existing ones. We conducted an online survey about the use of health-related social networking (SN) sites and learnt that, consistent with previous research, most patients were seeking information about their medical condition online, while, at the same time, still interacting with health professionals to talk about sensitive information and complex issues. We also found that, while people's natural social network played an important role for emotional support, sometimes, people chose to not involve their family, but instead interact with peers online because of their perceived support and ability to understand someone's experience, and also to maintain a comfortable emotional distance. Finally, our results show that people using general SN sites do not necessarily use health-related sites and vice versa.

  15. Patients' understanding of genetic susceptibility testing in mainstream medicine: qualitative study on thrombophilia

    PubMed Central

    Saukko, Paula M; Ellard, Sian; Richards, Suzanne H; Shepherd, Maggie H; Campbell, John L

    2007-01-01

    Background UK and US policy initiatives have suggested that, in the future, patients and clinicians in mainstream medicine could use genetic information to prevent common illnesses. There are no studies on patients' experience and understanding of the process of testing for common genetic susceptibilities in mainstream medicine. Methods Qualitative interviews with 42 individuals who had undergone testing for a genetic susceptibility for deep vein thrombosis in primary and secondary care in the UK. Results Some participants, often from higher social classes, had a good understanding of the test and its implications. They had often sought additional information on thrombophilia from relatives and from the Internet. Others, often from less privileged backgrounds, had a poorer understanding of the test – seven individuals were unaware of having had the genetic test. Features of genetic information led to misunderstandings: (i) at referral, (ii) when communicating results, and (iii) when making sense of the implications of testing. Participants' accounts indicated that non-specialist doctors may feel obliged to refer a patient for a genetic test they know little about, because a patient requests it after a relative had tested positive. Sometimes a referral for a genetic test was lost under information overload when multiple tests and issues were considered. The inconsistent and informal ways of communicating test results – for example by phone – in mainstream medicine also led to confusion. Participants did not generally overestimate their risk, but some were uncertain about whether they were taking the right preventive actions and/or whether their children were at risk. Information about genetic susceptibilities was difficult to make sense of, as it related to ambiguous risks for participants and family members, complicated and unfamiliar terminology and multiple genes and preventive strategies. Conclusion Policy visions of clinicians and patients in mainstream

  16. Understanding CAM Natural Health Products: Implications of Use Among Cancer Patients and Survivors

    PubMed Central

    Fouladbakhsh, Judith M.; Balneaves, Lynda; Jenuwine, Elizabeth

    2013-01-01

    Herbs, vitamins, and other natural health products are being used by cancer patients and survivors with increasing prevalence in the United States. These complementary and alternative medicine (CAM) products, which are also referred to as natural health products in Canada and abroad, are used during cancer treatment and the survivorship period to ease the burden of symptoms such as pain, fatigue, insomnia, anxiety, and depression and hence improve overall quality of life. Data indicate that while patients choose these products for self-treatment, they often do not inform their health-care providers, thereby presenting the potential for negative interactions. This article gives an overview of CAM natural health products, including discussion of herbs, vitamins, and other supplements such as minerals, enzymes, and more. Related research is presented, and implications for advanced practitioners are discussed. Insights into guiding safe and effective use among patients as well as appropriate decision-making strategies are explored. PMID:25032009

  17. Toward Understanding the Heterogeneity in OCD: Evidence from narratives in adult patients

    PubMed Central

    Van Schalkwyk, Gerrit I; Bhalla, Ish P; Griepp, Matthew; Kelmendi, Benjamin; Davidson, Larry; Pittenger, Christopher

    2015-01-01

    Background Current attempts at understanding the heterogeneity in OCD have relied on quantitative methods. The results of such work point towards a dimensional structure for OCD. Existing qualitative work in OCD has focused on understanding specific aspects of the OCD experience in greater depth. However, qualitative methods are also of potential value in furthering our understanding of OCD heterogeneity by allowing for open-ended exploration of the OCD experience and correlating identified subtypes with patient narratives. Aims We explored variations in patients’ experience prior to, during, and immediately after performing their compulsions. Method Semi-structured interviews were conducted with 20 adults with OCD, followed by inductive thematic analysis. Participant responses were not analyzed within the context of an existing theoretical framework, and themes were labeled descriptively. Results The previously dichotomy of ‘anxiety’ vs ‘incompleteness’ emerged organically during narrative analysis. In addition, we found that some individuals with OCD utilize their behaviors as a way to cope with stress and anxiety more generally. Other participants did not share this experience and denied finding any comfort in their OC behaviors. The consequences of attention difficulties were highlighted, with some participants describing how difficulty focusing on a task could influence the need for it to be repeated multiple times. Conclusions The extent to which patients use OCD as a coping mechanism is a relevant distinction with potential implications for treatment engagement. Patients may experience ambivalence about suppressing behaviors that they have come to rely upon for management of stress and anxiety, even if these behaviors represent symptoms of a psychiatric illness. PMID:25855685

  18. Understanding Evidence-Based Improvement in Higher Education: The Case of Student Engagement

    ERIC Educational Resources Information Center

    McCormick, Alexander C.; Kinzie, Jillian; Korkmaz, Ali

    2011-01-01

    This paper uses time series data from a widely used assessment to identify colleges and universities that demonstrate positive trends on a range of educational effectiveness measures, describe observed patterns of improvement, and examine informants' accounts of factors that contributed to the improvements. This study informs broad questions about…

  19. Harnessing quantitative genetics and genomics for understanding and improving complex traits in crops

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Classical quantitative genetics aids crop improvement by providing the means to estimate heritability, genetic correlations, and predicted responses to various selection schemes. Genomics has the potential to aid quantitative genetics and applied crop improvement programs via large-scale, high-thro...

  20. Improving students' understanding of carbohydrate metabolism in first-year biochemistry at tertiary level

    NASA Astrophysics Data System (ADS)

    Anderson, Trevor; Grayson, Diane

    1994-12-01

    Many introductory biochemistry students have problems understanding metabolism and acquiring the skills necessary to study metabolic pathways. In this paper we suggest that this may be largely due to the use of a traditional teaching approach which emphasises memorisation rather than understanding. We present an alternative approach to teaching carbohydrate metabolism which is designed to promote understanding of pathways. The approach also enables regular monitoring of, and reflection on, student progress and the identification of student reasoning and conceptual difficulties through the use of specially designed problems. Preliminary results are presented giving examples of specific student difficulties and the extent to which they were addressed by the alternative instructional approach. A qualitative evaluation of the approach is also presented.

  1. Evaluating and improving patient-specific QA for IMRT delivery

    NASA Astrophysics Data System (ADS)

    Yan, Guanghua

    2009-12-01

    Modern radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) and newly-emerging volumetric modulated arc therapy (VMAT) aim to deliver highly conformal radiation dose to the target volume while sparing nearby critical organs as much as possible with the complex motion of multi-leaf collimator (MLC) leaves. Pre-treatment patient specific quality assurance (QA) has become an essential part of IMRT in making sure the delivered dose distributions agree with the planned ones. This dissertation evaluates the performance of current patient-specific QA process and proposes solutions to improve its sensitivity, accuracy and efficiency. In step and shoot IMRT, the study on the sensitivity of patient-specific QA to minor MLC errors reveals tighter criterion such as 2%/2mm must be employed to detect systematic MLC positioning errors of 2 mm. However, such criterion results in low average passing rate which leads to excessive false alarms, mainly due to inadequate treatment planning system (TPS) beam modeling on beam penumbra. An analytical deconvolution approach is proposed to recover true photon beam profiles to obtain a true beam model which significantly improves agreement between calculated and measured dose distributions. Thus a tighter criterion could be employed to enhance the sensitivity of patient-specific QA to minor errors in the delivery system. Measurement based patient-specific IMRT QA is a time-consuming process. A fast and accurate independent planar dose calculation algorithm is proposed to replace measurement based QA. The algorithm analytically models photons coming out from the accelerator and computes dose distribution from first principles. Accuracy of the algorithm is validated against 2D diode array measurements. The algorithm is found to be fast and accurate enough to replace time consuming measurement based QA. Patient-specific QA for VMAT differs significantly from step and shoot IMRT due to the increased use of dynamic

  2. Improving Patient's Primary Medication Adherence: The Value of Pharmaceutical Counseling.

    PubMed

    Leguelinel-Blache, Géraldine; Dubois, Florent; Bouvet, Sophie; Roux-Marson, Clarisse; Arnaud, Fabrice; Castelli, Christel; Ray, Valérie; Kinowski, Jean-Marie; Sotto, Albert

    2015-10-01

    Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge.This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge.We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89).This study highlights that discharge counseling sessions are essential to improve

  3. Improving Students' Understanding of Waves by Plotting a Displacement-Time Graph in Class

    NASA Astrophysics Data System (ADS)

    Wei, Yajun

    2012-04-01

    The topic of waves is one that many high school physics students find difficult to understand. This is especially true when using some A-level textbooks1,2used in the U.K., where the concept of waves is introduced prior to the concept of simple harmonic oscillations. One of the challenges my students encounter is understanding the difference between displacement-time graphs and displacement-position graphs. Many students wonder why these two graphs have the same sinusoidal shape. Having the students use multimedia simulations allows them to see, in a hands-on fashion, the relationship between the two graphs.

  4. Florida State University Receives EPA Funding to Improve Understanding of the Effects of Climate Change on Indoor Air Quality

    EPA Pesticide Factsheets

    ATLANTA - The U.S. Environmental Protection Agency (EPA) today announced that Florida State University in Tallahassee, Fla. has received a $500,000 grant to improve understanding of the effects of climate change on indoor air quality. The grant is a

  5. Research Plans for Improving Understanding of Effects of Very Low-Frequency Noise of Heavy Lift Rotorcraft

    NASA Technical Reports Server (NTRS)

    Fidell, Sanford; Horonieff, Richard D.; Schmitz, Fredric H.

    2010-01-01

    This report reviews the English-language technical literature on infrasonic and low-frequency noise effects; identifies the most salient effects of noise produced by a future large civil tiltrotor aircraft on crew, passengers, and communities near landing areas; and recommends research needed to improve understanding of the effects of such noise on passengers, crew, and residents of areas near landing pads.

  6. WWC Review of the Report "Improving At-Risk Learners' Understanding of Fractions." What Works Clearinghouse Single Study Review

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2013

    2013-01-01

    The study examined the effects of "Fraction Challenge," a supplemental small-group tutoring math program that focuses on improving student understanding of fractions. Study authors randomly assigned fourth grade "at-risk" students in 53 classrooms in 13 schools to either an intervention group that received "Fraction…

  7. Improving Individualized Educational Program (IEP) Mathematics Learning Goals for Conceptual Understanding of Order and Equivalence of Fractions

    ERIC Educational Resources Information Center

    Scanlon, Regina M.

    2013-01-01

    The purpose of this Executive Position Paper project was to develop resources for improving Individual Educational Program (IEP) mathematics learning goals for conceptual understanding of fractions for middle school special education students. The investigation surveyed how IEP mathematics learning goals are currently determined and proposed a new…

  8. Using Targeted Active-Learning Exercises and Diagnostic Question Clusters to Improve Students' Understanding of Carbon Cycling in Ecosystems

    ERIC Educational Resources Information Center

    Maskiewicz, April Cordero; Griscom, Heather Peckham; Welch, Nicole Turrill

    2012-01-01

    In this study, we used targeted active-learning activities to help students improve their ways of reasoning about carbon flow in ecosystems. The results of a validated ecology conceptual inventory (diagnostic question clusters [DQCs]) provided us with information about students' understanding of and reasoning about transformation of inorganic and…

  9. An information theory application to improve understanding of subsurface flow and transport conditions at the BARC OPE3 site

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Improving understanding of subsurface conditions includes comparison and discrimination of concurrent models. Additional observations can be useful for that purpose. The objective of this work was to implement and test a novel method for optimization of selecting locations for additional observation...

  10. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction.

    PubMed

    Gausvik, Christian; Lautar, Ashley; Miller, Lisa; Pallerla, Harini; Schlaudecker, Jeffrey

    2015-01-01

    Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.

  11. Rare disease policies to improve care for patients in Europe.

    PubMed

    Rodwell, Charlotte; Aymé, Ségolène

    2015-10-01

    Rare diseases are those with a particularly low prevalence; in Europe, diseases are considered to be rare when they affect not more than 5 in 10000 persons in the European Union. The specificities of rare diseases make the area a veritable public health challenge: the limited number of patients and scarcity of knowledge and expertise single rare diseases out as a distinctive domain of high European added-value. The Orphan Medicinal Product Regulation of 1999 was the first European legislative text concerning rare diseases, followed by many initiatives, including recommendations by the Council of Ministers of the European Union in 2009. These initiatives contributed to the development of rare diseases policies at European and national level aimed at improving care for patients with rare diseases. A review of the political framework at European level and in European countries is provided to demonstrate how legislation has created a dynamic that is progressively improving care for patients with rare diseases. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".

  12. A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home

    PubMed Central

    Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.

    2013-01-01

    PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393

  13. Which patients improve: characteristics increasing sensitivity to a supportive patient-practitioner relationship.

    PubMed

    Conboy, Lisa Ann; Macklin, Eric; Kelley, John; Kokkotou, Efi; Lembo, Anthony; Kaptchuk, Ted

    2010-02-01

    Supportive social relationships, including a positive patient-practitioner relationship, have been associated with positive health outcomes. Using the data from a randomized controlled trial (RCT) undertaken in the Boston area of the United States, this study sought to identify baseline factors predictive of patients' response to an experimentally applied supportive patient-practitioner relationship. To sort through the hundreds of potential attributes affecting the patient-practitioner relationship, we applied a false discovery rate method borrowed from the field of genomics and bioinformatics. To our knowledge such a method has not previously been applied to generate hypotheses from clinical trial data. In a previous RCT, our team investigated the effect of the patient-practitioner relationship on symptom improvement in patients with irritable Bowel syndrome (IBS). Data were collected on a sample of 289 individuals with IBS using a three-week, single blind, three arm, randomized controlled design. We found that a supportive patient-practitioner relationship significantly improved symptomatology and quality of life. A complex, multi-level measurement package was used to prospectively measure change and identify factors associated with improvement. Using a local false discovery rate procedure, we examined the association of 452 baseline subject variables with sensitivity to treatment. Out of 452 variables, only two baseline factors, reclusiveness, and previous trial experience increased sensitivity to the supportive patient-practitioner relationship. A third variable, additional opportunity during the study for subjects to discuss their illness through experiential interview, was associated with improved outcomes among subjects who did not receive the supportive patient-practitioner relationship. The few variables associated with differential benefit suggest that a patient-centered supportive patient-practitioner relationship may be beneficial for most patients

  14. Which patients improve: characteristics increasing sensitivity to a supportive patient-practitioner relationship

    PubMed Central

    Macklin, Eric; Kelley, John; Kokkotou, Efi; Lembo, Anthony; Kaptchuk, Ted

    2009-01-01

    Supportive social relationships, including a positive patient-practitioner relationship, have been associated with positive health outcomes. Using the data from a randomized controlled trial (RCT) undertaken in the Boston area of the United States, this study sought to identify baseline factors predictive of patients' response to an experimentally applied supportive patient-practitioner relationship. To sort through the hundreds of potential attributes affecting the patient-practitioner relationship, we applied a false discovery rate method borrowed from the field of genomics and bioinformatics. To our knowledge such a method has not previously been applied to generate hypotheses from clinical trial data. In a previous RCT, our team investigated the effect of the patient-practitioner relationship on symptom improvement in patients with irritable bowel syndrome (IBS). Data were collected on a sample of 289 individuals with IBS using a three-week, single blind, three arm, randomized controlled design. We found that a supportive patient-practitioner relationship significantly improved symptomatology and quality of life. A complex, multi-level measurement package was used to prospectively measure change and identify factors associated with improvement. Using a local false discovery rate procedure, we examined the association of 452 baseline subject variables with sensitivity to treatment. Out of 452 variables, only two baseline factors, reclusiveness, and previous trial experience increased sensitivity to the supportive patient-practitioner relationship. A third variable, additional opportunity during the study for subjects to discuss their illness through experiential interview, was associated with improved outcomes among subjects who did not receive the supportive patient-practitioner relationship. The few variables associated with differential benefit suggest that a patient-centered supportive patient-practitioner relationship may be beneficial for most patients

  15. Interferometric Measurement for Improved Understanding of Boundary Effects in Micromachined Beams

    SciTech Connect

    Bitsie, Fernando; Jensen, Brian D.; de Boer, Maarten

    1999-07-15

    Micromachined beams are commonly used to measure material properties in MEMS. Such measurements are complicated by the fact that boundary effects at the ends of the beams have a significant effect on the properties being measured. In an effort to improve the accuracy and resolution of such measurements, we are conducting a study of support post compliance in cantilever and fixed-fixed beams. Three different support post designs have been analyzed by finite element modeling. The results are then compared to measurements made on actual devices using interferometry. Using this technique, the accuracy of measurements of Young's modulus has been improved. Continuing work will also improve the measurement of residual stress.

  16. Can Dynamic Visualizations Improve Middle School Students' Understanding of Energy in Photosynthesis?

    ERIC Educational Resources Information Center

    Ryoo, Kihyun; Linn, Marcia C.

    2012-01-01

    Dynamic visualizations have the potential to make abstract scientific phenomena more accessible and visible to students, but they can also be confusing and difficult to comprehend. This research investigates how dynamic visualizations, compared to static illustrations, can support middle school students in developing an integrated understanding of…

  17. Improved understanding and testing for salinity tolerance in cool-season turfgrasses

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Utah State University and the USDA-ARS in Logan, Utah, were funded to conduct research towards understanding how cool season turf specied tolerate salt stress. Salt tolerant and salt susceptible varieties of Kentucky bluegrass, perennial ryegrass, and the check alkaligrass were planted in a replica...

  18. An Exercise To Improve Career Understanding of Commencing Engineering and Technology Students.

    ERIC Educational Resources Information Center

    Palmer, Stuart R.; Bray, Sharyn L.

    2002-01-01

    Undergraduate engineering students (n=123) collected and analyzed engineering job ads from newspapers and the Internet and prepared reports. Many began with inaccurate conceptions; 86.2% reported change in their understanding of engineering. Some learned how to increase their employability. Initial concepts of engineering as focused on technology…

  19. Improving Students' Understanding and Explanation Skills through the Use of a Knowledge Building Forum

    ERIC Educational Resources Information Center

    Hamel, Christine; Turcotte, Sandrine; Laferriere, Therese; Bisson, Nicolas

    2015-01-01

    Education research has shown the importance of helping students develop comprehension skills. Explanation-seeking rather than fact-seeking pedagogies have been shown to warrant deeper student understanding. This study investigates the use of Knowledge Forum (KF) in K-6 classrooms (n = 251) to develop students' explanation skills. To this end, we…

  20. Teachers and Game-Based Learning: Improving Understanding of How to Increase Efficacy of Adoption

    ERIC Educational Resources Information Center

    Ketelhut, Diane Jass; Schifter, Catherine C.

    2011-01-01

    Interest in game-based learning for K-12 is growing. Thus, helping teachers understand how to use these new pedagogies is important. This paper presents a cross-case study of the development of teacher professional development for the River City project, a games-based multi-user virtual environment science curriculum project for middle school…

  1. Improving Student's Understanding of Career Decision-Making through Service Learning

    ERIC Educational Resources Information Center

    Coulter-Kern, Russell G.; Coulter-Kern, Paige E.; Schenkel, Aubree A.; Walker, Danielle R.; Fogle, Kelly L.

    2013-01-01

    This study examines the impact of an experiential service-learning project designed to help high school students begin to choose a career path and increase college students' understanding about how to make career decisions. In the study, two groups of college students attended information sessions on career advising. The first group then helped…

  2. Improving High School Students' Understanding of Potential Difference in Simple Electric Circuits

    ERIC Educational Resources Information Center

    Liegeois, Laurent; Chasseigne, G'erard; Papin, Sophie; Mullet, Etienne

    2003-01-01

    This paper reports two studies into the understanding of the concept of potential difference in the current-potential difference-resistance context among 8th-12th graders (Study 1), and the efficiency of a learning device derived from Social Judgment Theory (Study 2). These two studies showed that: (a) when asked to infer potential difference from…

  3. Using Art-Based Chemistry Activities to Improve Students' Conceptual Understanding in Chemistry

    ERIC Educational Resources Information Center

    Danipog, Dennis L.; Ferido, Marlene B.

    2011-01-01

    This study aimed to determine the effects of art-based chemistry activities (ABCA) on high school students' conceptual understanding in chemistry. The study used the pretest-posttest control group design. A total of 64 third-year high school students from two different chemistry classes participated in the study. One class was exposed to art-based…

  4. Drafting Exercises to Improve Understanding. Industrial Arts Series No. 10,007.

    ERIC Educational Resources Information Center

    Hinrichs, Roy S., Comp.

    These materials, which can be used to supplement a drafting program, are designed to assist the instructor in helping students develop a better understanding of certain areas of drafting. The materials are divided into exercises that allow the student to devote full attention to one aspect of drafting at a time, and tests, which can be used either…

  5. Four Cornerstones of Calibration Research: Why Understanding Students' Judgments Can Improve Their Achievement

    ERIC Educational Resources Information Center

    Dunlosky, John; Thiede, Keith W.

    2013-01-01

    The target articles make significant advances in our understanding of students' judgments of their cognitive processes and products. In general, the advances are relative to a subset of common themes, which we call the four cornerstones of research on metacognitive judgments. We discuss how the target articles build on these cornerstones (judgment…

  6. Effective Use of Discovery Learning to Improve Understanding of Factors That Affect Quality

    ERIC Educational Resources Information Center

    Mukherjee, Arup

    2015-01-01

    Undergraduate business majors are required to take a course in operations management. In this course, a great deal of emphasis is put on developing a good understanding of quality because this is likely to be the only required course that covers this important topic. Quality of output exhibits a great deal of variation. To produce high quality on…

  7. An Integrated Academic Literacy Approach to Improving Students' Understanding of Plagiarism in an Accounting Course

    ERIC Educational Resources Information Center

    Powell, Lisa; Singh, Nishani

    2016-01-01

    Plagiarism in higher education is a widespread and complex issue. Students' understanding of plagiarism differs as a result of combining their prior learning about referencing with their current experience of institutional policies and generic resources. Plagiarism was identified as a major learning issue in a core second-year undergraduate…

  8. Using the Theory of Reasoned Action to Improve the Understanding of Recreation Behavior.

    ERIC Educational Resources Information Center

    Young, Robert A.; Kent, Anne T.

    1985-01-01

    Using the theory of reasoned action, 100 residents of a small Midwestern city were questioned about intentions to camp, attitudes and beliefs about camping, and influences of "important others" in making decisions to camp. The study results demonstrate that the theory may be useful in predicting behavior and understanding the…

  9. Understanding Change for Effective School Improvement Initiatives: Critical Elements of School Reform

    ERIC Educational Resources Information Center

    Schnautz, Dee Ann Piercy

    2012-01-01

    With the historical political and social changes, which ultimately affect education, it is easy to see why teachers sometimes balk at new initiatives and perceived new best practices. For change to occur it is important to understand how perception of critical elements of change impact student academic growth. It is also important to have a…

  10. Improving high school physical science students' understanding of the electromagnetic spectrum: A modified diagram approach

    NASA Astrophysics Data System (ADS)

    Quebedeaux, James Edward

    The focus of this study was to identify major conceptual difficulties that selected public high school physical science students encounter in understanding a standard electromagnetic spectrum diagram. A research-driven, modified version of that standard diagram was used in this study to determine the value added to student understanding of electromagnetic waves. A content analysis was performed on electromagnetic spectrum diagrams found in US textbooks from the 1950s through the present. A class of public high school physical science students participated in a study consisting of four activities conducted during a three-week unit. Students were given a pre- and post-achievement test and a pre- and post-survey on the regions of the electromagnetic spectrum. At the conclusion of each activity, selected students were interviewed and each co-constructed a concept map with the researcher. The Electromagnetic Spectrum Literacy Rubric (ESLR) was designed and used to assess students' conceptual understanding periodically as they proceeded through the unit study. A mixed methods analysis was performed, employing both qualitative and quantitative data. A paired t-test determined that there was a statistically significant difference (p = 0.014) between the pre- and post-achievement test scores for the class of students participating in the unit study. Effect sizes also determined that students have difficulties with mathematical calculations and wave properties. These topics present conceptual challenges which must be overcome to understand and use an electromagnetic spectrum diagram effectively.

  11. Successful Storyreading Procedures: Working with Kindergarten Teachers to Improve Children's Story Understanding.

    ERIC Educational Resources Information Center

    Peterman, Carol L.

    Based on the hypothesis that teachers' naturally occurring presentations of storyreading have an effect on children's literacy learning, a study examined whether teachers can be trained to provide a structure for listening to stories and whether this type of presentation would result in significant gains in children's story understanding. Five…

  12. Improved analyses for soil carbohydrates, amino acids, and phenols: Tools for understanding soil processes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A process-level understanding of soil carbon(C) and nitrogen (N) cycling will be facilitated by precise measurement of biochemical compounds in soil organic matter. This review summarizes some recent developments in analyses for soil carbohydrates, amino compounds (amino acids and amino sugars), and...

  13. Patient safety in plastic surgery: identifying areas for quality improvement efforts.

    PubMed

    Hernandez-Boussard, Tina; McDonald, Kathryn M; Rhoads, Kim F; Curtin, Catherine M

    2015-05-01

    Improving quality of health care is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events (AEs). This project assessed risk-adjusted rates of inpatient AEs for soft tissue reconstructive procedures.Patients receiving soft tissue reconstructive procedures from 2005 to 2010 were extracted from the Nationwide Inpatient Sample. Inpatient AEs were identified using patient safety indicators (PSIs), established measures developed by Agency for Healthcare Research and Quality.We identified 409,991 patients with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. Patient safety indicators were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (P < 0.01). Patient characteristics associated with a higher risk-adjusted rate per 1000 patients at risk included older age, men, nonwhite, and public payer (P < 0.05). Overall, plastic surgery patients had significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. Risk-adjusted rates of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by sex and payer. In general, plastic surgery patients had lower rates of in-hospital AEs than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of AEs identified in this population.

  14. Improving efficacy of landscape interventions in the (sub) humid Ethiopian highlands by improved understanding of runoff processes

    NASA Astrophysics Data System (ADS)

    Tebebu, Tigist; Steenhuis, Tammo; Dagnew, Dessalegn; Guzman, Christian; Bayabil, Haimanote; Zegeye, Assefa; Collick, Amy; Langan, Simon; MacAlister, Charlotte; Langendoen, Eddy; Yitaferu, Birru; Tilahun, Seifu

    2015-09-01

    Despite millions of dollars invested in soil and water conservation practices in the (sub) humid Ethiopian highlands and billions of hours of food-for-work farm labor, sediment concentration in rivers is increasing. This paper reports on the research to reverse the current trend. Based on the understanding of the hydrology of highlands, we provide evidence on sources of surface runoff and sediment and on mechanisms that govern the erosion processes and approaches and how they affect soil and water conservation practices. We suggest that priority in landscape interventions should be given to re-vegetation of the degraded areas so as to reduce the sediment concentration contributions originating from these areas. Additionally, efforts should be directed to gully rehabilitation in the saturated bottom landscape that may consist of vegetating shallow gullies and stabilizing head cuts of deeper gullies Finally, rehabilitation efforts should be directed to increase the rain water infiltration in the upland areas through the hard pan layer by connecting the land surface to the original deep flow paths that exist below about 60 cm. It will reduce the direct runoff during the rainy season and increase baseflow during the dry season.

  15. How can we improve our understanding of cardiovascular safety liabilities to develop safer medicines?

    PubMed Central

    Laverty, HG; Benson, C; Cartwright, EJ; Cross, MJ; Garland, C; Hammond, T; Holloway, C; McMahon, N; Milligan, J; Park, BK; Pirmohamed, M; Pollard, C; Radford, J; Roome, N; Sager, P; Singh, S; Suter, T; Suter, W; Trafford, A; Volders, PGA; Wallis, R; Weaver, R; York, M; Valentin, JP

    2011-01-01

    Given that cardiovascular safety liabilities remain a major cause of drug attrition during preclinical and clinical development, adverse drug reactions, and post-approval withdrawal of medicines, the Medical Research Council Centre for Drug Safety Science hosted a workshop to discuss current challenges in determining, understanding and addressing ‘Cardiovascular Toxicity of Medicines’. This article summarizes the key discussions from the workshop that aimed to address three major questions: (i) what are the key cardiovascular safety liabilities in drug discovery, drug development and clinical practice? (ii) how good are preclinical and clinical strategies for detecting cardiovascular liabilities? and (iii) do we have a mechanistic understanding of these liabilities? It was concluded that in order to understand, address and ultimately reduce cardiovascular safety liabilities of new therapeutic agents there is an urgent need to: Fully characterize the incidence, prevalence and impact of drug-induced cardiovascular issues at all stages of the drug development process. Ascertain the predictive value of existing non-clinical models and assays towards the clinical outcome. Understand the mechanistic basis of cardiovascular liabilities; by addressing areas where it is currently not possible to predict clinical outcome based on preclinical safety data. Provide scientists in all disciplines with additional skills to enable them to better integrate preclinical and clinical data and to better understand the biological and clinical significance of observed changes. Develop more appropriate, highly relevant and predictive tools and assays to identify and wherever feasible to eliminate cardiovascular safety liabilities from molecules and wherever appropriate to develop clinically relevant and reliable safety biomarkers. PMID:21306581

  16. Cancer and Fertility Program Improves Patient Satisfaction With Information Received

    PubMed Central

    Thom, Bridgette; Benedict, Catherine; Carter, Jeanne; Corcoran, Stacie; Dickler, Maura N.; Goodman, Karyn A.; Margolies, Allison; Matasar, Matthew J.; Noy, Ariela; Goldfarb, Shari B.

    2016-01-01

    Purpose A cancer and fertility program was established at a large cancer center to support clinicians in discussing treatment-related fertility risks and fertility preservation (FP) options with patients and in referring patients to reproductive specialists. The program provides resources, clinician education, and fertility clinical nurse specialist consultation. This study evaluated the program’s impact on patient satisfaction with information received. Patients and Methods Retrospective cross-sectional surveys assessed satisfaction before (cohort 1 [C1]) and after (cohort 2 [C2]) program initiation. Questionnaires were investigator-designed, gender-specific, and anonymous. Results Most C1 (150 males, 271 females) and C2 (120 males, 320 females) respondents were 2 years postdiagnosis; the most frequently reported cancers were testicular, breast, and lymphoma. A significant difference in satisfaction with the amount of information received was seen between C1 and C2. For males, satisfaction with information on fertility risks was high in both cohorts but significantly greater in C2 for information on sperm banking (χ2 = 9.3, P = .01) and finding a sperm bank (χ2 = 13.3, P = .001). For females, satisfaction with information was significantly greater in C2 for information on fertility risks (χ2 = 62.1, P < .001), FP options (χ2 = 71.9, P < .001), help with decision making (χ2 = 80.2, P < .001), and finding a reproductive endocrinologist (χ2 = 60.5, P < .001). Among patients who received and read information materials, 96% of males and 99% of females found them helpful. Among C2 females, fertility clinical nurse specialist consultation was associated with significantly greater satisfaction with information on FP options (χ2 = 11.2, P = .004), help with decision making (χ2 = 10.4, P = .006), and finding a reproductive endocrinologist (χ2 = 22.6, P < .001), with 10% reporting lack of knowledge as a reason for not pursuing FP. Conclusion Improvements in

  17. An Improved Colonoscopy Preparation Method and its Acceptability by Patients

    PubMed Central

    1995-01-01

    The author presents an improved method of preparation for colonoscopy that involved no dietary limitation on the patient until the day of the examination and that was shown by a randomized questionnaire evaluation to earn good patient tolerance and acceptance. Patients were given 10 mg of cisapride and 75 mg of sodium picosulfate before sleep on the day preceding the examination, and 50 g of magnesium citrate powder (MP) in 1,200 mL lukewarm water before the examination. It was divided into 600-mL portions and ingested slowly during two 30-minute periods. Ninety-five percent of patients classified the taste of a magnesium citrate powder laxative as palatable in the questionnaire given immediately after the procedure. Concerning the quantity, 79.4% replied that it was tolerable, 17.3% considered it somewhat excessive, and 3.3% replied that it was barely tolerable. No patient classified it as intolerable. Symptoms after taking laxatives and lukewarm water such as abdominal pain, nausea and abdominal fullness were observed in 3.8%, 4.4% and 5.6%, respectively, whereas there were no symptoms in 79% of patients. Body weight and serum K level showed a tendency to decrease, whereas the serum Mg level showed an increase before and after colonoscopy. The quality of colonic cleansing evaluated by colonoscopy was excellent, good, or fair in a total of 93.3%. No adverse effects were observed. It was concluded that this method is a clinically beneficial and well-tolerated preparation for colonic examinations. PMID:18493356

  18. Nasal highflow improves ventilation in patients with COPD

    PubMed Central

    Bräunlich, Jens; Köhler, Marcus; Wirtz, Hubert

    2016-01-01

    Background Nasal highflow (NHF) provides a warmed and humidified air stream up to 60 L/min. Recent data demonstrated a positive effect in patients with acute hypoxemic respiratory failure, especially when caused by pneumonia. Preliminary data show a decrease in hypercapnia in patients with COPD. Therefore, NHF should be evaluated as a new ventilatory support device. This study was conducted to assess the impact of different flow rates on ventilatory parameters in patients with COPD. Materials and methods This interventional clinical study was performed with patients suffering from severe COPD. The aim was to characterize flow-dependent changes in mean airway pressure, breathing volumes, breathing frequency, and decrease in partial pressure of CO2 (pCO2). Mean airway pressure was measured in the nasopharyngeal space (19 patients). To evaluate breathing volumes, we used a polysomnographic device (18 patients). All patients received 20 L/min, 30 L/min, 40 L/min, and 50 L/min and – to illustrate the effects – nasal continuous positive airway pressure and nasal bilevel positive airway pressure. Capillary blood gas analyses were performed in 54 patients with hypercapnic COPD before and two hours after the use of NHF. We compared the extent of decrease in pCO2 when using 20 L/min and 30 L/min. Additionally, comfort and dyspnea during the use of NHF were surveyed. Results NHF resulted in a minor flow dependent increase in mean airway pressure. Tidal volume increased, and breathing rate decreased. The calculated minute volume decreased under NHF breathing. In spite of this fact, hypercapnia decreased with increasing flow (20 L/min vs 30 L/min). Additionally, an improvement in dyspnea was observed. The rapid shallow breathing index shows a decrease when using NHF. Conclusion NHF leads to a flow-dependent reduction in pCO2. This is most likely achieved by a washout of the respiratory tract and a functional reduction in dead space. In summary, NHF enhances effectiveness of

  19. Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients

    PubMed Central

    Wouters, Hans; Van Dijk, Liset; Geers, Harm C. J.; Winters, Nina A.; Van Geffen, Erica C. G.; Stiggelbout, Anne M.; Bouvy, Marcel L.

    2016-01-01

    Background Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences. Objectives To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations. Methods Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data. Results Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13–2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17–3.08, P < 0.01). Higher 'perceived self-efficacy' did not moderate these associations. Conclusions Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient

  20. Patient-Reported Use of Personalized Video Recordings to Improve Neurosurgical Patient-Provider Communication

    PubMed Central

    Porter, Randall

    2015-01-01

    Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication. Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes. Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed. Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more “at ease” with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action. Conclusions: Patient responses to the recording system and having a copy of their video

  1. [Concept for a National Implant Registry to Improve Patient Safety].

    PubMed

    Prantl, L; von Fritschen, U; Liebau, J; von Hassel, J; Baur, E M; Vogt, P M; Giunta, R E; Horch, R E

    2016-12-01

    Since the introduction of silicone implants, several events have led to considerable uncertainty among the patients, public, and users. So far, however, the necessary steps to significantly improving patient safety have not been taken in any of these cases. Requiring stricter approvals for medical devices, improving monitoring by the regulatory authorities and the revision of the Medical Devices Directive are all initial steps in the right direction towards a change in policy, but are insufficient as an early warning system. After the introduction of registers was announced in the coalition agreement, the German Society of Plastic, Aesthetic and Reconstructive Surgeons (DGPRÄC), in close consultation with the Ministry of Health, has developed a concept which is presented here. The need for a uniform and legally binding central register for breast implants is fully supported by the entire medical profession. According to the concept presented by the DGPRÄC, three data qualities would be applicable: Safety data (mandatory), physician information (voluntary) and research data (optional, except if safety related). The public authorities are creating a unified, secure entry portal for all professional associations concerned. This register is based with the professional associations, and from there the mandatory security data will be forwarded to the public authorities. Decoding of the identity of the patient and doctor would only occur in specifically defined emergency situations such as product recalls. Automated tools in the security database provide early detection of problems, so that rapid clarification is possible in consultation with the professional associations, manufacturers and possibly patients. This concept as proposed by the DGPRÄC has thus far been very positively received in all discussions between the various parties concerned.

  2. Improving the likelihood of neurology patients being examined using patient feedback.

    PubMed

    Appleton, Jason Philip; Ilinca, Andreea; Lindgren, Arne; Puschmann, Andreas; Hbahbih, Majed; A Siddiqui, Khurram; de Silva, Rajith; Jones, Matthew; Butterworth, Richard; Willmot, Mark; Hayton, Tom; Lunn, Michael; Nicholl, David

    2015-01-01

    We aimed to establish whether recall of elements of the neurological examination can be improved by use of a simple patient assessment score. In a previous study we demonstrated that in-patients referred to neurology at two United Kingdom (UK) hospitals were not fully examined prior to referral; we therefore designed a larger quality improvement report with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention. In-patients referred to neurology over a four month period (in hospitals in the UK (10), Jordan (1), Sweden (2), and the United Arab Emirates (1)) were asked whether they recalled being examined with a tendon hammer (T), ophthalmoscope (O), and stethoscope (S) since admission. The results were disseminated to local medical teams using various techniques (including Grand Round presentations, email, posters, discounted equipment). Data were then collected for a further four month period post-intervention. Pre-intervention and post-intervention data were available for 11 centres with 407 & 391 patients in each arm respectively. Median age of patients was 51 (range 13-100) and 49 (range 16-95) years respectively, with 44.72% and 44.76% being male in each group. 264 patients (64.86%) recalled being examined with a tendon hammer in the pre-intervention arm, which significantly improved to 298 (76.21%) (p<0.001). Only 119 patients (29.24%) recollected examination with an ophthalmoscope pre-intervention, which significantly improved to 149 (38.11%)(p=0.009). The majority of patients (321 (78.87%)) pre-intervention recalled examination with a stethoscope, which significantly improved to 330 (84.4%) to a lesser extent (p=0.045). Results indicate that most patients are not fully examined prior to neurology referral yet a simple assessment score and educational intervention can improve recall of elements of the neurological examination and thus the likelihood of patients being examined neurologically. This is the

  3. Improving psychosocial health in hemodialysis patients after a disaster.

    PubMed

    Weiner, Sheila; Kutner, Nancy G; Bowles, Tess; Johnstone, Stephanie

    2010-01-01

    Twenty-two social workers implemented a cognitive-behavioral intervention with 69 patients in 22 dialysis units in Louisiana to improve psychosocial health following Hurricanes Katrina and Rita. Pre- and post-intervention questionnaires measured psychosocial status domains (general health status, social functioning, burden of kidney disease, depressed mood, anxiety, and mastery). Participants rated their general health status (p < .05) and social functioning (p < .05) significantly higher after the intervention. Participants who listened to the class Managing stress through communication and problem solving and discussed it with their social worker, had significant improvement in depressed mood score (p < .05) after completing the program, compared to participants who did not discuss this material with their social worker. Sixty-five percent had scores indicating depressed mood before the program, compared with 56% following. The more positive participants' program evaluation, the higher their quality of life (lower perceived burden of kidney disease [p = .05]).

  4. Museum Monsters and Victorious Viruses: Improving Public Understanding of Emerging Biomedical Research

    PubMed Central

    Diamond, Judy; Jee, Benjamin; Matuk, Camilla; McQuillan, Julia; Spiegel, Amy N.; Uttal, David

    2015-01-01

    Although microbes directly impact everyone's health, most people have limited knowledge about them. In this article, we describe a museum and media public education campaign aimed at helping diverse audiences better understand emerging knowledge about microbes and infectious disease. Funded primarily by the Science Education Partnership (SEPA) program of the National Institutes of Health, this campaign involved crosscutting programs designed to extend impacts throughout a broad public audience. PMID:26392634

  5. Museum Monsters and Victorious Viruses: Improving Public Understanding of Emerging Biomedical Research.

    PubMed

    Diamond, Judy; Jee, Benjamin; Matuk, Camilla; McQuillan, Julia; Spiegel, Amy N; Uttal, David

    2015-07-01

    Although microbes directly impact everyone's health, most people have limited knowledge about them. In this article, we describe a museum and media public education campaign aimed at helping diverse audiences better understand emerging knowledge about microbes and infectious disease. Funded primarily by the Science Education Partnership (SEPA) program of the National Institutes of Health, this campaign involved crosscutting programs designed to extend impacts throughout a broad public audience.

  6. The solar activity measurements experiments (SAMEX) for improved scientific understanding of solar activity

    NASA Technical Reports Server (NTRS)

    1989-01-01

    The Solar Activity Measurements Experiments (SAMEX) mission is described. It is designed to provide a look at the interactions of magnetic fields and plasmas that create flares and other explosive events on the sun in an effort to understand solar activity and the nature of the solar magnetic field. The need for this mission, the instruments to be used, and the expected benefits of SAMEX are discussed.

  7. Understanding the Potential of Virtual Environments for Improving C2 Performance

    DTIC Science & Technology

    2011-06-01

    Collaboration, Information-sharing, and Trust) multiplayer online counterterrorism intelligence game . Currently ELICIT has only a primitive textual interface...Trust) multiplayer online counterterrorism intelligence game to understand the comparative advantages and disadvantages of alternate C2 approaches...steps 2 Background • ELICIT: multiplayer online game —Counterterrorism intelligence domain —Like game Clue: ID fictitious terrorist plots • Used for C2

  8. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries

    PubMed Central

    Secanell, Mariona; Groene, Oliver; Arah, Onyebuchi A.; Lopez, Maria Andrée; Kutryba, Basia; Pfaff, Holger; Klazinga, Niek; Wagner, Cordula; Kristensen, Solvejg; Bartels, Paul Daniel; Garel, Pascal; Bruneau, Charles; Escoval, Ana; França, Margarida; Mora, Nuria; Suñol, Rosa; Klazinga, N; Kringos, DS; Lopez, MA; Secanell, M; Sunol, R; Vallejo, P; Bartels, P; Kristensen, S; Michel, P; Saillour-Glenisson, F; Vlcek, F; Car, M; Jones, S; Klaus, E; Bottaro, S; Garel, P; Saluvan, M; Bruneau, C; Depaigne-Loth, A; Shaw, C; Hammer, A; Ommen, O; Pfaff, H; Groene, O; Botje, D; Wagner, C; Kutaj-Wasikowska, H; Kutryba, B; Escoval, A; Lívio, A; Eiras, M; Franca, M; Leite, I; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; Chow, A; DerSarkissian, M; Thompson, CA; Wang, A; Thompson, A

    2014-01-01

    Introduction and Objective This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. Design DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. Setting and Participants We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. Main outcome measures A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Results Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. Conclusions This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers

  9. Socioscientific Issues: A Path Towards Advanced Scientific Literacy and Improved Conceptual Understanding of Socially Controversial Scientific Theories

    NASA Astrophysics Data System (ADS)

    Pinzino, Dean William

    This thesis investigates the use of socioscientific issues (SSI) in the high school science classroom as an introduction to argumentation and socioscientific reasoning, with the goal of improving students' scientific literacy (SL). Current research is reviewed that supports the likelihood of students developing a greater conceptual understanding of scientific theories as well as a deeper understanding of the nature of science (NOS), through participation in informal and formal forms of argumentation in the context of SSI. Significant gains in such understanding may improve a student's ability to recognize the rigor, legitimacy, and veracity of scientific claims and better discern science from pseudoscience. Furthermore, students that participate in significant SSI instruction by negotiating a range of science-related social issues can make significant gains in content knowledge and develop the life-long skills of argumentation and evidence-based reasoning, goals not possible in traditional lecture-based science instruction. SSI-based instruction may therefore help students become responsible citizens. This synthesis also suggests that that the improvements in science literacy and NOS understanding that develop from sustained engagement in SSI-based instruction will better prepare students to examine and scrutinize socially controversial scientific theories (i.e., evolution, global warming, and the Big Bang).

  10. Patient Safety in Plastic Surgery: Identifying Areas for Quality Improvement Efforts

    PubMed Central

    Hernandez-Boussard, Tina; McDonald, Kathryn M.; Rhoads, Kim F.; Curtin, Catherine M.

    2016-01-01

    Summary Background Improving quality of healthcare is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events. This project assessed risk-adjusted rates of inpatient adverse events for soft tissue reconstructive procedures. Methods Patients receiving soft tissue reconstructive procedures from 2005–2010 were extracted from the Nationwide Inpatient Sample. Inpatient adverse events were identified using patient safety indicators (PSI), established measures developed by Agency for Healthcare Research and Quality. Results We identified 409,991 patient with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. PSIs were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (p<.01). Patient characteristics associated with a higher risk-adjusted rate per 1,000 patients at risk (RAR) included older age, men, non-white, and public payer (p<.05). Overall, plastic surgery patients had significantly lower RAR compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. RAR of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by gender and payer. Conclusions In general, plastic surgery patients had lower rates of in-hospital adverse events than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of adverse events identified in this population. PMID:24108144

  11. Techniques for improving efficiency in the emergency department for patients with acute ischemic stroke.

    PubMed

    Jauch, Edward C; Holmstedt, Christine; Nolte, Justin

    2012-09-01

    The past 15 years have witnessed significant strides in the management of acute stroke. The most significant advance, reperfusion therapy, has changed relatively little, but the integrated healthcare systems-stroke systems-established to effectively and safely administer stroke treatments have evolved greatly. Driving change is the understanding that "time is brain." Data are compelling that the likelihood of improvement is directly tied to time of reperfusion. Regional stroke systems of care ensure patients arrive at the most appropriate stroke-capable hospital in which intrahospital systems have been created to process the potential stroke patient as quickly as possible. The hospital-based systems are comprised of prehospital care providers, emergency department physicians and nurses, stroke team members, and critical ancillary services such as neuroimaging and laboratory. Given their complexity, these systems of care require maintenance. Through teamwork and ownership of the process, more patients will be saved from potential death and long-term disability.

  12. A Process-Centered Tool for Evaluating Patient Safety Performance and Guiding Strategic Improvement

    DTIC Science & Technology

    2005-01-01

    interdepartmental coordination of patient safety activities, would be crucial for introducing and improving patient safety. Two performance measures received a...seeking feedback and use of the information for improvement and creating a culture of safety. 1.2. Social Responsibility Ethical Behavior: How...all stakeholders, actively seeking feedback on patient safety and using the information for patient safety improvements . • Ensure ethical

  13. Community pharmacist–administered influenza immunization improves patient access to vaccination

    PubMed Central

    Folkins, Chris; Li, Wilson; Zervas, John

    2014-01-01

    Objectives: To describe the demographic characteristics and risk factors of patients receiving influenza vaccination in community pharmacies and to understand patient experiences and perceptions surrounding being vaccinated by a pharmacist. Methods: Survey data were collected by research pharmacists at 4 different community pharmacy locations in Toronto throughout a period of 8 weeks during October and November 2013. Participation in the survey was voluntary, and all patients vaccinated by pharmacists were invited to complete a survey following immunization. Results: During the course of the study, 2498 vaccine doses were administered among all study sites, and 1502 surveys were completed. Our data showed a high degree of patient satisfaction, with 92% of patients indicating they were very satisfied with the pharmacist’s injection technique and the services they received. Furthermore, 86% of patients were very comfortable with being vaccinated by a pharmacist, and 99% of patients reported they would recommend that friends and family be vaccinated by a pharmacist. Convenience and accessibility were major determinants of patient satisfaction, as shown by 46% of all written comments specifically addressing these factors. Of the patients surveyed, 25% were not regular annual vaccine recipients, and 47% were classified as being at high risk for influenza complications according to Public Health Agency of Canada criteria. Notably, 28% of total patients and 21% of high-risk patients reported that they would not have been immunized this year if pharmacy-based vaccination were not available. Conclusions: Our findings suggest that pharmacists provide a highly convenient and accessible option for seasonal flu vaccination that is viewed favourably by patients. Administration of the flu vaccine by pharmacists has the potential to positively affect public health by improving vaccination rates among high-risk patients, first-time or occasional vaccine recipients, and patients

  14. A Teacher's Guide to Classroom Assessment: Understanding and Using Assessment to Improve Student Learning

    ERIC Educational Resources Information Center

    Butler, Susan M.; McMunn, Nancy D.

    2006-01-01

    This book is a comprehensive guide that shows step-by-step how to effectively integrate assessment into the classroom. Written for both new and seasoned teachers, this important book offers a practical aid for developing assessment skills and strategies, building assessment literacy, and ultimately improving student learning. This book consists of…

  15. Understanding Effective Program Improvement Schools through a Distributed Leadership Task Context Model

    ERIC Educational Resources Information Center

    Gipson, Frances Marie

    2012-01-01

    Federal, state, and local agencies face challenges organizing resources that create the conditions necessary to create, sustain, and replicate effective high performing schools. Knowing that leadership does impact achievement outcomes and that school districts tackle growing numbers of sanctioned Program Improvement schools, a distributed…

  16. Using Sap Flow Monitoring for Improved Process-based Ecohydrologic Understanding 2022

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sap flow measurements can be an important tool for unraveling the complex web of ecosystem fluxes, especially when it is combined with other measurements like eddy covariance, isotopes, remote sensing, etc. In this talk, we will demonstrate how sap flow measurements have improved our process-level u...

  17. Improving Students' Understanding of Quantum Measurement. II. Development of Research-Based Learning Tools

    ERIC Educational Resources Information Center

    Zhu, Guangtian; Singh, Chandralekha

    2012-01-01

    We describe the development and implementation of research-based learning tools such as the Quantum Interactive Learning Tutorials and peer-instruction tools to reduce students' common difficulties with issues related to measurement in quantum mechanics. A preliminary evaluation shows that these learning tools are effective in improving students'…

  18. The Limits of Tutor Intervention: Understanding Improvement in a Cultural View of FE Learning and Teaching

    ERIC Educational Resources Information Center

    James, David; Wahlberg, Madeleine

    2007-01-01

    From its inception, the Transforming Learning Cultures in Further Education (TLC) project included an explicit intention to identify some principles for the enhancement of learning cultures in order to improve student and teacher learning, and a wish to see how effective different strategies could be in this endeavour. The project showed that both…

  19. Engineering in K-12 Education: Understanding the Status and Improving the Prospects

    ERIC Educational Resources Information Center

    Katehi, Linda, Ed.; Pearson, Greg, Ed.; Feder, Michael, Ed.

    2009-01-01

    Engineering education in K-12 classrooms is a small but growing phenomenon that may have implications for engineering and also for the other STEM subjects--science, technology, and mathematics. Specifically, engineering education may improve student learning and achievement in science and mathematics, increase awareness of engineering and the work…

  20. Patients' and professionals' understandings of the causes of chronic pain: blame, responsibility and identity protection.

    PubMed

    Eccleston, C; Williams, A C; Rogers, W S

    1997-09-01

    A social constructionist analysis of how sense is made of the causes of chronic pain is reported. It is recognised that there is a multiplicity of stories available in any culture from which understanding can be reached. Q-factor analysis is used within a critical framework as Q-methodology. Sixty chronic pain patients and pain professionals completed the sorting procedure. Four factors were derived that account for the causes of chronic pain. These are reported as the patients' account, the professionals' account, the scientists account and the alternative practitioner's account. Common to all four accounts are the themes of responsibility, blame and the need to protect identity. It is argued that in all accounts responsibility is repositioned away from the sufferer or the healer. In all of the accounts blame is resisted or deflected away from individual ownership. Finally, it is argued that when pain is no longer useful as a symptom, identity is challenged, weakened and at risk for both chronic pain patients and pain professionals. Implications of this study for chronic pain research and treatment are discussed.

  1. Interleaved processors improve cochlear implant patients' spectral resolution

    PubMed Central

    Aronoff, Justin M.; Stelmach, Julia; Padilla, Monica; Landsberger, David M.

    2015-01-01

    Objective Cochlear implant patients have difficulty in noisy environments in part because of channel interaction. Interleaving the signal by sending every other channel to the opposite ear has the potential to reduce channel interaction by increasing the space between channels in each ear. Interleaving still potentially provides the same amount of spectral information when the two ears are combined. Although this method has been successful in other populations such as hearing aid users, interleaving with cochlear implant patients has not yielded consistent benefits. This may be because perceptual misalignment between the two ears and the spacing between stimulation locations must be taken into account before interleaving. Design Eight bilateral cochlear implant users were tested. After perceptually aligning the two ears, twelve channel maps were made that spanned the entire aligned portions of the array. Interleaved maps were created by removing every other channel from each ear. Participants' spectral resolution and localization abilities were measured with perceptually aligned processing strategies both with and without interleaving. Results There was a significant improvement in spectral resolution with interleaving. However, there was no significant effect of interleaving on localization abilities. Conclusions The results indicate that interleaving can improve cochlear implant users' spectral resolution. However, it may be necessary to perceptually align the two ears and/or use relatively large spacing between stimulation locations. PMID:26656190

  2. Using Scientific Argumentation in a Science Methods Course to Improve Preservice Teachers' Understanding of Climate Change

    NASA Astrophysics Data System (ADS)

    Lambert, J. L.; Bleicher, R. E.; Soden, B. J.

    2014-12-01

    Given that K-12 students have numerous alternative conceptions, it is critical that teachers have an understanding of the fundamental science underlying climate change (Feldman et al., 2010). Many teachers, however, do not demonstrate adequate understanding of these concepts (Daskolia et al., 2006). Argumentation has been identified as a mechanism for conceptual change (Mercer et al., 2004). Even with several educational initiatives promoting and supporting the use of argumentation as an instructional practice, teachers often struggle to implement argumentation in the classroom (Sampson & Blanchard, 2012). To remedy both issues above, we have designed an innovative methods course to provide background in climate change knowledge and argumentation instruction. In our methods course, we utilize Climate Science Investigations (CSI), an online, interactive series of modules and teaching resources funded by a NASA grant to support teachers learning about the basic science concepts underlying climate change. A key assignment is to develop and present an evidence-based scientific argument. The teachers were assigned a typical question and claim of climate skeptics and asked to conduct research on the scientific findings to prepare a counter-argument (rebuttal). This study examined changes in 60 preservice teachers' knowledge and perceptions about climate change after participation in the course. The teachers' understanding of fundamental concepts increased significantly. Their perceptions about climate change became more aligned to those of climate scientists. Findings suggest that scientific argumentation can play an effective role in the preparation of science educators. In addition to reporting findings in more detail, methods course activities, particularly in argumentation, will be shared in our presentation.

  3. Improving Student Understanding of Magmatic Differentiation Using an M&M Magma Chamber

    NASA Astrophysics Data System (ADS)

    Wirth, K. R.

    2003-12-01

    Many students, especially those in introductory geology courses, have difficulty developing a deep understanding of the processes of magmatic differentiation. In particular, students often struggle to understand Bowen's reaction series and fractional crystallization. The process of fractional crystallization by gravity settling can be illustrated using a model magma chamber consisting of M&M's. In this model, each major cation (e.g., Si, Ti, Al, Fe, Mg, Ca, Na, K) is represented by a different color M&M; other kinds of differently colored or shaped pieces could also be used. Appropriate numbers of each color M&M are combined to approximate the cation proportions of a basaltic magma. Students then fractionate the magma by moving M&M's to the bottom of the magma chamber forming a series of cumulus layers; the M&M's are removed in the stoichiometric proportions of cations in the crystallizing minerals (e.g., olivine, pyroxene, feldspars, quartz, magnetite, ilmenite). Students observe the changing cation composition (proportions of colors of M&M's) in the cumulus layers and in the magma chamber and graph the results using spreadsheet software. More advanced students (e.g., petrology course) can classify the cumulates and resulting liquid after each crystallization step, and they can compare the model system with natural magmatic systems (e.g., absence of important fractionating phases, volatiles). Students who have completed this exercise generally indicate a positive experience and demonstrate increased understanding of Bowen's reaction series and fractionation processes. They also exhibit greater familiarity with mineral stoichiometry, classification, solid-solution in minerals, element behavior (e.g., incompatibility), and chemical variation diagrams. Other models (e.g., paths of equilibrium and fractional crystallization on phase diagrams) can also be used to illustrate differentiation processes in upper level courses (e.g., mineralogy and petrology).

  4. A web-based interactive tool to improve breast cancer patient centredness

    PubMed Central

    Gorini, Alessandra; Mazzocco, Ketti; Kondylakis, Haridimos; McVie, Gordon; Pravettoni, Gabriella

    2016-01-01

    The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient’s unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient–physician communication, improving the patient’s understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient–physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient’s profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient’s physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient’s answers in real time and send them, together with specific recommendations to the physician’s computer immediately before physician’s first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient’s profile). The proposed approach is supposed to improve the patient–physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in

  5. Improving pharmacy students' understanding and long-term retention of acid-base chemistry.

    PubMed

    Roche, Victoria F

    2007-12-15

    Despite repeated exposure to the principles underlying the behavior of organic acids and bases in aqueous solution, some pharmacy students remain confused about the topic of acid-base chemistry. Since a majority of organic drug molecules have acid-base character, the ability to predict their reactivity and the extent to which they will ionize in a given medium is paramount to students' understanding of essentially all aspects of drug action in vivo and in vitro. This manuscript presents a medicinal chemistry lesson in the fundamentals of acid-base chemistry that many pharmacy students have found enlightening and clarifying.

  6. Improving Pharmacy Students' Understanding and Long-term Retention of Acid-Base Chemistry

    PubMed Central

    2007-01-01

    Despite repeated exposure to the principles underlying the behavior of organic acids and bases in aqueous solution, some pharmacy students remain confused about the topic of acid-base chemistry. Since a majority of organic drug molecules have acid-base character, the ability to predict their reactivity and the extent to which they will ionize in a given medium is paramount to students' understanding of essentially all aspects of drug action in vivo and in vitro. This manuscript presents a medicinal chemistry lesson in the fundamentals of acid-base chemistry that many pharmacy students have found enlightening and clarifying PMID:19503706

  7. Improving our understanding of environmental controls on the distribution of C3 and C4 grasses.

    PubMed

    Pau, Stephanie; Edwards, Erika J; Still, Christopher J

    2013-01-01

    A number of studies have demonstrated the ecological sorting of C3 and C4 grasses along temperature and moisture gradients. However, previous studies of C3 and C4 grass biogeography have often inadvertently compared species in different and relatively unrelated lineages, which are associated with different environmental settings and distinct adaptive traits. Such confounded comparisons of C3 and C4 grasses may bias our understanding of ecological sorting imposed strictly by photosynthetic pathway. Here, we used MaxEnt species distribution modeling in combination with satellite data to understand the functional diversity of C3 and C4 grasses by comparing both large clades and closely related sister taxa. Similar to previous work, we found that C4 grasses showed a preference for regions with higher temperatures and lower precipitation compared with grasses using the C3 pathway. However, air temperature differences were smaller (2 °C vs. 4 °C) and precipitation and % tree cover differences were larger (1783 mm vs. 755 mm, 21.3% vs. 7.7%, respectively) when comparing C3 and C4 grasses within the same clade vs. comparing all C4 and all C3 grasses (i.e., ignoring phylogenetic structure). These results were due to important differences in the environmental preferences of C3 BEP and PACMAD clades (the two main grass clades). Winter precipitation was found to be more important for understanding the distribution and environmental niche of C3 PACMADs in comparison with both C3 BEPs and C4 taxa, for which temperature was much more important. Results comparing closely related C3 -C4 sister taxa supported the patterns derived from our modeling of the larger clade groupings. Our findings, which are novel in comparing the distribution and niches of clades, demonstrate that the evolutionary history of taxa is important for understanding the functional diversity of C3 and C4 grasses, and should have implications for how grasslands will respond to global change.

  8. Understanding the priorities for women diagnosed with lymphangioleiomyomatosis: a patient perspective.

    PubMed

    Bassi, Iris; Hollis, Gill; Cottin, Vincent; Harari, Sergio; Zwanenburg, Elma; Veltkamp, Marcel; Casanova, Alvaro; Fletcher, Monica; Masefield, Sarah; Powell, Pippa; Boyd, Jeanette

    2016-04-01

    Lymphangioleiomyomatosis (LAM) is a rare lung disease that almost exclusively affects women and develops in about one in 400 000 adult females. The European Lung Foundation worked closely with one of the patient organisations within its network, the European LAM Federation, to raise awareness of LAM at the 2014 European Respiratory Society International Congress in Munich, Germany. In addition, an invitation-only workshop with 45 individuals from 13 countries was held to discuss the priorities for women in Europe living with the disease. The need for ongoing collaboration to improve knowledge of this rare lung condition with healthcare professionals across Europe was highlighted.

  9. Understanding the priorities for women diagnosed with lymphangioleiomyomatosis: a patient perspective

    PubMed Central

    Bassi, Iris; Hollis, Gill; Cottin, Vincent; Harari, Sergio; Zwanenburg, Elma; Veltkamp, Marcel; Casanova, Alvaro; Fletcher, Monica; Masefield, Sarah; Powell, Pippa

    2016-01-01

    Lymphangioleiomyomatosis (LAM) is a rare lung disease that almost exclusively affects women and develops in about one in 400 000 adult females. The European Lung Foundation worked closely with one of the patient organisations within its network, the European LAM Federation, to raise awareness of LAM at the 2014 European Respiratory Society International Congress in Munich, Germany. In addition, an invitation-only workshop with 45 individuals from 13 countries was held to discuss the priorities for women in Europe living with the disease. The need for ongoing collaboration to improve knowledge of this rare lung condition with healthcare professionals across Europe was highlighted. PMID:27730199

  10. Training and Action for Patient Safety: Embedding Interprofessional Education for Patient Safety within an Improvement Methodology

    ERIC Educational Resources Information Center

    Slater, Beverley L.; Lawton, Rebecca; Armitage, Gerry; Bibby, John; Wright, John

    2012-01-01

    Introduction: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based…

  11. Anatomy of Teaching Anatomy: Do Prosected Cross Sections Improve Students Understanding of Spatial and Radiological Anatomy?

    PubMed Central

    Vithoosan, S.; Kokulan, S.; Dissanayake, M. M.; Dissanayake, Vajira; Jayasekara, Rohan

    2016-01-01

    Introduction. Cadaveric dissections and prosections have traditionally been part of undergraduate medical teaching. Materials and Methods. Hundred and fifty-nine first-year students in the Faculty of Medicine, University of Colombo, were invited to participate in the above study. Students were randomly allocated to two age and gender matched groups. Both groups were exposed to identical series of lectures regarding anatomy of the abdomen and conventional cadaveric prosections of the abdomen. The test group (n = 77, 48.4%) was also exposed to cadaveric cross-sectional slices of the abdomen to which the control group (n = 82, 51.6%) was blinded. At the end of the teaching session both groups were assessed by using their performance in a timed multiple choice question paper as well as ability to identify structures in abdominal CT films. Results. Scores for spatial and radiological anatomy were significantly higher among the test group when compared with the control group (P < 0.05, CI 95%). Majority of the students in both control and test groups agreed that cadaveric cross section may be useful for them to understand spatial and radiological anatomy. Conclusion. Introduction of cadaveric cross-sectional prosections may help students to understand spatial and radiological anatomy better. PMID:27579181

  12. Using Learner-Centered Strategies to Improve Student Understanding About Stars

    NASA Astrophysics Data System (ADS)

    Bailey, Janelle M.; Nagamine, K.

    2009-01-01

    As faculty increasingly adopt learner-centered strategies for their introductory astronomy classes, it is important to determine whether such strategies are positively impacting student learning. One measure of student achievement that has been adopted is the use of concept inventories to measure changes in understanding of a specific topic over some period of instruction. The Star Properties Concept Inventory (SPCI) was used as a pre/posttest in a lecture-only course during Spring 2007 and again in Fall 2007 when the instructors incorporated Peer Instruction-style questions and Lecture Tutorials. Initial analysis shows that although pretest results were not significantly different between the two semesters, posttest results for the Fall 2007 semester are statistically significantly higher than those of the Spring 2007 offering. This result supports the idea that learner-centered strategies are more effective at supporting student understanding than are traditional lecture-only methods. This project is supported by the University of Nevada, Las Vegas Division of Research and Graduate Studies.

  13. How evolutionary principles improve the understanding of human health and disease

    PubMed Central

    Gluckman, Peter D; Low, Felicia M; Buklijas, Tatjana; Hanson, Mark A; Beedle, Alan S

    2011-01-01

    An appreciation of the fundamental principles of evolutionary biology provides new insights into major diseases and enables an integrated understanding of human biology and medicine. However, there is a lack of awareness of their importance amongst physicians, medical researchers, and educators, all of whom tend to focus on the mechanistic (proximate) basis for disease, excluding consideration of evolutionary (ultimate) reasons. The key principles of evolutionary medicine are that selection acts on fitness, not health or longevity; that our evolutionary history does not cause disease, but rather impacts on our risk of disease in particular environments; and that we are now living in novel environments compared to those in which we evolved. We consider these evolutionary principles in conjunction with population genetics and describe several pathways by which evolutionary processes can affect disease risk. These perspectives provide a more cohesive framework for gaining insights into the determinants of health and disease. Coupled with complementary insights offered by advances in genomic, epigenetic, and developmental biology research, evolutionary perspectives offer an important addition to understanding disease. Further, there are a number of aspects of evolutionary medicine that can add considerably to studies in other domains of contemporary evolutionary studies. PMID:25567971

  14. Understanding How the "Open" of Open Source Software (OSS) Will Improve Global Health Security.

    PubMed

    Hahn, Erin; Blazes, David; Lewis, Sheri

    2016-01-01

    Improving global health security will require bold action in all corners of the world, particularly in developing settings, where poverty often contributes to an increase in emerging infectious diseases. In order to mitigate the impact of emerging pandemic threats, enhanced disease surveillance is needed to improve early detection and rapid response to outbreaks. However, the technology to facilitate this surveillance is often unattainable because of high costs, software and hardware maintenance needs, limited technical competence among public health officials, and internet connectivity challenges experienced in the field. One potential solution is to leverage open source software, a concept that is unfortunately often misunderstood. This article describes the principles and characteristics of open source software and how it may be applied to solve global health security challenges.

  15. Can hierarchical modeling improve our understanding of bovine abortion due to Neospora caninum infection?

    PubMed

    Martinez, Brayan Alexander Fonseca; Leotti, Vanessa Bielefeldt; Borba, Mauro Riegert; Silva, Gustavo de Sousa E; Corbellini, Luís Gustavo

    2017-04-15

    The purpose of this study was to use mixed logistic regression to evaluate the association between Neospora caninum serostatus and abortion, accounting for the effects of farms. The main objective was to explore the interpretation of this model and discuss the contribution of this analysis to our understanding of the disease's epidemiology. A mixed-effects logistic model using farms as a random effect and the serostatus for N. caninum, age of cattle and farm location as fixed effects was performed. The data from 1256 cows over 15 months of age from 60 farms were used, and the abortion information was obtained from farm records. A significant association between N. caninum serostatus and abortion was found (p<0.0001). Seropositive cows had 6.63 times greater odds of having a history of previous abortion (95% CI: 4.35-13.37). There was remarkable variability across farms in the probability of a cow having a history of an abortion. Including the effects of the farms in the regression, it was possible to estimate an intraclass correlation coefficient (ICC) of 16%. That means that 16% of the variation in abortion occurrence that was not explained by the fixed effects was due to farms. In practical terms, this variation means that while there are farms with several seropositive cows and no/few abortion cases, the opposite is also true, with a high number of abortions in farms with low/medium seroprevalence. The remaining variability (84%) was not explained by the effect of N. caninum, age, region, and the effect of farms, i.e., it is due to unknown factors that are causing abortions. The results of this study reinforce the importance of N. caninum as a cause of abortions and demonstrate the significant heterogeneity in the probability of a cow having a history of an abortion that cannot be explained completely by N. caninum serostatus, age or location. Including the hierarchical structure of the population along with correct interpretation of the model estimates helps us

  16. a Radiocarbon Database for Improved Understanding of Global Soil Carbon Dynamics: Part II

    NASA Astrophysics Data System (ADS)

    Trumbore, S.; Torn, M. S.; Sierra, C. A.; Smith, L. J.; Nave, L. E.; Workshop Paritipants, R.

    2011-12-01

    We report results of a workshop to initiate a global database of radiocarbon measurements in soil and other ecosystem compartments. Radiocarbon provides critical information for understanding the rate of exchange of soil carbon with the atmosphere and hydrosphere. For example, radiocarbon has been used to demonstrate the importance of short range order minerals in stabilizing organic carbon on millennial timescales in some soils. On decadal to centennial timescales, the infiltration of 'bomb' radiocarbon provides a measure of the amount and nature of soil carbon that responds on the timescale of most human impacts. The radiocarbon sigature of chemically or physically fractionated soil, or even in specific organic compounds, can yield clues as to controls on organic matter cycling on a range of timescales. Radiocarbon in microbial biomass or respiration can be a sensitive indicator of shifts in substrate use with vegetation, nutrient availability or temperature change. Taken toghether, such measurements can provide critical tests for models of soil carbon dynamics, while patterns in soil C dynamics with edaphic factors can be used to help parameterize models at spatial scales ranging from profile to landscape to global. The advent and proliferation of accelerator mass spectrometry since the early 1990s has vastly increased the number of radiocarbon analyses carried out in soils. However, these studies have usually been carried out by individual investigators within specific sites or regions, and to date the results have not been assembled, interpreted or compared at larger spatial scales. Given the expense of radiocarbon measurements, and the need for global synthesis products to evaluate and/or develop models of soil carbon response to climate and land use changes across a range of spatial scales, our goals are to: (1) bring together in one place existing radiocarbon measurements and provide a continuing common repository for new analyses; (2) supply ancillary

  17. Patient-powered research networks aim to improve patient care and health research.

    PubMed

    Fleurence, Rachael L; Beal, Anne C; Sheridan, Susan E; Johnson, Lorraine B; Selby, Joe V

    2014-07-01

    The era of big data, loosely defined as the development and analysis of large or complex data sets, brings new opportunities to empower patients and their families to generate, collect, and use their health information for both clinical and research purposes. In 2013 the Patient-Centered Outcomes Research Institute launched a large national research network, PCORnet, that includes both clinical and patient-powered research networks. This article describes these networks, their potential uses, and the challenges they face. The networks are engaging patients, family members, and caregivers in four key ways: contributing data securely, with privacy protected; including diverse and representative groups of patients in research; prioritizing research questions, participating in research, and disseminating results; and participating in the leadership and governance of patient-powered research networks. If technical, regulatory, and organizational challenges can be overcome, PCORnet will allow research to be conducted more efficiently and cost-effectively and results to be disseminated quickly back to patients, clinicians, and delivery systems to improve patient health.

  18. Anticipated Improvements in Precipitation Physics and Understanding of Water Cycle from GPM Mission

    NASA Technical Reports Server (NTRS)

    Smith, Eric A.

    2003-01-01

    The GPM mission is currently planned for start in the late-2007 to early-2008 time frame. Its main scientific goal is to help answer pressing scientific problems arising within the context of global and regional water cycles. These problems cut across a hierarchy of scales and include climate-water cycle interactions, techniques for improving weather and climate predictions, and better methods for combining observed precipitation with hydrometeorological prediction models for applications to hazardous flood-producing storms, seasonal flood/draught conditions, and fresh water resource assessments. The GPM mission will expand the scope of precipitation measurement through the use of a constellation of some 9 satellites, one of which will be an advanced TRMM-like core satellite carrying a dual-frequency Ku-Ka band precipitation radar and an advanced, multifrequency passive microwave radiometer with vertical-horizontal polarization discrimination. The other constellation members will include new dedicated satellites and co-existing operational/research satellites carrying similar (but not identical) passive microwave radiometers. The goal of the constellation is to achieve approximately 3-hour sampling at any spot on the globe -- continuously. The constellation s orbit architecture will consist of a mix of sun-synchronous and non-sun-synchronous satellites with the core satellite providing measurements of cloud-precipitation microphysical processes plus calibration-quality rainrate retrievals to be used with the other retrieval information to ensure bias-free constellation coverage. GPM is organized internationally, involving existing, pending, projected, and under-study partnerships which will link NASA and NOAA in the US, NASDA in Japan, ESA in Europe, ISRO in India, CNES in France, and possibly AS1 in Italy, KARI in South Korea, CSA in Canada, and AEB in Brazil. Additionally, the program is actively pursuing agreements with other international collaborators and

  19. Recombinant probiotics with antimicrobial peptides: a dual strategy to improve immune response in immunocompromised patients.

    PubMed

    Mandal, Santi M; Silva, Osmar N; Franco, Octavio L

    2014-08-01

    Bacterial infectious diseases are currently a serious health problem, especially in patients compromised by illness or those receiving immune-suppressant drugs. In this context, it is not only essential to improve the understanding of infectious mechanisms and host response but also to discover novel therapies with extreme urgency. Probiotics and antimicrobial peptides are also favorably viewed as novel strategies in the control of resistant bacteria. The present review will shed some light on the use of probiotic microorganisms expressing antimicrobial peptides as a dual therapy to control bacterial infectious diseases.

  20. On the Concept of Force: How Understanding its History can Improve Physics Teaching

    NASA Astrophysics Data System (ADS)

    Coelho, Ricardo Lopes

    2010-01-01

    Some physicists have pointed out that we do not know what force is. The most common definition of force in textbooks has been criticized for more than two centuries. Many studies have shown that the concept of force is a problem for teaching. How to conceive force on the basis of the concepts and criticism of force in the works of Newton, Euler, d’Alembert, Lagrange, Lazare Carnot, Saint-Venant, Reech, Kirchhoff, Mach, Hertz and Poincaré is the question of the present article. This part of the article is followed by an overview of definitions of force in contemporary textbooks. In the next part, an answer to the question is given: how to understand force within the framework of the laws of motion and in applications. Finally, some educational implications are considered.

  1. Using epigenomic studies in monozygotic twins to improve our understanding of cancer.

    PubMed

    Roos, Leonie; Spector, Timothy D; Bell, Christopher G

    2014-06-01

    Cancer is a set of diseases that exhibit not only genetic mutations but also a profoundly distorted epigenetic landscape. Over the last two decades, great advances have been made in identifying these alterations and their importance in the initiation and progression of cancer. Epigenetic changes can be seen from the very early stages in tumorigenesis and dysregulation of the epigenome has an increasingly acknowledged pathogenic role. Epigenomic twin studies have great potential to contribute to our understanding of complex diseases, such as cancer. This is because the use of monozygotic twins discordant for cancer enables epigenetic variation analysis without the confounding influence of the constitutive genetic background, age or cohort effects. It therefore allows the identification of susceptibility loci that may be sensitive to modification by the environment. These studies into cancer etiology will potentially lead to robust epigenetic markers for the detection and risk assessment of cancer.

  2. Integrating flux, satellite, and proximal optical data for an improved understanding of ecosystem carbon uptake

    NASA Astrophysics Data System (ADS)

    Gamon, J. A.; Huemmrich, K. F.; Garrity, S. R.

    2015-12-01

    The different scales and methods of satellite observations and flux measurements present challenges for data integration that can be partly addressed by the addition of scale-appropriate optical sampling. Proximal optical measurement facilitates experimental approaches that can inform upscaling, satellite validation, and lead to better understanding of controls on carbon fluxes and other ecosystem processes. Using the framework of the light-use efficiency model, this presentation will review efforts to explore the controls on ecosystem-atmosphere carbon fluxes using a variety of novel optical sensors and platforms. Topics of appropriate sampling methodology, scaling and data aggregation will also be considered, with examples of how information content and interpretation of optical data can be scale-dependent. Key challenges include informatics solutions that handle large, multi-dimensional data volumes and contextual information, including information about sampling protocols and scale. Key opportunities include the assessment of vegetation functional diversity with optical sensors.

  3. MoFlow: visualizing conformational changes in molecules as molecular flow improves understanding

    PubMed Central

    2015-01-01

    Background Current visualizations of molecular motion use a Timeline-analogous representation that conveys "first the molecule was shaped like this, then like this...". This scheme is orthogonal to the Pathline-like human understanding of motion "this part of the molecule moved from here to here along this path". We present MoFlow, a system for visualizing molecular motion using a Pathline-analogous representation. Results The MoFlow system produces high-quality renderings of molecular motion as atom pathlines, as well as interactive WebGL visualizations, and 3D printable models. In a preliminary user study, MoFlow representations are shown to be superior to canonical representations for conveying molecular motion. Conclusions Pathline-based representations of molecular motion are more easily understood than timeline representations. Pathline representations provide other advantages because they represent motion directly, rather than representing structure with inferred motion. PMID:26361501

  4. Melatonin acts as antioxidant and improves sleep in MS patients.

    PubMed

    Adamczyk-Sowa, Monika; Pierzchala, Krystyna; Sowa, Pawel; Mucha, Sebastian; Sadowska-Bartosz, Izabela; Adamczyk, Jowita; Hartel, Marcin

    2014-08-01

    The relationship between the prevalence of multiple sclerosis (MS) and sunlight's ultraviolet radiation was proved. Oxidative stress plays a role in the pathogenic traits of MS. Melatonin possesses antioxidative properties and regulates circadian rhythms. Sleep disturbances in MS patients are common and contribute to daytime fatigue. The aim of study was to evaluate 5 mg daily melatonin supplementation over 90 days on serum total oxidant status (TOS), total antioxidant capacity (TAC) and its influence on sleep quality and depression level of MS patients. A case-control prospective study was performed on 102 MS patients and 20 controls matched for age and sex. The Kurtzke's Expanded Disability Status Scale, magnetic resonance imaging examinations, Athens Insomnia Scale (AIS), Beck Depression Inventory questionnaires were completed. Serum TOS and TAC levels were measured. We observed higher serum levels of TOS in all MS groups, while after melatonin treatment the TOS levels significantly decreased. The TAC level was significantly lower only in mitoxantrone-treated group and it increased after melatonin supplementation. A strong positive correlation between T1Gd(+) number lesions and TAC level in interferon-beta-1A group was observed. AIS group mean score above 6 defining insomnia were observed in interferon-beta-1B-group, glatiramer acetate-group and mitoxantrone-group: 6.62 ± 2.88, 8.45 ± 2.07, 11.1 ± 3.25, respectively. After melatonin treatment the AIS mean scores decrease in glatiramer acetate-group and mitoxantrone-group achieving 5.25 ± 1.14 and 7.08 ± 2.39, respectively (p < 0.05). Finding from our study suggest that melatonin can act as an antioxidant and improves reduced sleep quality in MS patients.

  5. Understanding the systemic nature of cities to improve health and climate change mitigation.

    PubMed

    Chapman, Ralph; Howden-Chapman, Philippa; Capon, Anthony

    2016-09-01

    Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues.

  6. 'Genetics home reference': helping patients understand the role of genetics in health and disease.

    PubMed

    Fomous, Cathy; Mitchell, Joyce A; McCray, Alexa

    2006-01-01

    The surge of information generated by the Human Genome Project has left many health professionals and their patients struggling to understand the role of genetics in health and disease. To aid the lay public and health professionals, the US National Library of Medicine developed an online resource called 'Genetics Home Reference' (GHR), located at http://ghr.nlm.nih.gov/. Launched in April 2003, GHR's goal is to help the public interpret the health implications of the Human Genome Project. It bridges the clinical questions of consumers and the rich technical data emerging from the sequenced human genome. The GHR web site is designed for easy navigation among summaries for genetic conditions and the related gene(s) and chromosome(s). This design strategy enhances the user's appreciation of how genes, chromosomes, and conditions are interrelated.

  7. Terrain Analysis for Human-Robot Interaction (TAH-RI): Enabling Terrain Understanding to Improve Tactical Behavior

    DTIC Science & Technology

    2005-04-01

    Contractor Report 2005-04 Terrain Analysis for Human-Robot Interaction (TAH-RI): Enabling Terrain Understanding to Improve Tactical Behavior Jim...Hicinbothom, Dawn Riddle, Ken Graves CHI Systems, Inc. Robin Murphy University of South Florida This report is published to meet legal and contractual...for the Behavioral and Social Sciences Approved for public release; distribution is unlimited REPORT DOCUMENTATION PAGE 1. REPORT DATE (dd-mm-yy) 2

  8. Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes

    PubMed Central

    Lorincz, Ilona S.; Lawson, Brittany C. T.

    2012-01-01

    Incentive programs directed at both providers and patients have become increasingly widespread. Pay-for-performance (P4P) where providers receive financial incentives to carry out specific care or improve clinical outcomes has been widely implemented. The existing literature indicates they probably spur initial gains which then level off or partially revert if incentives are withdrawn. The literature also indicates that process measures are easier to influence through P4P programs but that intermediate outcomes such as glucose, blood pressure, and cholesterol control are harder to influence, and the long term impact of P4P programs on health is largely unknown. Programs directed at patients show greater promise as a means to influence patient behavior and intermediate outcomes such as weight loss; however, the evidence for long term effects are lacking. In combination, both patient and provider incentives are potentially powerful tools but whether they are cost-effective has yet to be determined. PMID:23225214

  9. Understanding the improved stability of hybrid polymer solar cells fabricated with copper electrodes.

    PubMed

    Reeja-Jayan, B; Manthiram, Arumugam

    2011-05-01

    It is known that atmospheric oxygen is essential for realizing the photovoltaic properties of P3HT-TiO₂-based hybrid polymer solar cells because oxygen vacancies created in TiO₂ can become recombination sites for charge carriers, causing photovoltaic properties like open-circuit voltage (V(oc)) to decline quickly in an inert atmosphere. We demonstrate here that using an annealed Cu layer as hole collecting electrode results in a remarkably stable hybrid solar cell that maintains its photovoltaic parameters during 1 h of continuous testing in an inert atmosphere. An analysis of the data from photovoltaic device performance tests and X-ray photoelectron spectroscopy (XPS) attributes this improvement to the tendency of Cu to form sulfide-like complexes with the S atoms on P3HT, thereby inducing a chemically driven vertical segregation of P3HT toward the hole-collecting metal electrode. Additionally, XPS depth profiling analysis shows that Cu atoms can diffuse up to the TiO₂ layer and assist in filling up oxygen vacancies on the TiO₂ surface, thus eliminating defects that can act as donors of free electrons and degrade photovoltaic performance in an inert atmosphere. We analyze these improvements by examining in situ the effect of Cu on the P3HT and TiO₂ layers and on the organic-inorganic interface formed between them inside a hybrid solar cell.

  10. Using the Astronomy Diagnostic Test to Identify Teaching Strategies that Improve Conceptual Understanding

    NASA Astrophysics Data System (ADS)

    Deming, G. L.; Hufnagel, B.

    2002-05-01

    The Astronomy Diagnostic Test (ADT) was developed in order to assess learning in undergraduate introductory astronomy classes, but an underlying goal was to use the information supplied by the ADT to improve student learning. The ADT National Project collected pre-course (5346 students) and post-course (3842 students) test results from 97 classes at a variety of institutions in 31 states. These results have been compiled in an extensive database. The overall gain between pre-course and post-course average scores amounts to a disappointing 15%, but significant gains are identifiable for specific questions in individual classes. Results from the ADT National Project database will be presented for specific questions with minimal gains. Astronomy education researchers in Maryland are beginning to use ADT results to identify minimal gain concepts and then to modify and assess instructional strategies with the goal of improving student learning. A comparison will be made between ADT pre-course and post-course responses for several classes in which different teaching methods were used. Successful teaching strategies applicable in a variety of class settings will be offered and instructors are encouraged to become involved in assessing results in their own introductory astronomy classes. This research was supported by the National Science Foundation through grant REC-0089239.

  11. Improving the understanding and diagnosis of Earth system changes in cold regions

    NASA Astrophysics Data System (ADS)

    Lettenmaier, D. P.

    2015-12-01

    I review key hydrological state variables and fluxes relevant to cold regions, specifically snow, permafrost and seasonally frozen soils, lakes, and wetlands, and comment on the ability of current models to represent the associated processes, and the quality of the data sets upon which model development and diagnosis efforts rest. Although snow processes are relatively well represented in current generation land surface models, at least at large scales for deep mountain snowpacks, the representation of high latitude snow processes remain complicated by the role of snow redistribution, and of sublimation during the shoulder (especially spring) season. Most credible land surface models now include representations of permafrost, some of which perform well when forced with local climate data; however their performance over large areas is limited by spatial variability of key processes, including soil thermal characteristics. Likewise, many land surface models now represent the hydrology and energetics of lakes, which cover a substantial portion of the landscape in many high latitude environs. However, accurate representation of lakes requires knowledge of certain characteristics of their bathymetry and hydrological connectivity, information which is not always available. Likewise, the representation of wetlands in models, although improved in many cases, is limited by topography (and the role of microtopography, even at large scales). Nonetheless, increased attention to high latitude hydrological processes has demonstrably improved the fidelity of land surface representations over the last decade or so.

  12. Manipulating Light to Understand and Improve Solar Cells (494th Brookhaven Lecture)

    SciTech Connect

    Eisaman, Matthew

    2014-04-16

    Energy consumption around the world is projected to approximately triple by the end of the century, according to the 2005 Report from the U.S. Department of Energy's Basic Energy Sciences Workshop on Solar Energy Utilization. Much will change in those next 86 years, but for all the power the world needs—for everything from manufacturing and transportation to air conditioning and charging cell phone batteries—improved solar cells will be crucial to meet this future energy demand with renewable energy sources. At Brookhaven Lab, scientists are probing solar cells and exploring variations within the cells—variations that are so small they are measured in billionths of a meter—in order to make increasingly efficient solar cells and ultimately help reduce the overall costs of deploying solar power plants. Dr. Eisaman will discuss DOE's Sunshot Initiative, which aims to reduce the cost of solar cell-generated electricity by 2020. He will also discuss how he and collaborators at Brookhaven Lab are probing different material compositions within solar cells, measuring how efficiently they collect electrical charge, helping to develop a new class of solar cells, and improving solar-cell manufacturing processes.

  13. Understanding Low-cycle Fatigue Life Improvement Mechanisms in a Pre-twinned Magnesium Alloy

    SciTech Connect

    Wu, Wei; An, Ke

    2015-10-03

    The mechanisms of fatigue life improvement by pre-twinning process in a commercial rolled magnesium (Mg) alloy have been investigated using real-time in situ neutron diffraction under a continuous-loading condition. It is found that by introducing the excess twinned grains through pre-compression along the rolling direction the fatigue life was enhanced approximately 50%, mainly resulting from the prolonged detwinning process and inhibited dislocation slip during reverse tension. Moreover, after pre-twinning process, the removal of the rapid strain hardening during reverse tension leads to a compressive mean stress value and more symmetric shape of stress-strain hysteresis loop. The pre-twinning has significant impacts on the twinning-detwinning characteristics and deformation modes during cyclic loading and greatly facilitates the twinning-detwinning activities in plastic deformation. The cyclic straining leads to the increase of contribution of tensile twinning deformation in overall plastic deformation in both the as-received and pre-deformed sample. The mechanisms of load partitioning in different groups of grains are closely related to the deformation modes in each deformation stage, while the fatigue cycling has little influence on the load sharing. The pre-twinning process provides an easy and cost-effective route to improve the low-cycle fatigue life through manufacturing and processing, which would advance the wide application of light-weight wrought Mg alloys as structural materials.

  14. Understanding Low-cycle Fatigue Life Improvement Mechanisms in a Pre-twinned Magnesium Alloy

    DOE PAGES

    Wu, Wei; An, Ke

    2015-10-03

    The mechanisms of fatigue life improvement by pre-twinning process in a commercial rolled magnesium (Mg) alloy have been investigated using real-time in situ neutron diffraction under a continuous-loading condition. It is found that by introducing the excess twinned grains through pre-compression along the rolling direction the fatigue life was enhanced approximately 50%, mainly resulting from the prolonged detwinning process and inhibited dislocation slip during reverse tension. Moreover, after pre-twinning process, the removal of the rapid strain hardening during reverse tension leads to a compressive mean stress value and more symmetric shape of stress-strain hysteresis loop. The pre-twinning has significant impactsmore » on the twinning-detwinning characteristics and deformation modes during cyclic loading and greatly facilitates the twinning-detwinning activities in plastic deformation. The cyclic straining leads to the increase of contribution of tensile twinning deformation in overall plastic deformation in both the as-received and pre-deformed sample. The mechanisms of load partitioning in different groups of grains are closely related to the deformation modes in each deformation stage, while the fatigue cycling has little influence on the load sharing. The pre-twinning process provides an easy and cost-effective route to improve the low-cycle fatigue life through manufacturing and processing, which would advance the wide application of light-weight wrought Mg alloys as structural materials.« less

  15. Towards an improved understanding of deep convection patterns over the tropical oceans

    NASA Astrophysics Data System (ADS)

    Back, Larissa

    We quantitatively assess thermodynamic characteristics shared by deep convection over the tropical oceans, and develop a simple model to explain the observed precipitation distribution, as well as geographic variability in the vertical development of deep convection. Relationships between humidity, surface wind speed and precipitation are analyzed using four years of daily satellite passive microwave retrievals. We find that throughout the ITCZ, at high-column relative humidities (conditions under which deep convection is likely to occur), faster winds are associated with substantially more precipitation, explaining a small, but highly statistically significant fraction of daily rainfall variability. The observed increases in precipitation are much greater than evaporation changes associated with the increased wind speed which suggests a convergence feedback. Several atmospheric reanalyses are used to compute daily column-integrated MSE budgets, and seperate the MSE export by the circulation into horizontal and vertical MSE advection terms to examine the extent to which observationally-derived data is consistent with the idea of a positive gross moist stability. Primarily due to substantial geographic variability in vertical motion profiles (and latent heating), the implied gross moist stability is negative in a 2000-km region in the central-eastern Pacific ITCZ. In the west Pacific warm pool rainy regions, mean horizontal convergence extends above 400mb, while in parts of the Pacific ITCZ where meridional SST gradients are strong, the vertical motion profile is "bottom-heavy", with convergence below 800mb and divergence above. We examine what combination of local column thermodynamic and non-local dynamic reasoning can lead to a simple quantitative understanding of the similarities and differences between the convection in the narrow eastern-central Pacific ITCZ with that in the west Pacific warm pool. A simple dynamical boundary layer model is used to understand

  16. Leveraging Conceptual Frameworks to Improve Students' Mental Organization of Astronomy Understanding

    NASA Astrophysics Data System (ADS)

    Slater, Timothy F.; Lee, K. M.

    2006-06-01

    Many different types of schematic diagrams are useful in helping students organize and internalize their developing understanding in introductory astronomy courses. These include Venn Diagrams, Flowcharts, Concept Maps, among others, which illustrate the relationships between astronomical objects and dynamic concepts. These conceptual framework diagrams have been incorporated into the NSF-funded ClassAction project. ClassAction is a collection of electronic materials designed to enhance the metacognitive skills of college and university introductory astronomy survey students by promoting interactive engagement and providing rapid feedback in a highly visual setting. The main effort is targeted at creating dynamic think-pair-share questions supported by simulations, animations, and visualizations to be projected in the lecture classroom. The infrastructure allows instructors to recast these questions into alternative forms based on their own pedagogical preferences and feedback from the class. The recourses can be easily selected from a FLASH computer database and are accompanied by outlines, graphics, and numerous simulations which the instructor can use to provide student feedback and, when necessary, remediation. ClassAction materials are publicly available online at URL: http://astro.unl.edu and is funded by NSF Grant #0404988.

  17. Your Planetarium: A Friend Indeed; or How to improve the public understanding of Science

    NASA Astrophysics Data System (ADS)

    Ratcliffe, Martin

    1995-05-01

    Astronomical research requires public funding, and thment on public support. The greatest contact between the public and astronomy occurs through the nationUs planetariums, and the staff of these facilities are frequently asked to com'ent on recent discoveries. It is in our best interest to use and support the work of planetariums as an already existing outlet, not only to build public support for research, but as a nationUs commitment to the greater public understanding o" science. AAS President Frank Shu notes in newsletter 74, "failure to prepare the general citizenry to face an increasingly complex technological future indeed puts the nation at risk". Indeed, the issue is an important one. The efforts of the Henry Buhl Jr. Planetarium in Pittsburgh to provide up-to-date, accurate information about current astronomical research, the collaborative effort between STScI and the Buhl Planetarium to produce a new planetarium show, Through the Eyes of Hubble, and future efforts for collaborative projects to present science in an informed, yet entertaining way will be presented, and reflect similar efforts of the entire planetarium communty. Following the presented papers, a discussion session will offer the opportunity to explore new links between the planetarium ommunity and the astronomical community. The ideas will be presented to the newly constituted Astronomy Education Policy Board of the AAS as part of the national astronomy education initiative.

  18. Toward an improved understanding of tropical forest carbon cycle feedbacks in the Earth's climate system

    NASA Astrophysics Data System (ADS)

    Chambers, J. Q.

    2015-12-01

    There are large uncertainties regarding the response of tropical forest carbon cycling to expected global changes over the 21st Century. Whether tropical forests continue to act as large carbon sinks, or shift to become significant carbon sources, plays a major role in determining the rate and intensity of climate change impacts. Most terrestrial models predict a large current tropical forest carbon sink due to the effects of rising atmospheric CO2 on plant productivity. Yet the strength of this sink is likely limited by multiple factors, and the magnitudes of these constraints remain in question. As atmospheric CO2 levels continue to rise, nutrient limitations are likely to become more prominent, yet the current suite of Earth system models (ESMs) have inadequate representations of nutrient constraints on tropical forest productivity. Concurrently, the negative effects of rising temperatures and shifting precipitation patterns on plant production are expected to become more pronounced, likely driving reductions in tropical forest carbon assimilation and storage. In addition to these carbon-climate feedbacks, human land-use activities in the tropics result in both carbon sources from deforestation, and carbon sinks in secondary forests, both of which are also inadequately represented in ESMs. This talk will focus on recent advances in our understanding of these key carbon cycle processes, and explore several field research activities needed to advance ESM treatment of the underlying mechanisms.

  19. Fundamentals of Melt-Water Interfacial Transport Phenomena: Improved Understanding for Innovative Safety Technologies in ALWRs

    SciTech Connect

    M. Anderson; M. Corradini; K.Y. Bank; R. Bonazza; D. Cho

    2005-04-26

    The interaction and mixing of high-temperature melt and water is the important technical issue in the safety assessment of water-cooled reactors to achieve ultimate core coolability. For specific advanced light water reactor (ALWR) designs, deliberate mixing of the core-melt and water is being considered as a mitigative measure, to assure ex-vessel core coolability. The goal of this work is to provide the fundamental understanding needed for melt-water interfacial transport phenomena, thus enabling the development of innovative safety technologies for advanced LWRs that will assure ex-vessel core coolability. The work considers the ex-vessel coolability phenomena in two stages. The first stage is the melt quenching process and is being addressed by Argonne National Lab and University of Wisconsin in modified test facilities. Given a quenched melt in the form of solidified debris, the second stage is to characterize the long-term debris cooling process and is being addressed by Korean Maritime University in via test and analyses. We then address the appropriate scaling and design methodologies for reactor applications.

  20. Understanding molecular mechanisms for improving phytoremediation of heavy metal-contaminated soils.

    PubMed

    Hong-Bo, Shao; Li-Ye, Chu; Cheng-Jiang, Ruan; Hua, Li; Dong-Gang, Guo; Wei-Xiang, Li

    2010-03-01

    Heavy metal pollution of soil is a significant environmental problem with a negative potential impact on human health and agriculture. Rhizosphere, as an important interface of soil and plants, plays a significant role in phytoremediation of contaminated soil by heavy metals, in which, microbial populations are known to affect heavy metal mobility and availability to the plant through release of chelating agents, acidification, phosphate solubilization and redox changes, and therefore, have potential to enhance phytoremediation processes. Phytoremediation strategies with appropriate heavy metal-adapted rhizobacteria or mycorrhizas have received more and more attention. In addition, some plants possess a range of potential mechanisms that may be involved in the detoxification of heavy metals, and they manage to survive under metal stresses. High tolerance to heavy metal toxicity could rely either on reduced uptake or increased plant internal sequestration, which is manifested by an interaction between a genotype and its environment.A coordinated network of molecular processes provides plants with multiple metal-detoxifying mechanisms and repair capabilities. The growing application of molecular genetic technologies has led to an increased understanding of mechanisms of heavy metal tolerance/accumulation in plants and, subsequently, many transgenic plants with increased heavy metal resistance, as well as increased uptake of heavy metals, have been developed for the purpose of phytoremediation. This article reviews advantages, possible mechanisms, current status and future direction of phytoremediation for heavy-metal-contaminated soils.

  1. Redox Proteomics and Platelet Activation: Understanding the Redox Proteome to Improve Platelet Quality for Transfusion

    PubMed Central

    Sonego, Giona; Abonnenc, Mélanie; Tissot, Jean-Daniel; Prudent, Michel; Lion, Niels

    2017-01-01

    Blood banks use pathogen inactivation (PI) technologies to increase the safety of platelet concentrates (PCs). The characteristics of PI-treated PCs slightly differ from those of untreated PCs, but the underlying reasons are not well understood. One possible cause is the generation of oxidative stress during the PI process. This is of great interest since reactive oxygen species (ROS) act as second messengers in platelet functions. Furthermore, there are links between protein oxidation and phosphorylation, another mechanism that is critical for cell regulation. Current research efforts focus on understanding the underlying mechanisms and identifying new target proteins. Proteomics technologies represent powerful tools for investigating signaling pathways involving ROS and post-translational modifications such as phosphorylation, while quantitative techniques enable the comparison of the platelet resting state versus the stimulated state. In particular, redox cysteine is a key player in platelet activation upon stimulation by different agonists. This review highlights the experiments that have provided insights into the roles of ROS in platelet function and the implications for platelet transfusion, and potentially in diseases such as inflammation and platelet hyperactivity. The review also describes the implication of redox mechanism in platelet storage considerations. PMID:28208668

  2. Communicating environmental health issues using GIS or improving response to citizens with understandable maps and data

    SciTech Connect

    Mann, J.H.

    1998-07-01

    People living near a Superfund site are understandably concerned about the effects of hazardous waste releases on the health of their families and themselves. These concerns often turn to anger if the residents believe investigators and public health officials are withholding critical details. In many communities with Superfund sites, residents are demanding detailed information on site investigations and public health assessments, even before such activities are completed. Investigators and public health officials can provide on-going public briefings using a geographic information system (GIS) as part of an interactive public presentation. A GIS is an excellent tool to answer questions about locations of multi-media site investigations and the analytical results because it combines computer mapping and graphics with a database. Rather than incorporate a multitude of slides and overheads into a detailed public presentation that too often never addresses the citizen concerns, a GIS can be used as a query system to answer citizen's questions. The GIS can be incorporated into a laptop or desktop computer for a one-on-one session with a resident or can be plugged into a computer projector to answer questions at public meetings.

  3. Improvements in Students' Understanding from Increased Implementation of Active Learning Strategies

    NASA Astrophysics Data System (ADS)

    Hayes-Gehrke, Melissa N.; Prather, E. E.; Rudolph, A. L.; Collaboration of Astronomy Teaching Scholars CATS

    2011-01-01

    Many instructors are hesitant to implement active learning strategies in their introductory astronomy classrooms because they are not sure which techniques they should use, how to implement those techniques, and question whether the investment in changing their course will really bring the advertised learning gains. We present an example illustrating how thoughtful and systematic implementation of active learning strategies into a traditionally taught Astro 101 class can translate into significant increases in students' understanding. We detail the journey of one instructor, over several years, as she changes the instruction and design of her course from one that focuses almost exclusively on lecture to a course that provides an integrated use of several active learning techniques such as Lecture-Tutorials and Think-Pair-Share questions. The students in the initial lecture-only course achieved a low normalized gain score of only 0.2 on the Light and Spectroscopy Concept Inventory (LSCI), while the students in the re-designed learner-centered course achieved a significantly better normalized gain of 0.43. This material is based upon work supported by the National Science Foundation under Grant No. 0715517, a CCLI Phase III Grant for the Collaboration of Astronomy Teaching Scholars (CATS), and Grant No. 0847170, a PAARE Grant for the Calfornia-Arizona Minority Partnership for Astronomy Research and Education (CAMPARE). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation.

  4. Formal Semantics in the Neurology Clinic: Atypical Understanding of Aspectual Coercion in ALS Patients

    PubMed Central

    Baggio, Giosuè; Granello, Giulia; Verriello, Lorenzo; Eleopra, Roberto

    2016-01-01

    Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the motor system with subtle adverse effects on cognition. It is still unclear whether ALS also affects language and semantics, and if so, what aspects and processes exactly. We investigated how ALS patients understand verb phrases modified by temporal preposition phrases, e.g., “To watch TV for half an hour.” Interpretation here requires operations such as aspectual coercion that add or delete elements from event structures, depending on temporal modifiers, and constraints on coercion, which make combinations with certain modifiers not viable. Using a theoretically-motivated experimental design, we observed that acceptance rates for aspectual coercion were abnormally high in ALS patients. The effect was largest for the more complex cases of coercion: not those that involve enrichment of event structures (“To switch on the TV in half an hour,” where a number of failed attempts must be included in the interpretation) but those that, if applied, would result in deletion of event structure elements (“To repair the TV for half an hour”). Our experimental results are consistent with a deficit of constraints on coercion, and not with impaired semantic processes or representations, in line with recent studies suggesting that verb semantics is largely spared in ALS. PMID:27867369

  5. Living for the weekend: electronic documentation improves patient handover.

    PubMed

    Govier, Matthew; Medcalf, Pippa

    2012-04-01

    With increasing shift work the importance of effective handover is becoming more widely recognised, resulting in the production of guidelines on written handover documentation. A particular area of poor compliance was handover from the week to weekend teams for medical inpatients, as shown through an audit cycle. Full implementation of any guidelines can be time and financially costly. However, a simple, minimal cost, electronic-based list improved the quantitative measures of written handover, particularly in areas of patient location, resuscitation status and investigations. Qualitative data showed multiple benefits, but also problems with logistics in computer terminals, networks and access. Solutions to such problems are discussed, with the importance of carefully implemented longer-term changes being emphasised.

  6. Use of Airport Noise Complaint Files to Improve Understanding of Community Response to Aircraft Noise

    NASA Technical Reports Server (NTRS)

    Fidell, Sanford; Howe, Richard

    1998-01-01

    This study assessed the feasibility of using complaint information archived by modem airport monitoring systems to conduct quantitative analyses of the causes of aircraft noise complaints and their relationship to noise- induced annoyance. It was found that all computer-based airport monitoring systems provide at least rudimentary tools for performing data base searches by complainant name, address, date, time of day, and types of aircraft and complaints. Analyses of such information can provide useful information about longstanding concerns, such as the extent to which complaint rates are driven by objectively measurable aspects of aircraft operations; the degree to which changes in complaint rates can be predicted prior to implementation of noise mitigation measures; and the degree to which aircraft complaint information can be used to simplify and otherwise improve prediction of the prevalence of noise-induced annoyance in communities.

  7. The Cryogenic Dark Matter Search: First 5-Tower Data and Improved Understanding of Ionization Collection

    SciTech Connect

    Bailey, Catherine N.

    2010-01-01

    The Cryogenic Dark Matter Search (CDMS) is searching for Weakly Interacting Massive Particles (WIMPs) with cryogenic particle detectors. These detectors have the ability to discriminate between nuclear recoil candidate and electron recoil background events by collecting both phonon and ionization energy from recoils in the detector crystals. The CDMS-II experiment has completed analysis of the first data runs with 30 semiconductor detectors at the Soudan Underground Laboratory, resulting in a world leading WIMP-nucleon spin-independent cross section limit for WIMP masses above 44 GeV/c2. As CDMS aims to achieve greater WIMP sensitivity, it is necessary to increase the detector mass and discrimination between signal and background events. Incomplete ionization collection results in the largest background in the CDMS detectors as this causes electron recoil background interactions to appear as false candidate events. Two primary causes of incomplete ionization collection are surface and bulk trapping. Recent work has been focused on reducing surface trapping through the modification of fabrication methods for future detectors. Analyzing data taken with test devices has shown that hydrogen passivation of the amorphous silicon blocking layer worsens surface trapping. Additional data has shown that the iron-ion implantation used to lower the critical temperature of the tungsten transition-edge sensors causes a degradation of the ionization collection. Using selective implantation on future detectors may improve ionization collection for events near the phonon side detector surface. Bulk trapping is minimized by neutralizing ionized lattice impurities. Detector investigations at testing facilities and in situ at the experimental site have provided methods to optimize the neutralization process and monitor running conditions to maintain full ionization collection. This work details my contribution to the 5-tower data taking, monitoring, and analysis effort as

  8. Download Alert: Understanding Gastroenterology Patients' Perspectives on Health-Related Smartphone Apps

    PubMed Central

    Zia, Jasmine K; Le, Thai; Munson, Sean; Heitkemper, Margaret M; Demiris, George

    2015-01-01

    Objectives: The aims of this study were to understand patients' willingness to use different types of health-related smartphone apps and to explore their attitudes on the overall value, usability, feasibility, credibility, intrusiveness, and obtrusiveness of these apps. Methods: Questionnaires were distributed to adult patients presenting to gastroenterology clinics at an academic medical center. The 25-question survey consisted of 5-point Likert-type scale statements, multiple-choice questions, and open-ended questions. Results: Participants were mainly White (N=94, 78%) and smartphone owners (N=125, 93%). The mean age was 40.8 years (N=121, s.d.=13.2). Participants were willing to use most types of apps unless it monitored their location or social networking activity. Half were less willing to use an app if it required a visible accessory. Most participants were willing to use a health-related app up to 5 min a day indefinitely but unwilling to pay out-of-pocket for it. Participants generally disagreed that an app would be hard to learn how to use, interfere with their daily routine, or be embarrassing to use in public. Overall, participants felt that health-related apps could help them and their doctors better manage their medical problems, but were neutral in trusting their quality. Most worried that personal information used for an app would fall into the wrong hands. Conclusion: Gastroenterology patients were willing to use and valued most types of health-related apps. They perceived this technology as feasible, usable, and relatively unobtrusive unless a visible accessory was required. However, many were concerned about their privacy. PMID:26133109

  9. Neurostimulation to improve level of consciousness in patients with epilepsy.

    PubMed

    Gummadavelli, Abhijeet; Kundishora, Adam J; Willie, Jon T; Andrews, John P; Gerrard, Jason L; Spencer, Dennis D; Blumenfeld, Hal

    2015-06-01

    When drug-resistant epilepsy is poorly localized or surgical resection is contraindicated, current neurostimulation strategies such as deep brain stimulation and vagal nerve stimulation can palliate the frequency or severity of seizures. However, despite medical and neuromodulatory therapy, a significant proportion of patients continue to experience disabling seizures that impair awareness, causing disability and risking injury or sudden unexplained death. We propose a novel strategy in which neuromodulation is used not only to reduce seizures but also to ameliorate impaired consciousness when the patient is in the ictal and postictal states. Improving or preventing alterations in level of consciousness may have an effect on morbidity (e.g., accidents, drownings, falls), risk for death, and quality of life. Recent studies may have elucidated underlying networks and mechanisms of impaired consciousness and yield potential novel targets for neuromodulation. The feasibility, benefits, and pitfalls of potential deep brain stimulation targets are illustrated in human and animal studies involving minimally conscious/vegetative states, movement disorders, depth of anesthesia, sleep-wake regulation, and epilepsy. We review evidence that viable therapeutic targets for impaired consciousness associated with seizures may be provided by key nodes of the consciousness system in the brainstem reticular activating system, hypothalamus, basal ganglia, thalamus, and basal forebrain.

  10. Driving improvement in patient care: lessons from Toyota.

    PubMed

    Thompson, Debra N; Wolf, Gail A; Spear, Steven J

    2003-11-01

    Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care.

  11. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    DOE PAGES

    Binley, Andrew; Hubbard, Susan S.; Huisman, Johan A.; ...

    2015-06-15

    Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field-based investigativemore » techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time-lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot-scale” experiments. More recently, however, the translation to larger-scale characterization has been the focus of a number of studies. In conclusion, geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services.« less

  12. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    SciTech Connect

    Binley, Andrew; Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-06-15

    Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field-based investigative techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time-lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot-scale” experiments. More recently, however, the translation to larger-scale characterization has been the focus of a number of studies. In conclusion, geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services.

  13. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    PubMed Central

    Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-01-01

    Abstract Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field‐based investigative techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time‐lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot‐scale” experiments. More recently, however, the translation to larger‐scale characterization has been the focus of a number of studies. Geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services. PMID:26900183

  14. Surveillance should be strengthened to improve epidemiological understandings of mosquito-borne Barmah Forest virus infection

    PubMed Central

    Eastwood, Keith; Webb, Cameron; Durrheim, David

    2012-01-01

    Introduction Barmah Forest virus (BFV) is a mosquito-borne virus causing epidemic polyarthritis in Australia. This study used case follow-up of cases from the surveillance system to demonstrate that routinely collected BFV notification data were an unreliable indicator of the true location of exposure. Methods BFV notifications from June 2001 to May 2011 were extracted from the New South Wales (NSW) Notifiable Conditions Information Management System to study case distribution. Disease cluster analysis was performed using spatial scan statistics. Exposure history data were collected from cases notified in 2010 and 2011 to accurately determine travel to high-risk areas. Results Cluster analysis using address data identified an area of increased BFV disease incidence in the mid-north coast of NSW contiguous with estuarine wetlands. When travel to this area was investigated, 96.7% (29/30) cases reported having visited coastal regions within four weeks of developing symptoms. Discussion Along the central NSW coastline, extensive wetlands occur in close proximity to populated areas. These wetlands provide ideal breeding habitats for a range of mosquito species implicated in the transmission of BFV. This is the first study to fully assess case exposure with findings suggesting that sporadic cases of BFV in people living further away from the coast do not reflect alternative exposure sites but are likely to result from travel to coastal regions. Spatial analysis by case address alone may lead to inaccurate understandings of the true distribution of arboviral diseases. Subsequently, this information has important implications for the collection of mosquito-borne disease surveillance information and public health response strategies. PMID:23908926

  15. Using and understanding consumer satisfaction to effect an improvement in mental health service delivery.

    PubMed

    Brunero, S; Lamont, S; Fairbrother, G

    2009-04-01

    Consumer satisfaction is today, widely accepted as a measure of the level and quality of service received by consumers. The aim of this survey-based study is to explore consumer satisfaction with quality of care, staff, environment and discharge in a south eastern Sydney adult acute inpatient mental health unit. A cross-sectional analysis is pursued in order to identify aspects of the patient stay, which form an associative relationship with an overall rating of consumer satisfaction on a 10-point scale. During the survey period, there were 182 discharges. Seventy questionnaires (38.5%) were returned from this group. The survey results highlight a number of areas of identified need, enabling the service to prioritize organizational systems around meeting these needs. Multiple regression analysis identified three items in the survey, which were independently significant associates of overall consumer satisfaction. They included being happy with the service provided by the consumer support worker, having support for services on discharge and feeling safe and secure on the ward. The model containing these three items accounted for 50% of the variation in overall satisfaction. Two primary interventions have been developed because survey administration which, it is hoped, will address issues raised in the survey. The interventions were the development of an admission and discharge pathway and a ward-based psychosocial intervention programme, which includes the involvement of consumer support workers.

  16. Interferon-Gamma Improves Macrophages Function against M. tuberculosis in Multidrug-Resistant Tuberculosis Patients

    PubMed Central

    Mazhar, Humaira; Muhammad, Niaz; Abbas, Muhammad Nasser

    2016-01-01

    Background. Mycobacterium tuberculosis (M. tuberculosis) that causes tuberculosis (TB) kills millions of infected people annually especially multidrug-resistant tuberculosis (MDR-TB). On infection, macrophages recognize the mycobacteria by toll-like receptor (TLR) followed by phagocytosis and control of mycobacteria. In addition, macrophages also secrete IL-12 to induce IFN-γ production by T, which, in turn, increases the phagocytosis and oxidative burst. Individuals with defects in innate or adaptive immunity exhibit increased susceptibility to M. tuberculosis. Understanding these immunologic mechanisms will help in TB control. We aimed to investigate the immunopathologic mechanisms in MDR-TB and role of recombinant human interferon-gamma (rhIFN-γ). Study Design and Methods. Monocyte-derived macrophages (MDMs) were generated from peripheral blood mononuclear cells of MDR-TB patients and healthy subjects and were investigated for immunologic response by ELISA and flow cytometry. Results. Different functional and molecular anomalies were observed in macrophages. In addition, a defective immune response to M. tuberculosis from the patient's MDMs was characterized, which in turn improved by pretreatment with rhIFN-γ. Conclusion. This work highlights the fact that rhIFN-γ improves macrophages function against M. tuberculosis and treatment of patients with poor responsiveness to TB therapy may be needed in future to include IFN-γ as adjuvant therapy after the full characterization of pathological and molecular mechanisms in these and in other more multidrug-resistant TB patients. PMID:27478636

  17. A New and Improved Carbon Dioxide Isotope Analyzer for Understanding Soil-Plant-Atmosphere Interactions

    NASA Astrophysics Data System (ADS)

    Huang, Y. W.; Berman, E. S.; Owano, T. G.; Verfaillie, J. G.; Oikawa, P. Y.; Baldocchi, D. D.; Still, C. J.; Gardner, A.; Baer, D. S.; Rastogi, B.

    2015-12-01

    Stable CO2 isotopes provide information on biogeochemical processes that occur at the soil-plant-atmosphere interface. While δ13C measurement can provide information on the sources of the CO2, be it photosynthesis, natural gas combustion, other fossil fuel sources, landfills or other sources, δ18O, and δ17O are thought to be determined by the hydrological cycling of the CO2. Though researchers have called for analytical tools for CO2 isotope measurements that are reliable and field-deployable, developing such instrument remains a challenge. The carbon dioxide isotope analyzer developed by Los Gatos Research (LGR) uses LGR's patented Off-Axis ICOS (Integrated Cavity Output Spectroscopy) technology and incorporates proprietary internal thermal control for high sensitivity and optimal instrument stability. This new and improved analyzer measures CO2 concentration as well as δ13C, δ18O, and δ17O from CO2 at natural abundance (150-2500 ppm). The laboratory precision is ±200 ppb (1σ) in CO2 at 1 s, with a long-term (2 min) precision of ±20 ppb. The 1-second precision for both δ13C and δ18O is 0.7 ‰, and for δ17O is 1.8 ‰. The long-term (2 min) precision for both δ13C and δ18O is 0.08 ‰, and for δ17O is 0.18 ‰. The instrument has improved precision, stability and user interface over previous LGR CO2 isotope instruments and can be easily programmed for periodic referencing and sampling from different sources when coupled with LGR's multiport inlet unit (MIU). We have deployed two of these instruments at two different field sites, one at Twitchell Island in Sacramento County, CA to monitor the CO2 isotopic fluxes from an alfalfa field from 6/29/2015-7/13/2015, and the other at the Wind River Experimental Forest in Washington to monitor primarily the oxygen isotopes of CO2 within the canopy from 8/4/2015 through mid-November 2015. Methodology, laboratory development and testing and field performance are presented.

  18. Effective colonoscopy training techniques: strategies to improve patient outcomes

    PubMed Central

    Papanikolaou, Ioannis S; Karatzas, Pantelis S; Varytimiadis, Lazaros T; Tsigaridas, Athanasios; Galanopoulos, Michail; Viazis, Nikos; Karamanolis, Dimitrios G

    2016-01-01

    Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists. PMID:27099542

  19. Effective colonoscopy training techniques: strategies to improve patient outcomes.

    PubMed

    Papanikolaou, Ioannis S; Karatzas, Pantelis S; Varytimiadis, Lazaros T; Tsigaridas, Athanasios; Galanopoulos, Michail; Viazis, Nikos; Karamanolis, Dimitrios G

    2016-01-01

    Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.

  20. Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

    PubMed Central

    2012-01-01

    Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above

  1. Improving Our Fundamental Understanding of the Role of Aerosol Cloud Interactions in the Climate System

    NASA Technical Reports Server (NTRS)

    Seinfeld, John H.; Bretherton, Christopher; Carslaw, Kenneth S.; Coe, Hugh; DeMott, Paul J.; Dunlea, Edward J.; Feingold, Graham; Ghan, Steven; Guenther, Alex B.; Kahn, Ralph; Kraucunas, Ian; Kreidenweis, Sonia M.; Molina, Mario J.; Nenes, Athanasios; Penner, Joyce E.; Prather, Kimberly A.; Ramanathan, V.; Ramaswamy, Venkatachalam; Rasch, Philip J.; Ravishankara, A. R.; Rosenfeld, Daniel; Stephens, Graeme; Wood, Robert

    2016-01-01

    The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth's clouds is the most uncertain component of the overall global radiative forcing from preindustrial time. General circulation models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol-cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions, but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol-cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. We suggest strategies for improving estimates of aerosol-cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty.

  2. Recent Advances in Improvement of Forecast Skill and Understanding Climate Processes Using AIRS Version-5 Products

    NASA Technical Reports Server (NTRS)

    Susskind, Joel; Molnar, Gyula; Iredell, Lena; Rosenberg, Robert

    2012-01-01

    AIRS/AMSU is the state of the art infrared and microwave atmospheric sounding system flying aboard EOS Aqua. These observations, covering the period September 2002 until the present, have been analyzed using the AIRS Science Team Version-5 retrieval algorithm. AIRS is a high spectral resolution infrared grating spectrometer with spect,ral coverage from 650 per centimeter extending to 2660 per centimeter, with low noise and a spectral resolving power of 2400. A brief overview of the AIRS Version-5 retrieval procedure will be presented, including the AIRS channels used in different steps in the retrieval process. Many researchers have used these products to make significant advances in both climate and weather applications. Recent significant results of these experiments will be presented, including results showing that 1) assimilation of AIRS Quality Controlled temperature profiles into a General Circulation Model (GCM) significantly improves the ability to predict storm tracks of intense precipitation events; and 2) anomaly time-series of Outgoing Longwave Radiation (OLR) computed using AIRS sounding products closely match those determined from the CERES instrument, and furthermore explain that the phenomenon that global and especially tropical mean OLR have been decreasing since September 2002 is a result of El Nino/La Nina oscillations during this period.

  3. Improving our fundamental understanding of the role of aerosol-cloud interactions in the climate system.

    PubMed

    Seinfeld, John H; Bretherton, Christopher; Carslaw, Kenneth S; Coe, Hugh; DeMott, Paul J; Dunlea, Edward J; Feingold, Graham; Ghan, Steven; Guenther, Alex B; Kahn, Ralph; Kraucunas, Ian; Kreidenweis, Sonia M; Molina, Mario J; Nenes, Athanasios; Penner, Joyce E; Prather, Kimberly A; Ramanathan, V; Ramaswamy, Venkatachalam; Rasch, Philip J; Ravishankara, A R; Rosenfeld, Daniel; Stephens, Graeme; Wood, Robert

    2016-05-24

    The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth's clouds is the most uncertain component of the overall global radiative forcing from preindustrial time. General circulation models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol-cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions, but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol-cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. We suggest strategies for improving estimates of aerosol-cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty.

  4. Improved Understanding of the Modeled QBO Using MLS Observations and MERRA Reanalysis

    NASA Technical Reports Server (NTRS)

    Oman, Luke David; Douglass, Anne Ritger; Hurwitz, Maggie M.; Garfinkel, Chaim I.

    2013-01-01

    The Quasi-Biennial Oscillation (QBO) dominates the variability of the tropical stratosphere on interannual time scales. The QBO has been shown to extend its influence into the chemical composition of this region through dynamical mechanisms. We have started our analysis using the realistic QBO internally generated by the Goddard Earth Observing System Version 5 (GEOS-5) general circulation model coupled to a comprehensive stratospheric and tropospheric chemical mechanism forced with observed sea surface temperatures over the past 33 years. We will show targeted comparisons with observations from NASAs Aura satellite Microwave Limb Sounder (MLS) and the Modern Era Retrospective-Analysis for Research and Applications (MERRA) reanalysis to provide insight into the simulation of the primary and secondary circulations associated with the QBO. Using frequency spectrum analysis and multiple linear regression we can illuminate the resulting circulations and deduce the strengths and weaknesses in their modeled representation. Inclusion of the QBO in our simulation improves the representation of the subtropical barriers and overall tropical variability. The QBO impact on tropical upwelling is important to quantify when calculating trends in sub-decadal scale datasets.

  5. Animal models to improve our understanding and treatment of suicidal behavior.

    PubMed

    Gould, T D; Georgiou, P; Brenner, L A; Brundin, L; Can, A; Courtet, P; Donaldson, Z R; Dwivedi, Y; Guillaume, S; Gottesman, I I; Kanekar, S; Lowry, C A; Renshaw, P F; Rujescu, D; Smith, E G; Turecki, G; Zanos, P; Zarate, C A; Zunszain, P A; Postolache, T T

    2017-04-11

    Worldwide, suicide is a leading cause of death. Although a sizable proportion of deaths by suicide may be preventable, it is well documented that despite major governmental and international investments in research, education and clinical practice suicide rates have not diminished and are even increasing among several at-risk populations. Although nonhuman animals do not engage in suicidal behavior amenable to translational studies, we argue that animal model systems are necessary to investigate candidate endophenotypes of suicidal behavior and the neurobiology underlying these endophenotypes. Animal models are similarly a critical resource to help delineate treatment targets and pharmacological means to improve our ability to manage the risk of suicide. In particular, certain pathophysiological pathways to suicidal behavior, including stress and hypothalamic-pituitary-adrenal axis dysfunction, neurotransmitter system abnormalities, endocrine and neuroimmune changes, aggression, impulsivity and decision-making deficits, as well as the role of critical interactions between genetic and epigenetic factors, development and environmental risk factors can be modeled in laboratory animals. We broadly describe human biological findings, as well as protective effects of medications such as lithium, clozapine, and ketamine associated with modifying risk of engaging in suicidal behavior that are readily translatable to animal models. Endophenotypes of suicidal behavior, studied in animal models, are further useful for moving observed associations with harmful environmental factors (for example, childhood adversity, mechanical trauma aeroallergens, pathogens, inflammation triggers) from association to causation, and developing preventative strategies. Further study in animals will contribute to a more informed, comprehensive, accelerated and ultimately impactful suicide research portfolio.

  6. Improved Understanding of Natural System Processes through Coupling of Geophysical Characterization and Numerical Modeling Approaches

    NASA Astrophysics Data System (ADS)

    Hubbard, S.; Williams, K.; Scheibe, T.; Peterson, J.; Chen, J.; Mukhopadhyay, S.; Sonnenthal, E.; Steefel, C.

    2006-12-01

    Numerical modeling of fluid flow and contaminant transport is often used to test hypotheses and to guide resource management. In complex natural systems, challenges are often associated with collecting sufficient information to parameterize numerical models over field relevant scales and with the development of mathematical representations of critical, coupled hydrological-biogeochemical processes. Geophysical methods can be helpful for guiding or constraining numerical models because they can provide extensive information about subsurface properties and processes. Obtaining quantitative parameter estimates from geophysical approaches can also be challenging, however, as these methods do not sample hydrological- biogeochemical properties directly and are often sensitive to various influences.Through a series of lab and field-based case studies, we will explore the benefits and current limitations of using geophysical information in conjunction with hydrological models to interrogate natural systems. We illustrate that where geophysical characterization approaches are sufficiently advanced, they can be useful for guiding model development, providing model parameter input, and for exploring the impact of heterogeneity on flow and transport processes. We also illustrate that where characterization and modeling methods are less well developed, as in the case of advanced subsurface reactive transport models or in the use of geophysical methods for monitoring biogeochemical transformations, comparison of monitoring and modeling information can lead to improvements in the use of both methods as investigative tools.

  7. Improving our fundamental understanding of the role of aerosol-cloud interactions in the climate system

    DOE PAGES

    Seinfeld, John H.; Bretherton, Christopher; Carslaw, Kenneth S.; ...

    2016-05-24

    The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth’s clouds is the most uncertain component of the overall global radiative forcing from pre-industrial time. General Circulation Models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol-cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions but significant challengesmore » exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol-cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. Lastly, we suggest strategies for improving estimates of aerosol-cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty.« less

  8. Improving our fundamental understanding of the role of aerosol−cloud interactions in the climate system

    PubMed Central

    Seinfeld, John H.; Bretherton, Christopher; Carslaw, Kenneth S.; Coe, Hugh; DeMott, Paul J.; Dunlea, Edward J.; Feingold, Graham; Ghan, Steven; Guenther, Alex B.; Kraucunas, Ian; Molina, Mario J.; Nenes, Athanasios; Penner, Joyce E.; Prather, Kimberly A.; Ramanathan, V.; Ramaswamy, Venkatachalam; Rasch, Philip J.; Ravishankara, A. R.; Rosenfeld, Daniel; Stephens, Graeme; Wood, Robert

    2016-01-01

    The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth’s clouds is the most uncertain component of the overall global radiative forcing from preindustrial time. General circulation models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol−cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions, but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol−cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. We suggest strategies for improving estimates of aerosol−cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty. PMID:27222566

  9. Improving our fundamental understanding of the role of aerosol-cloud interactions in the climate system

    SciTech Connect

    Seinfeld, John H.; Bretherton, Christopher; Carslaw, Kenneth S.; Coe, Hugh; DeMott, Paul J.; Dunlea, Edward J.; Feingold, Graham; Ghan, Steven; Guenther, Alex B.; Kahn, Ralph; Kraucunas, Ian; Kreidenweis, Sonia M.; Molina, Mario J.; Nenes, Athanasios; Penner, Joyce E.; Prather, Kimberly A.; Ramanathan, V.; Ramaswamy, Venkatachalam; Rasch, Philip J.; Ravishankara, A. R.; Rosenfeld, Daniel; Stephens, Graeme; Wood, Robert

    2016-05-24

    The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth’s clouds is the most uncertain component of the overall global radiative forcing from pre-industrial time. General Circulation Models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol-cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol-cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. Lastly, we suggest strategies for improving estimates of aerosol-cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty.

  10. Can Simulation Credibility Be Improved Using Sensitivity Analysis to Understand Input Data Effects on Model Outcome?

    NASA Technical Reports Server (NTRS)

    Myers, Jerry G.; Young, M.; Goodenow, Debra A.; Keenan, A.; Walton, M.; Boley, L.

    2015-01-01

    Model and simulation (MS) credibility is defined as, the quality to elicit belief or trust in MS results. NASA-STD-7009 [1] delineates eight components (Verification, Validation, Input Pedigree, Results Uncertainty, Results Robustness, Use History, MS Management, People Qualifications) that address quantifying model credibility, and provides guidance to the model developers, analysts, and end users for assessing the MS credibility. Of the eight characteristics, input pedigree, or the quality of the data used to develop model input parameters, governing functions, or initial conditions, can vary significantly. These data quality differences have varying consequences across the range of MS application. NASA-STD-7009 requires that the lowest input data quality be used to represent the entire set of input data when scoring the input pedigree credibility of the model. This requirement provides a conservative assessment of model inputs, and maximizes the communication of the potential level of risk of using model outputs. Unfortunately, in practice, this may result in overly pessimistic communication of the MS output, undermining the credibility of simulation predictions to decision makers. This presentation proposes an alternative assessment mechanism, utilizing results parameter robustness, also known as model input sensitivity, to improve the credibility scoring process for specific simulations.

  11. NASA Contributions to Improve Understanding of Extreme Events in the Global Energy and Water Cycle

    NASA Technical Reports Server (NTRS)

    Lapenta, William M.

    2008-01-01

    The U.S. Climate Change Science Program (CCSP) has established the water cycle goals of the Nation's climate change program. Accomplishing these goals will require, in part, an accurate accounting of the key reservoirs and fluxes associated with the global water and energy cycle, including their spatial and temporal variability. through integration of all necessary observations and research tools, To this end, in conjunction with NASA's Earth science research strategy, the overarching long-term NASA Energy and Water Cycle Study (NEWS) grand challenge can he summarized as documenting and enabling improved, observationally based, predictions of water and energy cycle consequences of Earth system variability and change. This challenge requires documenting and predicting trends in the rate of the Earth's water and energy cycling that corresponds to climate change and changes in the frequency and intensity of naturally occurring related meteorological and hydrologic events, which may vary as climate may vary in the future. The cycling of water and energy has obvious and significant implications for the health and prosperity of our society. The importance of documenting and predicting water and energy cycle variations and extremes is necessary to accomplish this benefit to society.

  12. Integrated stratigraphy of the Cenomanian-Turonian boundary interval: improving understanding of Oceanic Anoxic Events

    NASA Astrophysics Data System (ADS)

    Jarvis, Ian

    2014-05-01

    The Cenomanian-Turonian boundary (CTB) interval ~ 94 Ma represented a period of major global palaeoenvironmental change. Increasingly detailed multidisciplinary studies integrating sedimentological, palaeontological and geochemical data from multiple basins, are enabling the development of refined but complex models that aid understanding of the mechanisms driving changes in ocean productivity and climate. This paper reviews some of the exciting new developments in this field. Facies change characterizes the CTB interval in most areas. In the Chalk seas of northern Europe, a widespead hiatus was followed by the deposition of clay-rich organic-lean beds of the Plenus Marl and its equivalents, and then nodular chalks. In the North Sea basin and its onshore extension in eastern England and northern Germany, black shales of the Black Band (Blodøks Formation, Hasseltal Formation) occur. Similarly, in northern Tethys, a brief interval of black shale accumulation within a predominantly carbonate succession, is exemplified by the Niveau Thomel in the Vocontian Basin (SE France), and the Livello Bonarelli in Italy. Widespread deposition of organic-rich marine sediments during CTB times led to 12C depletion in surface carbon reservoirs (oceans, atmosphere, biosphere), and a large positive global δ13C excursion preserved in marine carbonates and both marine and terrestrial organic matter (Oceanic Anoxic Event 2). Significant biotic turnover characterises the boundary interval, and inter-regional correlation may be achieved at high resolution using integrated biostratigraphy employing macrofossils (ammonites, inoceramid bivalves), microfossils (planktonic foraminifera, dinoflagellate cysts) and calcareous nannofossils. Correlations can be tested against those based on comparison of δ13C profiles - carbon isotope chemostratigraphy, supplemented by oxygen isotope and elemental data. Interpretation of paired carbonate - organic matter δ13C data from multiple CTB sections

  13. Improved Understanding of Carbon Storage Risk Via Controlled-Release Experiments

    NASA Astrophysics Data System (ADS)

    Birkholzer, J. T.; Guglielmi, Y.; Rutqvist, J.; Zheng, L.; Spycher, N.

    2014-12-01

    Two issues are often recognized as main risk drivers for carbon storage projects. The first is the possibility of pressure-induced slip of pre-existing faults, which can lead to breaching of seals to CO2 storage reservoirs. Although the mechanics of induced seismicity are well known, the characteristics of such slip events are poorly constrained and significant questions remain. The second is the potential impact of leaking CO2 on the quality of shallow potable groundwater. While several studies have been conducted using laboratory tests, natural analogues, and numerical models to evaluate the water quality changes induced by elevated CO2 concentrations, predictive understanding of these coupled processes remains limited in realistic field settings. We discuss in this invited contribution two controlled-release field experiments targeting remaining science gaps associated with induced seismicity and groundwater chemistry. The first experiment is a planned active fault slip experiment conducted in an underground research laboratory (URL) in a hardened shale formation that serves as a caprock analog. The critically stressed fault will be perturbed by the injection of fluid under pressure to simulate the influence of CO2 overpressure. The in situ reactivation experiment will use a novel borehole deformation tool that assesses the magnitude of overpressure required to cause slip, defines the mode of this slip as creeping (aseismic) or rapid (seismic), and measures the evolution of permeability on the fault. The second controlled-release field experiment was conducted in 2011/2012 to simulate the release of CO2 from a geologic storage site and study the transport as well as the chemical mechanisms leading to the CO2-induced mobilization of trace elements in a shallow aquifer. The field test involved a dipole system in which the shallow groundwater was pumped from one well, saturated with CO2 at the pressure corresponding to the hydraulic pressure of the aquifer, and

  14. A Hands-on Exercise in Building Darcy Tubes to Improve Student Understanding of Groundwater Flow

    NASA Astrophysics Data System (ADS)

    Smith, J. A.

    2012-12-01

    Teaching undergraduate students about sustainability typically includes discussions of water resources and the flow of groundwater in aquifers. Understanding the flow of groundwater is a fundamental step for students, but one that can easily get mired in equations (e.g., Darcy's Law). In an effort to transform Darcy's Law, which describes flow of fluid through a porous medium, from an abstract concept to a hands-on experiment, I had undergraduate students build working "Darcy tubes" and calculate hydraulic conductivity during a three-hour lab period. At the beginning of the lab period, I presented the students with the materials: three pairs of plastic soda bottles with straight sides, glass tubing, pantyhose (for screens), rubber hosing, sieved sand in three grain sizes (1-2 mm, 0.5-1.0 mm, and 0.25-0.5 mm), and various types of tape and adhesive. After we discussed the basic design of a Darcy tube (inlet and outlet, with two piezometers), the students went to work. Real-time problem-solving was an integral (and exciting) part of the exercise. Within two hours, they had built three Darcy tubes, each filled with a different sand size. The students determined the cross-sectional area of each tube (A) and the distance between the two piezometers (L). We then ran the experiments, using tinted water so that we could more easily tell when the sand in the tubes was saturated. We measured discharge (Q) through the tube and marked the height of the water in each piezometer to calculate difference in hydraulic head (Δh). With the data we had collected, the students were able to calculate hydraulic conductivity (K) using a simple form of Darcy's Law: Q = -KA (Δh/L). Despite the simplicity of the Darcy tubes, the students' K values were reasonable for the sediment types that we used. Student comments on the Darcy tube exercise were overwhelmingly positive. The Darcy tubes could be used in a subsequent lab period for exploration of more advanced concepts, such as

  15. Towards an improved understanding of strength and anisotropy of cold compacted powder

    NASA Astrophysics Data System (ADS)

    Wang, Wenhai

    enough. These results, which are in agreement with recent strength anisotropy data for cold compaction, bring a new perspective on understanding the interparticle behavior and the origin of the strength and failure of cold compacts.

  16. Atmospheric Extremes in a Changing Climate: A Strategy for Improved Understanding Driven by International Security Concerns

    NASA Astrophysics Data System (ADS)

    Davis, A. B.; Kao, C. J.

    2001-05-01

    critical threshold crossing. So extreme atmospheric phenomena are of the essence yet they are poorly understood, even in a steady climate, because they challenge both dynamical modelers and statisticians. The authors will describe a preliminary proposal to harness some of the unique human, computational and observational resources at LANL that could lead to a significant breakthrough in our understanding of extreme weather mechanisms and how they relate to climate and climate change. If implemented, this program could open new relationships between the laboratory and presently unsuspecting client-agencies such as FEMA, CDC, EPA, State Department, and so on.

  17. Improvement of tactile roughness discrimination acuity correlates with perception of improved hand function in patients after hand surgery.

    PubMed

    Fujimoto, Shuhei; Kon, Noriko

    2016-04-01

    [Purpose] The purpose of this study was to elucidate how well patients' perceptions related to the improvements in their hand function during hospitalization. [Subjects] Sixteen patients who were hospitalized after hand surgery. [Methods] Using the Japanese Society for Surgery of the Hand edition of the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire; tactile roughness discrimination acuity, motor imagery, motor function, sensory function, and pain of the upper limb were assessed at admission and discharge. Spearman's rank-order correlation coefficients were calculated using the differences in all assessment items at admission and discharge. A multiple regression analysis (stepwise method) was performed to investigate factors that correlated with improvements in Quick-Disabilities of the Arm, Shoulder, and Hand scores. [Results] The improvement of tactile roughness discrimination acuity was significantly associated with patient perception of improved hand function. [Conclusion] The results suggest that an improvement in tactile roughness discrimination acuity was most strongly correlated with patient perception of improved hand function.

  18. Novel 3D imaging techniques for improved understanding of planetary surface geomorphology.

    NASA Astrophysics Data System (ADS)

    Muller, Jan-Peter

    2015-04-01

    Understanding the role of different planetary surface formation processes within our Solar System is one of the fundamental goals of planetary science research. There has been a revolution in planetary surface observations over the past decade for Mars and the Moon, especially in 3D imaging of surface shape (down to resolutions of 75cm) and subsequent correction for terrain relief of imagery from orbiting and co-registration of lander and rover robotic images. We present some of the recent highlights including 3D modelling of surface shape from the ESA Mars Express HRSC (High Resolution Stereo Camera), see [1], [2] at 30-100m grid-spacing; and then co-registered to HRSC using a resolution cascade of 20m DTMs from NASA MRO stereo-CTX and 0.75m DTMs from MRO stereo-HiRISE [3]. This has opened our eyes to the formation mechanisms of megaflooding events, such as the formation of Iani Vallis and the upstream blocky terrain, to crater lakes and receding valley cuts [4]. A comparable set of products is now available for the Moon from LROC-WA at 100m [5] and LROC-NA at 1m [6]. Recently, a very novel technique for the super-resolution restoration (SRR) of stacks of images has been developed at UCL [7]. First examples shown will be of the entire MER-A Spirit rover traverse taking a stack of 25cm HiRISE to generate a corridor of SRR images along the rover traverse of 5cm imagery of unresolved features such as rocks, created as a consequence of meteoritic bombardment, ridge and valley features. This SRR technique will allow us for ˜400 areas on Mars (where 5 or more HiRISE images have been captured) and similar numbers on the Moon to resolve sub-pixel features. Examples will be shown of how these SRR images can be employed to assist with the better understanding of surface geomorphology. Acknowledgements: The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under PRoViDE grant agreement n° 312377

  19. Shared Medical Appointments: A Promising Innovation to Improve Patient Engagement and Ease the Primary Care Provider Shortage.

    PubMed

    Stults, Cheryl D; McCuistion, Mary H; Frosch, Dominick L; Hung, Dorothy Y; Cheng, Peter H; Tai-Seale, Ming

    2016-02-01

    The Affordable Care Act has extended coverage for uninsured and underinsured Americans, but it could exacerbate existing problems of access to primary care. Shared medical appointments (SMAs) are one way to improve access and increase practice productivity, but few studies have examined the patient's perspective on participation in SMAs. To understand patient experiences, 5 focus group sessions were conducted with a total of 30 people in the San Francisco Bay Area. The sessions revealed that most participants felt that they received numerous tangible and intangible benefits from SMAs, particularly enhanced engagement with other patients and physicians, learning, and motivation for health behavior change. Most importantly, participants noted changes in the power dynamic during SMA visits as they increasingly saw themselves empowered to impart information to the physician. Although SMAs improve access, engagement with physicians and other patients, and knowledge of patients' health, they also help to ease the workload for physicians.

  20. Developing Vocabularies to Improve Understanding and Use of NOAA Observing Systems

    NASA Astrophysics Data System (ADS)

    Austin, M.

    2014-12-01

    The NOAA Observing System Integrated Analysis project (NOSIA II), is an attempt to capture and tell the story of how valuable observing systems are in producing products and services that are required to fulfill the NOAA's diverse mission. NOAA's goals and mission areas cover a broad range of environmental data; a complexity exists in terms and vocabulary as applied to the creation of observing system derived products. The NOSIA data collection focused first on decomposing NOAA's goals in the creation and acceptance of Mission Service Areas (MSAs) by NOAA senior leadership. Products and services that supported the MSAs were then identified through the process of interviewing product producers across NOAA organization. Product Data inputs including models, databases and observing system were also identified. The NOSIA model contains over 20,000 nodes each representing levels in a network connecting products, datasources, users and desired outcomes. An immediate need became apparent that the complexity and variety of the data collected required data management to mature the quality and the content of the NOSIA model. The NOSIA Analysis Database (ADB) was developed initially to improve consistency of terms and data types to allow for the linkage of observing systems, products and NOAA's Goals and mission. The ADB also allowed for the prototyping of reports and product generation in an easily accessible and comprehensive format for the first time. Web based visualization of relationships between products, datasources, users, producers were generated to make the information easily understood This includes developing ontologies/vocabularies that are used for the development of users type specific products for NOAA leadership, Observing System Portfolio mangers and the users of NOAA data.

  1. Understanding and Improving the Elastic Compressive Modulus of Fibre Reinforced Soy-Based Polyurethane Foams

    NASA Astrophysics Data System (ADS)

    Hussain, Sadakat

    Soy-based polyurethane foams (PUFs) were reinforced with fibres of different aspect ratios to improve the compressive modulus. Each of the three fibre types reinforced PUF differently. Shorter micro-crystalline cellulose fibres were found embedded inside the cell struts of PUF and reinforced them. The reinforcement was attributed to be stress transfer from the matrix to the fibre by comparing the experimental results to those predicted by micro-mechanical models for short fibre reinforced composites. The reinforced cell struts increased the overall compressive modulus of the foam. Longer glass fibres (470 microns, length) provided the best reinforcement. These fibres were found to be larger than the cell diameters. The micro-mechanical models could not predict the reinforcement provided by the longer glass fibres. The models predicted negligible reinforcement because the very low modulus PUF should not transfer load to the higher modulus fibres. However, using a finite element model, it was determined that the fibres were providing reinforcement through direct fibre interaction with each other. Intermediate length glass fibres (260 microns, length) were found to poorly reinforce the PUF and should be avoided. These fibres were too short to interact with each other and were on average too large to embed and reinforce cell struts. In order to produce natural fibre reinforced PUFs in the future, a novel device was invented. The purpose of the device is to deliver natural fibres at a constant mass flow rate. The device was found to consistently meter individual loose natural fibre tufts at a mass flow rate of 2 grams per second. However, the device is not robust and requires further development to deliver a fine stream of natural fibre that can mix and interact with the curing polymeric components of PUF. A design plan was proposed to address the remaining issues with the device.

  2. Understanding the role of different conductive polymers in improving the nanostructured sulfur cathode performance.

    PubMed

    Li, Weiyang; Zhang, Qianfan; Zheng, Guangyuan; Seh, Zhi Wei; Yao, Hongbin; Cui, Yi

    2013-01-01

    Lithium sulfur batteries have brought significant advancement to the current state-of-art battery technologies because of their high theoretical specific energy, but their wide-scale implementation has been impeded by a series of challenges, especially the dissolution of intermediate polysulfides species into the electrolyte. Conductive polymers in combination with nanostructured sulfur have attracted great interest as promising matrices for the confinement of lithium polysulfides. However, the roles of different conductive polymers on the electrochemical performances of sulfur electrode remain elusive and poorly understood due to the vastly different structural configurations of conductive polymer-sulfur composites employed in previous studies. In this work, we systematically investigate the influence of different conductive polymers on the sulfur cathode based on conductive polymer-coated hollow sulfur nanospheres with high uniformity. Three of the most well-known conductive polymers, polyaniline (PANI), polypyrrole (PPY), and poly(3,4-ethylenedioxythiophene) (PEDOT), were coated, respectively, onto monodisperse hollow sulfur nanopsheres through a facile, versatile, and scalable polymerization process. The sulfur cathodes made from these well-defined sulfur nanoparticles act as ideal platforms to study and compare how coating thickness, chemical bonding, and the conductivity of the polymers affected the sulfur cathode performances from both experimental observations and theoretical simulations. We found that the capability of these three polymers in improving long-term cycling stability and high-rate performance of the sulfur cathode decreased in the order of PEDOT > PPY > PANI. High specific capacities and excellent cycle life were demonstrated for sulfur cathodes made from these conductive polymer-coated hollow sulfur nanospheres.

  3. How Kaiser Permanente uses video ethnography of patients for quality improvement, such as in shaping better care transitions.

    PubMed

    Neuwirth, Esther B; Bellows, Jim; Jackson, Ana H; Price, Patricia M

    2012-06-01

    Keeping patients and caregivers at the center of quality improvement is critical. Kaiser Permanente's Care Management Institute adapted video ethnography to achieve this aim, using video to capture interviews with-and observations of-patients and caregivers, identify patient-centered improvement opportunities, and communicate them effectively to clinical and administrative leaders and front-line staff. This method is particularly effective for helping understand the needs of frail elders, patients nearing the end of life, those with multiple chronic conditions, and other vulnerable people who are not well represented in focus groups and patient advisory councils. As part of an initiative to improve care transitions for elders with heart failure, video ethnography contributed to greatly reduced thirty-day hospital readmission rates, helping reduce readmissions at one medical center from 13.6 percent to 9 percent in six months. It also helped improve the reliability of the readmissions reduction program. When embedded within an established quality improvement framework, video ethnography can be an effective tool for innovating new solutions, improving existing processes, and spreading knowledge about how best to meet patient needs.

  4. Improving the Process of Informed Consent for PCI: Patient Outcomes from the ePRISM Study

    PubMed Central

    Spertus, John A.; Bach, Richard; Bethea, Charles; Chhatriwalla, Adnan; Curtis, Jeptha P.; Gialde, Elizabeth; Guerrero, Mayra; Gosch, Kensey; Jones, Philip; Kugelmass, Aaron; Leonard, Bradley M.; McNulty, Edward J.; Shelton, Marc; Ting, Henry H.; Decker, Carole

    2014-01-01

    Background While the process of informed consent is designed to transfer knowledge of the risks and benefits of treatment and to engage patients in shared medical decision-making, this is poorly done in routine clinical care. We assessed the impact of a novel informed consent form for percutaneous coronary intervention (PCI) that is more simply written, includes images of the procedure and embeds individualized estimates of outcomes on multiple domains of successful informed consent and shared decision-making. Methods We interviewed 590 PCI patients receiving traditional consent documents and 527 patients receiving novel ePRISM consents at 9 US centers and compared patients' perceptions, knowledge transfer and engagement in medical decision-making. Heterogeneity across sites was assessed and adjusted for using hierarchical models. Results Site-adjusted analyses revealed more frequent review (72% for ePRISM vs. 45% for original consents) and better understanding of the ePRISM consents (odds ratios (ORs)=1.8–3.0, depending upon the outcome) with marked heterogeneity across sites (median relative difference (MRD) in the ORs of ePRISM's effect = 2–3.2). Patients receiving ePRISM consents better understood the purposes and risks of the procedure (ORs=1.9–3.9, MRDs=1.1–6.2), engaged more in shared decision-making (proportional OR=2.1 [95%CI=1.02–4.4], MRD=2.2) and discussed stent options with their physicians (58% vs. 31%; site-adjusted odds ratio=2.7 [95% CI=1.2, 6.3], MRD=2.6) more often. Conclusions A personalized consent document improved the process of informed consent and shared decision-making. Marked heterogeneity across hospitals highlights that consent documents are but one aspect of engaging patients in understanding and participating in treatment. PMID:25641532

  5. Splitting in-patient and out-patient responsibility does not improve patient care.

    PubMed

    Burns, Tom; Baggaley, Martin

    2017-01-01

    Over the past 15 years there has been a move away from consultants having responsibility for the care of patients both in the community and when in hospital towards a functional split in responsibility. In this article Tom Burns and Martin Baggaley debate the merits or otherwise of the split, identifying leadership, expertise and continuity of care as key issues; both recognise that this move is not evidence based.

  6. Improving understanding of controls on spatial variability in methane fluxes in Arctic tundra

    NASA Astrophysics Data System (ADS)

    Davidson, Scott J.; Sloan, Victoria; Phoenix, Gareth; Wagner, Robert; Oechel, Walter; Zona, Donatella

    2015-04-01

    determining the direction and magnitude of methane flux, with methane emissions occurring in saturated micro-topographic locations and drier sites showing low rates of uptake. An interesting exception was in tussock sedge vegetation, which had a deep water table (approximately 20cm - 40cm below the soil surface) but which emitted methane in comparable quantities to saturated communities late in the growing season. This highlights the importance of plant transport and of understanding temporal variation in fluxes. Automated chamber measurements from peak and late growing season showed minimal diurnal trends in methane fluxes, indicating that short-term chamber measurements are representative of average diurnal CH4 fluxes. The breadth of environmental and vegetation variables measured across a wide spatial extent of arctic tundra vegetation communities within this study highlights the overriding controls on methane emissions and will significantly help with upscaling methane emissions from the plot scale to the landscape scale. Reference: IPCC, 2013: Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Stocker, T.F., D. Qin, G.-K. Plattner, M. Tignor, S.K. Allen, J. Boschung, A. Nauels, Y. Xia, V. Bex and P.M. Midgley (eds.)]. Cambridge University Press, Cambridge, United Kingdom and New York, NY, USA, 1535 pp, doi:10.1017/CBO97811074153

  7. [Understanding and reaching young clandestine sex workers in Burkina Faso to improve response to HIV].

    PubMed

    Berthé, Abdramane; Huygens, Pierre; Ouattara, Cécile; Sanon, Anselme; Ouédraogo, Abdoulaye; Nagot, Nicolas

    2008-01-01

    In 1998, researchers in Burkina Faso enrolled 300 women more or less involved in commercial sex work in an open cohort to determine whether adequate management of their sexually transmitted infections and exposure to well-designed, well-delivered, and plentiful communication for behaviour change (CBC) might reduce their vulnerability to HIV. In 2000, they observed that the non-professional sex workers (occasional or clandestine sex workers) were more difficult to reach, to mobilize and to keep involved in the project's different activities. This group was also infected at the same or higher rates than professional sex workers because they did not use condoms routinely. To accomplish the project objectives, they therefore chose to recruit more non-professional sex workers in the new cohort of 700 women. This social-anthropological study was conducted to help them to enrol young clandestine sex workers. The overall objective of this study was to understand the life of this category of sex workers and to identify strategic actors to reach them. Using a qualitative method, social anthropologists reviewed literature, identified and geo-referenced all local places suitable to encountering these women, obtained life stories from some of them and interviewed key informants and participants in the field. The results showed that in Bobo-Dioulasso (Burkina Faso): - most young women who are clandestine sex workers are Burkinabe, and girls entering the sex trade are increasingly young and increasingly uneducated; - most of them come from families with low capital (financial, cultural, or social). The parents' socioeconomic status (contextual poverty) results in unmet financial needs, which in turn exposes them to starting work early, including commercial sex work; - of all the income-generating activities available to unskilled young girls, commercial sex work is one of the most profitable and easily accessible; - in the three-fold context of an HIV epidemic, poverty, and

  8. Investigation Leads to Improved Understanding of Space Shuttle RSRM Internal Insulation Joints

    NASA Technical Reports Server (NTRS)

    McWhorter, Bruce B.; Bolton, Doug E.; Hicken, Steve V.; Allred, Larry D.; Cook, Dave J.

    2003-01-01

    PSA has been weakened due to humidity, then the J-joint will partially pull apart (inboard side), and the J-joint surfaces will be charred by exposure to hot gases. After early operation, a J-joint that has been pulled apart will come back together as the J-joint deformation decreases. This J-joint heating event is relatively short and occurs only during the first part of motor operation. Internal instrumentation was developed for another full-scale static test in February 2000. The static test instrumentation did indeed prove this theory to be correct. Post-test inspection revealed very similar charring characteristics as observed on RSRM-55. This experience of the development of a new PSA, its testing, the RSRM-55 flight, followed by the J-joint investigation led to good 'lessons learned' and to an additional fundamental understanding of the RSRM J-joint function.

  9. Applying Chemical Imaging Analysis to Improve Our Understanding of Cold Cloud Formation

    NASA Astrophysics Data System (ADS)

    Laskin, A.; Knopf, D. A.; Wang, B.; Alpert, P. A.; Roedel, T.; Gilles, M. K.; Moffet, R.; Tivanski, A.

    2012-12-01

    The impact that atmospheric ice nucleation has on the global radiation budget is one of the least understood problems in atmospheric sciences. This is in part due to the incomplete understanding of various ice nucleation pathways that lead to ice crystal formation from pre-existing aerosol particles. Studies investigating the ice nucleation propensity of laboratory generated particles indicate that individual particle types are highly selective in their ice nucleating efficiency. This description of heterogeneous ice nucleation would present a challenge when applying to the atmosphere which contains a complex mixture of particles. Here, we employ a combination of micro-spectroscopic and optical single particle analytical methods to relate particle physical and chemical properties with observed water uptake and ice nucleation. Field-collected particles from urban environments impacted by anthropogenic and marine emissions and aging processes are investigated. Single particle characterization is provided by computer controlled scanning electron microscopy with energy dispersive analysis of X-rays (CCSEM/EDX) and scanning transmission X-ray microscopy with near edge X-ray absorption fine structure spectroscopy (STXM/NEXAFS). A particle-on-substrate approach coupled to a vapor controlled cooling-stage and a microscope system is applied to determine the onsets of water uptake and ice nucleation including immersion freezing and deposition ice nucleation as a function of temperature (T) as low as 200 K and relative humidity (RH) up to water saturation. We observe for urban aerosol particles that for T > 230 K the oxidation level affects initial water uptake and that subsequent immersion freezing depends on particle mixing state, e.g. by the presence of insoluble particles. For T < 230 K the particles initiate deposition ice nucleation well below the homogeneous freezing limit. Particles collected throughout one day for similar meteorological conditions show very similar

  10. Biomarkers in acute respiratory distress syndrome: from pathobiology to improving patient care.

    PubMed

    Walter, James M; Wilson, Jennifer; Ware, Lorraine B

    2014-10-01

    Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by alveolar flooding with protein-rich pulmonary edema fluid. Despite an improved understanding of ARDS pathogenesis, our ability to predict the development of ARDS and risk-stratify patients with the disease remains limited. Biomarkers may help identify patients at highest risk of developing ARDS, assess response to therapy, predict outcome, and optimize enrollment in clinical trials. This review begins with a general description of biomarker use in clinical medicine. We then review evidence that supports the value of various ARDS biomarkers organized by the cellular injury processes central to ARDS development: endothelial injury, epithelial injury, disordered inflammation and coagulation, fibrosis, and apoptosis. Finally, we summarize the growing contributions of genomic and proteomic research and suggest ways in which the field may evolve in the coming years.

  11. Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

    PubMed Central

    McGrice, Melanie; Don Paul, Kathlene

    2015-01-01

    Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2–10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments. PMID:26150731

  12. Improving Thai students' understanding of concepts in protein purification by using Thai and English versions of a simulation program*.

    PubMed

    Phornphisutthimas, Somkiat; Panijpan, Bhinyo; Wood, Edward J; Booth, Andrew G

    2007-09-01

    To support student learning in biochemistry and related courses, a simulation program, the Protein Purification Program, offers an alternative multimedia-based tool. This program has now been translated to produce a Thai version. However, translation from the original into the Thai language is limited by the differences between the language characteristics of English and Thai. Therefore, use of the program with Thai students had a twofold purpose. It helped their understanding of the concepts of protein purification by allowing code switching between the languages, but it also improved their understanding of, and competence in scientific English, which is a vital skill for functioning as a modern biochemist. According to the results of the questionnaires, undergraduates using the Thai/English program scored significantly higher than those using only the English language program (p < 0.05). In addition, the interview data suggested that the Thai/English program had improved student understanding of the concepts of protein purification to a greater extent than a single language (English) program. Students' overall preference in terms of their learning using the Thai/English program was 4.15 on a 1-5 Likert scale.

  13. The effects of automatic spelling correction software on understanding and comprehension in compensated dyslexia: improved recall following dictation.

    PubMed

    Hiscox, Lucy; Leonavičiūtė, Erika; Humby, Trevor

    2014-08-01

    Dyslexia is associated with difficulties in language-specific skills such as spelling, writing and reading; the difficulty in acquiring literacy skills is not a result of low intelligence or the absence of learning opportunity, but these issues will persist throughout life and could affect long-term education. Writing is a complex process involving many different functions, integrated by the working memory system; people with dyslexia have a working memory deficit, which means that concentration on writing quality may be detrimental to understanding. We confirm impaired working memory in a sample of university students with (compensated) dyslexia, and using a within-subject design with three test conditions, we show that these participants demonstrated better understanding of a piece of text if they had used automatic spelling correction software during a dictation/transcription task. We hypothesize that the use of the autocorrecting software reduced demand on working memory, by allowing word writing to be more automatic, thus enabling better processing and understanding of the content of the transcriptions and improved recall. Long-term and regular use of autocorrecting assistive software should be beneficial for people with and without dyslexia and may improve confidence, written work, academic achievement and self-esteem, which are all affected in dyslexia.

  14. Japanese Encephalitis in Assam, India: Need to Increase Healthcare Workers’ Understanding to Improve Health Care

    PubMed Central

    Ahmad, Akram; Khan, Muhammad Umair; Gogoi, Lakhya Jyoti; Kalita, Manabendra; Sikdar, Atul Prasad; Pandey, Sureshwar; Dhingra, Sameer

    2015-01-01

    Introduction Japanese encephalitis (JE) is a major cause of high morbidity and mortality in several states across India. However, in 2014, a sharp rise was observed in the number of cases of JE in north-eastern Assam state, and 51% of the total cases of JE in India were reported from the Assam in the same year. In this regard, a study was conducted to evaluate the knowledge and attitudes of healthcare workers in Darrang, a district of Assam highly affected by JE. Methods A cross sectional study was conducted for 2 months among HCWs in the major district hospital of Darrang, Assam. A pre-tested, self-administered questionnaire was used to collect data from the participants. Convenience sampling approach was used to collect data from different departments of the hospitals. Descriptive and logistic regression analyses were used to express the results. Results The knowledge of HCWs regarding JE was poor with a mean knowledge score of 11.02±2.39 (out of 17), while their attitudes were positive with a mean attitudes score of 43.16± 2.47 (ranging from 13 to 52). Overall, 40.4% and 74.3% of participants demonstrated good knowledge and positive attitudes respectively. Cut-off score for good knowledge and positive attitudes toward JE was set as ≥12 and >40 respectively. Older participants (40–49 years) and experienced workers (>10 years) were significantly associated with good knowledge as compared to their referent group (p<0.05), while knowledge of nurses and other orderlies were significantly lower than physicians (p<0.01). Similar factors were associated with the positive attitudes of the participants with the exception of experience. Television was the major source of information regarding JE reported by HCWs (79%). Conclusion Although the knowledge was not optimized, HCWs exhibited positive attitudes towards JE. Future research is required to design, implement and evaluate interventions to improve the knowledge of JE among HCWs. PMID:26296212

  15. A Novel Technique for Improving our Understanding of Arctic Methane and Carbon Dioxide Sources

    NASA Astrophysics Data System (ADS)

    Elder, C.; Czimczik, C. I.; Townsend-Small, A.; Xu, X.; Saltzman, E. S.; Aydin, M.

    2013-12-01

    Radiocarbon (14C) analysis of Arctic methane (CH4) and carbon dioxide (CO2) emissions and sources can verify the region's role in the global carbon cycle and provide potential evidence for an enhanced positive greenhouse gas feedback in the atmosphere. 14C data from the Arctic is limited, especially for CH4, and generally uncertain due to the complexity of measurement and remoteness of sampling sites. Previous methods rely on highly spatially and temporally variable ebullition events (bubble flux) to capture a CH4 sample concentrated enough for 14C-CH4 analysis, resulting in a limited representation of the Arctic's role in the global CH4 budget. To enhance 14C-CH4 and 14C-CO2 field sampling ability, improve our knowledge of Arctic lake biogeochemistry, and further constrain and verify pan-Arctic estimates of CH4 and CO2 sources and emissions, we have: (1) deployed a novel water-degassing field sampling technique that targets the highly distributed dissolved CH4 and CO2 (diffusive fraction) in Arctic lake water, (2) deployed a series of floating headspace chambers for estimating lake-to-atmosphere CH4 and CO2 fluxes, and (3) utilized a novel, flow-through vacuum line system to measure the 14C content of CH4 and CO2 in discrete air samples. This method eliminates the need to extensively observe Arctic lakes for highly sporadic CH4 ebullition events by targeting the less concentrated but prevalent fraction of dissolved CH4. Since this method extracts dissolved CH4 and CO2 from lake water in the field, the need for transporting large volumes of water back to an analytical laboratory (a task that becomes prohibitive when sampling in the remote Arctic) is eliminated. In-situ estimations of dissolved CH4 concentrations from the Arctic and Boreal wetland regions of Alaska range from essentially no dissolved CH4 to as high as 0.35 mg/L. Dissolved CH4 is estimated in the field via headspace equilibration and detection with a handheld catalytic converter sensor (Gas

  16. Plan for Quality to Improve Patient Safety at the Point of Care

    PubMed Central

    Ehrmeyer, Sharon S.

    2011-01-01

    The U.S. Institute of Medicine (IOM) much publicized report in “To Err is Human” (2000, National Academy Press) stated that as many as 98 000 hospitalized patients in the U.S. die each year due to preventable medical errors. This revelation about medical error and patient safety focused the public and the medical community's attention on errors in healthcare delivery including laboratory and point-of-care-testing (POCT). Errors introduced anywhere in the POCT process clearly can impact quality and place patient's safety at risk. While POCT performed by or near the patient reduces the potential of some errors, the process presents many challenges to quality with its multiple tests sites, test menus, testing devices and non-laboratory analysts, who often have little understanding of quality testing. Incoherent or no regulations and the rapid availability of test results for immediate clinical intervention can further amplify errors. System planning and management of the entire POCT process are essential to reduce errors and improve quality and patient safety. PMID:21808107

  17. Impact of online patient reminders to improve asthma care: A randomized controlled trial

    PubMed Central

    Pool, Andrew C.; Kraschnewski, Jennifer L.; Poger, Jennifer M.; Smyth, Joshua; Stuckey, Heather L.; Craig, Timothy J.; Lehman, Erik B.; Yang, Chengwu; Sciamanna, Christopher N.

    2017-01-01

    reminders improved asthma control among insured patients. Although future studies are needed to understand the mechanism of the improvement, the magnitude of the effect on asthma control was similar to the addition of an additional controller medication. Given the widespread use of the Internet, simple tools such as this may be useful for improving the control of other chronic diseases as well. Trial registration This study is registered at clinicaltrials.gov, NCT00921401, “Improving the Quality of Asthma Care Using the Internet” PMID:28158200

  18. Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk, Russian Federation.

    PubMed

    Miller, Ann C; Nelson, A Katrina; Livchits, Viktoria; Greenfield, Shelly F; Yanova, Galina; Yanov, Sergei; Connery, Hilary S; Atwood, Sidney; Lastimoso, Charmaine S; Shin, Sonya S

    2016-01-01

    Russian Federation's (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed.

  19. Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk, Russian Federation

    PubMed Central

    Miller, Ann C.; Nelson, A. Katrina; Livchits, Viktoria; Greenfield, Shelly F.; Yanova, Galina; Yanov, Sergei; Connery, Hilary S.; Atwood, Sidney; Lastimoso, Charmaine S.; Shin, Sonya S.

    2016-01-01

    Russian Federation’s (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed. PMID:26871943

  20. Evaluating the effects of ideology on public understanding of climate change science: how to improve communication across ideological divides?

    PubMed

    Zia, Asim; Todd, Anne Marie

    2010-11-01

    While ideology can have a strong effect on citizen understanding of science, it is unclear how ideology interacts with other complicating factors, such as college education, which influence citizens' comprehension of information. We focus on public understanding of climate change science and test the hypotheses: [H1] as citizens' ideology shifts from liberal to conservative, concern for global warming decreases; [H2] citizens with college education and higher general science literacy tend to have higher concern for global warming; and [H3] college education does not increase global warming concern for conservative ideologues. We implemented a survey instrument in California's San Francisco Bay Area, and employed regression models to test the effects of ideology and other socio-demographic variables on citizen concern about global warming, terrorism, the economy, health care and poverty. We are able to confirm H1 and H3, but reject H2. Various strategies are discussed to improve the communication of climate change science across ideological divides.

  1. Improving patient waiting times: a simulation study of an obesity care service

    PubMed Central

    Tako, Antuela A; Kotiadis, Kathy; Vasilakis, Christos; Miras, Alexander; le Roux, Carel W

    2014-01-01

    Background Obesity care services are often faced with the need to adapt their resources to rising levels of demand. The main focus of this study was to help prioritise planned investments in new capacity allowing the service to improve patient experience and meet future anticipated demand. Methods We developed computer models of patient flows in an obesity service in an Academic Health Science Centre that provides lifestyle, pharmacotherapy and surgery treatment options for the UK's National Health Service. Using these models we experiment with different scenarios to investigate the likely impact of alternative resource configurations on patient waiting times. Results Simulation results show that the timing and combination of adding extra resources (eg, surgeons and physicians) to the service are important. For example, increasing the capacity of the pharmacotherapy clinics equivalent to adding one physician reduced the relevant waiting list size and waiting times, but it then led to increased waiting times for surgical patients. Better service levels were achieved when the service operates with the resource capacity of two physicians and three surgeons. The results obtained from this study had an impact on the planning and organisation of the obesity service. Conclusions Resource configuration combined with demand management (reduction in referral rates) along the care service can help improve patient waiting time targets for obesity services, such as the 18 week target of UK's National Health Service. The use of simulation models can help stakeholders understand the interconnectedness of the multiple microsystems (eg, clinics) comprising a complex clinical service for the same patient population, therefore, making stakeholders aware of the likely impact of resourcing decisions on the different microsystems. PMID:24050985

  2. It Takes Two to Tango: Improving Patient Referrals from the Emergency Department to Inpatient Clinicians

    PubMed Central

    Lawrence, Sean; Spencer, Lyndall M.; Sinnott, Michael; Eley, Robert

    2015-01-01

    Background The transfer of responsibility for patient care across clinical specialties is a complex process. Published and anecdotal data suggest that referrals often fail to meet the needs of one or both parties and that patient focus can be lost during the process. Little is known about the Australian situation. Methods To obtain a more complete understanding of the referral process, including the nature of communication in an Australian context, we conducted semistructured interviews in a convenience sample of 25 volunteers. Two established strategies for analyzing qualitative data were used. Results All respondents considered the following information essential components of a referral: an account of the patient's current condition, a working diagnosis or problem statement and history of the presenting concern, key test results or tests awaiting results, a potential management plan, and any special characteristics of the patient. Respondents acknowledged implied, if not literal, power to accept or reject an emergency department (ED) referral and said the imbalance of power was reinforced when the ED physician was junior to the inpatient clinician. Respondents also noted that in addition to the predominant organizational culture, an independent culture is associated with specific shifts. Foremost among the nonclinical aspects of a referral considered to be important was the timeliness of the contact made to achieve the transition. Respondents also said the success of a referral depended on the speaking and listening abilities of all parties. The individual's motivation to accept or reject a referral can also have an impact on communication. Conclusion Respondents attributed the difficulty of negotiating the transfer of a patient's care across the ED and inpatient interface to three distinct factors: variations in the clinical information required, the culture of the organization and of the clinical team in which the transaction takes place, and the

  3. “Not Just a Receiver”: Understanding Patient Behavior in the Hospital Environment

    PubMed Central

    Mishra, Sonali R.; Haldar, Shefali; Pollack, Ari H.; Kendall, Logan; Miller, Andrew D.; Khelifi, Maher; Pratt, Wanda

    2016-01-01

    Patient engagement leads to better health outcomes and experiences of health care. However, existing patient engagement systems in the hospital environment focus on the passive receipt of information by patients rather than the active contribution of the patient or caregiver as a partner in their care. Through interviews with hospitalized patients and their caregivers, we identify ways that patients and caregivers actively participate in their care. We describe the different roles patients and caregivers assume in interacting with their hospital care team. We then discuss how systems designed to support patient engagement in the hospital setting can promote active participation and help patients achieve better outcomes. PMID:28345079

  4. Does administering albumin to postoperative gastroschisis patients improve outcome?

    PubMed Central

    Tannuri, Ana Cristina A; Silva, Luanna M; Leal, Antonio José G; de Moraes, Augusto César F; Tannuri, Uenis

    2012-01-01

    OBJECTIVES: Newborns who undergo surgery for gastroschisis correction may present with oliguria, anasarca, prolonged postoperative ileus, and infection. New postoperative therapeutic procedures were tested with the objective of improving postoperative outcome. PATIENTS AND METHODS: One hundred thirty-six newborns participated in one of two phases. Newborns in the first phase received infusions of large volumes of crystalloid solution and integral enteral formula, and newborns in the second phase received crystalloid solutions in smaller volumes, with albumin solution infusion when necessary and the late introduction of a semi-elemental diet. The studied variables were serum sodium and albumin levels, the need for albumin solution expansion, the occurrence of anasarca, the length of time on parenteral nutrition, the length of time before initiating an enteral diet and reaching a full enteral diet, orotracheal intubation time, length of hospitalization, and survival rates. RESULTS: Serum sodium levels were higher in newborns in the second phase. There was a correlation between low serum sodium levels and orotracheal intubation time; additionally, low serum albumin levels correlated with the length of time before the initiation of an oral diet and the time until a full enteral diet was reached. However, the discharge weights of newborns in the second phase were higher than in the first phase. The other studied variables, including survival rates (83.4% and 92.0%, respectively), were similar for both phases. CONCLUSIONS: The administration of an albumin solution to newborns in the early postoperative period following gastroschisis repair increased their low serum sodium levels but did not improve the final outcome. The introduction of a semi-elemental diet promoted an increase in body weight at the time of discharge. PMID:22358234

  5. Nursing Information Systems Requirements: A Milestone for Patient Outcome and Patient Safety Improvement.

    PubMed

    Farzandipour, Mehrdad; Meidani, Zahra; Riazi, Hossein; Sadeqi Jabali, Monireh

    2016-12-01

    Considering the integral role of understanding users' requirements in information system success, this research aimed to determine functional requirements of nursing information systems through a national survey. Delphi technique method was applied to conduct this study through three phases: focus group method modified Delphi technique and classic Delphi technique. A cross-sectional study was conducted to evaluate the proposed requirements within 15 general hospitals in Iran. Forty-three of 76 approved requirements were clinical, and 33 were administrative ones. Nurses' mean agreements for clinical requirements were higher than those of administrative requirements; minimum and maximum means of clinical requirements were 3.3 and 3.88, respectively. Minimum and maximum means of administrative requirements were 3.1 and 3.47, respectively. Research findings indicated that those information system requirements that support nurses in doing tasks including direct care, medicine prescription, patient treatment management, and patient safety have been the target of special attention. As nurses' requirements deal directly with patient outcome and patient safety, nursing information systems requirements should not only address automation but also nurses' tasks and work processes based on work analysis.

  6. Screening, diagnosis, and management of patients with Fabry disease: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference.

    PubMed

    Schiffmann, Raphael; Hughes, Derralynn A; Linthorst, Gabor E; Ortiz, Alberto; Svarstad, Einar; Warnock, David G; West, Michael L; Wanner, Christoph

    2017-02-01

    Patients with Fabry disease (FD) are at a high risk for developing chronic kidney disease and cardiovascular disease. The availability of specific but costly therapy has elevated the profile of this rare condition. This KDIGO conference addressed controversial areas in the diagnosis, screening, and management of FD, and included enzyme replacement therapy and nonspecific standard-of-care therapy for the various manifestations of FD. Despite marked advances in patient care and improved overall outlook, there is a need to better understand the pathogenesis of this glycosphingolipidosis and to determine the appropriate age to initiate therapy in all types of patients. The need to develop more effective specific therapies was also emphasized.

  7. Improving understanding in the research informed consent process: a systematic review of 54 interventions tested in randomized control trials

    PubMed Central

    2013-01-01

    Background Obtaining informed consent is a cornerstone of biomedical research, yet participants comprehension of presented information is often low. The most effective interventions to improve understanding rates have not been identified. Purpose To systematically analyze the random controlled trials testing interventions to research informed consent process. The primary outcome of interest was quantitative rates of participant understanding; secondary outcomes were rates of information retention, satisfaction, and accrual. Interventional categories included multimedia, enhanced consent documents, extended discussions, test/feedback quizzes, and miscellaneous methods. Methods The search spanned from database inception through September 2010. It was run on Ovid MEDLINE, Ovid EMBASE, Ovid CINAHL, Ovid PsycInfo and Cochrane CENTRAL, ISI Web of Science and Scopus. Five reviewers working independently and in duplicate screened full abstract text to determine eligibility. We included only RCTs. 39 out of 1523 articles fulfilled review criteria (2.6%), with a total of 54 interventions. A data extraction form was created in Distiller, an online reference management system, through an iterative process. One author collected data on study design, population, demographics, intervention, and analytical technique. Results Meta-analysis was possible on 22 interventions: multimedia, enhanced form, and extended discussion categories; all 54 interventions were assessed by review. Meta-analysis of multimedia approaches was associated with a non-significant increase in understanding scores (SMD 0.30, 95% CI, -0.23 to 0.84); enhanced consent form, with significant increase (SMD 1.73, 95% CI, 0.99 to 2.47); and extended discussion, with significant increase (SMD 0.53, 95% CI, 0.21 to 0.84). By review, 31% of multimedia interventions showed significant improvement in understanding; 41% for enhanced consent form; 50% for extended discussion; 33% for test/feedback; and 29% for

  8. Improving Physician-Patient Communication through Coaching of Simulated Encounters

    ERIC Educational Resources Information Center

    Ravitz, Paula; Lancee, William J.; Lawson, Andrea; Maunder, Robert; Hunter, Jonathan J.; Leszcz, Molyn; McNaughton, Nancy; Pain, Clare

    2013-01-01

    Objective: Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods: Twenty-six family…

  9. Moving Research to Patient Applications through Commercialization: Understanding and Evaluating the Role of Intellectual Property

    PubMed Central

    2010-01-01

    The advancement of research from discovery to the delivery of medical care can be limited without the support of industry to sponsor its continued development. Federal government financial support is generally crucial in early-stage development through funding from the NIH, National Science Foundation, and other federal agencies; however, government support generally stops shortly after basic research discoveries have been reported. Much of the cessation of financial support derives from the government's regulatory responsibilities, as sponsoring the commercialization of a product conflicts with regulation of the approval for clinical use of a drug or device. Furthermore, differences in goals, resources, and flexibility render government, as compared with private industry, inefficient and less responsive to market demands with regard to stream-lining the development of and enhancing the quality of products and services offered. Thus, industry and private investment provide the bridge that converts new discoveries into healthcare products that are available to consumers and patients. This conversion occurs through commercialization, which involves both high risks and high rewards. Taking advantage of the commercialization option for research development requires an understanding of the technology transfer process. This article reviews 5 topics: 1) industry motivation to invest in academic research; 2) institutional considerations in partnering with industry; 3) academia's interactions with inventors in the commercialization process; 4) the research institution's route to commercialization, and 5) the role of intellectual property and commercialization in the advancement of healthcare. PMID:20353687

  10. Developing an in vitro understanding of patient experience with hydrofluoroalkane-metered dose inhalers.

    PubMed

    Doub, William H; Shah, Vibhakar; Limb, Susan; Guo, Changning; Liu, Xiaofei; Ngo, Diem

    2014-11-01

    As a result of the Montreal Protocol on Substances that Deplete the Ozone Layer, manufacturers of metered dose inhalers began reformulating their products to use hydrofluoroalkanes (HFAs) as propellants in place of chlorofluorocarbons (CFCs). Although the new products are considered safe and efficacious by the US Food and Drug Administration (FDA), a large number of complaints have been registered via the FDA's Adverse Events Reporting System (FAERS)-more than 7000 as of May 2013. To develop a better understanding of the measurable parameters that may, in part, determine in vitro performance and thus patient compliance, we compared several CFC- and HFA-based products with respect to their aerodynamic performance in response to changes in actuator cleaning interval and interactuation delay interval. Comparison metrics examined in this study were: total drug delivered ex-actuator, fine particle dose (<5 μm), mass median aerodynamic diameter, plume width, plume temperature, plume impaction force, and actuator orifice diameter. Overall, no single metric or test condition distinguishes HFA products from CFC products, but, for individual products tested, there were a combination of metrics that differentiated one from another.

  11. Moving research to patient applications through commercialization: understanding and evaluating the role of intellectual property.

    PubMed

    Patino, Robert M

    2010-03-01

    The advancement of research from discovery to the delivery of medical care can be limited without the support of industry to sponsor its continued development. Federal government financial support is generally crucial in early-stage development through funding from the NIH, National Science Foundation, and other federal agencies; however, government support generally stops shortly after basic research discoveries have been reported. Much of the cessation of financial support derives from the government's regulatory responsibilities, as sponsoring the commercialization of a product conflicts with regulation of the approval for clinical use of a drug or device. Furthermore, differences in goals, resources, and flexibility render government, as compared with private industry, inefficient and less responsive to market demands with regard to stream-lining the development of and enhancing the quality of products and services offered. Thus, industry and private investment provide the bridge that converts new discoveries into healthcare products that are available to consumers and patients. This conversion occurs through commercialization, which involves both high risks and high rewards. Taking advantage of the commercialization option for research development requires an understanding of the technology transfer process. This article reviews 5 topics: 1) industry motivation to invest in academic research; 2) institutional considerations in partnering with industry; 3) academia's interactions with inventors in the commercialization process; 4) the research institution's route to commercialization, and 5) the role of intellectual property and commercialization in the advancement of healthcare.

  12. Improving uptake and engagement with child body image interventions delivered to mothers: Understanding mother and daughter preferences for intervention content.

    PubMed

    Garbett, Kirsty M; Diedrichs, Phillippa C

    2016-12-01

    Mothers are a key influence on adolescent girls' body image. This study aimed to improve understanding of mothers' and daughters' preferences for content in body image interventions designed to assist mothers to promote positive body image among their daughters. British mother-daughter dyads (N=190) viewed descriptions of five evidence-based influences on body image (family, friends, and relationships; appearance-based teasing; media and celebrities; appearance conversations; body acceptance and care). Mothers and daughters each selected the two most important influences to learn about in these interventions. Overall, both mothers and daughters most frequently opted for family, friends, and relationships and body acceptance and care, whereas media and celebrities was their least preferred topic. While the overall sample of mothers and daughters agreed on preferences, Fisher's exact tests showed that within-dyad agreement was low. Recommendations for improving parent and child engagement with, and effectiveness of, child body image interventions delivered to parents are discussed.

  13. The dying role: its relevance to improved patient care.

    PubMed

    Noyes, R; Clancy, J

    1977-02-01

    Society is failing to meet the obligation it has to its dying members. Persons with terminal illnesses suffer isolation and neglect in hospitals, receive overzealous treatment by physicians, and are kept in ignorance of their situation by families and medical personnel. Evidence for these statements has come from observers of the medical care system and from dying patients themselves (Kübler-Ross, 1969; Reynolds and Kalish, 1974; Sudnow, 1967); In the nineteenth century it was common for persons to die in the familiar environs of their homes, surrounded by grieving families from whom they parted in a meaningful manner (Blauner, 1966). Dying persons of today no longer fill a well-defined social role. Instead, the distinction between the roles of sick and dying persons has been lost and, in the resulting confusion, the care of dying people has suffered. The purpose of this article is to clarify the distinction between the dying and sick roles, identify the signs of existing role confusion, suggest ways in which this confusion may be corrected, and show how reestablishment of the dying role can result in improved care of dying people. The important part physicians play in defining sick and dying roles will be emphasized.

  14. The Dying Role: Its Relevance to Improved Patient Care.

    PubMed

    Noyes, Russell; Clancy, John

    2016-01-01

    SOCIETY is failing to meet the obligation it has to its dying members. Persons with terminal illnesses suffer isolation and neglect in hospitals, receive overzealous treatment by physicians, and are kept in ignorance of their situation by families and medical personnel. Evidence for these statements has come from observers of the medical care system and from dying patients themselves (Kübler-Ross, 1969; Reynolds and Kalish, 1974; Sudnow, 1967). In the nineteenth century it was common for persons to die in the familiar environs of their homes, surrounded by grieving families from whom they parted in a meaningful manner (Blauner, 1966). Dying persons of today no longer fill a well-defined social role. Instead, the distinction between the roles of sick and dying persons has been lost and, in the resulting confusion, the care of dying people has suffered. The purpose of this article is to clarify the distinction between the dying and sick roles, identify the signs of existing role confusion, suggest ways in which this confusion may be corrected, and show how reestablishment of the dying role can result in improved care of dying people. The important part physicians play in defining sick and dying roles will be emphasized.

  15. Walking improvements with nabiximols in patients with multiple sclerosis.

    PubMed

    Coghe, G; Pau, M; Corona, F; Frau, J; Lorefice, L; Fenu, G; Spinicci, G; Mamusa, E; Musu, L; Massole, S; Massa, R; Marrosu, M G; Cocco, E

    2015-11-01

    Recently, nabiximols was approved as a treatment in MS spasticity. Data leading to approval and clinical use of nabiximols, although widely recognised, are based on subjective scales. Movement analysis procedures would obtain more detailed data about the impact on mobility. The aim of the study was to quantitatively assess the functional modification of gait patterns induced by nabiximols in MS. We evaluated three-dimensional gait analysis (spatial-temporal and kinematic) variation by means of one-way ANOVA. Twenty patients were enrolled-9 male and 11 female-with mean EDSS of 5.3 (SD ± 0.81) and mean reduction of numerical rating scale during nabiximols treatment of 1.88. The spatial-temporal parameters of gait revealed an increased speed (+15 %, p < 0.001), cadence (+6 %, p < 0.001) and stride length (+10 %, p < 0.001) after treatment. Regarding the kinematics data, the Gait Profile Score after treatment was reduced by 10 % (p < 0.001): Significant changes involved the pelvic area, hip rotation and knee flexion-extension. We found that nabiximols is able to improve the speed, cadence and stride length. Furthermore, the dynamics of the proximal segment of the legs and the knee movement results after treatment are closer to the physiologic values.

  16. Post-disaster psychosocial support and quality improvement: A conceptual framework for understanding and improving the quality of psychosocial support programs.

    PubMed

    Dückers, Michel L A; Thormar, Sigridur B

    2015-06-01

    This article is original in that it addresses post-disaster psychosocial support programs from a quality-improvement perspective, not from the traditional viewpoint of mental health services. Based on a combination of renowned quality models, a framework is sketched that offers chances to better understand and optimize the quality of post-disaster psychosocial service delivery. The quality is reflected in the program's structure, process, and outcome. Moreover, quality can be expressed in scores per criterion (i.e. need centeredness, effectiveness, safety, timeliness, efficiency, and equity) that are proposed to be related to the "attitude" (more passive or active) toward affected people. When quality and attitude are combined in a 2-D parabolic model, psychosocial support is preferably found in the middle of the attitude-axis (high quality); extremely passive or active positions are to be avoided (low quality). Well-timed assessments of structure, process, and outcome aspects, and associations between them, will help planners, providers, and evaluators understand if the optimum is reached, as well as provide guidance for quality improvement.

  17. Improving self-efficacy in spinal cord injury patients through "design thinking" rehabilitation workshops.

    PubMed

    Wolstenholme, Daniel; Downes, Tom; Leaver, Jackie; Partridge, Rebecca; Langley, Joseph

    2014-01-01

    Advances in surgical and medical management have significantly reduced the length of time that patients with spinal cord injury (SCI) have to stay in hospital, but has left patients with potentially less time to psychologically adjust. Following a pilot in 2012, this project was designed to test the effect of "design thinking" workshops on the self-efficacy of people undergoing rehabilitation following spinal injuries. Design thinking is about understanding the approaches and methods that designers use and then applying these to think creatively about problems and suggest ways to solve them. In this instance, design thinking is not about designing new products (although the approaches can be used to do this) but about developing a long term creative and explorative mind-set through skills such as lateral thinking, prototyping and verbal and visual communication. The principles of "design thinking" have underpinned design education and practice for many years, it is also recognised in business and innovation for example, but a literature review indicated that there was no evidence of it being used in rehabilitation or spinal injury settings. Twenty participants took part in the study; 13 (65%) were male and the average age was 37 years (range 16 to 72). Statistically significant improvements were seen for EQ-5D score (t = -3.13, p = 0.007) and Patient Activation Measure score (t = -3.85, p = 0.001). Other outcome measures improved but not statistically. There were no statistical effects on length of stay or readmission rates, but qualitative interviews indicated improved patient experience.

  18. Improving self-efficacy in spinal cord injury patients through “design thinking" rehabilitation workshops

    PubMed Central

    Wolstenholme, Daniel; Downes, Tom; Leaver, Jackie; Partridge, Rebecca; Langley, Joseph

    2014-01-01

    Advances in surgical and medical management have significantly reduced the length of time that patients with spinal cord injury (SCI) have to stay in hospital, but has left patients with potentially less time to psychologically adjust. Following a pilot in 2012, this project was designed to test the effect of “design thinking” workshops on the self-efficacy of people undergoing rehabilitation following spinal injuries. Design thinking is about understanding the approaches and methods that designers use and then applying these to think creatively about problems and suggest ways to solve them. In this instance, design thinking is not about designing new products (although the approaches can be used to do this) but about developing a long term creative and explorative mind-set through skills such as lateral thinking, prototyping and verbal and visual communication. The principles of “design thinking” have underpinned design education and practice for many years, it is also recognised in business and innovation for example, but a literature review indicated that there was no evidence of it being used in rehabilitation or spinal injury settings. Twenty participants took part in the study; 13 (65%) were male and the average age was 37 years (range 16 to 72). Statistically significant improvements were seen for EQ-5D score (t = -3.13, p = 0.007) and Patient Activation Measure score (t = -3.85, p = 0.001). Other outcome measures improved but not statistically. There were no statistical effects on length of stay or readmission rates, but qualitative interviews indicated improved patient experience. PMID:27493735

  19. Body Mass Index and Pressure Ulcers: Improved Predictability of Pressure Ulcers in Intensive Care Patients

    PubMed Central

    Hyun, Sookyung; Li, Xiaobai; Vermillion, Brenda; Newton, Cheryl; Fall, Monica; Kaewprag, Pacharmon; Moffatt-Bruce, Susan; Lenz, Elizabeth R.

    2015-01-01

    Background Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. Objectives To examine the incidence of pressure ulcers in patients who differ in body mass index and to determine whether inclusion of body mass index enhanced use of the Braden scale in the prediction of pressure ulcers. Methods In this retrospective cohort study, data were collected from the medical records of 4 groups of patients with different body mass index values: underweight, normal weight, obese, and extremely obese. Data included patients’ demographics, body weight, score on the Braden scale, and occurrence of pressure ulcers. Results The incidence of pressure ulcers in the underweight, normal weight, obese, and extremely obese groups was 8.6%, 5.5%, 2.8%, and 9.9%, respectively. When both the score on the Braden scale and the body mass index were predictive of pressure ulcers, extremely obese patients were about 2 times more likely to experience an ulcer than were normal weight patients. In the final model, the area under the curve was 0.71. The baseline area under the curve for the Braden scale was 0.68. Conclusions Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers. PMID:25362673

  20. The Development of Learning Devices Based Guided Discovery Model to Improve Understanding Concept and Critical Thinking Mathematically Ability of Students at Islamic Junior High School of Medan

    ERIC Educational Resources Information Center

    Yuliani, Kiki; Saragih, Sahat

    2015-01-01

    The purpose of this research was to: 1) development of learning devices based guided discovery model in improving of understanding concept and critical thinking mathematically ability of students at Islamic Junior High School; 2) describe improvement understanding concept and critical thinking mathematically ability of students at MTs by using…