Assessing MSW Students' Integrated Behavioral Health Skills Using an Objective Structured Clinical Examination

ERIC Educational Resources Information Center

Sampson, McClain; Parrish, Danielle E.; Washburn, Micki

2018-01-01

Within the last decade, there has been a significant shift in the field of social work toward competency-based education. This article details the use of the Objective Structured Clinical Examination (OSCE) Adapted for Social Work Performance Rating Scale. We used the measure to evaluate specific practice competencies among students (n = 33)…

Video-assisted feedback in general practice internships using German general practitioner's guidelines

PubMed Central

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept. The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. Conclusion: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out. PMID:23255963

Video-assisted feedback in general practice internships using German general practitioner's guidelines.

PubMed

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient - student - consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The Following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.

Dimensions of vegetable parenting practices among preschoolers.

PubMed

Baranowski, Tom; Chen, Tzu-An; O'Connor, Teresia; Hughes, Sheryl; Beltran, Alicia; Frankel, Leslie; Diep, Cassandra; Baranowski, Janice C

2013-10-01

The objective of this study was to determine the factor structure of 31 effective and ineffective vegetable parenting practices used by parents of preschool children based on three theoretically proposed factors: responsiveness, control and structure. The methods employed included both corrected item-total correlations and confirmatory factor analysis. Acceptable fit was obtained only when effective and ineffective parenting practices were analyzed separately. Among effective items the model included one second order factor (effectiveness) and the three proposed first order factors. The same structure was revealed among ineffective items, but required correlated paths be specified among items. A theoretically specified three factor structure was obtained among 31 vegetable parenting practice items, but likely to be effective and ineffective items had to be analyzed separately. Research is needed on how these parenting practices factors predict child vegetable intake. Copyright © 2013 Elsevier Ltd. All rights reserved.

Expedite random structure searching using objects from Wyckoff positions

NASA Astrophysics Data System (ADS)

Wang, Shu-Wei; Hsing, Cheng-Rong; Wei, Ching-Ming

2018-02-01

Random structure searching has been proved to be a powerful approach to search and find the global minimum and the metastable structures. A true random sampling is in principle needed yet it would be highly time-consuming and/or practically impossible to find the global minimum for the complicated systems in their high-dimensional configuration space. Thus the implementations of reasonable constraints, such as adopting system symmetries to reduce the independent dimension in structural space and/or imposing chemical information to reach and relax into low-energy regions, are the most essential issues in the approach. In this paper, we propose the concept of "object" which is either an atom or composed of a set of atoms (such as molecules or carbonates) carrying a symmetry defined by one of the Wyckoff positions of space group and through this process it allows the searching of global minimum for a complicated system to be confined in a greatly reduced structural space and becomes accessible in practice. We examined several representative materials, including Cd3As2 crystal, solid methanol, high-pressure carbonates (FeCO3), and Si(111)-7 × 7 reconstructed surface, to demonstrate the power and the advantages of using "object" concept in random structure searching.

The Health Behavior Checklist: Factor structure in community samples and validity of a revised good health practices scale.

PubMed

Hampson, Sarah E; Edmonds, Grant W; Goldberg, Lewis R

2017-01-01

This study examined the factor structure and predictive validity of the commonly used multidimensional Health Behavior Checklist. A three-factor structure was found in two community samples that included men and women. The new 16-item Good Health Practices scale and the original Wellness Maintenance scale were the only Health Behavior Checklist scales to be related to cardiovascular and metabolic risk factors. While the other Health Behavior Checklist scales require further validation, the Good Health Practices scale could be used where more objective or longer measures are not feasible.

Integrating Prevention into Obstetrics/Gynecology.

ERIC Educational Resources Information Center

Carey, J. Christopher

2000-01-01

Discusses formats to teach preventive medicine in obstetrics and gynecology (including learning objectives, lectures/seminars, and rounds/office practice) and evaluation methods (oral examinations, computerized question banks, objective structured clinical examinations). Offers examples from specific programs at American medical schools, including…

Energy Center Structure Optimization by using Smart Technologies in Process Control System

NASA Astrophysics Data System (ADS)

Shilkina, Svetlana V.

2018-03-01

The article deals with practical application of fuzzy logic methods in process control systems. A control object - agroindustrial greenhouse complex, which includes its own energy center - is considered. The paper analyzes object power supply options taking into account connection to external power grids and/or installation of own power generating equipment with various layouts. The main problem of a greenhouse facility basic process is extremely uneven power consumption, which forces to purchase redundant generating equipment idling most of the time, which quite negatively affects project profitability. Energy center structure optimization is largely based on solving the object process control system construction issue. To cut investor’s costs it was proposed to optimize power consumption by building an energy-saving production control system based on a fuzzy logic controller. The developed algorithm of automated process control system functioning ensured more even electric and thermal energy consumption, allowed to propose construction of the object energy center with a smaller number of units due to their more even utilization. As a result, it is shown how practical use of microclimate parameters fuzzy control system during object functioning leads to optimization of agroindustrial complex energy facility structure, which contributes to a significant reduction in object construction and operation costs.

Guided Pathways to Careers: Four Dimensions of Structure in Community College Career-Technical Programs

ERIC Educational Resources Information Center

Van Noy, Michelle; Trimble, Madeline; Jenkins, Davis; Barnett, Elisabeth; Wachen, John

2016-01-01

Objective: Some have hypothesized that community college programs are not sufficiently structured to support student success and that students would benefit from more highly structured programs. This study examines the specific ways that structure is expressed in policy and practice at representative community colleges. Method: Using data obtained…

Terrestrial laser scanning-based bridge structural condition assessment : InTrans project reports.

DOT National Transportation Integrated Search

2016-05-01

Objective, accurate, and fast assessment of a bridges structural condition is critical to the timely assessment of safety risks. : Current practices for bridge condition assessment rely on visual observations and manual interpretation of reports a...

Report Writing for Social Workers: Special Needs in the Business Communication Course.

ERIC Educational Resources Information Center

Reep, Diana C.

1989-01-01

Discusses the special training in report writing needed by students majoring in social work (practice in specific report structures, and in certain style matters, including objective word choice, excessive passive voice, and parallel structure in lists). (SR)

Transforming Clinical Imaging Data for Virtual Reality Learning Objects

ERIC Educational Resources Information Center

Trelease, Robert B.; Rosset, Antoine

2008-01-01

Advances in anatomical informatics, three-dimensional (3D) modeling, and virtual reality (VR) methods have made computer-based structural visualization a practical tool for education. In this article, the authors describe streamlined methods for producing VR "learning objects," standardized interactive software modules for anatomical sciences…

Student's perspectives on objective structured practical examination (OSPE) in Forensic Medicine - a report from India.

PubMed

Pramod Kumar, G N; Sentitoshi; Nath, Dhritiman; Menezes, Ritesh G; Kanchan, Tanuj

2015-05-01

The objective of the present study was to know the perceptions of students regarding objective structured practical examination (OSPE) as a tool for assessment in Forensic Medicine. The present study was conducted in the Department of Forensic Medicine and Toxicology, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, India. Undergraduate medical students of the 4th semester were enrolled in the study to know their perceptions regarding OSPE. The students were briefed regarding OSPE with a PowerPoint presentation and interaction. An examination was conducted using OSPE with10 stations and a total of 74 students participated in the study. The feedback was collected using a preformed proforma consisting of 12 items and analyzed. Most of the participants (82.4%) agreed that OSPE is a better method of examination than the conventional/traditional practical examination. The majority of the participants (77.0%) said that the OSPE covered wide range of knowledge than the conventional practical examination. A large number of students (63.5%) were of the opinion that the OSPE may be exhausting and stressful if number of stations are increased. Overall a larger proportion of the participants preferred OSPE over the conventional practical examination considering the various attributes examined in the study. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Objective structured practical examination in biochemistry: An experience in Medical College, Kolkata.

PubMed

Kundu, Dipankar; Das, H N; Sen, Gargi; Osta, Manish; Mandal, T; Gautam, Divyendu

2013-01-01

Undergraduate medical examination is undergoing extensive re evaluation with new core educational objectives being defined. Consequently, new exam systems have also been designed to test the objectives. Objective structured practical examination (OSPE) is one of them. To introduce OSPE as a method of assessment of practical skills and learning and to determine student satisfaction regarding the OSPE. Furthermore, to explore the faculty perception of OSPE as a learning and assessment tool. The first M.B.B.S students of 2011 12 batch of Medical College, Kolkata, were the subjects for the study. OSPE was organized and conducted on "Identification of Unknown Abnormal Constituents in Urine." Coefficient of reliability of questions administered was done by calculating Cronbach's alpha. A questionnaire on various components of the OSPE was administered to get the feedback. 16 students failed to achieve an average of 50% or above in the assessment. However, 49 students on an average achieved >75%, 52 students achieved between 65% and 75%, and 29 students scored between 50% and 65%. Cronbach's alpha of the questions administered showed to be having high internal consistency with a score of 0.80. Ninety nine percent of students believed that OSPE helps them to improve and 81% felt that this type of assessment fits in as both learning and evaluation tools. Faculty feedback reflected that such assessment tested objectivity, measured practical skills better, and eliminated examiner bias to a greater extent. OSPE tests different desired components of competence better and eliminated examiner bias. Student feedback reflects that such assessment helps them to improve as it is effective both as teaching and evaluation tools.

Long-term prospective teaching effectivity of practical skills training and a first OSCE in cranio maxillofacial surgery for dental students.

PubMed

Landes, Constantin A; Hoefer, Sebastian; Schuebel, Florian; Ballon, Alexander; Teiler, Anna; Tran, Andreas; Weber, Roxane; Walcher, Felix; Sader, Robert

2014-07-01

Basic skills in oral/CMF surgery should be taught effectively to dental students as surgical skills training is traditionally under-represented in the dental curriculum compared to its later need in daily clinical practice. Rigid curricular time frames and prospectively condensed professional education foster new effective teaching and examination formats. Transmitting and assessing clinical competence objectively (independent of subjective bias), reliably (repeatable, inter-rater consistency) and valid (representative, structured task selection) was intended and evaluated in oral/CMF surgery skills acquisition starting in summer 2009. A small-group practical skills training (PST) day initiated a one-week practical training course, covering previously formulated learning objectives. An objective structured clinical evaluation (OSCE) was held at the end of each semester. Theoretical background knowledge and clinical skills should have to be memorized within a representative number of practical tasks (test stations). A first semester (26 students) used classical practical training alone as controls, the following semesters (171 students) had PST, considered as a study group. All 197 students were assessed with OSCE's over a 3-year period. An instructor held PST based on presentations, videos and practical training, including mannequins, with pairs of students. This included history taking, communication and interpretation of laboratory/image diagnostics, structured clinical facial examination, fracture diagnosis, venipuncture, suturing, biopsy and wire loops on pig jaws for manual and clinical skills, which were later incorporated in OSCE stations. OSCE average results increased from 63.3 ± 9.7% before and to 75.5 ± 10% after the inclusion of PST (p < 0.05). Knowledge diffusion between sittings on the same test date and between consecutive semesters was insignificant. Students and faculty rated their learning/teaching experience "very good" to "good". PST was effective in optimizing clinical skills as evaluated by OSCE. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Integration of Histology Lectures and Practical Teaching in China

ERIC Educational Resources Information Center

Lu, Xiaoye; Cheng, Xin; Li, Ke; Lee, Kenneth Ka Ho; Yang, Xuesong

2016-01-01

Objectives: Human histology is a discipline concerning the study of microscopic structures of human tissues and organs--with the aid of light or electron microscopes. Traditional teaching of histology is composed of two separated components, theory and practice. The main disadvantage with traditional histology teaching is the detachment of theory…

What is an Objective Structured Practical Examination in Anatomy?

ERIC Educational Resources Information Center

Yaqinuddin, Ahmed; Zafar, Muhammad; Ikram, Muhammad Faisal; Ganguly, Paul

2013-01-01

Assessing teaching-learning outcomes in anatomical knowledge is a complex task that requires the evaluation of multiple domains: theoretical, practical, and clinical knowledge. In general, theoretical knowledge is tested by a written examination system constituted by multiple choice questions (MCQs) and/or short answer questions (SAQ). The…

Comparative Effectiveness of Alternative Administrative Structures. Final Report on a Pilot Investigation. Programme on Institutional Management in Higher Education.

ERIC Educational Resources Information Center

Rivett, B. H. P.; And Others

Initial objectives of this pilot study were to: define the effectiveness and structure of administration in institutions of higher education; explore and identify measures of administrative effectiveness and structure; test the practicability of such definitions and measures against on-going processes at Sussex University; direct, coordinate, and…

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

ERIC Educational Resources Information Center

Evaluation, Dissemination and Assessment Center, Dallas.

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

The Radical Reform of Administrative Policies in New South Wales School Education: Practical and Theoretical Implications.

ERIC Educational Resources Information Center

Macpherson, R. J. S.

The government of New South Wales (Australia) is attempting to enhance the quality of public education by radically altering management structures and practices. Despite some popular objections, political intervention was mandated and warranted due to excessive centralization in administrative policy making, curriculum development, and resource…

Vineyard soil bacterial diversity and composition revealed by 16S rRNA genes: Differentiation by vineyard management

USDA-ARS?s Scientific Manuscript database

Here, we demonstrate how vineyard management practices influence shifts in soil resources, which in turn affects shifts in soil-borne bacterial communities. The objective is to determine the hierarchical effects of management practices, soil attributes and location factors on the structure of soil-b...

Toward a Social Ontology for Science Education: Introducing Deleuze and Guattari's Assemblages

ERIC Educational Resources Information Center

Bazzul, Jesse; Kayumova, Shakhnoza

2016-01-01

This essay's main objective is to develop a theoretical, ontological basis for critical, social justice-oriented science education. Using Deleuze and Guattari's notion of assemblages, rhizomes, and arborescent structures, this article challenges authoritarian institutional practices, as well as the subject of these practices, and offers a way for…

Confirmatory Factor Analysis on the Professional Suitability Scale for Social Work Practice

ERIC Educational Resources Information Center

Tam, Dora M. Y.; Twigg, Robert C.; Boey, Kam-Wing; Kwok, Siu-Ming

2013-01-01

Objective: This article presents a validation study to examine the factor structure of an instrument designed to measure professional suitability for social work practice. Method: Data were collected from registered social workers in a provincial mailed survey. The response rate was 23.2%. After eliminating five cases with multivariate outliers,…

Interdisciplinarity: Policies and Practices. AIR Forum Paper 1978.

ERIC Educational Resources Information Center

Assimopoulos, Nadia; Belanger, Charles H.

Interdisciplinary policies and practices at the University of Montreal were studied to determine their effectiveness. The three study objectives were to: (1) determine the magnitude of the range set up by the department degree structure to give student majors an opportunity to take courses outside their basic discipline; (2) assess the degree of…

Creating a Structured Practice Space with Online Mini-Speeches

ERIC Educational Resources Information Center

Gerbensky-Kerber, Anne

2017-01-01

Courses: This semester-long assignment series was developed for an online introductory public speaking class, but it has also been used successfully in a hybrid (combination of online/face-to-face meetings) format. Objectives: Students will practice delivering speeches in an online format by applying key concepts from course materials to personal…

Forest fuel treatments in western North America: merging silvicultural and fire management.

Treesearch

Morris C. Johnson; David L. Peterson

2005-01-01

For many years silviculture and fire management have mostly been separate forestry disciplines with disparate objectives and activities. However, in order to accomplish complex and multiple management objectives related to forest structure, fuels, and fxe disturbance, these two disciplines must be effectively integrated in science and practice. We have linked...

Training in Structured Diagnostic Assessment Using DSM-IV Criteria

ERIC Educational Resources Information Center

Ponniah, Kathryn; Weissman, Myrna M.; Bledsoe, Sarah E.; Verdeli, Helen; Gameroff, Marc J.; Mufson, Laura; Fitterling, Heidi; Wickramaratne, Priya

2011-01-01

Objectives: Determining a patient's psychiatric diagnosis is an important first step for the selection of empirically supported treatments and a critical component of evidence-based practice. Structured diagnostic assessment covers the range of psychiatric diagnoses and is usually more complete and accurate than unstructured assessment. Method: We…

Tensor products of process matrices with indefinite causal structure

NASA Astrophysics Data System (ADS)

Jia, Ding; Sakharwade, Nitica

2018-03-01

Theories with indefinite causal structure have been studied from both the fundamental perspective of quantum gravity and the practical perspective of information processing. In this paper we point out a restriction in forming tensor products of objects with indefinite causal structure in certain models: there exist both classical and quantum objects the tensor products of which violate the normalization condition of probabilities, if all local operations are allowed. We obtain a necessary and sufficient condition for when such unrestricted tensor products of multipartite objects are (in)valid. This poses a challenge to extending communication theory to indefinite causal structures, as the tensor product is the fundamental ingredient in the asymptotic setting of communication theory. We discuss a few options to evade this issue. In particular, we show that the sequential asymptotic setting does not suffer the violation of normalization.

Teaching undergraduate students in rural general practice: an evaluation of a new rural campus in England.

PubMed

Bartlett, Maggie; Pritchard, Katie; Lewis, Leo; Hays, Richard B; Mckinley, Robert K

2016-01-01

One approach to facilitating student interactions with patient pathways at Keele University School of Medicine, England, is the placement of medical students for 25% of their clinical placement time in general practices. The largest component is a 15-week 'student attachment' in primary care during the final year, which required the development of a new network of teaching practices in a rural district of England about 90 km (60 mi) from the main campus in North Staffordshire. The new accommodation and education hub was established in 2011-2012 to enable students to become immersed in those communities and learn about medical practice within a rural and remote context. Objectives were to evaluate the rural teaching from the perspectives of four groups: patients, general practice tutors, community hospital staff and students. Learning outcomes (as measured by objective structured clinical examinations) of students learning in rural practices in the final year were compared with those in other practices. Data were gathered from a variety of sources. Students' scores in cohort-wide clinical assessment were compared with those in other locations. Semi-structured interviews were conducted with general practice tutors and community hospital staff. Serial focus groups explored the perceptions of the students, and questionnaires were used to gather the views of patients. Patients reported positive experiences of students in their consultations, with 97% expressing willingness to see students. The majority of patients considered that teaching in general practice was a good thing. They also expressed altruistic ideas about facilitating learning. The tutors were enthusiastic and perceived that teaching had positive impacts on their practices despite negative effects on their workload. The community hospital staff welcomed students and expressed altruistic ideas about helping them learn. There was no significant difference between the rurally placed students' objective structured clinical examination performance and that of their peers in other locations. Some students had difficulty with the isolation from peers and academic activities, and travel was a problem despite their accommodation close to the practices. Students valued the learning opportunities offered by the rural practice placements. The general practice tutors, patients and community hospital staff found teaching to be a positive experience overall and perceived a value to the health system and broader community in students learning locally for substantial periods of time. The evaluation has identified some student concerns about transport times and costs, social isolation, and access to resources and administrative tasks, and these are being addressed.

Organization of Model Systems for Primary Care Practice and Education: Problems and Issues

ERIC Educational Resources Information Center

Seidel, Henry M.

1975-01-01

Lists issues in planning primary care education, e.g. fear of dilution of excellence, competition for resources, delivery of care, the teaching objective, M.D. and new health professional, benefit and service structure, financial structure, physical and administrative locus, marketing. Emphasis is on coordination of educational research, and…

Assuring structural integrity in Army systems

NASA Technical Reports Server (NTRS)

1985-01-01

The object of this study was to recommend possible improvements in the manner in which structural integrity of Army systems is assured. The elements of a structural integrity program are described, and relevant practices used in various industries and government organizations are reviewed. Some case histories of Army weapon systems are examined. The mandatory imposition of a structural integrity program patterned after the Air Force Aircraft Structural Integrity Program is recommended and the benefits of such an action are identified.

A novel approach to assessing technical competence of colorectal surgery residents: the development and evaluation of the Colorectal Objective Structured Assessment of Technical Skill (COSATS).

PubMed

de Montbrun, Sandra L; Roberts, Patricia L; Lowry, Ann C; Ault, Glenn T; Burnstein, Marcus J; Cataldo, Peter A; Dozois, Eric J; Dunn, Gary D; Fleshman, James; Isenberg, Gerald A; Mahmoud, Najjia N; Reznick, Richard K; Satterthwaite, Lisa; Schoetz, David; Trudel, Judith L; Weiss, Eric G; Wexner, Steven D; MacRae, Helen

2013-12-01

To develop and evaluate an objective method of technical skills assessment for graduating subspecialists in colorectal (CR) surgery-the Colorectal Objective Structured Assessment of Technical Skill (COSATS). It may be reasonable for the public to assume that surgeons certified as competent have had their technical skills assessed. However, technical skill, despite being the hallmark of a surgeon, is not directly assessed at the time of certification by surgical boards. A procedure-based, multistation technical skills examination was developed to reflect a sample of the range of skills necessary for CR surgical practice. These consisted of bench, virtual reality, and cadaveric models. Reliability and construct validity were evaluated by comparing 10 graduating CR residents with 10 graduating general surgery (GS) residents from across North America. Expert CR surgeons, blinded to level of training, evaluated performance using a task-specific checklist and a global rating scale. The mean global rating score was used as the overall examination score and a passing score was set at "borderline competent for CR practice." The global rating scale demonstrated acceptable interstation reliability (0.69) for a homogeneous group of examinees. Both the overall checklist and global rating scores effectively discriminated between CR and GS residents (P < 0.01), with 27% of the variance attributed to level of training. Nine CR residents but only 3 GS residents were deemed competent. The Colorectal Objective Structured Assessment of Technical Skill effectively discriminated between CR and GS residents. With further validation, the Colorectal Objective Structured Assessment of Technical Skill could be incorporated into the colorectal board examination where it would be the first attempt of a surgical specialty to formally assess technical skill at the time of certification.

Using the Knowledge, Process, Practice (KPP) model for driving the design and development of online postgraduate medical education.

PubMed

Shaw, Tim; Barnet, Stewart; Mcgregor, Deborah; Avery, Jennifer

2015-01-01

Online learning is a primary delivery method for continuing health education programs. It is critical that programs have curricula objectives linked to educational models that support learning. Using a proven educational modelling process ensures that curricula objectives are met and a solid basis for learning and assessment is achieved. To develop an educational design model that produces an educationally sound program development plan for use by anyone involved in online course development. We have described the development of a generic educational model designed for continuing health education programs. The Knowledge, Process, Practice (KPP) model is founded on recognised educational theory and online education practice. This paper presents a step-by-step guide on using this model for program development that encases reliable learning and evaluation. The model supports a three-step approach, KPP, based on learning outcomes and supporting appropriate assessment activities. It provides a program structure for online or blended learning that is explicit, educationally defensible, and supports multiple assessment points for health professionals. The KPP model is based on best practice educational design using a structure that can be adapted for a variety of online or flexibly delivered postgraduate medical education programs.

Student's perception about innovative teaching learning practices in Forensic Medicine.

PubMed

Gupta, Sanjay; Parekh, Utsav N; Ganjiwale, Jaishree D

2017-11-01

Since decades, Forensic Medicine is mainly taught by didactic methods but in last couple of years some other teachinglearning and assessment methods are also introduced at some places which also lacks uniformity. Feedback from learners is most fundamental aspect to assess effectiveness of applied methods, but is not implemented in practice at most medical schools in India. Unfortunately, medical students are deprived of this practical empowerment and thus may not be efficient enough to contribute potentially to the justice system during their professional life. In order to improve their efficiency in the field, we introduced few innovative teaching-learning methods and documented their perceptions. This pilot study was carried out with students who had completed their second professional year (5th semester) of medical curriculum. Students were exposed to few innovative teaching-learning and assessment approaches in addition to conventional methods during their Forensic Medicine term. These approaches were interactivity in large group lecturing, small group activities, student led objective tutorial, court visit in real scenario, practical records book, surprise tests, structured theory question papers, model answers, objective structured practical examinations and structured oral viva. Their perceptions were documented later through structured questionnaire. Students reported all methods as 'interesting' except 'surprise tests'. Court visits were rated highest for generating interest (98%). Clarity of concept was experienced through all methods (range of 71-95%). Interactive large group lectures reported highest (by 95%students) for clarifying concepts, although this is not a typical characteristic of large group teaching. Enhanced learning experience was reported in 75-92.5% for different methods. Student Led Objective Tutorials seemed to facilitate enhance learning most (92.5%). Innovations in teaching-learning are need of hour especially in subject like Forensic Medicine which has direct implications to add into administration of justice in the court of law. This pilot study has given us ideas for making teaching-learning and assessment more student centric considering emerging societal needs. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

A Consensus Statement on Practical Skills in Medical School – a position paper by the GMA Committee on Practical Skills

PubMed Central

Schnabel, Kai P.; Boldt, Patrick D.; Breuer, Georg; Fichtner, Andreas; Karsten, Gudrun; Kujumdshiev, Sandy; Schmidts, Michael; Stosch, Christoph

2011-01-01

Introduction: Encouraged by the change in licensing regulations the practical professional skills in Germany received a higher priority and are taught in medical schools therefore increasingly. This created the need to standardize the process more and more. On the initiative of the German skills labs the German Medical Association Committee for practical skills was established and developed a competency-based catalogue of learning objectives, whose origin and structure is described here. Goal of the catalogue is to define the practical skills in undergraduate medical education and to give the medical schools a rational planning basis for the necessary resources to teach them. Methods: Building on already existing German catalogues of learning objectives a multi-iterative process of condensation was performed, which corresponds to the development of S1 guidelines, in order to get a broad professional and political support. Results: 289 different practical learning goals were identified and assigned to twelve different organ systems with three overlapping areas to other fields of expertise and one area of across organ system skills. They were three depths and three different chronological dimensions assigned and the objectives were matched with the Swiss and the Austrian equivalent. Discussion: This consensus statement may provide the German faculties with a basis for planning the teaching of practical skills and is an important step towards a national standard of medical learning objectives. Looking ahead: The consensus statement may have a formative effect on the medical schools to teach practical skills and plan the resources accordingly. PMID:22205916

An Extensible Schema-less Database Framework for Managing High-throughput Semi-Structured Documents

NASA Technical Reports Server (NTRS)

Maluf, David A.; Tran, Peter B.; La, Tracy; Clancy, Daniel (Technical Monitor)

2002-01-01

Object-Relational database management system is an integrated hybrid cooperative approach to combine the best practices of both the relational model utilizing SQL queries and the object oriented, semantic paradigm for supporting complex data creation. In this paper, a highly scalable, information on demand database framework, called NETMARK is introduced. NETMARK takes advantages of the Oracle 8i object-relational database using physical addresses data types for very efficient keyword searches of records for both context and content. NETMARK was originally developed in early 2000 as a research and development prototype to solve the vast amounts of unstructured and semi-structured documents existing within NASA enterprises. Today, NETMARK is a flexible, high throughput open database framework for managing, storing, and searching unstructured or semi structured arbitrary hierarchal models, XML and HTML.

NETMARK: A Schema-less Extension for Relational Databases for Managing Semi-structured Data Dynamically

NASA Technical Reports Server (NTRS)

Maluf, David A.; Tran, Peter B.

2003-01-01

Object-Relational database management system is an integrated hybrid cooperative approach to combine the best practices of both the relational model utilizing SQL queries and the object-oriented, semantic paradigm for supporting complex data creation. In this paper, a highly scalable, information on demand database framework, called NETMARK, is introduced. NETMARK takes advantages of the Oracle 8i object-relational database using physical addresses data types for very efficient keyword search of records spanning across both context and content. NETMARK was originally developed in early 2000 as a research and development prototype to solve the vast amounts of unstructured and semi-structured documents existing within NASA enterprises. Today, NETMARK is a flexible, high-throughput open database framework for managing, storing, and searching unstructured or semi-structured arbitrary hierarchal models, such as XML and HTML.

Design Considerations of a Compounded Sterile Preparations Course

PubMed Central

Petraglia, Christine; Mattison, Melissa J.

2016-01-01

Objective. To design a comprehensive learning and assessment environment for the practical application of compounded sterile preparations using a constructivist approach. Design. Compounded Sterile Preparations Laboratory is a required 1-credit course that builds upon the themes of training aseptic technique typically used in health system settings and threads application of concepts from other courses in the curriculum. Students used critical-thinking skills to devise appropriate strategies to compound sterile preparations. Assessment. Aseptic technique skills were assessed with objective, structured, checklist-based rubrics. Most students successfully completed practical assessments using appropriate technique (mean assessment grade=83.2%). Almost all students passed the practical media fill (98%) and gloved fingertip sampling (86%) tests on the first attempt; all passed on the second attempt. Conclusion. Employing a constructivist scaffold approach to teaching proper hygiene and aseptic technique prepared students to pass media fill and gloved fingertip tests and to perform well on practical compounding assessments. PMID:26941438

An object-oriented class library for medical software development.

PubMed

O'Kane, K C; McColligan, E E

1996-12-01

The objective of this research is the development of a Medical Object Library (MOL) consisting of reusable, inheritable, portable, extendable C++ classes that facilitate rapid development of medical software at reduced cost and increased functionality. The result of this research is a library of class objects that range in function from string and hierarchical file handling entities to high level, procedural agents that perform increasingly complex, integrated tasks. A system built upon these classes is compatible with any other system similarly constructed with respect to data definitions, semantics, data organization and storage. As new objects are built, they can be added to the class library for subsequent use. The MOL is a toolkit of software objects intended to support a common file access methodology, a unified medical record structure, consistent message processing, standard graphical display facilities and uniform data collection procedures. This work emphasizes the relationship that potentially exists between the structure of a hierarchical medical record and procedural language components by means of a hierarchical class library and tree structured file access facility. In doing so, it attempts to establish interest in and demonstrate the practicality of the hierarchical medical record model in the modern context of object oriented programming.

Matematicas en la vida actual. Volumen II, edicion para el maestro. (Mathematics: A Practical View. Volume II, Teacher Edition). Applied Basic Curriculum Series.

ERIC Educational Resources Information Center

Evaluation, Dissemination and Assessment Center, Dallas.

This Spanish language teacher's edition of a practical mathematics text for the intermediate grades contains three components which can be structured in different combinations according to different student needs. Built around a review of selected objectives in the mathematics basic curriculum, the material is intended to stimulate interest in…

Matematicas en la vida actual. Volumen I, edicion para el maestro. (Mathematics: A Practical View. Volume I, Teacher Edition). Applied Basic Curriculum Series.

ERIC Educational Resources Information Center

Evaluation, Dissemination and Assessment Center, Dallas.

This Spanish language teacher's edition of a practical mathematics text for the intermediate grades contains three components which can be structured in different combinations according to different student needs. Built around a review of selected objectives in the mathematics basic curriculum, the material is intended to stimulate interest in…

Matematicas en la vida actual. Volumen III, edicion para el maestro. (Mathematics: A Practical View. Volume III, Teacher Edition). Applied Basic Curriculum Series.

ERIC Educational Resources Information Center

Evaluation, Dissemination and Assessment Center, Dallas.

This Spanish language teacher's edition of a practical mathematics text for the intermediate grades contains three components which can be structured in different combinations according to different student needs. Built around a review of selected objectives in the mathematics basic curriculum, the material is intended to stimulate interest in…

[Pierre Bourdieu: sociology as a "symbolic revolution"].

PubMed

Suaud, Charles

2014-03-01

The article combines two objectives: understand the genesis and development of the sociology of Bourdieu in connection with his social and intellectual positioning. The sociology of Bourdieu is a theory of Action which reconciles the double requirement of objectification and taking account of the practical logic bound by social agents. From the character both objective and subjective of social space, he analyzes how different institutions (firstly School) are doing that mental structures match the objective structures of society. By making acceptable reality and registering it in the body, these instances contribute to reproduce social divisions and participate in the work of domination. Gradually, Bourdieu develops a general theory about Power, which leads to a sociology of State. But he refuses any sociological fatalism. Because he perceived homologies between the sociologist and the artist facing the social order, each in their own way, he devoted two researches to Flaubert and Manet, seized in the same enterprise of aesthetic subversion he described as a 'symbolic revolution'. In many aspects, the sociology of Bourdieu opens ways of looking for an objectification of caregivers and their practices.

Why Is the Learning of Elementary Arithmetic Concepts Difficult? Semiotic Tools for Understanding the Nature of Mathematical Objects

ERIC Educational Resources Information Center

Godino, Juan D.; Font, Vicenc; Wilhelmi, Miguel R.; Lurduy, Orlando

2011-01-01

The semiotic approach to mathematics education introduces the notion of "semiotic system" as a tool to describe mathematical activity. The semiotic system is formed by the set of signs, the production rules of signs and the underlying meaning structures. In this paper, we present the notions of system of practices and configuration of objects and…

Evaluation of Clinical and Communication Skills of Pharmacy Students and Pharmacists with an Objective Structured Clinical Examination.

PubMed

Urteaga, Elizabeth M; Attridge, Rebecca L; Tovar, John M; Witte, Amy P

2015-10-25

Objective. To evaluate how effectively pharmacy students and practicing pharmacists communicate and apply knowledge to simulations of commonly encountered patient scenarios using an objective structured clinical examination (OSCE). Design. Second-, third-, and fourth-year pharmacy students completed an OSCE as part of their required courses in 2012 and 2013. All students in both years completed identical OSCE cases. Licensed pharmacists were recruited to complete the OSCE and serve as controls in 2012. A survey assessed student perception and acceptance of the OSCE as well as student confidence in performance. Assessment. Licensed pharmacists had significantly higher clinical and communication skills scores than did pharmacy students. Student progression in communication and clinical skills improved significantly over time. Survey results indicated that students felt the OSCE was well-structured and assessed clinical skills taught in pharmacy school; 86% of students felt confident they could provide these skills. Conclusion. Objective structured clinical examinations can evaluate clinical competence and communication skills among professional students. Implementation of OSCEs may be an effective tool for assessment of the Center for the Advancement of Pharmacy Education domains.

A study on the utilization of advanced composites in commercial aircraft wing structure: Executive summary

NASA Technical Reports Server (NTRS)

Watts, D. J.

1978-01-01

The overall wing study objectives are to study and plan the effort by commercial transport aircraft manufacturers to accomplish the transition from current conventional materials and practices to extensive use of advanced composites in wings of aircraft that will enter service in the 1985-1990 time period. Specific wing study objectives are to define the technology and data needed to support an aircraft manufacturer's commitment to utilize composites primary wing structure in future production aircraft and to develop plans for a composite wing technology program which will provide the needed technology and data.

Adding Hierarchical Objects to Relational Database General-Purpose XML-Based Information Managements

NASA Technical Reports Server (NTRS)

Lin, Shu-Chun; Knight, Chris; La, Tracy; Maluf, David; Bell, David; Tran, Khai Peter; Gawdiak, Yuri

2006-01-01

NETMARK is a flexible, high-throughput software system for managing, storing, and rapid searching of unstructured and semi-structured documents. NETMARK transforms such documents from their original highly complex, constantly changing, heterogeneous data formats into well-structured, common data formats in using Hypertext Markup Language (HTML) and/or Extensible Markup Language (XML). The software implements an object-relational database system that combines the best practices of the relational model utilizing Structured Query Language (SQL) with those of the object-oriented, semantic database model for creating complex data. In particular, NETMARK takes advantage of the Oracle 8i object-relational database model using physical-address data types for very efficient keyword searches of records across both context and content. NETMARK also supports multiple international standards such as WEBDAV for drag-and-drop file management and SOAP for integrated information management using Web services. The document-organization and -searching capabilities afforded by NETMARK are likely to make this software attractive for use in disciplines as diverse as science, auditing, and law enforcement.

Virtual temporal bone dissection system: OSU virtual temporal bone system: development and testing.

PubMed

Wiet, Gregory J; Stredney, Don; Kerwin, Thomas; Hittle, Bradley; Fernandez, Soledad A; Abdel-Rasoul, Mahmoud; Welling, D Bradley

2012-03-01

The objective of this project was to develop a virtual temporal bone dissection system that would provide an enhanced educational experience for the training of otologic surgeons. A randomized, controlled, multi-institutional, single-blinded validation study. The project encompassed four areas of emphasis: structural data acquisition, integration of the system, dissemination of the system, and validation. Structural acquisition was performed on multiple imaging platforms. Integration achieved a cost-effective system. Dissemination was achieved on different levels including casual interest, downloading of software, and full involvement in development and validation studies. A validation study was performed at eight different training institutions across the country using a two-arm randomized trial where study subjects were randomized to a 2-week practice session using either the virtual temporal bone or standard cadaveric temporal bones. Eighty subjects were enrolled and randomized to one of the two treatment arms; 65 completed the study. There was no difference between the two groups using a blinded rating tool to assess performance after training. A virtual temporal bone dissection system has been developed and compared to cadaveric temporal bones for practice using a multicenter trial. There was no statistical difference between practice on the current simulator compared to practice on human cadaveric temporal bones. Further refinements in structural acquisition and interface design have been identified, which can be implemented prior to full incorporation into training programs and used for objective skills assessment. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Special Features in the Structure of Resonant Perturbations of Uncontrollable Objects of Glonass and GPS Navigating Systems. Influence on the Orbital Evolution

NASA Astrophysics Data System (ADS)

Tomilova, I. V.; Bordovitsyna, T. V.

2017-08-01

Results of investigation into the resonant structure of perturbations and long-term orbital evolution of space vehicles of GLONASS and GPS global navigating satellite systems (GNSS) under assumption that all of them have lost control on 08/01/2015 are presented. It is demonstrated that the majority of the examined objects are in the range of action of the secular resonances of various types. In addition, practically all satellites of the GPS system are within the scope of the 2:1 orbital resonance with rotation of the Earth. Results of the MEGNO analysis demonstrate that the motion of all objects of the GLONASS system during the 100-year period is regular, whereas the motion of the majority of objects of the GPS system is subject to chaotization.

[The influence of the organizational structure on the internal controls of a foundation for cancer research, prevention and care in the interior of the state of São Paulo, Brazil].

PubMed

Bonacim, Carlos Alberto Grespam; Salgado, André Luís; Girioli, Lumila Souza; de Araujo, Adriana Maria Procópio

2011-05-01

This work focuses on a discussion about the extent to which the level of organizational structure interferes in the internal control practices of non-governmental organizations (NGOs), especially those related to health. The objective of this work was to observe the efficiency of the internal control tests applied within the organizational structure of the Foundation for Cancer Research, Prevention and Care, checking the reliability of the accounting records and operational controls. A case study in a third sector health organization was the chosen methodology. The case study involved company interviews and the analysis of confidential reports. After an evaluation of the organizational structure (of the relations between officials and volunteers) and the application of evaluation proceedings on the quality of the internal controls, the extent to which the organizational structure interferes with the internal control practices of the hospital was assessed. It was revealed that there are structured mechanisms of control in the institution, however the implementation of these controls is inadequately performed. It was further detected that the level of the organizational structure does indeed interfere in internal control practices at the entity.

Self-perceived versus objectively measured competence in performing clinical practical procedures by final year medical students

PubMed Central

Banda, Sekelani

2016-01-01

Objectives To determine and compare the self-perceived and objectively measured competence in performing 14 core-clinical practical procedures by Final Year Medical Students of the University of Zambia. Methods The study included 56 out of 60 graduating University of Zambia Medical Students of the 2012/2013 academic year. Self-perceived competence: students rated their competence on 14 core- clinical practical procedures using a self-administered questionnaire on a 5-point Likert scale. Objective competence: it was measured by Objective Structured Clinical Examination (OSCE) by faculty using predetermined rating scales. Rank order correlation test was performed for self-perceived and objectively measured competence. Results Two thirds 36 (66.7%) of the participants perceived themselves as moderately competent, 15 (27.8%) rated themselves as highly competent while 3 (5.6%) had low self-perception. With objective competence, the majority 52 (92.8%) were barely competent while 4 (7.2%) were absolutely competent. When overall self-perception was compared to objectively measured competence, there was a discordance which was demonstrated by a negative correlation (Spearman rho -.123). Conclusions Significant numbers of students reported low self-competence in performing procedures such as endotracheal intubation, gastric lavage and cardiopulmonary resuscitation which most never performed during the clinical years of medical education. In addition, the negative correlation between self-perceived and objectively measured competence demonstrated the inability of students to assess and rate themselves objectively due to fear that others may know their weaknesses and realize that they are not as competent as expected at a specific level of training. PMID:27132255

Upper Washita River experimental watersheds: Sediment Database

USDA-ARS?s Scientific Manuscript database

Improving the scientific understanding of the effectiveness of watershed conservation practices and floodwater-retardation structures to control floods and soil erosion is one of the primary objectives for sediment studies in the upper Washita River Experimental Watersheds. This paper summarizes se...

Knights in White Sneakers.

ERIC Educational Resources Information Center

Raggio, Susan; Zjawin, Dorothy

1982-01-01

A teaching unit to help students explore daily life during the Middle Ages is presented. Techniques for teaching about the medieval social structure, feudal rights and objectives, living arrangements, agricultural practices, and suggestions for building a replica of a medieval village are included. (PP)

Segmentation of touching mycobacterium tuberculosis from Ziehl-Neelsen stained sputum smear images

NASA Astrophysics Data System (ADS)

Xu, Chao; Zhou, Dongxiang; Liu, Yunhui

2015-12-01

Touching Mycobacterium tuberculosis objects in the Ziehl-Neelsen stained sputum smear images present different shapes and invisible boundaries in the adhesion areas, which increases the difficulty in objects recognition and counting. In this paper, we present a segmentation method of combining the hierarchy tree analysis with gradient vector flow snake to address this problem. The skeletons of the objects are used for structure analysis based on the hierarchy tree. The gradient vector flow snake is used to estimate the object edge. Experimental results show that the single objects composing the touching objects are successfully segmented by the proposed method. This work will improve the accuracy and practicability of the computer-aided diagnosis of tuberculosis.

Assessment for learning with Objectively Structured Practical Examination in Biochemistry

PubMed Central

Jaswal, Shivani; Chattwal, Jugesh; Kaur, Jasbinder; Gupta, Seema; Singh, Tejinder

2015-01-01

Context: Despite a radical shift in assessment methodologies over the last decade, the majority of medical colleges still follow the Traditional Practical Examination (TPE). TPE raises concerns about examiner variability, standardization, and uniformity of assessment. To address these issues and in line with the notion of assessments as motivating what and how students learn, Objectively Structured Practical Examination (OSPE) was introduced, as an assessment modality. Despite its usefulness, awareness and motivation to use the same, still needs to be probed. Aims: To implement OSPE in the assessment of practical skills in biochemistry, and to know student and faculty perspectives regarding OSPE. Settings and Design: OSPE was introduced at the stage of formative assessment of practical skills, for 94 year one MBBS students. Subjects and Methods: Students were divided into two groups; the first group was evaluated by the traditional method and the second by OSPE. Students were crossed over on a second examination. The mean score obtained by both the methods was compared statistically. Students and faculty perspectives regarding OSPE were obtained by a questionnaire. Student performance was compared using “Bland–Altman technique,” and Student's t-test. Results: The mean scores of students was found to be significantly higher (P < 0.0001) when assessed with OSPE as compared to TPE. Number of students achieving >70% marks was also significantly higher with OSPE. Validity was supported by a significant correlation coefficient of comparison of marks by the two methods. Feedback from students and faculty indicated that they endorsed OSPE. Conclusions: This evaluation demonstrated the need for a structured approach to assessment. Going in line with the notion that assessment drives learning, introducing OSPE would help tailoring teaching-learning to optimize student satisfaction and learning. PMID:26380217

Analysis of eHealth Search Perspectives Among Female College Students in the Health Professions Using Q Methodology

PubMed Central

Hanik, Bruce; Chaney, J. Don; Tennant, Bethany

2012-01-01

Background The current “Millennial Generation” of college students majoring in the health professions has unprecedented access to the Internet. Although some research has been initiated among medical professionals to investigate the cognitive basis for health information searches on the Internet, little is known about Internet search practices among health and medical professional students. Objective To systematically identify health professional college student perspectives of personal eHealth search practices. Methods Q methodology was used to examine subjective perspectives regarding personal eHealth search practices among allied health students majoring in a health education degree program. Thirteen (n = 13) undergraduate students were interviewed about their attitudes and experiences conducting eHealth searches. From the interviews, 36 statements were used in a structured ranking task to identify clusters and determine which specific perceptions of eHealth search practices discriminated students into different groups. Scores on an objective measure of eHealth literacy were used to help categorize participant perspectives. Results Q-technique factor analysis of the rankings identified 3 clusters of respondents with differing views on eHealth searches that generally coincided with participants’ objective eHealth literacy scores. The proficient resourceful students (pattern/structure coefficient range 0.56-0.80) described themselves as using multiple resources to obtain eHealth information, as opposed to simply relying on Internet search engines. The intermediate reluctant students (pattern/structure coefficient range 0.75-0.90) reported engaging only Internet search engines to locate eHealth information, citing undeveloped evaluation skills when considering sources of information located on the Internet. Both groups of advanced students reported not knowing how to use Boolean operators to conduct Internet health searches. The basic hubristic students (pattern/structure coefficient range 0.54-0.76) described themselves as independent procrastinators when searching for eHealth information. Interestingly, basic hubristic students represented the only cluster of participants to describe themselves as (1) having received instruction on using the Internet to conduct eHealth searches, and (2) possessing relative confidence when completing a search task. Conclusions Subjective perspectives of eHealth search practices differed among students possessing different levels of eHealth literacy. These multiple perspectives present both challenges and opportunities for empowering college students in the health professions to use the Internet to obtain and appraise evidence-based health information using the Internet. PMID:22543437

Exploring the Best Practices of Nursing Research Councils in Magnet® Organizations: Findings From a Qualitative Research Study.

PubMed

Day, Jennifer; Lindauer, Cathleen; Parks, Joyce; Scala, Elizabeth

2017-05-01

The objective of this descriptive qualitative study was to identify best practices of nursing research councils (NRCs) at Magnet®-designated hospitals. Nursing research (NR) is essential, adding to the body of nursing knowledge. Applying NR to the bedside improves care, enhances patient safety, and is an imperative for nursing leaders. We interviewed NR designees at 26 Magnet-recognized hospitals about the structure and function of their NRCs and used structural coding to identify best practices. Most organizations link NR and evidence-based practice. Council membership includes leadership and clinical nurses. Councils conduct scientific reviews for nursing studies, supporting nurse principal investigators. Tracking and reporting of NR vary widely and are challenging. Councils provide education, sponsor research days, and collaborate interprofessionally, including with academic partners. Findings from this study demonstrate the need to create formal processes to track and report NR and to develop outcome-focused NR education.

Parallel processing for nonlinear dynamics simulations of structures including rotating bladed-disk assemblies

NASA Technical Reports Server (NTRS)

Hsieh, Shang-Hsien

1993-01-01

The principal objective of this research is to develop, test, and implement coarse-grained, parallel-processing strategies for nonlinear dynamic simulations of practical structural problems. There are contributions to four main areas: finite element modeling and analysis of rotational dynamics, numerical algorithms for parallel nonlinear solutions, automatic partitioning techniques to effect load-balancing among processors, and an integrated parallel analysis system.

School Finance: A Primer. A Practical Guide to the Structural Components of, Alternative Approaches to, and Policy Questions about State School Finance Systems.

ERIC Educational Resources Information Center

Augenblick, John; And Others

Although school funding structures are similar in many ways across the states, no two states have school finance systems that are precisely the same. School finance systems which are used to achieve multiple objectives, must consider characteristics of numerous school districts, distribute large amounts of money, and have developed incrementally…

Self-perceived versus objectively measured competence in performing clinical practical procedures by final year medical students.

PubMed

Katowa-Mukwato, Patricia; Banda, Sekelani

2016-04-30

To determine and compare the self-perceived and objectively measured competence in performing 14 core-clinical practical procedures by Final Year Medical Students of the University of Zambia. The study included 56 out of 60 graduating University of Zambia Medical Students of the 2012/2013 academic year. Self-perceived competence: students rated their competence on 14 core- clinical practical procedures using a self-administered questionnaire on a 5-point Likert scale. Objective competence: it was measured by Objective Structured Clinical Examination (OSCE) by faculty using predetermined rating scales. Rank order correlation test was performed for self-perceived and objectively measured competence. Two thirds 36 (66.7%) of the participants perceived themselves as moderately competent, 15 (27.8%) rated themselves as highly competent while 3 (5.6%) had low self-perception. With objective competence, the majority 52 (92.8%) were barely competent while 4 (7.2%) were absolutely competent. When overall self-perception was compared to objectively measured competence, there was a discordance which was demonstrated by a negative correlation (Spearman rho -.123). Significant numbers of students reported low self-competence in performing procedures such as endotracheal intubation, gastric lavage and cardiopulmonary resuscitation which most never performed during the clinical years of medical education. In addition, the negative correlation between self-perceived and objectively measured competence demonstrated the inability of students to assess and rate themselves objectively due to fear that others may know their weaknesses and realize that they are not as competent as expected at a specific level of training.

A general model-based design of experiments approach to achieve practical identifiability of pharmacokinetic and pharmacodynamic models.

PubMed

Galvanin, Federico; Ballan, Carlo C; Barolo, Massimiliano; Bezzo, Fabrizio

2013-08-01

The use of pharmacokinetic (PK) and pharmacodynamic (PD) models is a common and widespread practice in the preliminary stages of drug development. However, PK-PD models may be affected by structural identifiability issues intrinsically related to their mathematical formulation. A preliminary structural identifiability analysis is usually carried out to check if the set of model parameters can be uniquely determined from experimental observations under the ideal assumptions of noise-free data and no model uncertainty. However, even for structurally identifiable models, real-life experimental conditions and model uncertainty may strongly affect the practical possibility to estimate the model parameters in a statistically sound way. A systematic procedure coupling the numerical assessment of structural identifiability with advanced model-based design of experiments formulations is presented in this paper. The objective is to propose a general approach to design experiments in an optimal way, detecting a proper set of experimental settings that ensure the practical identifiability of PK-PD models. Two simulated case studies based on in vitro bacterial growth and killing models are presented to demonstrate the applicability and generality of the methodology to tackle model identifiability issues effectively, through the design of feasible and highly informative experiments.

Dimensional Model for Estimating Factors influencing Childhood Obesity: Path Analysis Based Modeling

PubMed Central

Kheirollahpour, Maryam; Shohaimi, Shamarina

2014-01-01

The main objective of this study is to identify and develop a comprehensive model which estimates and evaluates the overall relations among the factors that lead to weight gain in children by using structural equation modeling. The proposed models in this study explore the connection among the socioeconomic status of the family, parental feeding practice, and physical activity. Six structural models were tested to identify the direct and indirect relationship between the socioeconomic status and parental feeding practice general level of physical activity, and weight status of children. Finally, a comprehensive model was devised to show how these factors relate to each other as well as to the body mass index (BMI) of the children simultaneously. Concerning the methodology of the current study, confirmatory factor analysis (CFA) was applied to reveal the hidden (secondary) effect of socioeconomic factors on feeding practice and ultimately on the weight status of the children and also to determine the degree of model fit. The comprehensive structural model tested in this study suggested that there are significant direct and indirect relationships among variables of interest. Moreover, the results suggest that parental feeding practice and physical activity are mediators in the structural model. PMID:25097878

Changes in soil microbial community structure influenced by agricultural management practices in a mediterranean agro-ecosystem.

PubMed

García-Orenes, Fuensanta; Morugán-Coronado, Alicia; Zornoza, Raul; Cerdà, Artemi; Scow, Kate

2013-01-01

Agricultural practices have proven to be unsuitable in many cases, causing considerable reductions in soil quality. Land management practices can provide solutions to this problem and contribute to get a sustainable agriculture model. The main objective of this work was to assess the effect of different agricultural management practices on soil microbial community structure (evaluated as abundance of phospholipid fatty acids, PLFA). Five different treatments were selected, based on the most common practices used by farmers in the study area (eastern Spain): residual herbicides, tillage, tillage with oats and oats straw mulching; these agricultural practices were evaluated against an abandoned land after farming and an adjacent long term wild forest coverage. The results showed a substantial level of differentiation in the microbial community structure, in terms of management practices, which was highly associated with soil organic matter content. Addition of oats straw led to a microbial community structure closer to wild forest coverage soil, associated with increases in organic carbon, microbial biomass and fungal abundances. The microbial community composition of the abandoned agricultural soil was characterised by increases in both fungal abundances and the metabolic quotient (soil respiration per unit of microbial biomass), suggesting an increase in the stability of organic carbon. The ratio of bacteria:fungi was higher in wild forest coverage and land abandoned systems, as well as in the soil treated with oat straw. The most intensively managed soils showed higher abundances of bacteria and actinobacteria. Thus, the application of organic matter, such as oats straw, appears to be a sustainable management practice that enhances organic carbon, microbial biomass and activity and fungal abundances, thereby changing the microbial community structure to one more similar to those observed in soils under wild forest coverage.

Alaska Department of Transportation and Public Facilities, Arizona Department of Transportation : research programs peer exchange, October 31 - November 2, 2011.

DOT National Transportation Integrated Search

2011-10-01

The objectives of the peer exchange were to explore and identify: : Effective research advisory council structures : Strategic research topic/focus areas : Effective research project selection practices : Effective strategies to embed...

Investigation of high-strength bolt-tightening verification techniques : tech transfer summary.

DOT National Transportation Integrated Search

2016-03-01

The primary objective of this project was to explore the current state-of-practice and the state-of-the-art techniques for high-strength bolt tightening and verification in structural steel connections. This project was completed so that insight coul...

Consumer focus can spur group practice turnaround.

PubMed

Foreman, M S; Draper, A

2001-06-01

Many healthcare organizations have lost money on their employed group practices. The solution to this dilemma is not necessarily divestment of the group practices. Instead, some healthcare organizations should view their physicians as an asset. Healthcare organizations and physicians need to develop a new framework for their relationship to optimize their competitive advantage. Three guiding principles that will help accomplish this objective are to recast the healthcare organization-physician relationship to focus on the consumer, reconfigure the economic model to exceed consumer demands, and restructure the group practice to encourage fiscal and service excellence. In developing a new relationship framework, the stakeholders need to define the group practice's mission, strategic direction, composition, infrastructure, compensation model, and structure.

An application of object-oriented knowledge representation to engineering expert systems

NASA Technical Reports Server (NTRS)

Logie, D. S.; Kamil, H.; Umaretiya, J. R.

1990-01-01

The paper describes an object-oriented knowledge representation and its application to engineering expert systems. The object-oriented approach promotes efficient handling of the problem data by allowing knowledge to be encapsulated in objects and organized by defining relationships between the objects. An Object Representation Language (ORL) was implemented as a tool for building and manipulating the object base. Rule-based knowledge representation is then used to simulate engineering design reasoning. Using a common object base, very large expert systems can be developed, comprised of small, individually processed, rule sets. The integration of these two schemes makes it easier to develop practical engineering expert systems. The general approach to applying this technology to the domain of the finite element analysis, design, and optimization of aerospace structures is discussed.

Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices

PubMed Central

Friedberg, Mark W.; Safran, Dana G.; Coltin, Kathryn L.; Dresser, Marguerite

2008-01-01

Background The Patient-Centered Medical Home (PCMH), a popular model for primary care reorganization, includes several structural capabilities intended to enhance quality of care. The extent to which different types of primary care practices have adopted these capabilities has not been previously studied. Objective To measure the prevalence of recommended structural capabilities among primary care practices and to determine whether prevalence varies among practices of different size (number of physicians) and administrative affiliation with networks of practices. Design Cross-sectional analysis. Participants One physician chosen at random from each of 412 primary care practices in Massachusetts was surveyed about practice capabilities during 2007. Practice size and network affiliation were obtained from an existing database. Measurements Presence of 13 structural capabilities representing 4 domains relevant to quality: patient assistance and reminders, culture of quality, enhanced access, and electronic health records (EHRs). Main Results Three hundred eight (75%) physicians responded, representing practices with a median size of 4 physicians (range 2–74). Among these practices, 64% were affiliated with 1 of 9 networks. The prevalence of surveyed capabilities ranged from 24% to 88%. Larger practice size was associated with higher prevalence for 9 of the 13 capabilities spanning all 4 domains (P < 0.05). Network affiliation was associated with higher prevalence of 5 capabilities (P < 0.05) in 3 domains. Associations were not substantively altered by statistical adjustment for other practice characteristics. Conclusions Larger and network-affiliated primary care practices are more likely than smaller, non-affiliated practices to have adopted several recommended capabilities. In order to achieve PCMH designation, smaller non-affiliated practices may require the greatest investments. Electronic supplementary material The online version of this article (doi:10.1007/s11606-008-0856-x) contains supplementary material, which is available to authorized users. PMID:19050977

CSB: a Python framework for structural bioinformatics.

PubMed

Kalev, Ivan; Mechelke, Martin; Kopec, Klaus O; Holder, Thomas; Carstens, Simeon; Habeck, Michael

2012-11-15

Computational Structural Biology Toolbox (CSB) is a cross-platform Python class library for reading, storing and analyzing biomolecular structures with rich support for statistical analyses. CSB is designed for reusability and extensibility and comes with a clean, well-documented API following good object-oriented engineering practice. Stable release packages are available for download from the Python Package Index (PyPI) as well as from the project's website http://csb.codeplex.com. ivan.kalev@gmail.com or michael.habeck@tuebingen.mpg.de

Qualitative analysis of student beliefs and attitudes after an objective structured clinical evaluation: implications for affective domain learning in undergraduate nursing education.

PubMed

Cazzell, Mary; Rodriguez, Amber

2011-12-01

This qualitative study explored the feelings, beliefs, and attitudes of senior-level undergraduate pediatric nursing students upon completion of a medication administration Objective Structured Clinical Evaluation (OSCE). The affective domain is the most neglected domain in higher education, although it is deemed the "gateway to learning." Quantitative assessments of clinical skills performed during OSCEs usually address two of the three domains of learning: cognitive (knowledge) and psychomotor skills. Twenty students volunteered to participate in focus groups (10 per group) and were asked three questions relevant to their feelings, beliefs, and attitudes about their OSCE experiences. Students integrated the attitude of safety first into future practice but felt that anxiety, loss of control, reaction under pressure, and no feedback affected their ability to connect the OSCE performance with future clinical practice. The findings affect future affective domain considerations in the development, modification, and assessment of OSCEs across the undergraduate nursing curriculum.

An exploration of the perceived factors that affect the learning and transfer of skills taught to student midwives.

PubMed

Longworth, Mary K

2013-08-01

the aim of this study was to examine the attitudes of student midwives towards skills training and practise. The objectives were to explore the factors in the skills laboratory environment and in clinical practice which affect how successfully student midwives transfer into clinical practice the various skills they have learnt in preparation for an Objective Structured Clinical Examination. a review of the background literature revealed that there were many variables related to successful transfer of skills in general but there appeared to be a gap around perceived factors affecting transfer of skills of student midwives. a mixed methods design was conducted using both questionnaires and semi-structured interviews between June and August 2010. questionnaires were administered to all midwifery students at one university in Wales. These were later followed by semi-structured interviews for 6 student midwives who were purposively selected from all year groups. the results from the questionnaires revealed that a majority of students had positive attitudes to educators and mentors and to their skills acquisition experience in the skills laboratory and to the available opportunities to practise in clinical practice. Although students believed in the transferability of skills from the laboratory setting to clinical practice, a majority thought that clinical practice provided them with a better opportunity to learn clinical skills. The semi-structured interviews demonstrated that facilitating factors in the skills laboratory included having adequate instruction as well as having a designated space. Hindering factors included unrealistic models and equipment. In clinical practice, facilitating factors included having the opportunities to practise skills and support and feedback from the mentor. Hindering factors included deficits in the student-mentor relationship. this study highlighted that midwifery students must be adequately prepared to carry out clinical skills competently and effectively. Educators and mentors must provide adequate support and feedback to promote transfer of knowledge and skills into the workplace to optimise high standards of care for women and their babies. Copyright © 2012 Elsevier Ltd. All rights reserved.

Hierarchical combinatorial deep learning architecture for pancreas segmentation of medical computed tomography cancer images.

PubMed

Fu, Min; Wu, Wenming; Hong, Xiafei; Liu, Qiuhua; Jiang, Jialin; Ou, Yaobin; Zhao, Yupei; Gong, Xinqi

2018-04-24

Efficient computational recognition and segmentation of target organ from medical images are foundational in diagnosis and treatment, especially about pancreas cancer. In practice, the diversity in appearance of pancreas and organs in abdomen, makes detailed texture information of objects important in segmentation algorithm. According to our observations, however, the structures of previous networks, such as the Richer Feature Convolutional Network (RCF), are too coarse to segment the object (pancreas) accurately, especially the edge. In this paper, we extend the RCF, proposed to the field of edge detection, for the challenging pancreas segmentation, and put forward a novel pancreas segmentation network. By employing multi-layer up-sampling structure replacing the simple up-sampling operation in all stages, the proposed network fully considers the multi-scale detailed contexture information of object (pancreas) to perform per-pixel segmentation. Additionally, using the CT scans, we supply and train our network, thus get an effective pipeline. Working with our pipeline with multi-layer up-sampling model, we achieve better performance than RCF in the task of single object (pancreas) segmentation. Besides, combining with multi scale input, we achieve the 76.36% DSC (Dice Similarity Coefficient) value in testing data. The results of our experiments show that our advanced model works better than previous networks in our dataset. On the other words, it has better ability in catching detailed contexture information. Therefore, our new single object segmentation model has practical meaning in computational automatic diagnosis.

[How can institutional structures make clinical research in France more operational?].

PubMed

Funck-Brentano, C; Brouard, R

The laws regulating the practice of clinical research in France, in particular the law of 20 December 1988, the so-called Huriet's law, constitute a major advance for medical progress. However, their implementation by administrative offices generates practical difficulties which impair the development of applied research in human beings. Beyond the laws themselves, it appears that our institutions are unprepared to optimize the conduct of such research. This round table sought to list the existing problems and to propose constructive solutions or objectives to be reached to optimize clinical research in France, with a view to improving French participation in international collaborative programmes, notably European ones. Evaluation of projects and practices, financial support and accounting, and some aspects of existing laws have been identified as the major sources of our difficulties. Harmonization and clarification of our procedures as well as improvement of training should be our primary objectives to achieve a higher level of medical, scientific, financial and administrative quality in the conduct of clinical research. Creation of a referential Web site, designed and updated by a central public organization, is an imperative step towards reaching these objectives.

Practice management: observations, issues, and empirical evidence.

PubMed

Wong, H M; Braithwaite, J

2001-02-01

The primary objective of this study is to provide objective, empirical, evidence-based practice management information. This is a hitherto under-researched area of considerable interest for both the practitioner and educator. A questionnaire eliciting a mix of structured and free text responses was administered to a random sample of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted. The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges. Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidence-based practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs.

The effects of a team-based continuous quality improvement intervention on the management of primary care: a randomised controlled trial

PubMed Central

Engels, Yvonne; van den Hombergh, Pieter; Mokkink, Henk; van den Hoogen, Henk; van den Bosch, Wil; Grol, Richard

2006-01-01

Aim To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management. Design of study Randomised controlled trial. Setting Twenty-six intervention and 23 control primary care practices in the Netherlands. Method Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later. Results Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant. Conclusion The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument. PMID:17007709

The Direction of Web-based Training: A Practitioner's View.

ERIC Educational Resources Information Center

Kilby, Tim

2001-01-01

Web-based training has had achievements and disappointments as online learning has matured. Best practices include user-centered design, knowledge object structures, usability engineering, and formal evaluation. Knowledge management, peer-to-peer learning, and personal learning appliances will continue to alter the online learning landscape. (SK)

Improving Preceptor Behavior through Formative Feedback in Preceptor Training

ERIC Educational Resources Information Center

Groh, Nancy; Gill, Diane; Henning, Jolene; Stevens, Susan W.; Dondanville, Abbey

2013-01-01

Context: Clinical instructor educators (CIEs) prepare athletic trainers (ATs) to serve as preceptors. Structured performance observation and supervisory conferencing is a well-established method to improve teaching practice that may prove effective for training preceptors. Objective: To explore the impact of a systematic preceptor training program…

Inclusive Education at Primary Level: Reality or Phantasm

ERIC Educational Resources Information Center

Khan, Itfaq Khaliq; Behlol, Malik Ghulam

2014-01-01

The objectives of this study were to assess the impacts of Inclusive Education (IE) Project implemented in government schools of Islamabad and anticipate its practicability for public schools. Quantitative and qualitative methods were applied for data collection. Study instruments were structured interviews, unstructured focus group discussions,…

Disrupting Borders: A Case Study in Engaged Pedagogy

ERIC Educational Resources Information Center

Ross, Laurie

2012-01-01

Through an analysis of a practice-oriented course on youth worker professional development consisting of 10 community youth workers and 11 traditional college students, this paper suggests the need to construct the classroom as a "borderland." Course structure, class composition, pedagogical strategies, and deliberate learning objectives disrupted…

Significance of Objective Structured Clinical Examinations to Plastic Surgery Residency Training.

PubMed

Simmons, Brian J; Zoghbi, Yasmina; Askari, Morad; Birnbach, David J; Shekhter, Ilya; Thaller, Seth R

2017-09-01

Objective structured clinical examinations (OSCEs) have proven to be a powerful tool. They possess more than a 30-year track record in assessing the competency of medical students, residents, and fellows. Objective structured clinical examinations have been used successfully in a variety of medical specialties, including surgery. They have recently found their way into the subspecialty of plastic surgery. This article uses a systematic review of the available literature on OSCEs and their recent use in plastic surgery. It incorporates survey results assessing program directors' views on the use of OSCEs. Approximately 40% of programs surveyed use OSCEs to assess the Accreditation Council for Graduate Medical Education core competencies. We found that 40% use OSCEs to evaluate specific plastic surgery milestones. Objective structured clinical examinations are usually performed annually. They cost anywhere between $100 and more than $1000 per resident. Four milestones giving residents the most difficulties on OSCEs were congenital anomalies, noncancer breast surgery, breast reconstruction, and practice-based learning and improvement. It was determined that challenges with milestones were due to lack of adequate general knowledge and surgical ward patient care, as well as deficits in professionalism and system-based problems. Programs were able to remediate weakness found by OSCEs using a variety of methods. Objective structured clinical examinations offer a unique tool to objectively assess the proficiency of residents in key areas of the Accreditation Council for Graduate Medical Education core competencies. In addition, they can be used to assess the specific milestones that plastic surgery residents must meet. This allows programs to identify and improve identified areas of weakness.

An Extensible "SCHEMA-LESS" Database Framework for Managing High-Throughput Semi-Structured Documents

NASA Technical Reports Server (NTRS)

Maluf, David A.; Tran, Peter B.

2003-01-01

Object-Relational database management system is an integrated hybrid cooperative approach to combine the best practices of both the relational model utilizing SQL queries and the object-oriented, semantic paradigm for supporting complex data creation. In this paper, a highly scalable, information on demand database framework, called NETMARK, is introduced. NETMARK takes advantages of the Oracle 8i object-relational database using physical addresses data types for very efficient keyword search of records spanning across both context and content. NETMARK was originally developed in early 2000 as a research and development prototype to solve the vast amounts of unstructured and semistructured documents existing within NASA enterprises. Today, NETMARK is a flexible, high-throughput open database framework for managing, storing, and searching unstructured or semi-structured arbitrary hierarchal models, such as XML and HTML.

Randomized clinical trial to evaluate mental practice in enhancing advanced laparoscopic surgical performance.

PubMed

Louridas, M; Bonrath, E M; Sinclair, D A; Dedy, N J; Grantcharov, T P

2015-01-01

Mental practice, the cognitive rehearsal of a task without physical movement, is known to enhance performance in sports and music. Investigation of this technique in surgery has been limited to basic operations. The purpose of this study was to develop mental practice scripts, and to assess their effect on advanced laparoscopic skills and surgeon stress levels in a crisis scenario. Twenty senior surgical trainees were randomized to either conventional training or mental practice groups, the latter being trained by an expert performance psychologist. Participants' skills were assessed while performing a porcine laparoscopic jejunojejunostomy as part of a crisis scenario in a simulated operating room, using the Objective Structured Assessment of Technical Skill (OSATS) and bariatric OSATS (BOSATS) instruments. Objective and subjective stress parameters were measured, as well as non-technical skills using the Non-Technical Skills for Surgeons rating tool. An improvement in OSATS (P = 0.003) and BOSATS (P = 0.003) scores was seen in the mental practice group compared with the conventional training group. Seven of ten trainees improved their technical performance during the crisis scenario, whereas four of the ten conventionally trained participants deteriorated. Mental imagery ability improved significantly following mental practice training (P = 0.011), but not in the conventional group (P = 0.083). No differences in objective or subjective stress levels or non-technical skills were evident. Mental practice improves technical performance for advanced laparoscopic tasks in the simulated operating room, and allows trainees to maintain or improve their performance despite added stress. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Detecting of foreign object debris on airfield pavement using convolution neural network

NASA Astrophysics Data System (ADS)

Cao, Xiaoguang; Gu, Yufeng; Bai, Xiangzhi

2017-11-01

It is of great practical significance to detect foreign object debris (FOD) timely and accurately on the airfield pavement, because the FOD is a fatal threaten for runway safety in airport. In this paper, a new FOD detection framework based on Single Shot MultiBox Detector (SSD) is proposed. Two strategies include making the detection network lighter and using dilated convolution, which are proposed to better solve the FOD detection problem. The advantages mainly include: (i) the network structure becomes lighter to speed up detection task and enhance detection accuracy; (ii) dilated convolution is applied in network structure to handle smaller FOD. Thus, we get a faster and more accurate detection system.

Mapping Diversity Efforts as Inquiry

ERIC Educational Resources Information Center

Halualani, Rona Tamiko; Haiker, Hugh; Lancaster, Christopher

2010-01-01

In this essay, we discuss the importance for a higher education institution to participate in self-inquiry, or a reflexive practice of identifying where a university is with regard to establishing an embedded campus structure grounded in diversity in terms of values, principles, objectives and goals, outcomes and resource allocations. This process…

Vocational Education: Options and Directions. Working Paper 18.

ERIC Educational Resources Information Center

Stokes, Helen; Holdsworth, Roger

This paper presents practical options for school development in relation to vocational education ranging from small and specific steps to larger whole school change. Chapter 1 describes the context. Chapter 2 highlights three interlocked imperatives to attain this objective: a comprehensive and well-structured educational program that deals…

Connecting Instances to Promote Children's Relational Reasoning

ERIC Educational Resources Information Center

Son, Ji Y.; Smith, Linda B.; Goldstone, Robert L.

2011-01-01

The practice of learning from multiple instances seems to allow children to learn about relational structure. The experiments reported here focused on two issues regarding relational learning from multiple instances: (a) what kind of perceptual situations foster such learning and (b) how particular object properties, such as complexity and…

Learning by Seeing: The TEMAS Multimedia Learning Objects for Civil Engineers

ERIC Educational Resources Information Center

Cadoni, Ezio; Botturi, Luca; Forni, Daniele

2008-01-01

A goal of engineering and architecture bachelor and master's programs is to provide students with practical and technical preparation in the mechanical characterization of materials and structures: future architects and civil engineers should be able to recognize and describe different construction materials and their behavior when used for…

[Social representations on HIV/AIDS among adolescentes: implications for nursing care].

PubMed

Thiengo, Maria Aparecida; de Oliveira, Denize Cristina; Rodrigues, Benedita Maria Rêgo Deusdará

2005-03-01

With the objective of discussing the implications of the social representations of HIV/AIDS for the interpersonal relations and the practices for protection among adolescents, 15 semidirective interviews were carried out with adolescents, both with and without HIV, assisted at a Hospital School in Rio de Janeiro. The software ALCESTE 4.5 was used for the data analysis. It was observed that the social representation of AIDS is structured around cognitions connected to prevention, revealing a contradiction between the knowledge and the practices reported by the group. It is suggested that the nursing practices should be directed towards the reduction of the distance between practices, representations and scientific knowledge.

Exotic objects of atomic physics

NASA Astrophysics Data System (ADS)

Eletskii, A. V.

2017-11-01

There has been presented a short survey of physical properties, methods of production and exploration as well as directions of practical usage of the objects of atomic physics which are not yet described in detail in modern textbooks and manuals intended for students of technical universities. The family of these objects includes negative and multicharged ions, Rydberg atoms, excimer molecules, clusters. Besides of that, in recent decades this family was supplemented with new nanocarbon structures such as fullerenes, carbon nanotubes and graphene. The textbook “Exotic objects of atomic physics” [1] edited recently contains some information on the above-listed objects of the atomic physics. This textbook can be considered as a supplement to classic courses of atomic physics teaching in technical universities.

Developing evidence-based physical therapy clinical practice guidelines.

PubMed

Kaplan, Sandra L; Coulter, Colleen; Fetters, Linda

2013-01-01

Recommended strategies for developing evidence-based clinical practice guidelines (CPGs) are provided. The intent is that future CPGs developed with the support of the Section on Pediatrics of the American Physical Therapy Association would consistently follow similar developmental processes to yield consistent quality and presentation. Steps in the process of developing CPGs are outlined and resources are provided to assist CPG developers in carrying out their task. These recommended processes may also be useful to CPG developers representing organizations with similar structures, objectives, and resources.

[Inter-rater reliability and construct validity of the OPD-CA axis structure: first study results regarding the integration of OPD-CA into clinical practice].

PubMed

Cropp, Carola; Salzer, Simone; Häusser, Leonard F; Streeck-Fischer, Annette

2013-01-01

The axis structure of the Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) has proven to be a reliable and valid diagnostic tool under research conditions. However, corresponding data regarding the integration of OPD-CA axis structure into clinical practice is still lacking. Hence, this aspect was examined as part of a randomized controlled clinical trial realized at Asklepios Fachklinikum Tiefenbrunn. Here, the OPD-CA axis structure has been applied to assess the structural level of 42 adolescent patients (15-19 years). In contrast to previous studies, the assessment was not carried out by independent raters using a videotaped OPD-CA interview, but the rating was part of clinical routine procedures. Also under these conditions, inter-rater reliability was high, in particular regarding the four subscales of the OPD-CA axis structure. With respect to construct validity, the results of our study supported a two-factor solution, which is in accordance with the findings of two previous works. One factor corresponded to the dimension "self-regulation" while the other factor included both the dimension "self-perception and object perception" as well as the dimension "communication skills". Implications of the findings for research and practice are discussed.

[Volunteer satisfaction: Internal structure and relationship with permanence in organizations].

PubMed

Vecina Jiménez, M L; Chacón Fuertes, Fernando; Sueiro Abad, Manuel J

2009-02-01

Volunteer satisfaction: Internal structure and relationship with permanence in organizations. The concept of satisfaction is considered theoretically relevant in practically all the studies that have investigated the factors that influence the permanence of volunteer participation in organizations. However, the practical results are not conclusive, perhaps due to the wide range of ways in which the concept is understood and measured. The object of this study is: to analyse the internal structure of satisfaction and to verify its relationship with volunteer duration in organizations. The results of the factor analysis yield a three-factor structure: Satisfaction with the management of the organization, Satisfaction with the tasks, Satisfaction of motivations. The three factors allow us to differentiate between individuals who remain in the organization for a period of 12 consecutive months, and those who leave earlier. The results of structural equation model analysis show that the relationship between satisfaction and the length of time that volunteers stay with the organization is affected by the intention to remain.

On sine dwell or broadband methods for modal testing

NASA Technical Reports Server (NTRS)

Chen, Jay-Chung; Wada, Ben K.

1987-01-01

For large, complex spacecraft structural systems, the objectives of the modal test are outlined. Based on these objectives, the comparison criteria for the modal test methods, namely, the broadband excitation and the sine dwell methods are established. Using the Galileo spacecraft modal test and the Centaur G Prime upper stage vehicle modal test as examples, the relative advantages or disadvantages of each method are examined. The usefulness or shortcoming of the methods are given from a practicing engineer's view point.

Using the Journal Club to teach and assess competence in practice-based learning and improvement: a literature review and recommendation for implementation.

PubMed

Lee, Andrew G; Boldt, H Culver; Golnik, Karl C; Arnold, Anthony C; Oetting, Thomas A; Beaver, Hilary A; Olson, Richard J; Carter, Keith

2005-01-01

The traditional journal club has historically been used to teach residents about critically reading and reviewing the literature in order to improve patient care. The Accreditation Council for Graduate Medical Education competencies mandate requires that ophthalmology residency programs both teach and assess practice-based learning and improvement. A systematically conducted review of the literature regarding the use of the journal club in resident medical education was performed to define specific recommendations for implementation of a journal club tool. Selected best practices for a successful journal club were gleaned from the existing medical literature. These include the following: 1) the use of a structured review checklist, 2) explicit written learning objectives, and 3) a formalized meeting structure and process. The journal club might prove to be an excellent tool for the assessment of competencies like practice-based learning which may be difficult to assess by other means. Future study is necessary to determine if journal club can improve educational outcomes and promote lifelong competence in practice-based learning.

The effect of a sequential structure of practice for the training of perceptual-cognitive skills in tennis

PubMed Central

2017-01-01

Objective Anticipation of opponent actions, through the use of advanced (i.e., pre-event) kinematic information, can be trained using video-based temporal occlusion. Typically, this involves isolated opponent skills/shots presented as trials in a random order. However, two different areas of research concerning representative task design and contextual (non-kinematic) information, suggest this structure of practice restricts expert performance. The aim of this study was to examine the effect of a sequential structure of practice during video-based training of anticipatory behavior in tennis, as well as the transfer of these skills to the performance environment. Methods In a pre-practice-retention-transfer design, participants viewed life-sized video of tennis rallies across practice in either a sequential order (sequential group), in which participants were exposed to opponent skills/shots in the order they occur in the sport, or a non-sequential (non-sequential group) random order. Results In the video-based retention test, the sequential group was significantly more accurate in their anticipatory judgments when the retention condition replicated the sequential structure compared to the non-sequential group. In the non-sequential retention condition, the non-sequential group was more accurate than the sequential group. In the field-based transfer test, overall decision time was significantly faster in the sequential group compared to the non-sequential group. Conclusion Findings highlight the benefits of a sequential structure of practice for the transfer of anticipatory behavior in tennis. We discuss the role of contextual information, and the importance of representative task design, for the testing and training of perceptual-cognitive skills in sport. PMID:28355263

Evaluation of thermal sprayed metallic coatings for use on the structures at Launch Complex 39

NASA Technical Reports Server (NTRS)

Welch, Peter J.

1990-01-01

The current status of the evaluation program is presented. The objective was to evaluate the applicability of Thermal Sprayed Coatings (TSC) to protect the structures in the high temperature acid environment produced by exhaust of the Solid Rocket Boosters during the launches of the Shuttle Transportation System. Only the relatively low cost aluminum TSC which provides some cathodic protection for steel appears to be a practical candidate for further investigation.

Documenting Collections: Cornerstones for More History of Science in Museums

NASA Astrophysics Data System (ADS)

Lourenço, Marta C.; Gessner, Samuel

2014-04-01

Historians of science have recently become increasingly involved with collections and scientific instruments. This creates opportunities for a more significant role of history in museums of science, as well as more meaningful and contextualized exhibitions and educational programmes. However, complementing the mainstream focus on universal scientific principles with history requires structural and cultural changes in museums' approaches and practices. In this paper we draw from recent collaborative work with historians of science at the University of Lisbon to reflect on the challenges museums face as they prepare for a more meaningful historical approach to science. We argue that documentation is crucial both before objects enter the museum and as regular collections practice. We propose a conceptual and methodological framework comprising two operational levels: documenting individual objects and documenting collections.

Exploring How Institutional Structures and Practices Influence English Learners' Opportunity to Learn Social Studies

ERIC Educational Resources Information Center

Heafner, Tina L.; Plaisance, Michelle

2016-01-01

Background/Context: Current research addresses the marginalization of social studies and trends in teaching English learners (ELs) in monolingual schools; however, few studies have examined the way in which support services provided to ELs impact their exposure to social studies instruction. Purpose/Objective/Research Question/Focus of Study:…

Special Education: Program of Studies for Senior High School, Core IV.

ERIC Educational Resources Information Center

Forsyth County - Winston-Salem City Schools, NC.

A curriculum guide for senior high school educable retarded pupils, based on activities undertaken during the first 2 years of the special program, is oriented toward job training and preparation. Purposes, course structure, and objectives are given for each of the following areas of study: arts and crafts, binding, business practice, driver…

Identifying and structuring objectives for a coral reef protection plan at the U.S. Environmental Protection Agency

EPA Science Inventory

Region 2 of the U.S. Environmental Protection Agency initiated a Coral Reef Protection Plan (CRPP) in 2014 to reduce anthropogenic stress on Caribbean coral reefs. The CRPP is intended to foster institutional practices that improve reef condition and focus regulatory and non-regu...

Practical Applications and Community Needs: Placing the Communication Campaign in the Community.

ERIC Educational Resources Information Center

James, Anita C.

Within the structure of a senior and graduate level course, students in the Ohio University school of interpersonal communication collaborate with community groups in the creation of campaigns promoting issue-awareness, political candidates, fund raising events, and citizen action. The course objectives include teaching students to understand the…

Credentialing Structures, Pedagogies, Practices, and Curriculum Goals: Trajectories of Change in Community College Mission Statements

ERIC Educational Resources Information Center

Ayers, David F.

2015-01-01

Objective: To examine the discursive strategies deployed by community colleges to sustain legitimacy in an evolving and contradictory institutional environment. Method: Using corpus linguistics software, I compared 1,009 mission statements from 2012-2013 with a reference corpus of 427 mission statements from 2004. Results: Keywords analysis,…

Teaching and assessing procedural skills: a qualitative study.

PubMed

Touchie, Claire; Humphrey-Murto, Susan; Varpio, Lara

2013-05-14

Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them. Focus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed. Residents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills. The acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs.

Quantitative structural MRI for early detection of Alzheimer’s disease

PubMed Central

McEvoy, Linda K; Brewer, James B

2011-01-01

Alzheimer’s disease (AD) is a common progressive neurodegenerative disorder that is not currently diagnosed until a patient reaches the stage of dementia. There is a pressing need to identify AD at an earlier stage, so that treatment, when available, can begin early. Quantitative structural MRI is sensitive to the neurodegeneration that occurs in mild and preclinical AD, and is predictive of decline to dementia in individuals with mild cognitive impairment. Objective evidence of ongoing brain atrophy will be critical for risk/benefit decisions once potentially aggressive, disease-modifying treatments become available. Recent advances have paved the way for the use of quantitative structural MRI in clinical practice, and initial clinical use has been promising. However, further experience with these measures in the relatively unselected patient populations seen in clinical practice is needed to complete translation of the recent enormous advances in scientific knowledge of AD into the clinical realm. PMID:20977326

The psychometric properties of the Retrospective Child Feeding Questionnaire in Hebrew.

PubMed

Lev-Ari, Lilac; Zohar, Ada H

2013-06-01

The objective of this study was to develop the Retrospective Child Feeding Questionnaire (RCFQ), and to assess its structural validity. In its original version, the CFQ was constructed to measure current practices of maternal feeding of children. For the present study, the CFQ was translated into Hebrew by translation, independent back-translation, and revision, and was then reworded to assess a retrospective assessment of maternal child feeding practices by adults. A large community sample of volunteers (N=406) was recruited and administered the RCFQ, and self-reported on body satisfaction, disordered eating, and body mass. The structural validity of the RCFQ was established by exploratory and confirmatory factor analysis for men and women. Some measure of construct validity is provided by correlational analysis. The RCFQ is structurally robust, and useful in assessing early influences on adult BMI, eating behavior, and body dissatisfaction. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed Central

2015-01-01

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

Evidence-based protocol for structural rehabilitation of the spine and posture: review of clinical biomechanics of posture (CBP®) publications

PubMed Central

Oakley, Paul A.; Harrison, Donald D.; Harrison, Deed E.; Haas, Jason W.

2005-01-01

BACKGROUND Although practice protocols exist for SMT and functional rehabilitation, no practice protocols exist for structural rehabilitation. Traditional chiropractic practice guidelines have been limited to acute and chronic pain treatment, with limited inclusion of functional and exclusion of structural rehabilitation procedures. OBJECTIVE (1) To derive an evidence-based practice protocol for structural rehabilitation from publications on Clinical Biomechanics of Posture (CBP®) methods, and (2) to compare the evidence for Diversified, SMT, and CBP®. METHODS Clinical control trials utilizing CBP® methods and spinal manipulative therapy (SMT) were obtained from searches in Mantis, CINAHL, and Index Medicus. Using data from SMT review articles, evidence for Diversified Technique (as taught in chiropractic colleges), SMT, and CBP® were rated and compared. RESULTS From the evidence from Clinical Control Trials on SMT and CBP®, there is very little evidence support for Diversified (our rating = 18), as taught in chiropractic colleges, for the treatment of pain subjects, while CBP® (our rating = 46) and SMT for neck pain (rating = 58) and low back pain (our rating = 202) have evidence-based support. CONCLUSIONS While CBP® Technique has approximately as much evidence-based support as SMT for neck pain, CBP® has more evidence to support its methods than the Diversified technique taught in chiropractic colleges, but not as much as SMT for low back pain. The evolution of chiropractic specialization has occurred, and doctors providing structural-based chiropractic care require protocol guidelines for patient quality assurance and standardization. A structural rehabilitation protocol was developed based on evidence from CBP® publications. PMID:17549209

Invisibility cloak with image projection capability

PubMed Central

Banerjee, Debasish; Ji, Chengang; Iizuka, Hideo

2016-01-01

Investigations of invisibility cloaks have been led by rigorous theories and such cloak structures, in general, require extreme material parameters. Consequently, it is challenging to realize them, particularly in the full visible region. Due to the insensitivity of human eyes to the polarization and phase of light, cloaking a large object in the full visible region has been recently realized by a simplified theory. Here, we experimentally demonstrate a device concept where a large object can be concealed in a cloak structure and at the same time any images can be projected through it by utilizing a distinctively different approach; the cloaking via one polarization and the image projection via the other orthogonal polarization. Our device structure consists of commercially available optical components such as polarizers and mirrors, and therefore, provides a significant further step towards practical application scenarios such as transparent devices and see-through displays. PMID:27958334

Invisibility cloak with image projection capability

NASA Astrophysics Data System (ADS)

Banerjee, Debasish; Ji, Chengang; Iizuka, Hideo

2016-12-01

Investigations of invisibility cloaks have been led by rigorous theories and such cloak structures, in general, require extreme material parameters. Consequently, it is challenging to realize them, particularly in the full visible region. Due to the insensitivity of human eyes to the polarization and phase of light, cloaking a large object in the full visible region has been recently realized by a simplified theory. Here, we experimentally demonstrate a device concept where a large object can be concealed in a cloak structure and at the same time any images can be projected through it by utilizing a distinctively different approach; the cloaking via one polarization and the image projection via the other orthogonal polarization. Our device structure consists of commercially available optical components such as polarizers and mirrors, and therefore, provides a significant further step towards practical application scenarios such as transparent devices and see-through displays.

Invisibility cloak with image projection capability.

PubMed

Banerjee, Debasish; Ji, Chengang; Iizuka, Hideo

2016-12-13

Investigations of invisibility cloaks have been led by rigorous theories and such cloak structures, in general, require extreme material parameters. Consequently, it is challenging to realize them, particularly in the full visible region. Due to the insensitivity of human eyes to the polarization and phase of light, cloaking a large object in the full visible region has been recently realized by a simplified theory. Here, we experimentally demonstrate a device concept where a large object can be concealed in a cloak structure and at the same time any images can be projected through it by utilizing a distinctively different approach; the cloaking via one polarization and the image projection via the other orthogonal polarization. Our device structure consists of commercially available optical components such as polarizers and mirrors, and therefore, provides a significant further step towards practical application scenarios such as transparent devices and see-through displays.

Use of an Objective Structured Clinical Examination in Clinical Nurse Specialist Education.

PubMed

Cuevas, Heather E; Timmerman, Gayle M

2016-01-01

Helping patients maximize their potential using expert coaching to facilitate lifestyle change is an important practice area for clinical nurse specialists (CNSs). The purpose is to determine the usefulness of objective structured clinical examinations (OSCEs) for evaluating CNS students' coaching competencies in the context of facilitating lifestyle change. Despite the use of OSCEs to assess competencies in clinical skills (eg, performance of procedures, decision making), its potential for evaluating coaching competencies for lifestyle change has not been demonstrated. We developed 4 OSCEs dealing with coaching patients in exercise, weight loss, stress reduction, or nonpharmacologic management of hyperlipidemia. Evaluation criteria included (1) approach to the patient, (2) information gathering, (3) motivational interviewing, and (4) management (medical and behavioral strategies). Student performance ranged from highly organized with proficient coaching skills to disorganized and focused solely on clinical management and prescriptive communication. Student responses were positive. Objective structured clinical examinations were highly useful for evaluating CNS students' coaching competencies for lifestyle change. Using OSCEs early in the semester to provide students feedback on their performance and again at the end to determine improvement optimizes use of this teaching strategy.

Viability of piping plover Charadrius melodus metapopulations

USGS Publications Warehouse

Plissner, Jonathan H.; Haig, Susan M.

2000-01-01

The metapopulation viability analysis package, VORTEX, was used to examine viability and recovery objectives for piping plovers Charadrius melodus, an endangered shorebird that breeds in three distinct regions of North America. Baseline models indicate that while Atlantic Coast populations, under current management practices, are at little risk of near-term extinction, Great Plains and Great Lakes populations require 36% higher mean fecundity for a significant probability of persisting for the next 100 years. Metapopulation structure (i.e. the delineation of populations within the metapopulation) and interpopulation dispersal rates had varying effects on model results; however, spatially-structured metapopulations exhibited lower viability than that reported for single-population models. The models were most sensitive to variation in survivorship; hence, additional mortality data will improve their accuracy. With this information, such models become useful tools in identifying successful management objectives; and sensitivity analyses, even in the absence of some data, may indicate which options are likely to be most effective. Metapopulation viability models are best suited for developing conservation strategies for achieving recovery objectives based on maintaining an externally derived, target population size and structure.

Analysis of Regulatory Guidance for Health Monitoring

NASA Technical Reports Server (NTRS)

Munns, Thomas E.; Beard, Richard E.; Culp, Aubrey M.; Murphy, Dennis A.; Kent, Renee M.; Cooper, Eric G. (Technical Monitor)

2000-01-01

The purpose of this study was to assess the connection between current FAA regulations and the incorporation of Health Management (HM) systems into commercial aircraft. To address the overall objectives ARINC: (1) investigated FAA regulatory guidance, (2) investigated airline maintenance practices, (3) systematically identified regulations and practices that would be affected or could act as barriers to the introduction of HM technology, and (4) assessed regulatory and operational tradeoffs that should be considered for implementation. The assessment procedure was validated on a postulated structural HM capability for the B757 horizontal stabilizer.

A qualitative evaluation of scalpel skill teaching of podiatry students.

PubMed

Causby, Ryan S; McDonnell, Michelle N; Reed, Lloyd; Fryer, Caroline E; Hillier, Susan L

2017-01-01

Degrees in health disciplines need a balance of theoretical knowledge and sufficient clinical practice to meet registration requirements, in particular those requiring specialist skills such as the use of scalpels and other small instruments, such as podiatry. However, despite this requirement there is a scarcity of literature and research to inform teaching of these particular manual clinical skills. Therefore, the aims of this study were to determine the current approaches being used to teach manual skills, in particular scalpel skills, in university podiatry programs in Australia and New Zealand, and to explore what issues, challenges and innovations exist. A qualitative study, consisting of semi-structured interviews with staff at eight university podiatry programs in Australia and New Zealand was undertaken to determine how these skills are taught and evaluated, and how poor performers are managed. A conventional content analysis technique was used to analyse and code interview data, with the resultant categories reported. Approaches to teaching manual clinical skills, in particular scalpel skills, appear to be consistent between university programs in Australia and New Zealand in utilising didactic-style content, demonstration, physical practice on inanimate objects and real skin, and often the use of supplementary audio-visual material. The main reported differences between programs were in methods and processes of practice, with controversy regarding the use of inanimate objects versus real skin for practice. Despite a lack of research and literature surrounding this topic, the approach to teaching is relatively consistent between programs with greatest disparity being the structure and duration of practice. Key issues for teaching staff in teaching manual skills were students' clinical exposure, motivation, levels of anxiety and dexterity.

Sandwich Structure Risk Reduction in Support of the Payload Adapter Fitting

NASA Technical Reports Server (NTRS)

Nettles, A. T.; Jackson, J. R.; Guin, W. E.

2018-01-01

Reducing risk for utilizing honeycomb sandwich structure for the Space Launch System payload adapter fitting includes determining what parameters need to be tested for damage tolerance to ensure a safe structure. Specimen size and boundary conditions are the most practical parameters to use in damage tolerance inspection. The effect of impact over core splices and foreign object debris between the facesheet and core is assessed. Effects of enhanced damage tolerance by applying an outer layer of carbon fiber woven cloth is examined. A simple repair technique for barely visible impact damage that restores all compression strength is presented.

Assessment of Surgical Skills and Competency.

PubMed

Bhatti, Nasir I

2017-10-01

Evaluation of surgical skills and competency are important aspects of the medical education process. Measurable and reproducible methods of assessment with objective feedback are essential components of surgical training. Objective Structured Assessment of Technical Skills (OSATS) is widely used across the medical specialties and otolaryngology-specific tools have been developed and validated for sinus and mastoid surgery. Although assessment of surgical skills can be time-consuming and requires human and financial resources, new evaluation methods and emerging technology may alleviate these barriers while also improving data collection practices. Copyright © 2017 Elsevier Inc. All rights reserved.

Best Practices for Use of Blended Learning

PubMed Central

Porter, Andrea L.; Pitterle, Michael E.

2017-01-01

Objective. To determine instructional best practice recommendations for use of blended learning from the students’ perspective. Methods. Three focus groups were created, one for each of the first three years at a school of pharmacy. The focus group discussions were audio recorded and transcribed for content analysis. Results. Ten instructional best practices were identified from the focus groups: setting the stage, consistency when team teaching, timeliness in posting materials, time on task, accountability for online activities, use of structured active learning, instructor use of feedback on student preparation, incorporation of student feedback into the course, short reviews of online material during class, and ensuring technologies are user friendly. Conclusion. Instructors using blended learning should consider incorporating these best practices into their course design and management. More evaluation is needed to see if implementation of these practices affects student performance. PMID:28496269

Best Practices for Use of Blended Learning.

PubMed

Margolis, Amanda R; Porter, Andrea L; Pitterle, Michael E

2017-04-01

Objective. To determine instructional best practice recommendations for use of blended learning from the students' perspective. Methods. Three focus groups were created, one for each of the first three years at a school of pharmacy. The focus group discussions were audio recorded and transcribed for content analysis. Results. Ten instructional best practices were identified from the focus groups: setting the stage, consistency when team teaching, timeliness in posting materials, time on task, accountability for online activities, use of structured active learning, instructor use of feedback on student preparation, incorporation of student feedback into the course, short reviews of online material during class, and ensuring technologies are user friendly. Conclusion. Instructors using blended learning should consider incorporating these best practices into their course design and management. More evaluation is needed to see if implementation of these practices affects student performance.

Structural considerations for solar installers : an approach for small, simplified solar installations or retrofits.

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

Richards, Elizabeth H.; Schindel, Kay; Bosiljevac, Tom

2011-12-01

Structural Considerations for Solar Installers provides a comprehensive outline of structural considerations associated with simplified solar installations and recommends a set of best practices installers can follow when assessing such considerations. Information in the manual comes from engineering and solar experts as well as case studies. The objectives of the manual are to ensure safety and structural durability for rooftop solar installations and to potentially accelerate the permitting process by identifying and remedying structural issues prior to installation. The purpose of this document is to provide tools and guidelines for installers to help ensure that residential photovoltaic (PV) power systemsmore » are properly specified and installed with respect to the continuing structural integrity of the building.« less

Exploring family forest landowner diversity: Place, race, and gender in Alabama, United States

Treesearch

John Schelhas; Yaoqui Zhang; Robert Zabawa; Bin Zheng

2012-01-01

Family forestry is characterized by heterogeneity in ownership structure, owners’ objectives, and management practices. Differences among forest landowners by age and occupation have been regularly documented, but other social dimensions, such as race and gender, have received considerably less attention. We conducted exploratory research on racial and gender...

Increasing Physical Activity in Preschool: A Pilot Study to Evaluate Animal Trackers

ERIC Educational Resources Information Center

Williams, Christine L.; Carter, Betty Jean; Kibbe, Debra L.; Dennison, David

2009-01-01

Objective: This report describes a pilot study to evaluate Animal Trackers (AT), a preschool program designed to (1) increase structured physical activity (PA) during the preschool day; (2) increase practice of gross motor skills; (3) provide teachers with an easy-to-use PA program regardless of teacher experience; and (4) implement a teacher…

Growth and yield of white spruce plantations in the Lake States (a literature review).

Treesearch

H. Michael Rauscher

1984-01-01

This summary of the white spruce literature covers the structure, site relations, population dynamics, and cultural practices applicable to established plantations in the Lake States. The objective of this paper is to assemble and organize all information relevant to the silviculture, growth, and yield of white spruce plantations in the Lake States .

Single Concept Film Clip Project; Parts One and Two.

ERIC Educational Resources Information Center

Miller, Elwood E., Director

This project had a two-fold objective, namely to record on film aspects of a significant period in the history of education in the United States which had been reported almost entirely in print heretofore, and to organize and structure this information so as to link theory with practice, to the improvement of instruction generally when used in…

Music as Transitional Object and Practice: Children's Spontaneous Musical Behaviors in the Subway

ERIC Educational Resources Information Center

Custodero, Lori A.; Calì, Claudia; Diaz-Donoso, Adriana

2016-01-01

This study looks at children's music making in a public setting designed for society writ large. Although known to most children in the city, the subway presents a unique environment, both structurally predictable yet sonically dynamic; it is in continuous transition. Adopting Winnicott's psychoanalytical perspective, we make a case for viewing…

Dealing with Organizational Silos with Communities of Practice and Human Resource Management

ERIC Educational Resources Information Center

Forsten-Astikainen, Riitta; Hurmelinna-Laukkanen, Pia; Lämsä, Tuija; Heilmann, Pia; Hyrkäs, Elina

2017-01-01

Purpose: Organizational silos that build on the existing organizational structures are often considered to have negative effects in the form of focus on private narrow objectives and organizational fragmentation. To avoid such harmful outcomes, competence management is called for, and in this, the human resources (HR) function takes a key role.…

Complete denture impression techniques: evidence-based or philosophical.

PubMed

Singla, Shefali

2007-01-01

Code of practice is dangerous and ever-changing in today's world. Relating this to complete denture impression technique, we have been provided with a set of philosophies--"no pressure, minimal pressure, definite pressure and selective pressure". The objectives and principles of impression-making have been clearly defined. Do you think any philosophy can satisfy any operator to work on these principles and achieve these objectives? These philosophies take into consideration only the tissue part and not the complete basal seat, which comprises the periphery, the tissues and the bone structure. Under such circumstances, should we consider a code of practice dangerous or should we develop an evidence-based approach having a scientific background following certain principles, providing the flexibility to adapt to clinical procedures and to normal biological variations in patients rather than the rigidity imposed by strict laws?

European network for health technology assessment, EUnetHTA: planning, development, and implementation of a sustainable European network for health technology assessment.

PubMed

Kristensen, Finn Børlum; Mäkelä, Marjukka; Neikter, Susanna Allgurin; Rehnqvist, Nina; Håheim, Lise Lund; Mørland, Berit; Milne, Ruairidh; Nielsen, Camilla Palmhøj; Busse, Reinhard; Lee-Robin, Sun Hae; Wild, Claudia; Espallargues, Mireia; Chamova, Julia

2009-12-01

The European network on Health Technology Assessment (EUnetHTA) aimed to produce tangible and practical results to be used in the various phases of health technology assessment and to establish a framework and processes to support this. This article presents the background, objectives, and organization of EUnetHTA, which involved a total of sixty-four partner organizations. Establishing an effective and sustainable structure for a transnational network involved many managerial, policy, and methodological tools, according to the objective of each task or Work Package. Transparency in organization, financial transactions, and decision making was a key principle in the management of the Project as was the commitment to appropriately involve stakeholders. EUnetHTA activities resulted in a clear management and governance structure, efficient partnership, and transnational cooperation. The Project developed a model for sustainable continuation of the EUnetHTA Collaboration. The EUnetHTA Project achieved its goals by producing a suite of practical tools, a strong network, and plans for continuing the work in a sustainable EUnetHTA Collaboration that facilitates and promotes the use of HTA at national and regional levels. Responsiveness to political developments in Europe should be balanced with maintaining a high level of ambition to promote independent, evidence-based information and well-tested tools for best practice based on a strong network of HTA institutions.

Operationalizing Dynamic Ocean Management (DOM): Understanding the Incentive Structure, Policy and Regulatory Context for DOM in Practice

NASA Astrophysics Data System (ADS)

Lewison, R. L.; Saumweber, W. J.; Erickson, A.; Martone, R. G.

2016-12-01

Dynamic ocean management, or management that uses near real-time data to guide the spatial distribution of commercial activities, is an emerging approach to balance ocean resource use and conservation. Employing a wide range of data types, dynamic ocean management in a fisheries context can be used to meet multiple objectives - managing target quota, bycatch reduction, and reducing interactions with species of conservation concern. There is a growing list of DOM applications currently in practice in fisheries around the world, yet the approach is new enough that both fishers and fisheries managers are unclear how DOM can be applied to their fishery. Here, we use the experience from dynamic ocean management applications that are currently in practice to address the commonly asked question "How can dynamic management approaches be implemented in a traditionally managed fishery?". Combining knowledge from the DOM participants with a review of regulatory frameworks and incentive structures, stakeholder participation, and technological requirements of DOM in practice, we identify ingredients that have supported successful implementation of this new management approach.

Parenting style and practices in stepfamilies

PubMed Central

Cassoni, Cynthia; Caldana, Regina HL

2012-01-01

There are several studies on the best way to raise a child, ie, what would be the consequences of our actions for our children. We tend to think of how to educate children in a traditional family, but society has undergone many changes and, hence, family structures have undergone changes too. Today, we find a large number of stepfamilies facing the same issues concerning how to educate a child. Stepfamily configuration often entails more than just the addition of a new parent figure. The objective of this study was to shed some light on how these stepfamilies deal with issues of parenting style and practices. We reviewed the Brazilian and international literature concerning parenting styles and practices in stepfamilies. The papers identified were organized and submitted to analysis. We identified very few papers addressing parenting styles and practices, pointing to an important but unaddressed social change as reflected in new family structures. There is a need for longitudinal studies aimed at understanding not only a particular moment in time, but also moments within a context, ie, an analysis with a holistic approach without preconceived ideas. PMID:22977315

Best Practices in Establishing and Sustaining Consortia in Pharmacy Education

PubMed Central

Hincapie, Ana; Baugh, Gina; Rice, Luke; Sy, Erin; Penm, Jonathan; Albano, Christian

2017-01-01

Objective. To describe best practices, necessary resources, and success or lessons learned from established consortia in pharmacy education. Methods. Using semi-structured interviews and qualitative analysis, interviews with members of established consortia in pharmacy education were conducted until saturation was reached. Themes were analyzed and meaningful descriptions of consortia characteristics were developed using systematic text condensation. Results. Thirteen interviews were conducted. The primary purpose for forming a consortium was identified as threefold: share ideas/best practices; facilitate collaboration; and perform shared problem-solving. For experiential education consortia, two additional purposes were found: share capacity for practice sites, and promote standardization across programs. When investigating best practices for established consortia, three main themes were identified. These included strategies for: (1) relationship building within consortia, (2) successful outcomes of consortia, and (3) sustainability. Successful outcomes included scholarship and, sometimes, program standardization. Sustainability was linked to structure/support and momentum. Respect was considered the foundation for collaborative relationships to flourish in these consortia. Conclusions. Pharmacy education consortia form through a process that involves relationship building to produce outcomes that promote sustainability, which benefits both pharmacy schools and individual faculty members. Consortium formation is a viable, productive, and often necessary institutional goal for pharmacy schools. PMID:28381887

SKILLED BIMANUAL TRAINING DRIVES MOTOR CORTEX PLASTICITY IN CHILDREN WITH UNILATERAL CEREBRAL PALSY

PubMed Central

Friel, Kathleen M.; Kuo, Hsing-Ching; Fuller, Jason; Ferre, Claudio L.; Brandão, Marina; Carmel, Jason B.; Bleyenheuft, Yannick; Gowatsky, Jaimie L.; Stanford, Arielle D.; Rowny, Stefan B.; Luber, Bruce; Bassi, Bruce; Murphy, David LK; Lisanby, Sarah H.; Gordon, Andrew M.

2015-01-01

Background Intensive bimanual therapy can improve hand function in children with unilateral spastic cerebral palsy (USCP). We compared the effects of structured bimanual skill training vs. unstructured bimanual practice on motor outcomes and motor map plasticity in children with USCP. Objective We hypothesized that structured skill training would produce greater motor map plasticity than unstructured practice. Methods Twenty children with USCP (average age 9,5; 12 males) received therapy in a day-camp-setting, 6 h/day, 5 days/week, for 3 weeks. In structured skill training (n=10), children performed progressively more difficult movements and practiced functional goals. In unstructured practice (n=10), children engaged in bimanual activities but did not practice skillful movements or functional goals. We used the Assisting Hand Assessment (AHA), Jebsen-Taylor test of Hand Function (JTTHF) and Canadian Occupational Performance Measure (COPM) to measure hand function. We used single-pulse transcranial magnetic stimulation (TMS) to map the representation of first dorsal interosseous (FDI) and flexor carpi radialis (FCR) muscles bilaterally. Results Both groups showed significant improvements in bimanual hand use (AHA; p<0.05) and hand dexterity (JTTHF; p<0.001). However, only the structured skill group showed increases in the size of the affected hand motor map and amplitudes of motor evoked potentials (p<0.01). Most children who showed the most functional improvements (COPM) had the largest changes in map size. Conclusions These findings uncover a dichotomy of plasticity: the unstructured practice group improved hand function but did not show changes in motor maps. Skill training is important for driving motor cortex plasticity in children with USCP. PMID:26867559

Knowledge and practices towards influenza A (H1N1) among adults in three residential areas in Tampin Negeri Sembilan: a cross sectional survey.

PubMed

Zairina, A R; Nooriah, M S; Yunus, A Mohd

2011-08-01

A cross-sectional survey was conducted with the objective to explore a community's knowledge and practices towards prevention of Influenza A (H1N1) in three residential areas in Tampin. Respondents were randomly selected from a list of residences and interviewed face-to-face using a structured questionnaire. A total of 221 respondents (80.9%) were involved with the majority (64.7%) comprising female and who had attained secondary level of education (86.0%). The main source of information was from television/radio. The total score for knowledge questions was 15 and practice questions were 25. A total of 60.2% attained "adequate knowledge" and 52.0% "good practice". Mean (SD) for knowledge score was 11.6 (2.3) and practice was 18.1 (4.1). Ethnicity, education, income and practice score were identified as predictors for knowledge score. Income and knowledge scores were predictors for practice score. There was positive correlation between knowledge and practice scores.

Qualitative Analysis of Sexually Experienced Adolescent Females: Attitudes about Vaginal Health

PubMed Central

Francis, Jenny K R; Fraiz, Lauren Dapena; Catallozzi, Marina; Rosenthal, Susan L

2016-01-01

Structured Abstract Study Objective To explore adolescent’s perceptions of vaginal health, practices, and vaginally-placed products. Design Semi-structured interviews were audio-recorded and transcribed until achieving theoretical saturation. Setting Adolescent medicine clinics in NYC. Participants Adolescent females (n = 22) who were sexually experienced, predominately Hispanic (73%) with a mean age of 17.7 years (range 15–20 years). Interventions None Main Outcome Measures Interviews assessed perspectives on vaginal health, specific vaginal hygiene practices and attitudes about vaginally-placed products (contraceptive rings, intrauterine devices (IUDs), and proposed multi-purpose technologies (MPTs) administered as ring or gel). The interviews were transcribed and coded for relevant themes. Results Overlapping themes included young women’s view of their vagina as a space that needed to be healthy for sexual partners and future fertility. The vagina could not be presumed to be healthy and conversations about vaginal health were limited to only include specific individuals. All reported a variety of practices to maintain their vaginal health, including showering 1 to 5 times a day and using soaps specifically for the vagina. Attitudes about vaginally-placed products revealed concerns about the sensory experience of having a product in the vagina, safety concerns and interest in the product’s objective (prevention of pregnancy or infection). Conclusions Adolescents have very specific views and practices about their vaginas. Clinicians should initiate conversations about vaginal health and hygiene with adolescents and focus on the normalcy of the vagina. Development of vaginally-placed products should focus on the sensory experience, safety and purpose of the product. PMID:27133374

Evaluation of effectiveness of a paediatric simulation course in procedural skills for paediatric residents - A pilot study.

PubMed

AlShammari, Abdullah; Inayah, Aman; Afsar, Nasir Ali; Nurhussen, Akram; Siddiqui, Amna; Anwer, Muhammad Lucman; Obeidat, Sadek; Bakro, Mohammed Khaled; Abu Assale, Tawfik Samer; Almidani, Eyad; Alsonbul, Abdullah; Alhaider, Sami; Hussain, Ibrahim Bin; Khadawardi, Emad; Zafar, Muhammad

2018-02-01

To explore the effects of simulation training on paediatric residents' confidence and skills in managing advanced skills in critical care. The study was conducted at Alfaisal University, Riyadh, Saudi Arabia, from March to June 2016, and comprised junior residents in paediatrics. All paediatric residents (years 1 and 2) were recruited into two workshops, held one week apart. The first workshop covered lumbar puncture/ cerebrospinal fluid interpretation, oral intubation, bone marrow aspiration, and critical airway management. The second workshop covered chest tube insertion, pleural tap, insertion of central line, and arthrocentesis. The participants were surveyed using a 5-point Likert scale survey pre- and post-course, assessing their confidence. Their practical skills were assessed using a pre-objective structured clinical examination on the same day and post-course objective structured clinical examination a week later on selected skills. The outcome measures were: (1) pre-/post-course confidence rating, and (2) pre-/post-course objective structured clinical examination results. Data was analysed using SPSS 20. Of the 16 participants, 8(50%) were boys and 8(50%) girls. Besides, 13(81%) residents were in year-1 and 3(19%) in year-2. Median post-course confidence level ranks for all the skills were higher (p<0.05). There was no improvement in mean pre-objective structured clinical examination scores (2.31±2.66/ 7.46±3.02) and post- objective structured clinical examination scores (22.54±4.39/ 31.85±6.90) in Year 1 residents (p<0.001). Simulation course was significantly successful in improving residents' clinical skills and confidence in performing critical tasks.

Subjective experience or objective process: understanding the gap between values and practice for involving patients in designing patient-centred care.

PubMed

Lord, Laura; Gale, Nicola

2014-01-01

Patient-centred care and patient involvement are increasingly central concepts in health policy in the UK and elsewhere. However, there is little consensus regarding their definition or how to achieve "patient-centred" care in everyday practice or how to involve patients in service redesign initiatives. The purpose of this paper is to explore these issues from the perspective of key stakeholders within National Health Service (NHS) hospitals in the UK. Semi-structured interviews, covering a range of topics related to service redesign, were conducted with 77 key stakeholders across three NHS Trusts in the West Midlands. In total, 20 of these stakeholders were re-interviewed 18 months later. Data were managed and analysed using the Framework Method. While patient-centred care and patient involvement were regularly cited as important to the stakeholders, a gap persisted between values and reported practice. This gap is explained through close examination of the ways in which the concepts were used by stakeholders, and identifying the way in which they were adapted to fit other organizational priorities. The value placed on positive subjective experience changed to concerns about objective measurement of the patients as they move through the system. Increased awareness and reflection on the conceptual tensions between objective processes and subjective experiences could highlight reasons why patient-centred values fail to translate into improved practice. The paper describes and explains a previously unarticulated tension in health organisations between values and practice in patient centred care and patient involvement in service redesign.

Ruby-Helix: an implementation of helical image processing based on object-oriented scripting language.

PubMed

Metlagel, Zoltan; Kikkawa, Yayoi S; Kikkawa, Masahide

2007-01-01

Helical image analysis in combination with electron microscopy has been used to study three-dimensional structures of various biological filaments or tubes, such as microtubules, actin filaments, and bacterial flagella. A number of packages have been developed to carry out helical image analysis. Some biological specimens, however, have a symmetry break (seam) in their three-dimensional structure, even though their subunits are mostly arranged in a helical manner. We refer to these objects as "asymmetric helices". All the existing packages are designed for helically symmetric specimens, and do not allow analysis of asymmetric helical objects, such as microtubules with seams. Here, we describe Ruby-Helix, a new set of programs for the analysis of "helical" objects with or without a seam. Ruby-Helix is built on top of the Ruby programming language and is the first implementation of asymmetric helical reconstruction for practical image analysis. It also allows easier and semi-automated analysis, performing iterative unbending and accurate determination of the repeat length. As a result, Ruby-Helix enables us to analyze motor-microtubule complexes with higher throughput to higher resolution.

Recognition-induced forgetting is not due to category-based set size.

PubMed

Maxcey, Ashleigh M

2016-01-01

What are the consequences of accessing a visual long-term memory representation? Previous work has shown that accessing a long-term memory representation via retrieval improves memory for the targeted item and hurts memory for related items, a phenomenon called retrieval-induced forgetting. Recently we found a similar forgetting phenomenon with recognition of visual objects. Recognition-induced forgetting occurs when practice recognizing an object during a two-alternative forced-choice task, from a group of objects learned at the same time, leads to worse memory for objects from that group that were not practiced. An alternative explanation of this effect is that category-based set size is inducing forgetting, not recognition practice as claimed by some researchers. This alternative explanation is possible because during recognition practice subjects make old-new judgments in a two-alternative forced-choice task, and are thus exposed to more objects from practiced categories, potentially inducing forgetting due to set-size. Herein I pitted the category-based set size hypothesis against the recognition-induced forgetting hypothesis. To this end, I parametrically manipulated the amount of practice objects received in the recognition-induced forgetting paradigm. If forgetting is due to category-based set size, then the magnitude of forgetting of related objects will increase as the number of practice trials increases. If forgetting is recognition induced, the set size of exemplars from any given category should not be predictive of memory for practiced objects. Consistent with this latter hypothesis, additional practice systematically improved memory for practiced objects, but did not systematically affect forgetting of related objects. These results firmly establish that recognition practice induces forgetting of related memories. Future directions and important real-world applications of using recognition to access our visual memories of previously encountered objects are discussed.

Parallel-vector computation for structural analysis and nonlinear unconstrained optimization problems

NASA Technical Reports Server (NTRS)

Nguyen, Duc T.

1990-01-01

Practical engineering application can often be formulated in the form of a constrained optimization problem. There are several solution algorithms for solving a constrained optimization problem. One approach is to convert a constrained problem into a series of unconstrained problems. Furthermore, unconstrained solution algorithms can be used as part of the constrained solution algorithms. Structural optimization is an iterative process where one starts with an initial design, a finite element structure analysis is then performed to calculate the response of the system (such as displacements, stresses, eigenvalues, etc.). Based upon the sensitivity information on the objective and constraint functions, an optimizer such as ADS or IDESIGN, can be used to find the new, improved design. For the structural analysis phase, the equation solver for the system of simultaneous, linear equations plays a key role since it is needed for either static, or eigenvalue, or dynamic analysis. For practical, large-scale structural analysis-synthesis applications, computational time can be excessively large. Thus, it is necessary to have a new structural analysis-synthesis code which employs new solution algorithms to exploit both parallel and vector capabilities offered by modern, high performance computers such as the Convex, Cray-2 and Cray-YMP computers. The objective of this research project is, therefore, to incorporate the latest development in the parallel-vector equation solver, PVSOLVE into the widely popular finite-element production code, such as the SAP-4. Furthermore, several nonlinear unconstrained optimization subroutines have also been developed and tested under a parallel computer environment. The unconstrained optimization subroutines are not only useful in their own right, but they can also be incorporated into a more popular constrained optimization code, such as ADS.

Object-Oriented Multi-Disciplinary Design, Analysis, and Optimization Tool

NASA Technical Reports Server (NTRS)

Pak, Chan-gi

2011-01-01

An Object-Oriented Optimization (O3) tool was developed that leverages existing tools and practices, and allows the easy integration and adoption of new state-of-the-art software. At the heart of the O3 tool is the Central Executive Module (CEM), which can integrate disparate software packages in a cross platform network environment so as to quickly perform optimization and design tasks in a cohesive, streamlined manner. This object-oriented framework can integrate the analysis codes for multiple disciplines instead of relying on one code to perform the analysis for all disciplines. The CEM was written in FORTRAN and the script commands for each performance index were submitted through the use of the FORTRAN Call System command. In this CEM, the user chooses an optimization methodology, defines objective and constraint functions from performance indices, and provides starting and side constraints for continuous as well as discrete design variables. The structural analysis modules such as computations of the structural weight, stress, deflection, buckling, and flutter and divergence speeds have been developed and incorporated into the O3 tool to build an object-oriented Multidisciplinary Design, Analysis, and Optimization (MDAO) tool.

A resource oriented webs service for environmental modeling

NASA Astrophysics Data System (ADS)

Ferencik, Ioan

2013-04-01

Environmental modeling is a largely adopted practice in the study of natural phenomena. Environmental models can be difficult to build and use and thus sharing them within the community is an important aspect. The most common approach to share a model is to expose it as a web service. In practice the interaction with this web service is cumbersome due to lack of standardized contract and the complexity of the model being exposed. In this work we investigate the use of a resource oriented approach in exposing environmental models as web services. We view a model as a layered resource build atop the object concept from Object Oriented Programming, augmented with persistence capabilities provided by an embedded object database to keep track of its state and implementing the four basic principles of resource oriented architectures: addressability, statelessness, representation and uniform interface. For implementation we use exclusively open source software: Django framework, dyBase object oriented database and Python programming language. We developed a generic framework of resources structured into a hierarchy of types and consequently extended this typology with recurses specific to the domain of environmental modeling. To test our web service we used cURL, a robust command-line based web client.

Orbital assembly and maintenance study. Executive summary. [space erectable structures/structural design criteria

NASA Technical Reports Server (NTRS)

Gorman, D.; Grant, C.; Kyrias, G.; Lord, C.; Rombach, J. P.; Salis, M.; Skidmore, R.; Thomas, R.

1975-01-01

A sound, practical approach for the assembly and maintenance of very large structures in space is presented. The methods and approaches for assembling two large structures are examined. The maintenance objectives include the investigation of methods to maintain five geosynchronous satellites. The two assembly examples are a 200-meter-diameter radio astronomy telescope and a 1,000-meter-diameter microwave power transmission system. The radio astronomy telescope operates at an 8,000-mile altitude and receives RF signals from space. The microwave power transmission system is part of a solar power satellite that will be used to transmit converted solar energy to microwave ground receivers. Illustrations are included.

Solid, Cystic, and Tubular: Novice Ultrasound Skills Training Using a Versatile, Affordable Practice Model.

PubMed

Sevak, Shruti; Lurvey, Benjamin; Woodfin, Ashley A; Hothem, Zachary; Callahan, Rose E; Robbins, James; Ziegler, Kathryn

2018-04-09

In spite of the recognized benefits of ultrasound, many physicians have little experience with using ultrasound to perform procedures. Many medical schools and residency programs lack a formal ultrasound training curriculum. We describe an affordable ultrasound training curriculum and versatile, inexpensive practice model. Participants underwent a didactic session to teach the theory required to perform ultrasound-guided procedures. Motor skills were taught using a practice model incorporating analogs of common anatomic and pathologic structures into an opacified gelatin substrate. The Marcia and Eugene Applebaum Simulation Learning Institute, Beaumont Hospital, Royal Oak, MI; a private nonprofit tertiary care hospital associated with the OUWB School of Medicine, Rochester, MI. The model was tested in a cohort of 50 medical students and general surgery residents. The gelatin model can be constructed for $1.03 per learner. The solid, cystic, and vascular structural analogs were readily identifiable on ultrasound and easily differentiated based on their echotextures. Eighty-four percent of participants successfully aspirated the cystic structure, 88% successfully biopsied a portion of the solid structure, and 76% successfully cannulated the tubular structure. Overall, 82% of participants achieved a passing score for the exercise based on a validated Objective Structured Assessment of Technical Skill instrument. There were no significant differences between the medical students and residents. This model can be used to teach basic ultrasound skills such as aspiration, biopsy, and vessel cannulation, providing a foundation for the use of ultrasound in a broad range of clinical procedures, as well as providing practice opportunities for medical students and residents to gain increased ultrasound competency and confidence. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Analysis of ehealth search perspectives among female college students in the health professions using Q methodology.

PubMed

Stellefson, Michael; Hanik, Bruce; Chaney, J Don; Tennant, Bethany

2012-04-27

The current "Millennial Generation" of college students majoring in the health professions has unprecedented access to the Internet. Although some research has been initiated among medical professionals to investigate the cognitive basis for health information searches on the Internet, little is known about Internet search practices among health and medical professional students. To systematically identify health professional college student perspectives of personal eHealth search practices. Q methodology was used to examine subjective perspectives regarding personal eHealth search practices among allied health students majoring in a health education degree program. Thirteen (n = 13) undergraduate students were interviewed about their attitudes and experiences conducting eHealth searches. From the interviews, 36 statements were used in a structured ranking task to identify clusters and determine which specific perceptions of eHealth search practices discriminated students into different groups. Scores on an objective measure of eHealth literacy were used to help categorize participant perspectives. Q-technique factor analysis of the rankings identified 3 clusters of respondents with differing views on eHealth searches that generally coincided with participants' objective eHealth literacy scores. The proficient resourceful students (pattern/structure coefficient range 0.56-0.80) described themselves as using multiple resources to obtain eHealth information, as opposed to simply relying on Internet search engines. The intermediate reluctant students (pattern/structure coefficient range 0.75-0.90) reported engaging only Internet search engines to locate eHealth information, citing undeveloped evaluation skills when considering sources of information located on the Internet. Both groups of advanced students reported not knowing how to use Boolean operators to conduct Internet health searches. The basic hubristic students (pattern/structure coefficient range 0.54-0.76) described themselves as independent procrastinators when searching for eHealth information. Interestingly, basic hubristic students represented the only cluster of participants to describe themselves as (1) having received instruction on using the Internet to conduct eHealth searches, and (2) possessing relative confidence when completing a search task. Subjective perspectives of eHealth search practices differed among students possessing different levels of eHealth literacy. These multiple perspectives present both challenges and opportunities for empowering college students in the health professions to use the Internet to obtain and appraise evidence-based health information using the Internet.

Bridging Class and Field: Field Instructors' and Liaisons' Reactions to Information about Students' Baseline Performance Derived from Simulated Interviews

ERIC Educational Resources Information Center

Bogo, Marion; Lee, Barbara; McKee, Eileen; Ramjattan, Roxanne; Baird, Stephanie L.

2017-01-01

To strengthen students' preparation for engaging in field learning, an innovation was implemented to teach and assess foundation-year students' performance prior to entering field education. An Objective Structured Clinical Examination informed the final evaluation of students' performance in two companion courses on practice theory and skills.…

Job-Embedded Professional Development: How School Leaders Create and Support the Structures for Improved Teacher Effectiveness

ERIC Educational Resources Information Center

Hussey, Maureen P.

2013-01-01

This study was an exploration of the steps school leaders take when creating site-based professional support for school-based staff. The objective was to learn the steps taken by school leaders to implement job-embedded professional development practices and to identify the impact those steps had on the teachers, the students, and the school…

Comparing the effectiveness of thinning and prescribed fire for modifying structure in dry coniferous forests

Treesearch

Richy J. Harrod; Nicholas A. Povak; David W. Peterson

2007-01-01

Forest thinning and prescribed fires are the main practices used by managers to address concerns over ecosystem degradation and severe wildland fire potential in dry forests of the Western United States. There is some debate, however, about treatment effectiveness in meeting management objectives as well as their ecological consequences. This study assesses the...

Dynamics of a temperate deciduous forest under landscape-scale management: Implications for adaptability to climate change

Treesearch

Matthew G. Olson; Benjamin O. Knapp; John M. Kabrick

2017-01-01

Landscape forest management is an approach to meeting diverse objectives that collectively span multiple spatial scales. It is critical that we understand the long-term effects of landscape management on the structure and composition of forest tree communities to ensure that these practices are sustainable. Furthermore, it is increasingly important to also consider...

Parenting, Peer Orientation, Drug Use, and Antisocial Behavior in Late Adolescence: A Cross-National Study

ERIC Educational Resources Information Center

Claes, Michel; Lacourse, Eric; Ercolani, Anna-Paula; Pierro, Antonio; Leone, Luigi; Presaghi, Fabio

2005-01-01

The objective of this study was to investigate the links between maternal and paternal bonding, parental practices, orientation toward peers, and the prevalence of drug use and antisocial behavior during late adolescence. A model was tested using structural equation modeling in order to verify the robustness of the investigated links across 3…

Continuous Practice-Based Research on the Use of Standardized Patients: Experience from Shanghai Medical College of Fudan University

ERIC Educational Resources Information Center

Zeng, Yong; Wu, Yan; Lai, Yanni; Lu, Yingqing; Zou, Hejian; Feng, Xueshan

2014-01-01

In the past ten years, the objective structured clinical examination (OSCE) project team of the Shanghai Medical College of Fudan University has continuously conducted further study on the development and maintenance of standardized patients and their application in teaching. The team carried out a series of randomized controlled studies on the…

Preservice teachers' objectives and their experience of practical work

NASA Astrophysics Data System (ADS)

Nivalainen, V.; Asikainen, M. A.; Hirvonen, P. E.

2013-06-01

This study explores third-year preservice physics teachers’ (n=32) views concerning the objectives of practical work at school and university. Content analysis of their essays about practical work revealed not only the objectives of the practical work undertaken but also how they had experienced teaching as school and university students. The objectives most commonly referred to were related to the connections between theory and practice, motivation, understanding phenomena, learning how to observe, and learning how to report. In contrast, some objectives were recognized only rarely, which is an important issue for discussion as a future challenge. Preservice teachers’ positive experiences of practical work resulted from the successful implementation of practical work. According to our findings, practical work can in many cases be regarded as successful, especially when the participants understand the objectives of the teaching. In contrast, negative experiences reflected failures or difficulties in implementation. We conclude by suggesting that preservice teachers should be offered opportunities to reflect on their previous experiences and to see and experience in practice the advantages of practical work.

The Professional Culture of Community Pharmacy and the Provision of MTM Services.

PubMed

Rosenthal, Meagen M; Holmes, Erin R

2018-03-21

The integration of advanced pharmacy services into community pharmacy practice is not complete. According to implementation research understanding professional culture, as a part of context, may provide insights for accelerating this process. There are three objectives in this study. The first objective of this study was to validate an adapted version of an organizational culture measure in a sample of United States' (US) community pharmacists. The second objective was to examine potential relationships between the cultural factors identified using the validated instrument and a number of socialization and education variables. The third objective was to examine any relationships between the scores on the identified cultural factors and the provision of MTM services. This study was a cross-sectional online survey for community pharmacists in the southeastern US. The survey contained questions on socialization/education, respondents' self-reported provision of medication therapy management (MTM) services, and the organizational culture profile (OCP). Analyses included descriptive statistics, a principle components analysis (PCA), independent samples t-test, and multivariate ordinal regression. A total of 303 surveys were completed. The PCA revealed a six-factor structure: social responsibility, innovation, people orientation, competitiveness, attention to detail, and reward orientation. Further analysis revealed significant relationships between social responsibility and years in practice, and people orientation and attention to detail and pharmacists' training and practice setting. Significant positive relationships were observed between social responsibility, innovation, and competitiveness and the increased provision of MTM services. The significant relationships identified between the OCP factors and community pharmacist respondents' provision of MTM services provides an important starting point for developing interventions to improve the uptake of practice change opportunities.

Teaching and assessing procedural skills: a qualitative study

PubMed Central

2013-01-01

Background Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them. Methods Focus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed. Results Residents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills. Conclusions The acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs. PMID:23672617

Comparative study of representations of professional autonomy produced by first and last-period undergraduate nursing students 1

PubMed Central

dos Santos, Érick Igor; Gomes, Antonio Marcos Tosoli; Marques, Sergio Corrêa; Ramos, Raquel de Souza; da Silva, Aline Cerqueira Santos Santana; de Oliveira, Francimar Tinoco

2017-01-01

ABSTRACT Objective: to compare the social representations of professional nurse autonomy produced by first and last-period undergraduate nursing students. Method: qualitative, descriptive and exploratory study, based on the structural approach of social representations, the Central Core Theory, carried out with 171 students from three federal public universities, using the free association technique on the object “professional nurse autonomy”. The data were submitted to EVOC 2005 software and to similarity analysis. Results: care was the central core of the representational structure identified among the students of the first period. Among last-period students, knowledge stood out as a core element. The term responsibility was identified as common to both central cores. Conclusion: regarding professional autonomy, the results point to an overlapping process of the reified and consensual universes during the undergraduate course. However, responsibility, inherent in the profession, remains cross-sectional. For the first period students, autonomy is resignified in a practical and attitudinal way, whereas for the last period students, the knowledge acquired stimulates them to assign meaning to professional autonomy with a cognitive and attitudinal representation. The data can support the use of innovative teaching practices in nursing undergraduate courses.

Development of framework for sustainable Lean implementation: an ISM approach

NASA Astrophysics Data System (ADS)

Jadhav, Jagdish Rajaram; Mantha, S. S.; Rane, Santosh B.

2014-07-01

The survival of any organization depends upon its competitive edge. Even though Lean is one of the most powerful quality improvement methodologies, nearly two-thirds of the Lean implementations results in failures and less than one-fifth of those implemented have sustained results. One of the most significant tasks of top management is to identify, understand and deploy the significant Lean practices like quality circle, Kanban, Just-in-time purchasing, etc. The term `bundle' is used to make groups of inter-related and internally consistent Lean practices. Eight significant Lean practice bundles have been identified based on literature reviewed and opinion of the experts. The order of execution of Lean practice bundles is very important. Lean practitioners must be able to understand the interrelationship between these practice bundles. The objective of this paper is to develop framework for sustainable Lean implementation using interpretive structural modelling approach.

A nurse-led model of chronic disease management in general practice: Patients' perspectives.

PubMed

Young, Jacqueline; Eley, Diann; Patterson, Elizabeth; Turner, Catherine

2016-12-01

Evidence suggests that current models of chronic disease management within general practice are not effective in meeting the needs of the community. The objective of this article is to examine patients' perceptions of a nurse-led collaborative model of care trialled in three general practices in Australia. This article reports on the second phase of a mixed-methods study in which semi-structured interviews with purposively selected patients were conducted to elicit information about their perceptions of nurse-led care. Three themes emerged from the data - time, ambiance and dimensions of the nurse role. The results suggest that general practice nurses had a positive impact on patients' ability to manage their chronic disease. This infers that there is scope for general practice nurses to expand their role in chronic disease management to assist patients to better self-manage their chronic diseases.

Basic practical skills teaching and learning in undergraduate medical education – a review on methodological evidence

PubMed Central

Vogel, Daniela; Harendza, Sigrid

2016-01-01

Objective: Practical skills are an essential part of physicians’ daily routine. Nevertheless, medical graduates’ performance of basic skills is often below the expected level. This review aims to identify and summarize teaching approaches of basic practical skills in undergraduate medical education which provide evidence with respect to effective students’ learning of these skills. Methods: Basic practical skills were defined as basic physical examination skills, routine skills which get better with practice, and skills which are also performed by nurses. We searched PubMed with different terms describing these basic practical skills. In total, 3467 identified publications were screened and 205 articles were eventually reviewed for eligibility. Results: 43 studies that included at least one basic practical skill, a comparison of two groups of undergraduate medical students and effects on students’ performance were analyzed. Seven basic practical skills and 15 different teaching methods could be identified. The most consistent results with respect to effective teaching and acquisition of basic practical skills were found for structured skills training, feedback, and self-directed learning. Simulation was effective with specific teaching methods and in several studies no differences in teaching effects were detected between expert or peer instructors. Multimedia instruction, when used in the right setting, also showed beneficial effects for basic practical skills learning. Conclusion: A combination of voluntary or obligatory self-study with multimedia applications like video clips in combination with a structured program including the possibility for individual exercise with personal feedback by peers or teachers might provide a good learning opportunity for basic practical skills. PMID:27579364

An exploration of student nurses' thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE).

PubMed

Paul, Fiona

2010-09-01

Cardiopulmonary resuscitation (CPR) is an essential skill taught within undergraduate nursing programmes. At the author's institution, students must pass the CPR objective structured clinical examination (OSCE) before progressing to second year. However, some students have difficulties developing competence in CPR and evidence suggests that resuscitation skills may only be retained for several months. This has implications for practice as nurses are required to be competent in CPR. Therefore, further opportunities for students to develop these skills are necessary. An action research project was conducted with six students who were assessed by an examiner at a video-recorded mock OSCE. Students self-assessed their skills using the video and a checklist. Semi-structured interviews were conducted to compare checklist scores, and explore students' thoughts and experiences of the OSCE. The findings indicate that students may need to repeat this exercise by comparing their previous and current performances to develop both their self-assessment and CPR skills. Although there were some differences between the examiner's and student's checklist scores, all students reported the benefits of participating in this project, e.g. discussion and identification of knowledge and skills deficits, thus emphasising the benefits of formative assessments to prepare students for summative assessments and ultimately clinical practice. (c) 2010 Elsevier Ltd. All rights reserved.

Optics and materials research for controlled radiant energy transfer in buildings

NASA Astrophysics Data System (ADS)

Goldner, R. B.

1983-11-01

The overall objective of the Tufts research program was to identify and attempt to solve some of the key materials problems associated with practical approaches for achieving controlled radiant energy transfer (CRET) through building windows and envelopes, so as to decrease heating and cooling loads in buildings. Major accomplishments included: the identification of electrochromic (EC)-based structures as the preferred structures for achieving CRET; the identification of modulated reflectivity as the preferred mode of operation for EC-based structures; demonstration of the feasibility of operating EC-materials in a modulated R(lambda) mode; and demonstration of the applicability of free electron model to colored polycrystalline WO3 films.

Block-structured grids for complex aerodynamic configurations: Current status

NASA Technical Reports Server (NTRS)

Vatsa, Veer N.; Sanetrik, Mark D.; Parlette, Edward B.

1995-01-01

The status of CFD methods based on the use of block-structured grids for analyzing viscous flows over complex configurations is examined. The objective of the present study is to make a realistic assessment of the usability of such grids for routine computations typically encountered in the aerospace industry. It is recognized at the very outset that the total turnaround time, from the moment the configuration is identified until the computational results have been obtained and postprocessed, is more important than just the computational time. Pertinent examples will be cited to demonstrate the feasibility of solving flow over practical configurations of current interest on block-structured grids.

Languages for artificial intelligence: Implementing a scheduler in LISP and in Ada

NASA Technical Reports Server (NTRS)

Hays, Dan

1988-01-01

A prototype scheduler for space experiments originally programmed in a dialect of LISP using some of the more traditional techniques of that language, was recast using an object-oriented LISP, Common LISP with Flavors on the Symbolics. This object-structured version was in turn partially implemented in Ada. The Flavors version showed a decided improvement in both speed of execution and readability of code. The recasting into Ada involved various practical problems of implementation as well as certain challenges of reconceptualization in going from one language to the other. Advantages were realized, however, in greater clarity of the code, especially where more standard flow of control was used. This exercise raised issues about the influence of programming language on the design of flexible and sensitive programs such as schedule planners, and called attention to the importance of factors external to the languages themselves such as system embeddedness, hardware context, and programmer practice.

Covering of Discrete Quasiperiodic Sets: Concepts and Theory

NASA Astrophysics Data System (ADS)

Kramer, Peter

The packing of congruent, convex, impenetrable bodies in 3-space has obvious practical applications. Tilings are, in a sense, optimal packings, leaving no space between the bodies. Their applications range from practical tilings or tessellations of walls and areas of ground, through structure determination in crystallography and the physics of crystalline matter, to aperiodic tilings and to the mathematical analysis of topological manifolds and their applications in cosmology. In many applications, a local motif is uniquely related to a body or geometric object. The geometric arrangement then generates a pattern with this motif. In covering, one allows the overlap of the geometric objects. This survey of approaches to covering shows the variety of pathways opened up in this new field. In the theory of covering there arise a number of distinctions, some of which will be taken up in the other contributions to this book.

The use of objective structured self-assessment and peer-feedback (OSSP) for learning communication skills: evaluation using a controlled trial.

PubMed

Perera, Jennifer; Mohamadou, Galy; Kaur, Satpal

2010-05-01

Feedback is essential to guide students towards expected performance goals. The usefulness of teacher feedback on improving communication skills (CS) has been well documented. It has been proposed that self-assessment and peer-feedback has an equally important role to play in enhancing learning. This is the focus of this study. Objectively structured self-assessment and peer feedback (OSSP) was incorporated into small group CS teaching sessions of a group of semester one medical students who were learning CS for the first time, to minimise the influence of previous educational interventions. A control group matched for academic performance, gender and age was used to enable parallel evaluation of the innovation. A reflective log containing closed and open ended questions was used for OSSP. Facilitators and simulated patients provided feedback to students in both groups during CS learning as per routine practice. Student perceptions on OSSP and acceptability as a learning method were explored using a questionnaire. CS were assessed in both groups using objective structured clinical examination (OSCE) as per routine practice and assessors were blinded as to which group the student belonged. Mean total score and scores for specific areas of interview skills were significantly higher in the experimental group. Analysis of the questionnaire data showed that students gained fresh insights into specific areas such as empathy, addressing patients' concerns and interview style during OSSP which clearly corroborated the specific differences in scores. The free text comments were highly encouraging as to acceptability of OSSP, in spite of 67% being never exposed to formal self- and peer-assessment during pre-university studies. OSSP promotes effective CS learning and learner acceptability is high.

A Virtual Practice Environment to Develop Communication Skills in Pharmacy Students

PubMed Central

Styles, Kim; Duncan, Greg

2012-01-01

Objective. To develop communication skills in second-year pharmacy students using a virtual practice environment (VPE) and to assess students’ and tutors’ (instructors’) experiences. Design. A VPE capable of displaying life-sized photographic and video images and representing a pharmacy setting was constructed. Students viewed prescriptions and practiced role-playing with each other and explored the use of nonverbal communication in patient-pharmacist interactions. The VPE experiences were complemented with lectures, reflective journaling, language and learning support, and objective structured clinical examinations (OSCEs). Assessment. Most students believed the VPE was a useful teaching resource (87%) and agreed that the video component enabled them to contextualize patient problems (73%). While 45% of students questioned the usefulness of watching the role plays between students after they were video recorded, most (90%) identified improvement in their own communication as a result of participating in the tutorials. Most tutors felt comfortable using the technology. Focus group participants found the modified tutorials more engaging and aesthetically positive than in their previous experience. Conclusion. The VPE provided an effective context for communication skills development classes. PMID:23275667

[The possibilities of forensic medical assessment of the wounds caused by discharges of 9 millimeter air rifles (pre-charge pneumatics)].

PubMed

Makarov, I Iu; Raĭzberg, S A

2012-01-01

The data available from the forensic medical practice do not allow the comprehensive, objective, and reliable assessment of injuries to the human body and damages to the clothes inflicted by the shots from a 9 millimeter (.357) or higher-caliber pneumatic rifle equipped with the pre-charge pneumatic system. The use of bullets of specific structure and configuration for such weapons accounts for their marked influence on the morphological features and the extent of the resulting wounds. These peculiarities provide a basis for the objective differentiation between their injurious effects.

Governance for clinical decision support: case studies and recommended practices from leading institutions

PubMed Central

Sittig, Dean F; Ash, Joan S; Bates, David W; Feblowitz, Joshua; Fraser, Greg; Maviglia, Saverio M; McMullen, Carmit; Nichol, W Paul; Pang, Justine E; Starmer, Jack; Middleton, Blackford

2011-01-01

Objective Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study. Design Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems. Measurements Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys. Results Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted. Conclusion Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support. PMID:21252052

Role of Social Knowledge Networking technology in facilitating meaningful use of Electronic Health Record medication reconciliation.

PubMed

Rangachari, Pavani

2016-06-01

Despite the federal policy impetus towards EHR Medication Reconciliation, hospital adherence has lagged for one chief reason; low physician engagement, which in turn emanates from lack of consensus in regard to which physician is responsible for managing a patient's medication list, and the importance of medication reconciliation as a tool for improving patient safety and quality of care. The Technology-in-Practice (TIP) framework stresses the role of human action in enacting structures of technology use or "technologies-in-practice." Applying the TIP framework to the EHR Medication Reconciliation context, helps frame the problem as one of low physician engagement in performing EHR Medication Reconciliation, translating to limited-use-EHR-in-practice. Concurrently, the problem suggests a hierarchical network structure, reflecting limited communication among hospital administrators and clinical providers on the importance of EHR Medication Reconciliation in improving patient safety. Integrating the TIP literature with the more recent knowledge-in-Practice (KIP) literature suggests that EHR-in-practice could be transformed from "limited use" to "meaningful use" through the use of Social Knowledge Networking (SKN) Technology to create new social network structures, and enable engagement, learning, and practice change. Correspondingly, the objectives of this paper are to: 1) Conduct a narrative review of the literature on "technology use," to understand how technologies-in-practice may be transformed from limited use to meaningful use; 2) Conduct a narrative review of the literature on "organizational change implementation," to understand how changes in technology use could be successfully implemented and sustained in a healthcare organizational context; and 3) Apply lessons learned from the narrative literature reviews to identify strategies for the meaningful use and successful implementation of EHR Medication Reconciliation technology.

A Qualitative Study Exploring Community Yoga Practice in Adults with Rheumatoid Arthritis

PubMed Central

Greysen, Heather M.; Greysen, S. Ryan; Lee, Kathryn A.; Hong, Oi Saeng; Katz, Patricia; Leutwyler, Heather

2017-01-01

Abstract Objective: Yoga may improve physical function and reduce disease symptoms in adults with rheumatoid arthritis (RA). However, little is known about how patients with RA are practicing yoga in the community. The objective of this qualitative study was to explore community yoga practice characteristics and thoughts about yoga practice for adults with RA. Design: Participants completed a semi-structured telephone interview with open-ended questions. Thematic analysis was used to analyze interview transcripts. Participants: A convenience sample of 17 adults with rheumatologist-diagnosed RA who had participated in yoga within the past year were asked about the decision to start, continue, and stop yoga; the perceived benefits of yoga; components of yoga sessions; and general thoughts about yoga as it relates to RA. Results: Although eight different styles of yoga were practiced, commonalities in yoga class components (such as stretching, strengthening, deep breathing, meditation, and positive messaging from the instructor) reveal examples of preferred types of yoga for patients with RA. Three main themes emerged, each with multiple subthemes: (1) motivators (physical fitness, influence of others, reduced price), (2) barriers (cost, symptom burden, class difficulty), and (3) benefits of yoga practice (mind–body, a tool for coping, pride/achievement, social, and “yoga meets you where you are”). Conclusion: In this study, patients with RA described how yoga practice helped improve physical and psychosocial symptoms related to their disease. Yoga practice, a dynamic exercise, encompassing many different styles, can provide many benefits for adults with RA; however, yoga may not be beneficial for every adult with RA. PMID:28075155

Active vibration absorber for CSI evolutionary model: Design and experimental results

NASA Technical Reports Server (NTRS)

Bruner, Anne M.; Belvin, W. Keith; Horta, Lucas G.; Juang, Jer-Nan

1991-01-01

The development of control of large flexible structures technology must include practical demonstration to aid in the understanding and characterization of controlled structures in space. To support this effort, a testbed facility was developed to study practical implementation of new control technologies under realistic conditions. The design is discussed of a second order, acceleration feedback controller which acts as an active vibration absorber. This controller provides guaranteed stability margins for collocated sensor/actuator pairs in the absence of sensor/actuator dynamics and computational time delay. The primary performance objective considered is damping augmentation of the first nine structural modes. Comparison of experimental and predicted closed loop damping is presented, including test and simulation time histories for open and closed loop cases. Although the simulation and test results are not in full agreement, robustness of this design under model uncertainty is demonstrated. The basic advantage of this second order controller design is that the stability of the controller is model independent.

Structural engineering masters level education framework of knowledge for the needs of initial professional practice

NASA Astrophysics Data System (ADS)

Balogh, Zsuzsa Enriko

For at least the last decade, engineering, civil engineering, along with structural engineering as a profession within civil engineering, have and continue to face an emerging need for "Raising the Bar" of preparedness of young engineers seeking to become practicing professional engineers. The present consensus of the civil engineering profession is that the increasing need for broad and in-depth knowledge should require the young structural engineers to have at least a Masters-Level education. This study focuses on the Masters-Level preparedness in the structural engineering area within the civil engineering field. It follows much of the methodology used in the American Society of Civil Engineers (ASCE) Body of Knowledge determination for civil engineering and extends this type of study to better define the portion of the young engineers preparation beyond the undergraduate program for one specialty area of civil engineering. The objective of this research was to create a Framework of Knowledge for the young engineer which identifies and recognizes the needs of the profession, along with the profession's expectations of how those needs can be achieved in the graduate-level academic setting, in the practice environment, and through lifelong learning opportunities with an emphasis on the initial five years experience past completion of a Masters program in structural engineering. This study applied a modified Delphi method to obtain the critical information from members of the structural engineering profession. The results provide a Framework of Knowledge which will be useful to several groups seeking to better ensure the preparedness of the future young structural engineers at the Masters-Level.

National evaluation of the benefits and risks of greater structuring and coding of the electronic health record: exploratory qualitative investigation

PubMed Central

Morrison, Zoe; Fernando, Bernard; Kalra, Dipak; Cresswell, Kathrin; Sheikh, Aziz

2014-01-01

Objective We aimed to explore stakeholder views, attitudes, needs, and expectations regarding likely benefits and risks resulting from increased structuring and coding of clinical information within electronic health records (EHRs). Materials and methods Qualitative investigation in primary and secondary care and research settings throughout the UK. Data were derived from interviews, expert discussion groups, observations, and relevant documents. Participants (n=70) included patients, healthcare professionals, health service commissioners, policy makers, managers, administrators, systems developers, researchers, and academics. Results Four main themes arose from our data: variations in documentation practice; patient care benefits; secondary uses of information; and informing and involving patients. We observed a lack of guidelines, co-ordination, and dissemination of best practice relating to the design and use of information structures. While we identified immediate benefits for direct care and secondary analysis, many healthcare professionals did not see the relevance of structured and/or coded data to clinical practice. The potential for structured information to increase patient understanding of their diagnosis and treatment contrasted with concerns regarding the appropriateness of coded information for patients. Conclusions The design and development of EHRs requires the capture of narrative information to reflect patient/clinician communication and computable data for administration and research purposes. Increased structuring and/or coding of EHRs therefore offers both benefits and risks. Documentation standards within clinical guidelines are likely to encourage comprehensive, accurate processing of data. As data structures may impact upon clinician/patient interactions, new models of documentation may be necessary if EHRs are to be read and authored by patients. PMID:24186957

Quality assurance program requirements, Amendment 5 (9-26-79) to August 1973 issue

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

Not Available

This standard sets forth general requirements for planning, managing, conducting, and evaluating quality assurance programs for reactor development and test facility projects and associated processes, structures, components, and systems. These quality assurance requirements are based on proven practices and provide the means of control and verification whereby those responsible fo poject management can assure that the quality required for safe, reliable, and economical operation will be achieved. The objective of the program of the programs covered by this standard is to assure that structures, components, systems, and facilities are designed, developed, manufactured, constructed, operated, and maintained in compliance with establishedmore » engineering criteria. To achieve this objective, controls are to be established and implemented at predetermined points, and necessary action taken to prevent, detect, and correct any deficiencies.« less

Do quality indicators for general practice teaching practices predict good outcomes for students?

PubMed

Bartlett, Maggie; Potts, Jessica; McKinley, Bob

2016-07-01

Keele medical students spend 113 days in general practices over our five-year programme. We collect practice data thought to indicate good quality teaching. We explored the relationships between these data and two outcomes for students; Objective Structured Clinical Examination (OSCE) scores and feedback regarding the placements. Though both are surrogate markers of good teaching, they are widely used. We collated practice and outcome data for one academic year. Two separate statistical analyses were carried out: (1) to determine how much of the variation seen in the OSCE scores was due to the effect of the practice and how much to the individual student. (2) to identify practice characteristics with a relationship to student feedback scores. (1) OSCE performance: 268 students in 90 practices: six quality indicators independently influenced the OSCE score, though without linear relationships and not to statistical significance. (2) Student satisfaction: 144 students in 69 practices: student feedback scores are not influenced by practice characteristics. The relationships between the quality indicators we collect for practices and outcomes for students are not clear. It may be that neither the quality indicators nor the outcome measures are reliable enough to inform decisions about practices' suitability for teaching.

Imparting Desired Attributes by Optimization in Structural Design

NASA Technical Reports Server (NTRS)

Sobieszczanski-Sobieski, Jaroslaw; Venter, Gerhard

2003-01-01

Commonly available optimization methods typically produce a single optimal design as a Constrained minimum of a particular objective function. However, in engineering design practice it is quite often important to explore as much of the design space as possible with respect to many attributes to find out what behaviors are possible and not possible within the initially adopted design concept. The paper shows that the very simple method of the sum of objectives is useful for such exploration. By geometrical argument it is demonstrated that if every weighting coefficient is allowed to change its magnitude and its sign then the method returns a set of designs that are all feasible, diverse in their attributes, and include the Pareto and non-Pareto solutions, at least for convex cases. Numerical examples in the paper include a case of an aircraft wing structural box with thousands of degrees of freedom and constraints, and over 100 design variables, whose attributes are structural mass, volume, displacement, and frequency. The method is inherently suitable for parallel, coarse-grained implementation that enables exploration of the design space in the elapsed time of a single structural optimization.

Cost of Equity Estimation in Fuel and Energy Sector Companies Based on CAPM

NASA Astrophysics Data System (ADS)

Kozieł, Diana; Pawłowski, Stanisław; Kustra, Arkadiusz

2018-03-01

The article presents cost of equity estimation of capital groups from the fuel and energy sector, listed at the Warsaw Stock Exchange, based on the Capital Asset Pricing Model (CAPM). The objective of the article was to perform a valuation of equity with the application of CAPM, based on actual financial data and stock exchange data and to carry out a sensitivity analysis of such cost, depending on the financing structure of the entity. The objective of the article formulated in this manner has determined its' structure. It focuses on presentation of substantive analyses related to the core of equity and methods of estimating its' costs, with special attention given to the CAPM. In the practical section, estimation of cost was performed according to the CAPM methodology, based on the example of leading fuel and energy companies, such as Tauron GE and PGE. Simultaneously, sensitivity analysis of such cost was performed depending on the structure of financing the company's operation.

Using the Intervention Mapping Protocol to develop an online video intervention for parents to prevent childhood obesity: Movie Models.

PubMed

De Lepeleere, Sara; Verloigne, Maïté; Brown, Helen Elizabeth; Cardon, Greet; De Bourdeaudhuij, Ilse

2016-08-08

The increasing prevalence of childhood overweight/obesity caused by an unhealthy diet, insufficient physical activity (PA) and high levels of sedentary behaviour (SB) is a prominent public health concern. Parenting practices may contribute to healthy behaviour change in children, but well-researched examples are limited. The aim of this study is to describe the systematic development of an intervention for parents to prevent childhood overweight/obesity through the improvement of parenting practices. The six steps of the Intervention Mapping Protocol (IMP), a theory- and evidence-based tool to develop health-related interventions, were used as a framework to develop the 'Movie Models' programme. In Step 1, a needs assessment was performed to better understand the health problem of overweight/obesity in children and its association with diet, PA and SB. In Step 2, the programme goal (increasing the adoption of effective parenting practices) was sub-divided into performance objectives. Change objectives, which specify explicit actions required to accomplish the performance objectives, were also identified. Step 3 included the selection of theoretical methods (e.g. 'modelling' and 'images'), which were then translated into the practical strategy of online parenting videos. Step 4 comprised the development of a final intervention framework, and Step 5 included the planning of programme adoption and implementation. The final phase, Step 6, included the development of an effect- and process-evaluation plan. The IMP was used to structure the development of 'Movie Models', an intervention targeting specific parenting practices related to children's healthy diet, PA, SB, and parental self-efficacy. A clear framework for process analyses is offered, which aims to increase the potential effectiveness of an intervention and can be useful for those developing health promotion programmes. © The Author(s) 2016.

Risky traditional practices and prevention of mother-to-child transmission of HIV: the case of Chiota community in Zimbabwe.

PubMed

Nyati-Jokomo, Zibusiso; January, James; Ruparanganda, Watch; Chitsike, Inam

2016-01-01

The objective of this study was to explore cultural practices that could expose babies to HIV infection during the postnatal period in Chiota community in Zimbabwe. Purposively selected and gender disaggregated members of the community (n = 231) were informants to 23 focus group discussions and 8 semi-structured key-informant interviews. Data were analysed thematically. Emerging themes relating to risky practices were rituals surrounding open fontanelle, toning of child's sexual libido, initiation of sex after childbirth, treatment of eye and ear infections, tongue-tie and pre-mastication. These practices exposed babies to bodily fluids such as saliva, breast milk, vaginal fluids, pre-cum and semen which in turn put the babies at low to high risk of contracting HIV. This paper discusses implications for these risky practices in prevention of mother-to-child transmission of HIV. There is, therefore, need for studies to establish the prevalence of these practices.

Do primary health centres and hospitals contribute equally towards achievement of the transversal clinical competencies of medical students? Performance on the Objective Structured Clinical Examination (OSCE) in competency acquisition.

PubMed

Soler-González, Jorge; Buti, Miquel; Boada, Jordi; Ayala, Victoria; Peñascal, Eduard; Rodriguez, Toni

2016-01-01

The adaptation of the educational programmes of European faculties of medicine to the European Higher Education Area guidelines has focused curricula design on competence acquisition. Competencies are defined as the achievements of a predetermined level of efficacy in real-world scenarios. Our objective was to assess whether performance on a common competence evaluation test, the Objective Structured Clinical Examination (OSCE), resulted in different scores for second-year students after a practical medical training course took place in a primary health centre (PHC) or in a hospital. A descriptive study was conducted during the 2010-2014 academic year of the OSCE test scores obtained by all second-year students. Faculty of Medicine at the University of Lleida (Catalonia, Spain). We performed a correlation analysis between students who completed their practical medical training at the PHC and hospitals utilising Student's t-test for comparison of means. 423 students who completed internships at the PHC and at hospitals obtained OSCE mean scores of 7.32 (SD; IC) (0.82; 7.18-7.47) points and 7.17 (0.83; 6.07-7.26) points, respectively (p=0.07). Second-year medical students acquired similar competency levels in the two analysed training scenarios. The two areas both serve their teaching purpose. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Effect of an Educational Intervention Related to Health and Nutrition on Pregnant Women in the Villages of Central Java Province, Indonesia

ERIC Educational Resources Information Center

Wijaya-Erhardt, Maria; Muslimatun, Siti; Erhardt, Juergen G.

2014-01-01

Objective: To assess the effects of a health and nutrition educational intervention on maternal knowledge, attitudes and practices. Design: Pre- and post-test design using structured interviews of pregnant women. Setting: Thirty-nine villages in Central Java Province, Indonesia. Method: Pregnant women (N = 252) at 12-20 weeks of gestation were…

Thinning and prescribed fire effects on overstory tree and snag structure in dry coniferous forests of the interior Pacific Northwest

Treesearch

Richy J. Harrod; David W. Peterson; Nicholas A. Povak; Erich Kyle Dodson

2009-01-01

Forest thinning and prescribed fires are practices used by managers to address concerns over ecosystem degradation and severe wildland fire potential in dry forests. There is some debate, however, about treatment effectiveness in meeting management objectives as well as their ecological consequences. The purpose of this study was to assess changes to forest stand...

Longleaf Pine Root System Development and Seedling Quality in Response to Copper Root Pruning and Cavity Size

Treesearch

Mary Anne Sword Sayer; Shi-Jean Susana Sung; James D. Haywood

2011-01-01

Cultural practices that modify root system structure in the plug of container-grown seedlings have the potential to improve root system function after planting. Our objective was to assess how copper root pruning affects the quality and root system development of longleaf pine seedlings grown in three cavity sizes in a greenhouse. Copper root pruning increased seedling...

Using Simulation in Assessment and Teaching: OSCE Adapted for Social Work

ERIC Educational Resources Information Center

Bogo, Marion; Rawlings, Mary; Katz, Ellen; Logie, Carmen

2014-01-01

This detailed book by the most experienced authors in the field describes how to develop and implement the objective structured clinical examination (OSCE) for social work education. In addition to a wealth of practical material in the appendices, two videos produced especially for this book (accessible online) show the OSCE process step-by-step.…

Fabrication process scale-up and optimization for a boron-aluminum composite radiator

NASA Technical Reports Server (NTRS)

Okelly, K. P.

1973-01-01

Design approaches to a practical utilization of a boron-aluminum radiator for the space shuttle orbiter are presented. The program includes studies of laboratory composite material processes to determine the feasibility of a structural and functional composite radiator panel, and to estimate the cost of its fabrication. The objective is the incorporation of boron-aluminum modulator radiator on the space shuttle.

Introduction of structural health and safety monitoring warning systems for Shenzhen-Hong Kong Western Corridor Shenzhen Bay Bridge

NASA Astrophysics Data System (ADS)

Li, N.; Zhang, X. Y.; Zhou, X. T.; Leng, J.; Liang, Z.; Zheng, C.; Sun, X. F.

2008-03-01

Though the brief introduction of the completed structural health and safety monitoring warning systems for Shenzhen-Hongkong western corridor Shenzhen bay highway bridge (SZBHMS), the self-developed system frame, hardware and software scheme of this practical research project are systematically discussed in this paper. The data acquisition and transmission hardware and the basic software based on the NI (National Instruments) Company virtual instruments technology were selected in this system, which adopted GPS time service receiver technology and so on. The objectives are to establish the structural safety monitoring and status evaluation system to monitor the structural responses and working conditions in real time and to analyze the structural working statue using information obtained from the measured data. It will be also provided the scientific decision-making bases for the bridge management and maintenance. Potential technical approaches to the structural safety warning systems, status identification and evaluation method are presented. The result indicated that the performance of the system has achieved the desired objectives, ensure the longterm high reliability, real time concurrence and advanced technology of SZBHMS. The innovate achievement which is the first time to implement in domestic, provide the reference for long-span bridge structural health and safety monitoring warning systems design.

Judging adaptive management practices of U.S. agencies.

PubMed

Fischman, Robert L; Ruhl, J B

2016-04-01

All U.S. federal agencies administering environmental laws purport to practice adaptive management (AM), but little is known about how they actually implement this conservation tool. A gap between the theory and practice of AM is revealed in judicial decisions reviewing agency adaptive management plans. We analyzed all U.S. federal court opinions published through 1 January 2015 to identify the agency AM practices courts found most deficient. The shortcomings included lack of clear objectives and processes, monitoring thresholds, and defined actions triggered by thresholds. This trio of agency shortcuts around critical, iterative steps characterizes what we call AM-lite. Passive AM differs from active AM in its relative lack of management interventions through experimental strategies. In contrast, AM-lite is a distinctive form of passive AM that fails to provide for the iterative steps necessary to learn from management. Courts have developed a sophisticated understanding of AM and often offer instructive rather than merely critical opinions. The role of the judiciary is limited by agency discretion under U.S. administrative law. But courts have overturned some agency AM-lite practices and insisted on more rigorous analyses to ensure that the promised benefits of structured learning and fine-tuned management have a reasonable likelihood of occurring. Nonetheless, there remains a mismatch in U.S. administrative law between the flexibility demanded by adaptive management and the legal objectives of transparency, public participation, and finality. © 2015 Society for Conservation Biology.

Clinical competency evaluation of Brazilian chiropractic interns

PubMed Central

Facchinato, Ana Paula A.; Benedicto, Camila C.; Mora, Aline G.; Cabral, Dayane M.C.; Fagundes, Djalma J.

2015-01-01

Objective This study compares the results of an objective structured clinical examination (OSCE) between 2 groups of students before an internship and after 6 months of clinical practice in an internship. Methods Seventy-two students participated, with 36 students in each cohort. The OSCEs were performed in the simulation laboratory before the participants' clinical practice internship and after 6 months of the internship. Students were tested in 9 stations for clinical skills and knowledge. The same procedures were repeated for both cohorts. The t test was used for unpaired parametric samples and Fisher's exact test was used for comparison of proportions. Results There was no difference in the mean final score between the 2 groups (p = .34 for test 1; p = .08 for test 2). The performance of the students in group 1 was not significantly different when performed before and after 6 months of clinical practice, but in group 2 there was a significant decrease in the average score after 6 months of clinical practice. Conclusions There was no difference in the cumulative average score for the 2 groups before and after 6 months of clinical practice in the internship. There were differences within the cohorts, however, with a significant decrease in the average score in group 2. Issues pertaining to test standardization and student motivation for test 2 may have influenced the scores. PMID:25588200

A hybrid method for evaluating enterprise architecture implementation.

PubMed

Nikpay, Fatemeh; Ahmad, Rodina; Yin Kia, Chiam

2017-02-01

Enterprise Architecture (EA) implementation evaluation provides a set of methods and practices for evaluating the EA implementation artefacts within an EA implementation project. There are insufficient practices in existing EA evaluation models in terms of considering all EA functions and processes, using structured methods in developing EA implementation, employing matured practices, and using appropriate metrics to achieve proper evaluation. The aim of this research is to develop a hybrid evaluation method that supports achieving the objectives of EA implementation. To attain this aim, the first step is to identify EA implementation evaluation practices. To this end, a Systematic Literature Review (SLR) was conducted. Second, the proposed hybrid method was developed based on the foundation and information extracted from the SLR, semi-structured interviews with EA practitioners, program theory evaluation and Information Systems (ISs) evaluation. Finally, the proposed method was validated by means of a case study and expert reviews. This research provides a suitable foundation for researchers who wish to extend and continue this research topic with further analysis and exploration, and for practitioners who would like to employ an effective and lightweight evaluation method for EA projects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessment of photoselective vaporization of prostate skills during Urology Objective Structured Clinical Examinations (OSCE)

PubMed Central

Noureldin, Yasser A.; Elkoushy, Mohamed A.; Fahmy, Nader; Carrier, Serge; Elhilali, Mostafa M.; Andonian, Sero

2015-01-01

Introduction: We evaluated the use of the GreenLight Simulator (GL-SIM) (American Medical Systems, Guelph, ON) in the skill assessment of postgraduate trainees (PGTs) in photoselective vaporization of the prostate (PVP). We also sought to determine whether previous PVP experience or GL-SIM practice improved performance. Methods: PGTs in postgraduate years (PGY-3 to PGY-5) from all 4 Quebec urology training programs were recruited during 2 annual Objective Structured Clinical Examinations (OSCEs). During a 20-minute OSCE station, PGTs were asked to perform 2 exercises: (1) identification of endoscopic landmarks and (2) a PVP of a 30-g normal prostate. Grams vaporized, global scores, and number of correct anatomical landmarks were recorded and correlated with PGY level, practice on the GL-SIM, and previous PVP experience. Results: In total, 25 PGTs were recruited at each OSCE, with 13 PGTs participating in both OSCEs. When comparing scores from the first and second OSCEs, there was a significant improvement in the number of grams vaporized (2.9 vs. 4.3 g; p = 0.003) and global score (100 vs. 165; p = 0.03). There was good correlation between the number of previously performed PVPs and the global score (r = 0.4, p = 0.04). Similarly, PGTs with previous practice on the GL-SIM had significantly higher global score (100.6 vs. 162.6; p = 0.04) and grams vaporized (3.1 vs. 4.1 g; p = 0.04) when compared with those who did not practice on GL-SIM. Furthermore, there were significantly more competent PGTs among those who had previously practiced on the GL-SIM (32.7% vs. 10.2%; p = 0.009). PGY level did not significantly affect grams vaporized or global score (p > 0.05). Conclusion: Performance on the GL-SIM at OSCEs significantly correlated with previous practice on the GL-SIM and previous PVP experience rather than PGY level. Furthermore, there were significantly more competent PGTs among those who had previously practiced on the GL-SIM. PMID:25737763

Self-Care Practices among Diabetes Patients in Addis Ababa: A Qualitative Study

PubMed Central

Tewahido, Dagmawit; Berhane, Yemane

2017-01-01

Background Self-care practices that include self-monitoring of blood sugar level, diet management, physical exercise, adherence to medications, and foot care are the cornerstones of diabetes management. However, very little is known about self-care in developing countries where the prevalence of diabetes is increasing. Objective The objective of this study was to describe self-care practices among individuals with type II diabetes in Addis Ababa, Ethiopia. Methods A qualitative method was used to gather data from type II diabetes patients. Patients were recruited from the outpatient diabetes clinics of two public hospitals in Addis Ababa. Data were collected using a semi structured interview guide. A thematic analysis approach was used to process the data. Results Overall self-care practices were not adequate. Most patients reported irregular self-monitoring of blood sugar. Dietary and physical exercise recommendations were inadequately practiced by most of the participants. Most patients better adhered to medication prescriptions. Patients generally lack proper information/knowledge regarding the importance of self-care and how it should be implemented. Based on reported behavior we identified three main categories of patients; which are those ‘endeavor to be compliant’, ‘confused’ and ‘negligent’. Conclusion Diabetes patients largely depend on prescribed medications to control their blood sugar level. The importance of proper self-care practices for effective management of diabetes is not adequately emphasized in diabetes care centers and patients lack sufficient knowledge for proper self-care. PMID:28045992

Approach for Structurally Clearing an Adaptive Compliant Trailing Edge Flap for Flight

NASA Technical Reports Server (NTRS)

Miller, Eric J.; Lokos, William A.; Cruz, Josue; Crampton, Glen; Stephens, Craig A.; Kota, Sridhar; Ervin, Gregory; Flick, Pete

2015-01-01

The Adaptive Compliant Trailing Edge (ACTE) flap was flown on the National Aeronautics and Space Administration (NASA) Gulfstream GIII testbed at the NASA Armstrong Flight Research Center. This smoothly curving flap replaced the existing Fowler flaps creating a seamless control surface. This compliant structure, developed by FlexSys Inc. in partnership with the Air Force Research Laboratory, supported NASA objectives for airframe structural noise reduction, aerodynamic efficiency, and wing weight reduction through gust load alleviation. A thorough structures airworthiness approach was developed to move this project safely to flight. A combination of industry and NASA standard practice require various structural analyses, ground testing, and health monitoring techniques for showing an airworthy structure. This paper provides an overview of compliant structures design, the structural ground testing leading up to flight, and the flight envelope expansion and monitoring strategy. Flight data will be presented, and lessons learned along the way will be highlighted.

Environmentally Preferable Coatings for Structural Steel Project

NASA Technical Reports Server (NTRS)

Lewis, Pattie L. (Editor)

2014-01-01

The Ground Systems Development and Operations (GSDO) Program at NASA John F. Kennedy Space Center (KSC) has the primary objective of modernizing and transforming the launch and range complex at KSC to benefit current and future NASA programs along with other emerging users. Described a the "launch support and infrastructure modernization program" in the NASA Authorization Act of 2010, the GSDO Program will develop and implement shared infrastructure and process improvements to provide more flexible, affordable, and responsive capabilities to a multi-user community. In support of the GSDO Program, the objective of this project is to determine the feasibility of environmentally friendly corrosion resistant coatings for launch facilities and ground support equipment. The focus of the project is corrosion resistance and survivability with the goal to reduce the amount of maintenance required to preserve the performance of launch facilities while reducing mission risk. Number of facilities/structures with metallic structural and non-structural components in a highly corrosive environment. Metals require periodic maintenance activity to guard against the insidious effects of corrosion and thus ensure that structures meet or exceed design or performance life. The standard practice for protecting metallic substrates in atmospheric environments is the application of corrosion protective coating system.

Visual completion from 2D cross-sections: Implications for visual theory and STEM education and practice.

PubMed

Gagnier, Kristin Michod; Shipley, Thomas F

2016-01-01

Accurately inferring three-dimensional (3D) structure from only a cross-section through that structure is not possible. However, many observers seem to be unaware of this fact. We present evidence for a 3D amodal completion process that may explain this phenomenon and provide new insights into how the perceptual system processes 3D structures. Across four experiments, observers viewed cross-sections of common objects and reported whether regions visible on the surface extended into the object. If they reported that the region extended, they were asked to indicate the orientation of extension or that the 3D shape was unknowable from the cross-section. Across Experiments 1, 2, and 3, participants frequently inferred 3D forms from surface views, showing a specific prior to report that regions in the cross-section extend straight back into the object, with little variance in orientation. In Experiment 3, we examined whether 3D visual inferences made from cross-sections are similar to other cases of amodal completion by examining how the inferences were influenced by observers' knowledge of the objects. Finally, in Experiment 4, we demonstrate that these systematic visual inferences are unlikely to result from demand characteristics or response biases. We argue that these 3D visual inferences have been largely unrecognized by the perception community, and have implications for models of 3D visual completion and science education.

A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage scheme.

PubMed

Pongpirul, Krit; Walker, Damian G; Winch, Peter J; Robinson, Courtland

2011-04-08

In the Thai Universal Coverage health insurance scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group-based retrospective payment, for which quality of the diagnosis and procedure codes is crucial. However, there has been limited understandings on which health care professions are involved and how the diagnosis and procedure coding is actually done within hospital settings. The objective of this study is to detail hospital coding structure and process, and to describe the roles of key hospital staff, and other related internal dynamics in Thai hospitals that affect quality of data submitted for inpatient care reimbursement. Research involved qualitative semi-structured interview with 43 participants at 10 hospitals chosen to represent a range of hospital sizes (small/medium/large), location (urban/rural), and type (public/private). Hospital Coding Practice has structural and process components. While the structural component includes human resources, hospital committee, and information technology infrastructure, the process component comprises all activities from patient discharge to submission of the diagnosis and procedure codes. At least eight health care professional disciplines are involved in the coding process which comprises seven major steps, each of which involves different hospital staff: 1) Discharge Summarization, 2) Completeness Checking, 3) Diagnosis and Procedure Coding, 4) Code Checking, 5) Relative Weight Challenging, 6) Coding Report, and 7) Internal Audit. The hospital coding practice can be affected by at least five main factors: 1) Internal Dynamics, 2) Management Context, 3) Financial Dependency, 4) Resource and Capacity, and 5) External Factors. Hospital coding practice comprises both structural and process components, involves many health care professional disciplines, and is greatly varied across hospitals as a result of five main factors.

A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage Scheme

PubMed Central

2011-01-01

Background In the Thai Universal Coverage health insurance scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group-based retrospective payment, for which quality of the diagnosis and procedure codes is crucial. However, there has been limited understandings on which health care professions are involved and how the diagnosis and procedure coding is actually done within hospital settings. The objective of this study is to detail hospital coding structure and process, and to describe the roles of key hospital staff, and other related internal dynamics in Thai hospitals that affect quality of data submitted for inpatient care reimbursement. Methods Research involved qualitative semi-structured interview with 43 participants at 10 hospitals chosen to represent a range of hospital sizes (small/medium/large), location (urban/rural), and type (public/private). Results Hospital Coding Practice has structural and process components. While the structural component includes human resources, hospital committee, and information technology infrastructure, the process component comprises all activities from patient discharge to submission of the diagnosis and procedure codes. At least eight health care professional disciplines are involved in the coding process which comprises seven major steps, each of which involves different hospital staff: 1) Discharge Summarization, 2) Completeness Checking, 3) Diagnosis and Procedure Coding, 4) Code Checking, 5) Relative Weight Challenging, 6) Coding Report, and 7) Internal Audit. The hospital coding practice can be affected by at least five main factors: 1) Internal Dynamics, 2) Management Context, 3) Financial Dependency, 4) Resource and Capacity, and 5) External Factors. Conclusions Hospital coding practice comprises both structural and process components, involves many health care professional disciplines, and is greatly varied across hospitals as a result of five main factors. PMID:21477310

Communication in production animal medicine: modelling a complex interaction with the example of dairy herd health medicine

PubMed Central

2011-01-01

Background The importance of communication skills in veterinary medicine is increasingly recognised. Appropriate communication skills towards the client are of utmost importance in both companion animal practice and production animal field and consultancy work. The need for building a relationship with the client, alongside developing a structure for the consultation is widely recognised and applies to both types of veterinary practice. Results Veterinary advisory practice in production animal medicine is, however, characterised by a more complex communication on different levels. While the person-orientated communication is a permanent process between veterinarian and client with a rather personal perspective and defines the roles of interaction, the problem-orientated communication deals with emerging difficulties; the objective is to solve an acute health problem. The solution - orientated communication is a form of communication in which both veterinarian and client address longstanding situations or problems with the objective to improve herd health and subsequently productivity performance. All three forms of communication overlap. Conclusions Based on this model, it appears useful for a veterinary practice to offer both a curative and an advisory service, but to keep these two separated when deemed appropriate. In veterinary education, the strategies and techniques necessary for solution orientated communication should be included in the teaching of communication skills. PMID:21777495

Communication in production animal medicine: modelling a complex interaction with the example of dairy herd health medicine.

PubMed

Kleen, Joachim L; Atkinson, Owen; Noordhuizen, Jos Ptm

2011-07-20

The importance of communication skills in veterinary medicine is increasingly recognised. Appropriate communication skills towards the client are of utmost importance in both companion animal practice and production animal field and consultancy work. The need for building a relationship with the client, alongside developing a structure for the consultation is widely recognised and applies to both types of veterinary practice. Veterinary advisory practice in production animal medicine is, however, characterised by a more complex communication on different levels. While the person-orientated communication is a permanent process between veterinarian and client with a rather personal perspective and defines the roles of interaction, the problem-orientated communication deals with emerging difficulties; the objective is to solve an acute health problem. The solution - orientated communication is a form of communication in which both veterinarian and client address longstanding situations or problems with the objective to improve herd health and subsequently productivity performance. All three forms of communication overlap. Based on this model, it appears useful for a veterinary practice to offer both a curative and an advisory service, but to keep these two separated when deemed appropriate. In veterinary education, the strategies and techniques necessary for solution orientated communication should be included in the teaching of communication skills.

Pharmacy practice simulations: performance of senior pharmacy students at a University in southern Brazil

PubMed Central

Galato, Dayani; Alano, Graziela M.; Trauthman, Silvana C.; França, Tainã F.

Objective A simulation process known as objective structured clinical examination (OSCE) was applied to assess pharmacy practice performed by senior pharmacy students. Methods A cross-sectional study was conducted based on documentary analysis of performance evaluation records of pharmacy practice simulations that occurred between 2005 and 2009. These simulations were related to the process of self-medication and dispensing, and were performed with the use of patients simulated. The simulations were filmed to facilitate the evaluation process. It presents the OSCE educational experience performed by pharmacy trainees of the University of Southern Santa Catarina and experienced by two evaluators. The student general performance was analyzed, and the criteria for pharmacy practice assessment often identified trainees in difficulty. Results The results of 291 simulations showed that students have an average yield performance of 70.0%. Several difficulties were encountered, such as the lack of information about the selected/prescribed treatment regimen (65.1%); inadequate communication style (21.9%); lack of identification of patients’ needs (7.7%) and inappropriate drug selection for self-medication (5.3%). Conclusions These data show that there is a need for reorientation of clinical pharmacy students because they need to improve their communication skills, and have a deeper knowledge of medicines and health problems in order to properly orient their patients. PMID:24367467

Practical Strategies for Integrating Final Ecosystem Goods and ...

EPA Pesticide Factsheets

The concept of Final Ecosystem Goods and Services (FEGS) explicitly connects ecosystem services to the people that benefit from them. This report presents a number of practical strategies for incorporating FEGS, and more broadly ecosystem services, into the decision-making process. Whether a decision process is in early or late stages, or whether a process includes informal or formal decision analysis, there are multiple points where ecosystem services concepts can be integrated. This report uses Structured Decision Making (SDM) as an organizing framework to illustrate the role ecosystem services can play in a values-focused decision-process, including: • Clarifying the decision context: Ecosystem services can help clarify the potential impacts of an issue on natural resources together with their spatial and temporal extent based on supply and delivery of those services, and help identify beneficiaries for inclusion as stakeholders in the deliberative process. • Defining objectives and performance measures: Ecosystem services may directly represent stakeholder objectives, or may be means toward achieving other objectives. • Creating alternatives: Ecosystem services can bring to light creative alternatives for achieving other social, economic, health, or general well-being objectives. • Estimating consequences: Ecosystem services assessments can implement ecological production functions (EPFs) and ecological benefits functions (EBFs) to link decision alt

English Validation of the Parental Socialization Scale—ESPA29

PubMed Central

Martínez, Isabel; Cruise, Edie; García, Óscar F.; Murgui, Sergio

2017-01-01

Parenting styles have traditionally been studied following the classical two-dimensional orthogonal model of parental socialization. The Parental Socialization Scale ESPA29 is used to measure the four styles of parental socialization through the acceptance/involvement and strictness/imposition dimensions. The ESPA29 scale is a developmentally appropriate measure of parenting styles, which has been validated in several languages including Spanish, Italian, and Brazilian Portuguese. In this study, the English translation of the ESPA29 was evaluated. The objective of the work is to test the ESPA29’s structure of parenting practices with a United States sample measuring parenting practices using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The scores of fathers’ and mothers’ behavioral practices toward their children were obtained for a sample of 911 United States adolescents between 14 and 18 years of age. First, the total sample was split and a principal components analysis with varimax rotation was carried out with one of the two halves. EFA showed a two-factor structure fully congruent with the theoretical model for mothers’ and fathers’ scores. Next, a CFA was calculated on the second half by using the factor structure obtained in the previous EFA. The CFA replicated the two-factor structure with appropriate fit index. The seven parenting practices that were measured loaded appropriately on the acceptance/involvement and strictness/imposition dimensions. Then, the multigroup analysis between girls and boys showed equal loading in the factors and equal covariation between the acceptance/involvement and the strictness/imposition dimensions. Additionally, the two dimensions of the ESPA29 scale were related to self-esteem in order to obtain an external validity index. The findings confirm the invariant structure of the ESPA29 was in the United States and their equivalence in both fathers’ and mothers’ scores. These findings validate the instrument and confirm its applicability in cross-cultural research on parenting practices and child adjustment. PMID:28611711

English Validation of the Parental Socialization Scale-ESPA29.

PubMed

Martínez, Isabel; Cruise, Edie; García, Óscar F; Murgui, Sergio

2017-01-01

Parenting styles have traditionally been studied following the classical two-dimensional orthogonal model of parental socialization. The Parental Socialization Scale ESPA29 is used to measure the four styles of parental socialization through the acceptance/involvement and strictness/imposition dimensions. The ESPA29 scale is a developmentally appropriate measure of parenting styles, which has been validated in several languages including Spanish, Italian, and Brazilian Portuguese. In this study, the English translation of the ESPA29 was evaluated. The objective of the work is to test the ESPA29's structure of parenting practices with a United States sample measuring parenting practices using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The scores of fathers' and mothers' behavioral practices toward their children were obtained for a sample of 911 United States adolescents between 14 and 18 years of age. First, the total sample was split and a principal components analysis with varimax rotation was carried out with one of the two halves. EFA showed a two-factor structure fully congruent with the theoretical model for mothers' and fathers' scores. Next, a CFA was calculated on the second half by using the factor structure obtained in the previous EFA. The CFA replicated the two-factor structure with appropriate fit index. The seven parenting practices that were measured loaded appropriately on the acceptance/involvement and strictness/imposition dimensions. Then, the multigroup analysis between girls and boys showed equal loading in the factors and equal covariation between the acceptance/involvement and the strictness/imposition dimensions. Additionally, the two dimensions of the ESPA29 scale were related to self-esteem in order to obtain an external validity index. The findings confirm the invariant structure of the ESPA29 was in the United States and their equivalence in both fathers' and mothers' scores. These findings validate the instrument and confirm its applicability in cross-cultural research on parenting practices and child adjustment.

Inhibition Plasticity in Older Adults: Practice and Transfer Effects Using a Multiple Task Approach.

PubMed

Wilkinson, Andrea J; Yang, Lixia

2016-01-01

OBJECTIVE. To examine plasticity of inhibition, as indexed by practice effects of inhibition tasks and the associated transfer effects, using a multiple task approach in healthy older adults. METHOD. Forty-eight healthy older adults were evenly assigned to either a practice group or a no-contact control group. All participants completed pretest (2.5 hours) and posttest (2 hours) sessions, with a 2-week interval in between. During the 2-week interval, only the practice group completed six 30-minute practice sessions (three sessions per week for two consecutive weeks) of three lab-based inhibition tasks. RESULTS. All three inhibition tasks demonstrated significant improvement across practice sessions, suggesting practice-induced plasticity. The benefit, however, only transferred to near-near tasks. The results are inconclusive with regard to the near-far and far-far transfer effects. DISCUSSION. This study further extends literature on practice effects of inhibition in older adults by using a multiple task approach. Together with previous work, the current study suggests that older adults are able to improve inhibition performance through practice and transfer the practice gains to tasks that overlap in both target cognitive ability and task structure (i.e., near-near tasks).

Inhibition Plasticity in Older Adults: Practice and Transfer Effects Using a Multiple Task Approach

PubMed Central

Wilkinson, Andrea J.; Yang, Lixia

2016-01-01

Objective. To examine plasticity of inhibition, as indexed by practice effects of inhibition tasks and the associated transfer effects, using a multiple task approach in healthy older adults. Method. Forty-eight healthy older adults were evenly assigned to either a practice group or a no-contact control group. All participants completed pretest (2.5 hours) and posttest (2 hours) sessions, with a 2-week interval in between. During the 2-week interval, only the practice group completed six 30-minute practice sessions (three sessions per week for two consecutive weeks) of three lab-based inhibition tasks. Results. All three inhibition tasks demonstrated significant improvement across practice sessions, suggesting practice-induced plasticity. The benefit, however, only transferred to near-near tasks. The results are inconclusive with regard to the near-far and far-far transfer effects. Discussion. This study further extends literature on practice effects of inhibition in older adults by using a multiple task approach. Together with previous work, the current study suggests that older adults are able to improve inhibition performance through practice and transfer the practice gains to tasks that overlap in both target cognitive ability and task structure (i.e., near-near tasks). PMID:26885407

Optics and materials research for controlled radiant energy transfer in buildings

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

Goldner, R.B.

1983-11-01

The overall objective of the Tufts research program was to identify and attempt to solve some of the key materials problems associated with practical approaches for achieving controlled radiant energy transfer (CRET) through building windows and envelopes, so as to decrease heating and cooling loads in buildings. Major accomplishments included: the identification of electrochromic (EC)-based structures as the preferred structures for achieving CRET the identification of modulated reflectivity as the preferred mode of operation for EC-based structures demonstration of the feasibility of operating EC-materials in a modulated R(lambda) mode and demonstration of the applicability of free electron model to coloredmore » polycrystalline WO3 films.« less

An application of artificial intelligence to the interpretation of mass spectra.

NASA Technical Reports Server (NTRS)

Buchanan, B. G.; Duffield, A. M.; Robertson, A. V.

1971-01-01

Description of the DENDRAL (Dendritic Algorithm) project, the objectives of which were to base the computer program on an alogorithm that generates an exhaustive, nonredundant list of all the structural isomers of a given chemical composition, and to devise a computer program that would perform an organic structure determination, given a molecular formula and a mass spectrum. This program is called 'Heuristic DENDRAL' and it operates by using the known structure/spectrum correlations to constrain the DENDRAL isomer generator to produce a single isomer for that composition. The collaboration of chemists and computer scientists has produced a tool of some practical utility from the chemical viewpoint, and an interesting program from the viewpoint of artificial intelligence.

Meaning-based group counseling for bereavement: bridging theory with emerging trends in intervention research.

PubMed

MacKinnon, Christopher J; Smith, Nathan Grant; Henry, Melissa; Berish, Mel; Milman, Evgenia; Körner, Annett; Copeland, Laura S; Chochinov, Harvey M; Cohen, S Robin

2014-01-01

A growing body of scholarship has evaluated the usefulness of meaning-based theories in the context of bereavement counseling. Although scholars have discussed the application of meaning-based theories for individual practice, there is a lack of inquiry regarding its implications when conducting bereavement support groups. The objective of this article is to bridge meaning-based theories with bereavement group practice, leading to a novel intervention and laying the foundation for future efficacy studies. Building on recommendations specified in the literature, this article outlines the theoretical paradigms and structure of a short-term meaning-based group counseling intervention for uncomplicated bereavement.

Implementing human factors in clinical practice

PubMed Central

Timmons, Stephen; Baxendale, Bryn; Buttery, Andrew; Miles, Giulia; Roe, Bridget; Browes, Simon

2015-01-01

Objectives To understand whether aviation-derived human factors training is acceptable and useful to healthcare professionals. To understand whether and how healthcare professionals have been able to implement human factors approaches to patient safety in their own area of clinical practice. Methods Qualitative, longitudinal study using semi-structured interviews and focus groups, of a multiprofessional group of UK NHS staff (from the emergency department and operating theatres) who have received aviation-derived human factors training. Results The human factors training was evaluated positively, and thought to be both acceptable and relevant to practice. However, the staff found it harder to implement what they had learned in their own clinical areas, and this was principally attributed to features of the informal organisational cultures. Conclusions In order to successfully apply human factors approaches in hospital, careful consideration needs to be given to the local context and informal culture of clinical practice. PMID:24631959

A Systematic Review of Collaboration and Network Research in the Public Affairs Literature: Implications for Public Health Practice and Research

PubMed Central

Shoup, Jo Ann; Miller, Sara

2012-01-01

Objectives. We explored and analyzed how findings from public affairs research can inform public health research and practice, specifically in the area of interorganizational collaboration, one of the most promising practice-based approaches in the public health field. Methods. We conducted a systematic review of the public affairs literature by following a grounded theory approach. We coded 151 articles for demographics and empirical findings (n = 258). Results. Three primary findings stand out in the public affairs literature: network structure affects governance, management strategies exist for administrators, and collaboration can be linked to outcomes. These findings are linked to priorities in public health practice. Conclusions. Overall, we found that public affairs has a long and rich history of research in collaborations that offers unique organizational theory and management tools to public health practitioners. PMID:22021311

Recommendations for Clinical Decision Support Deployment: Synthesis of a Roundtable of Medical Directors of Information Systems

PubMed Central

Jenders, Robert A.; Osheroff, Jerome A.; Sittig, Dean F.; Pifer, Eric A.; Teich, Jonathan M

2007-01-01

Background: Ample evidence exists that clinical decision support (CDS) can improve clinician performance. Nevertheless, additional evidence demonstrates that clinicians still do not perform adequately in many instances. This suggests an ongoing need for implementation of CDS, in turn prompting development of a roadmap for national action regarding CDS. Objective: Develop practical advice to aid CDS implementation in order to improve clinician performance. Method: Structured group interview during a roundtable discussion by medical directors of information systems (N = 30), with subsequent review by participants and synthesis. Results: Participant consensus was that CDS should be comprehensive and should involve techniques such as order sets and facilitated documentation as well as alerts; should be subject to ongoing feedback; and should flow from and be governed by an organization’s clinical goals. Conclusion: A structured roundtable discussion of clinicians experienced in health information technology can yield practical, consensus advice for implementation of CDS. PMID:18693858

Quantitative diagnostics of multilayered composite structures with ultrasonic guided waves

NASA Astrophysics Data System (ADS)

Bunget, Gheorghe; Friedersdorf, Fritz; Na, Jeong K.

2015-03-01

The main objective of the current work is to develop a practical nondestructive inspection methodology for a highly sound absorbing composite structural system consisting of polymeric and metallic materials. Due to constraints in geometrical shapes and thicknesses of the composite system used in this work, ultrasonic guided wave approach has been chosen. Since the polymer coatings have high damping properties, less energy is dissipated into the adjacent media in the presence of interface delaminations. Experimental measurements performed on a targeted composite system, whether it has an aluminum, carbon-fiber-composite, or steel outer casing, show promising results.

Practices of depression care in home health care: Home health clinician perspectives

PubMed Central

Bao, Yuhua; Eggman, Ashley A.; Richardson, Joshua E.; Sheeran, Thomas; Bruce, Martha L.

2015-01-01

Objective To assess any gaps between published best practices and real-world practices of treating depression in home health care (HHC), and barriers to closing any gaps. Methods A qualitative study based on semi-structured interviews with HHC nurses and administrators from five home health agencies in five states (n=20). Audio-recorded interviews were transcribed and analyzed by a multi-disciplinary team using grounded theory method to identify themes. Results Routine home health nursing care overlapped with all functional areas of depression care. However, there were reported gaps between best practices and real-world practices. Gaps were associated with perceived scope of practice by HHC nurses, knowledge gaps and low self-efficacy in depression treatment, stigma attached to depression, poor quality of antidepressant management in primary care, and poor communication between HHC and primary care. Conclusions Strategies to close gaps between typical and best practices need to enhance HHC clinician knowledge and self-efficacy with depression treatment and improve the quality of antidepressant management and communication with primary care. PMID:26423098

Ageing, Drama, and Creativity: Translating Research Into Practice.

PubMed

Reynolds, Jackie; Bernard, Miriam; Rezzano, Jill; Rickett, Michelle

2016-01-01

Ageing, Drama, and Creativity was a pilot six-session interprofessional training course delivered collaboratively by Keele University and the New Vic Theatre, Newcastle-under-Lyme, as part of our Arts and Humanities Research Council (AHRC) funded Ages and Stages follow-on project. The course brought together a critical gerontological approach with arts-based educational practices and was designed to develop practice capabilities and age awareness among a diverse group of professionals working in arts organizations, the voluntary sector, local government, health and social services, and housing. This article describes how the course was developed and how participants were selected, details its aims and objectives, provides an overview of the sessions and a flavor of some of the exercises that were used, and considers findings from the structured evaluation alongside written reflections from participants.

Deep Neural Network for Structural Prediction and Lane Detection in Traffic Scene.

PubMed

Li, Jun; Mei, Xue; Prokhorov, Danil; Tao, Dacheng

2017-03-01

Hierarchical neural networks have been shown to be effective in learning representative image features and recognizing object classes. However, most existing networks combine the low/middle level cues for classification without accounting for any spatial structures. For applications such as understanding a scene, how the visual cues are spatially distributed in an image becomes essential for successful analysis. This paper extends the framework of deep neural networks by accounting for the structural cues in the visual signals. In particular, two kinds of neural networks have been proposed. First, we develop a multitask deep convolutional network, which simultaneously detects the presence of the target and the geometric attributes (location and orientation) of the target with respect to the region of interest. Second, a recurrent neuron layer is adopted for structured visual detection. The recurrent neurons can deal with the spatial distribution of visible cues belonging to an object whose shape or structure is difficult to explicitly define. Both the networks are demonstrated by the practical task of detecting lane boundaries in traffic scenes. The multitask convolutional neural network provides auxiliary geometric information to help the subsequent modeling of the given lane structures. The recurrent neural network automatically detects lane boundaries, including those areas containing no marks, without any explicit prior knowledge or secondary modeling.

An Uncertainty Structure Matrix for Models and Simulations

NASA Technical Reports Server (NTRS)

Green, Lawrence L.; Blattnig, Steve R.; Hemsch, Michael J.; Luckring, James M.; Tripathi, Ram K.

2008-01-01

Software that is used for aerospace flight control and to display information to pilots and crew is expected to be correct and credible at all times. This type of software is typically developed under strict management processes, which are intended to reduce defects in the software product. However, modeling and simulation (M&S) software may exhibit varying degrees of correctness and credibility, depending on a large and complex set of factors. These factors include its intended use, the known physics and numerical approximations within the M&S, and the referent data set against which the M&S correctness is compared. The correctness and credibility of an M&S effort is closely correlated to the uncertainty management (UM) practices that are applied to the M&S effort. This paper describes an uncertainty structure matrix for M&S, which provides a set of objective descriptions for the possible states of UM practices within a given M&S effort. The columns in the uncertainty structure matrix contain UM elements or practices that are common across most M&S efforts, and the rows describe the potential levels of achievement in each of the elements. A practitioner can quickly look at the matrix to determine where an M&S effort falls based on a common set of UM practices that are described in absolute terms that can be applied to virtually any M&S effort. The matrix can also be used to plan those steps and resources that would be needed to improve the UM practices for a given M&S effort.

Children's Hospitals' Solutions for Patient Safety Collaborative Impact on Hospital-Acquired Harm.

PubMed

Lyren, Anne; Brilli, Richard J; Zieker, Karen; Marino, Miguel; Muething, Stephen; Sharek, Paul J

2017-09-01

To determine if an improvement collaborative of 33 children's hospitals focused on reliable best practice implementation and culture of safety improvements can reduce hospital-acquired conditions (HACs) and serious safety events (SSEs). A 3-year prospective cohort study design with a 12-month historical control population was completed by the Children's Hospitals' Solutions for Patient Safety collaborative. Identification and dissemination of best practices related to 9 HACs and SSE reduction focused on key process and culture of safety improvements. Individual hospital improvement teams leveraged the resources of a large, structured children's hospital collaborative using electronic, virtual, and in-person interactions. Thirty-three children's hospitals from across the United States volunteered to be part of the Children's Hospitals' Solutions for Patient Safety collaborative. Thirty-two met all the data submission eligibility requirements for the HAC improvement objective of this study, and 21 participated in the high-reliability culture work aimed at reducing SSEs. Significant harm reduction occurred in 8 of 9 common HACs (range 9%-71%; P < .005 for all). The mean monthly SSE rate decreased 32% (from 0.77 to 0.52; P < .001). The 12-month rolling average SSE rate decreased 50% (from 0.82 to 0.41; P < .001). Participation in a structured collaborative dedicated to implementing HAC-related best-practice prevention bundles and culture of safety interventions designed to increase the use of high-reliability organization practices resulted in significant HAC and SSE reductions. Structured collaboration and rapid sharing of evidence-based practices and tools are effective approaches to decreasing hospital-acquired harm. Copyright © 2017 by the American Academy of Pediatrics.

Enhancing CIDOC-CRM and compatible models with the concept of multiple interpretation

NASA Astrophysics Data System (ADS)

Van Ruymbeke, M.; Hallot, P.; Billen, R.

2017-08-01

Modelling cultural heritage and archaeological objects is used as much for management as for research purposes. To ensure the sustainable benefit of digital data, models benefit from taking the data specificities of historical and archaeological domains into account. Starting from a conceptual model tailored to storing these specificities, we present, in this paper, an extended mapping to CIDOC-CRM and its compatible models. Offering an ideal framework to structure and highlight the best modelling practices, these ontologies are essentially dedicated to storing semantic data which provides information about cultural heritage objects. Based on this standard, our proposal focuses on multiple interpretation and sequential reality.

Design and Verification of Critical Pressurised Windows for Manned Spaceflight

NASA Astrophysics Data System (ADS)

Lamoure, Richard; Busto, Lara; Novo, Francisco; Sinnema, Gerben; Leal, Mendes M.

2014-06-01

The Window Design for Manned Spaceflight (WDMS) project was tasked with establishing the state-of-art and explore possible improvements to the current structural integrity verification and fracture control methodologies for manned spacecraft windows.A critical review of the state-of-art in spacecraft window design, materials and verification practice was conducted. Shortcomings of the methodology in terms of analysis, inspection and testing were identified. Schemes for improving verification practices and reducing conservatism whilst maintaining the required safety levels were then proposed.An experimental materials characterisation programme was defined and carried out with the support of the 'Glass and Façade Technology Research Group', at the University of Cambridge. Results of the sample testing campaign were analysed, post-processed and subsequently applied to the design of a breadboard window demonstrator.Two Fused Silica glass window panes were procured and subjected to dedicated analyses, inspection and testing comprising both qualification and acceptance programmes specifically tailored to the objectives of the activity.Finally, main outcomes have been compiled into a Structural Verification Guide for Pressurised Windows in manned spacecraft, incorporating best practices and lessons learned throughout this project.

[Integral care, a SUS (Brazilian Unified Health System) guideline for the sanitary surveillance].

PubMed

O'Dwyer, Gisele; Reis, Daniela Carla de Souza; da Silva, Luciana Leite Gonçalves

2010-11-01

The sanitary surveillance (Visa) performs several practices, on different objects and its actions are guided by principles and guidelines of the SUS. It was done a critical reflection on the interaction conditions of practice in Visa, with a constitutional proposition of the SUS: integral care. The analysis was based on the theory of structuration (Giddens) that considers mobilization of structural resources as dimensions of social interaction, which would justify the legitimacy exercised since the standards. Have been analyzed the following categories: Visa and its insertion within the SUS; the integral care and the Visa; and political impediments. The Visa has been organized by National Health Surveillance Agency. Nowadays it has as sanitary responsibilities, communication with society and health promotion. The proposal of the literature concerning integral care is based on the assistance issue. The organization of the services in the different federative entities is the sense of integral care most adopted by Visa. Political impediments focus on the institutional renewal, on the conflicts of interest arena, on the distance between formulated policies and established practices and gaps concerning work management and the insufficiency of financial support.

A Five-Year Evaluation of Examination Structure in a Cardiovascular Pharmacotherapy Course

PubMed Central

Kolar, Claire; Janke, Kristin K.

2015-01-01

Objective. To evaluate the composition and effectiveness as an assessment tool of a criterion-referenced examination comprised of clinical cases tied to practice decisions, to examine the effect of varying audience response system (ARS) questions on student examination preparation, and to articulate guidelines for structuring examinations to maximize evaluation of student learning. Design. Multiple-choice items developed over 5 years were evaluated using Bloom’s Taxonomy classification, point biserial correlation, item difficulty, and grade distribution. In addition, examination items were classified into categories based on similarity to items used in ARS preparation. Assessment. As the number of items directly tied to clinical practice rose, Bloom’s Taxonomy level and item difficulty also rose. In examination years where Bloom’s levels were high but preparation was minimal, average grade distribution was lower compared with years in which student preparation was higher. Conclusion. Criterion-referenced examinations can benefit from systematic evaluation of their composition and effectiveness as assessment tools. Calculated design and delivery of classroom preparation is an asset in improving examination performance on rigorous, practice-relevant examinations. PMID:27168611

Short- and long-term effects on fuels, forest structure, and wildfire potential from prescribed fire and resource benefit fire in southwestern forests, USA

Treesearch

Molly E. Hunter; Jose M. Iniguez; Leigh B. Lentile

2011-01-01

Prescribed and resource benefit fires are used to manage fuels in fire-prone landscapes in the Southwest. These practices, however, typically occur under different conditions, potentially leading to differences in fire behavior and effects. The objectives of this study were to investigate the effects of recent prescribed fires, resource benefit fires, and repeated...

Sizing Single Cantilever Beam Specimens for Characterizing Facesheet/Core Peel Debonding in Sandwich Structure

NASA Technical Reports Server (NTRS)

Ratcliffe, James G.

2010-01-01

This paper details part of an effort focused on the development of a standardized facesheet/core peel debonding test procedure. The purpose of the test is to characterize facesheet/core peel in sandwich structure, accomplished through the measurement of the critical strain energy release rate associated with the debonding process. The specific test method selected for the standardized test procedure utilizes a single cantilever beam (SCB) specimen configuration. The objective of the current work is to develop a method for establishing SCB specimen dimensions. This is achieved by imposing specific limitations on specimen dimensions, with the objectives of promoting a linear elastic specimen response, and simplifying the data reduction method required for computing the critical strain energy release rate associated with debonding. The sizing method is also designed to be suitable for incorporation into a standardized test protocol. Preliminary application of the resulting sizing method yields practical specimen dimensions.

Structured thermal surface for radiative camouflage.

PubMed

Li, Ying; Bai, Xue; Yang, Tianzhi; Luo, Hailu; Qiu, Cheng-Wei

2018-01-18

Thermal camouflage has been successful in the conductive regime, where thermal metamaterials embedded in a conductive system can manipulate heat conduction inside the bulk. Most reported approaches are background-dependent and not applicable to radiative heat emitted from the surface of the system. A coating with engineered emissivity is one option for radiative camouflage, but only when the background has uniform temperature. Here, we propose a strategy for radiative camouflage of external objects on a given background using a structured thermal surface. The device is non-invasive and restores arbitrary background temperature distributions on its top. For many practical candidates of the background material with similar emissivity as the device, the object can thereby be radiatively concealed without a priori knowledge of the host conductivity and temperature. We expect this strategy to meet the demands of anti-detection and thermal radiation manipulation in complex unknown environments and to inspire developments in phononic and photonic thermotronics.

Bioarchitecture: bioinspired art and architecture--a perspective.

PubMed

Ripley, Renee L; Bhushan, Bharat

2016-08-06

Art and architecture can be an obvious choice to pair with science though historically this has not always been the case. This paper is an attempt to interact across disciplines, define a new genre, bioarchitecture, and present opportunities for further research, collaboration and professional cooperation. Biomimetics, or the copying of living nature, is a field that is highly interdisciplinary, involving the understanding of biological functions, structures and principles of various objects found in nature by scientists. Biomimetics can lead to biologically inspired design, adaptation or derivation from living nature. As applied to engineering, bioinspiration is a more appropriate term, involving interpretation, rather than direct copying. Art involves the creation of discrete visual objects intended by their creators to be appreciated by others. Architecture is a design practice that makes a theoretical argument and contributes to the discourse of the discipline. Bioarchitecture is a blending of art/architecture and biomimetics/bioinspiration, and incorporates a bioinspired design from the outset in all parts of the work at all scales. Herein, we examine various attempts to date of art and architecture to incorporate bioinspired design into their practice, and provide an outlook and provocation to encourage collaboration among scientists and designers, with the aim of achieving bioarchitecture.This article is part of the themed issue 'Bioinspired hierarchically structured surfaces for green science'. © 2016 The Author(s).

A High-Speed Target-Free Vision-Based Sensor for Bus Rapid Transit Viaduct Vibration Measurements Using CMT and ORB Algorithms.

PubMed

Hu, Qijun; He, Songsheng; Wang, Shilong; Liu, Yugang; Zhang, Zutao; He, Leping; Wang, Fubin; Cai, Qijie; Shi, Rendan; Yang, Yuan

2017-06-06

Bus Rapid Transit (BRT) has become an increasing source of concern for public transportation of modern cities. Traditional contact sensing techniques during the process of health monitoring of BRT viaducts cannot overcome the deficiency that the normal free-flow of traffic would be blocked. Advances in computer vision technology provide a new line of thought for solving this problem. In this study, a high-speed target-free vision-based sensor is proposed to measure the vibration of structures without interrupting traffic. An improved keypoints matching algorithm based on consensus-based matching and tracking (CMT) object tracking algorithm is adopted and further developed together with oriented brief (ORB) keypoints detection algorithm for practicable and effective tracking of objects. Moreover, by synthesizing the existing scaling factor calculation methods, more rational approaches to reducing errors are implemented. The performance of the vision-based sensor is evaluated through a series of laboratory tests. Experimental tests with different target types, frequencies, amplitudes and motion patterns are conducted. The performance of the method is satisfactory, which indicates that the vision sensor can extract accurate structure vibration signals by tracking either artificial or natural targets. Field tests further demonstrate that the vision sensor is both practicable and reliable.

A High-Speed Target-Free Vision-Based Sensor for Bus Rapid Transit Viaduct Vibration Measurements Using CMT and ORB Algorithms

PubMed Central

Hu, Qijun; He, Songsheng; Wang, Shilong; Liu, Yugang; Zhang, Zutao; He, Leping; Wang, Fubin; Cai, Qijie; Shi, Rendan; Yang, Yuan

2017-01-01

Bus Rapid Transit (BRT) has become an increasing source of concern for public transportation of modern cities. Traditional contact sensing techniques during the process of health monitoring of BRT viaducts cannot overcome the deficiency that the normal free-flow of traffic would be blocked. Advances in computer vision technology provide a new line of thought for solving this problem. In this study, a high-speed target-free vision-based sensor is proposed to measure the vibration of structures without interrupting traffic. An improved keypoints matching algorithm based on consensus-based matching and tracking (CMT) object tracking algorithm is adopted and further developed together with oriented brief (ORB) keypoints detection algorithm for practicable and effective tracking of objects. Moreover, by synthesizing the existing scaling factor calculation methods, more rational approaches to reducing errors are implemented. The performance of the vision-based sensor is evaluated through a series of laboratory tests. Experimental tests with different target types, frequencies, amplitudes and motion patterns are conducted. The performance of the method is satisfactory, which indicates that the vision sensor can extract accurate structure vibration signals by tracking either artificial or natural targets. Field tests further demonstrate that the vision sensor is both practicable and reliable. PMID:28587275

[Implementation of bedside training and advanced objective structured clinical examination (OSCE) trial to learn and confirm about pharmacy clinical skills].

PubMed

Tokunaga, Jin; Takamura, Norito; Ogata, Kenji; Setoguchi, Nao; Sato, Keizo

2013-01-01

Bedside training for fourth-year students, as well as seminars in hospital pharmacy (vital sign seminars) for fifth-year students at the Department of Pharmacy of Kyushu University of Health and Welfare have been implemented using patient training models and various patient simulators. The introduction of simulation-based pharmaceutical education, where no patients are present, promotes visually, aurally, and tactilely simulated learning regarding the evaluation of vital signs and implementation of physical assessment when disease symptoms are present or adverse effects occur. A patient simulator also promotes the creation of training programs for emergency and critical care, with which basic as well as advanced life support can be practiced. In addition, an advanced objective structured clinical examination (OSCE) trial has been implemented to evaluate skills regarding vital signs and physical assessments. Pharmacists are required to examine vital signs and conduct physical assessment from a pharmaceutical point of view. The introduction of these pharmacy clinical skills will improve the efficacy of drugs, work for the prevention or early detection of adverse effects, and promote the appropriate use of drugs. It is considered that simulation-based pharmaceutical education is essential to understand physical assessment, and such education will ideally be applied and developed according to on-site practices.

An efficient direct method for image registration of flat objects

NASA Astrophysics Data System (ADS)

Nikolaev, Dmitry; Tihonkih, Dmitrii; Makovetskii, Artyom; Voronin, Sergei

2017-09-01

Image alignment of rigid surfaces is a rapidly developing area of research and has many practical applications. Alignment methods can be roughly divided into two types: feature-based methods and direct methods. Known SURF and SIFT algorithms are examples of the feature-based methods. Direct methods refer to those that exploit the pixel intensities without resorting to image features and image-based deformations are general direct method to align images of deformable objects in 3D space. Nevertheless, it is not good for the registration of images of 3D rigid objects since the underlying structure cannot be directly evaluated. In the article, we propose a model that is suitable for image alignment of rigid flat objects under various illumination models. The brightness consistency assumptions used for reconstruction of optimal geometrical transformation. Computer simulation results are provided to illustrate the performance of the proposed algorithm for computing of an accordance between pixels of two images.

Object-oriented programming for the biosciences.

PubMed

Wiechert, W; Joksch, B; Wittig, R; Hartbrich, A; Höner, T; Möllney, M

1995-10-01

The development of software systems for the biosciences is always closely connected to experimental practice. Programs must be able to handle the inherent complexity and heterogeneous structure of biological systems in combination with the measuring equipment. Moreover, a high degree of flexibility is required to treat rapidly changing experimental conditions. Object-oriented methodology seems to be well suited for this purpose. It enables an evolutionary approach to software development that still maintains a high degree of modularity. This paper presents experience with object-oriented technology gathered during several years of programming in the fields of bioprocess development and metabolic engineering. It concentrates on the aspects of experimental support, data analysis, interaction and visualization. Several examples are presented and discussed in the general context of the experimental cycle of knowledge acquisition, thus pointing out the benefits and problems of object-oriented technology in the specific application field of the biosciences. Finally, some strategies for future development are described.

Comparative analysis of structural concrete quality assurance practices on nine nuclear power plant construction projects. Final report

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

Willenbrock, J.H.; Thomas, H.R. Jr.; Burati, J.L. Jr.

1978-06-01

The basic objective of this research effort was to perform a comparative analysis of the Quality Assurance practices related to the structural concrete phase on nine nuclear power plant projects which are (or have been) under construction in the United States in the past ten years. This analysis identified the response of each Quality Assurance program to the applicable criteria of 10 CFR Part 50, Appendix B as well as to the pertinent regulatory requirements and industry standards. The major emphasis was placed on the construction aspects of the structural concrete phase of each project. The engineering and design aspectsmore » were examined whenever they interfaced with the construction aspects. For those aspects of the Quality Assurance system which can be considered managerial in nature (i.e., organizational relationships, types of Quality Assurance programs, corrective action procedures, etc.) an attempt has been made to present the alternative approaches that were identified. For those aspects of the Quality Assurance system which are technical in nature (i.e., the frequency of testing for slump, compressive strength, etc.) an attempt has been made to present a comparative analysis between projects and in relation to the recommended or mandated practices presented in the appropriate industry codes and standards.« less

Constructing Robust Cooperative Networks using a Multi-Objective Evolutionary Algorithm

PubMed Central

Wang, Shuai; Liu, Jing

2017-01-01

The design and construction of network structures oriented towards different applications has attracted much attention recently. The existing studies indicated that structural heterogeneity plays different roles in promoting cooperation and robustness. Compared with rewiring a predefined network, it is more flexible and practical to construct new networks that satisfy the desired properties. Therefore, in this paper, we study a method for constructing robust cooperative networks where the only constraint is that the number of nodes and links is predefined. We model this network construction problem as a multi-objective optimization problem and propose a multi-objective evolutionary algorithm, named MOEA-Netrc, to generate the desired networks from arbitrary initializations. The performance of MOEA-Netrc is validated on several synthetic and real-world networks. The results show that MOEA-Netrc can construct balanced candidates and is insensitive to the initializations. MOEA-Netrc can find the Pareto fronts for networks with different levels of cooperation and robustness. In addition, further investigation of the robustness of the constructed networks revealed the impact on other aspects of robustness during the construction process. PMID:28134314

Listening to food workers: Factors that impact proper health and hygiene practice in food service

PubMed Central

Clegg Smith, Katherine; Neff, Roni A.; Pollack, Keshia M.; Ensminger, Margaret

2015-01-01

Background Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers' improper health and hygiene practice. Objective To investigate food workers' perceptions of factors that impact proper food safety practice. Method Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior. Results Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies. Conclusion Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers' social and structural context, that impact food safety practice. PMID:26243248

[Compensated sex: a practice at the heart of young Mexican women's vulnerabilities (STI/HIV/AIDS)].

PubMed

Théodore, Florence Lise; Gutiérrez, Juan Pablo; Torres, Pilar; Luna, Gabriela

2004-01-01

To discuss the risks for Mexican young women who engage in sexual relations in exchange for social or economic benefits, also known as compensated sex (CS), with the objective of exploring its possible public health implications. This is a qualitative study conducted in youths 15 to 25 years of age in Cuernavaca, Morelos, Mexico, between September 2001 and December 2002. The theoretical framework included sociology of knowledge, post-structuralism, and gender studies. Research methods consisted of six focal groups and eight interviews with young subjects identified or self-declared as having practiced CS. To conceal their CS practices as a way to obtain social or economic benefits, young girls disguise it as "courtship" and subject themselves to rules and behaviors that restrain them in terms of condom use and expose them to sexually transmitted infections (STI). Although CS itself may not necessarily constitute a risky practice, the courtship context in which young women tend to develop these practices exposes them to a greater risk of STIs.

Advanced Methods of Nondestructive Inspection of Composite Structures Based on Limited Angle X-Ray Computed Tomography

NASA Astrophysics Data System (ADS)

Bostaph, Ekaterina

This research aimed to study the potential for breaking through object size limitations of current X-ray computed tomography (CT) systems by implementing a limited angle scanning technique. CT stands out among other industrial nondestructive inspection (NDI) methods due to its unique ability to perform 3D volumetric inspection, unmatched micro-focus resolution, and objectivity that allows for automated result interpretation. This work attempts to advance NDI technique to enable microstructural material characterization and structural diagnostics of composite structures, where object sizes often prohibit the application of full 360° CT. Even in situations where the objects can be accommodated within existing micro-CT configuration, achieving sufficient magnification along with full rotation may not be viable. An effort was therefore made to achieve high-resolution scans from projection datasets with limited angular coverage (less than 180°) by developing effective reconstruction algorithms in conjunction with robust scan acquisition procedures. Internal features of inspected objects barely distinguishable in a 2D X-ray radiograph can be enhanced by additional projections that are reconstructed to a stack of slices, dramatically improving depth perception, a technique referred to as digital tomosynthesis. Building on the success of state-of-the-art medical tomosynthesis systems, this work sought to explore the feasibility of this technique for composite structures in aerospace applications. The challenge lies in the fact that the slices generated in medical tomosynthesis are too thick for relevant industrial applications. In order to adapt this concept to composite structures, reconstruction algorithms were expanded by implementation of optimized iterative stochastic methods (capable of reducing noise and refining scan quality) which resulted in better depth perception. The optimal scan acquisition procedure paired with the improved reconstruction algorithm facilitated higher in-plane and depth resolution compared to the clinical application. The developed limited angle tomography technique was demonstrated to be able to detect practically significant manufacturing defects (voids) and structural damage (delaminations) critical to structural integrity of composite parts. Keeping in mind the intended real-world aerospace applications where objects often have virtually unlimited in-plane dimensions, the developed technique of partial scanning could potentially extend the versatility of CT-based inspection and enable game changing NDI systems.

The use of the "Objective Structured Assessment of Technical Skills" as an Assessment Tool Among Danish Vascular Surgeons in Training.

PubMed

Lladó Grove, Gabriela; Langager Høgh, Annette; Nielsen, Judith; Sandermann, Jes

2015-01-01

The concept of the Objective Structured Assessment of Technical Skills (OSATS) is to quantify surgical skills in an objective way and, thereby, produce an additional procedure-specific assessment tool. Since 2005, a 2-day practical course for upcoming specialist registrars in vascular surgery has been obligatory. The aim of this study is to describe the results from a tailored OSATS test as a tool for the evaluation of practical skills during an intensive training session in a simple simulator box for vascular anastomoses. Between 2005 and 2013, we registered the OSATS scores of all course participants. The following data were collected from the questionnaires: years as a candidate, months in vascular surgery or in another type of surgery, and the number of vascular anastomoses performed before the course. The assessment of surgical skills was conducted with an OSATS score template specifically made for this purpose. It consists of a 12-item table with a 5-point grading scale. OSATS score (points) and time for the procedure (OSATS time in min) were registered at baseline (OSATS I) and at the end of the course (OSATS II). OSATS scores were given in both OSATS I and OSATS II for the 83 trainees, and the mean difference was 8.1 points (95% CI: 6.7; 9.5, p < 0.001). OSATS time was given for 69 trainees, and the mean difference was 2.8 minutes (95% CI: 1.4; 4.2, p < 0.001). We found no relationship between years since graduation, months in any surgical specialty, or the experience with vascular anastomoses and outcomes. OSATS is a valuable tool for evaluating the advancement of technical skills during an intensive practical course in performing vascular anastomoses. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Anatomy of the Volar Retinacular Elements of the Hand: A Unified Nomenclature.

PubMed

Godfrey, Jenna; Rayan, Ghazi M

2018-03-01

Many investigators have described the anatomy of the volar retinacular structures of the hand over the last 60 years. As a result, multiple terms have been assigned to 1 anatomical structure and 1 name designated to more than 1 structure. Our purpose is to review the detailed anatomy and key components of the volar retinacular elements of the hand, their etymology, and their most recent descriptions. The objective also is to organize these structures into systems, which can be helpful for learners to assimilate into a practical anatomical guide. Lastly, the goal is to create a common nomenclature for identifying the volar retinacular structures of the hand in order to facilitate clear communication about them across languages. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Practical inquiry/theory in nursing.

PubMed

Stevenson, Chris

2005-04-01

This paper explores a social constructionist, pragmatist approach to inquiry and theory-building with a view to exploring its relevance for nursing as a practical discipline. Positivist and postpositivist inquiry approaches in practical disciplines have produced "detached" theories that lack relevance for everyday practice and so sustain the theory-practice gap. Both meta- and mid-range theories tend to see practice as fixed or fixable rather than being enacted in a state of flux. Practical inquiry and theory are described structurally and as co-dependent processes. The research process is sensitive to the influence of context and consists of construction rather than capture. Practical theory is judged in terms of whether it helps people to "go on with" their lives. Practical inquiry/practical theory is superimposed on a previous nursing study in the field of mental health to illustrate how it can account for the processes of clinical research. In particular, the illustration demonstrates the surrender of researcher objectivity in the interests of collaborative understanding that occurs with practical inquiry/theory. Shared meaning arises as rich constructs of the research situation are developed that point to future possibilities for action for all those engaged in the research process. Practical inquiry/theory offers the means to conduct cogent, collaborative, developmental research, although further "trying out" is required.

Fractal morphometry of cell complexity.

PubMed

Losa, Gabriele A

2002-01-01

Irregularity and self-similarity under scale changes are the main attributes of the morphological complexity of both normal and abnormal cells and tissues. In other words, the shape of a self-similar object does not change when the scale of measurement changes, because each part of it looks similar to the original object. However, the size and geometrical parameters of an irregular object do differ when it is examined at increasing resolution, which reveals more details. Significant progress has been made over the past three decades in understanding how irregular shapes and structures in the physical and biological sciences can be analysed. Dominant influences have been the discovery of a new practical geometry of Nature, now known as fractal geometry, and the continuous improvements in computation capabilities. Unlike conventional Euclidean geometry, which was developed to describe regular and ideal geometrical shapes which are practically unknown in nature, fractal geometry can be used to measure the fractal dimension, contour length, surface area and other dimension parameters of almost all irregular and complex biological tissues. We have used selected examples to illustrate the application of the fractal principle to measuring irregular and complex membrane ultrastructures of cells at specific functional and pathological stage.

Fellowships in Community Pharmacy Research: Experiences of Five Schools and Colleges of Pharmacy

PubMed Central

Snyder, Margie E.; Frail, Caitlin K.; Gernant, Stephanie A.; Bacci, Jennifer L.; Coley, Kim C.; Colip, Lauren M.; Ferreri, Stefanie P.; Hagemeier, Nicholas E.; McGivney, Melissa Somma; Rodis, Jennifer L.; Smith, Megan G.; Smith, Randall B.

2017-01-01

Objective To describe common facilitators, challenges, and lessons learned of five schools and colleges of pharmacy in establishing community pharmacy research fellowships. Setting Five schools and colleges of pharmacy in the United States. Practice Description Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Practice Innovation Community pharmacy fellowships, each structured as two years in length and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill and The Ohio State University. Evaluation Program directors from each of the five community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Results Common characteristics across the programs include length of training, pre-requisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n=4) have been successful in securing pharmacy faculty positions. Conclusion Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice. PMID:27083852

Parenting practices regarding TV viewing in low-income Mexican American mothers of preschoolers: Development of the Parenting Practices Regarding TV Viewing (PPRTV) scale

PubMed Central

Thompson, Darcy A.; Johnson, Susan L.; Vandewater, Elizabeth A.; Schmiege, Sarah J.; Boles, Richard E.; Lev, Jerusha; Tschann, Jeanne M.

2016-01-01

Objective To develop and test a comprehensive, culturally-based measure of parenting practices regarding TV viewing in low-income Mexican American mothers of preschoolers. Methods Low-income Mexican American female primary caregivers of preschoolers were recruited in urban safety-net pediatric clinics during the 2013-14 academic year. Items on parenting practices regarding TV viewing were developed from a prior scale, review of the literature, and results from semi-structured interviews. Items were administered by phone and analyses included evaluation of the factor structure and psychometric properties of a 40-item measure of Parenting Practices Regarding TV Viewing (PPRTV). Results Using exploratory factor analysis, a 7-factor model emerged as the best fit for the data representing the following domains of parenting practices: Time Restriction, Behavioral Control, Instructive Practices, Coviewing, Planful Restriction, Reactive Content Restriction, and Commercial Endorsement. Internal reliabilities were acceptable (Cronbach's alpha> 0.75). Correlations among the resulting subscales were small to moderate (rs = 0.01-0.43). Subscales were correlated with child TV viewing amounts: Time Restriction (−0.14, p<0.05); Behavioral Control (0.27, p<0.001); Coviewing (0.16, p<0.01); Planful Restriction (−0.20, p<0.001); Commercial Endorsement (0.11, p<0.05), which provides support for construct validity. Conclusion The Parenting Practices Regarding TV Viewing (PPRTV) scale measures 7 domains of parenting practices, and has good initial reliability and validity. It allows investigators to conduct more in-depth evaluations of the role parents play in socializing young children on TV use. Results of such work will be important to informing the design of interventions aiming to ensure healthy screen media habits in young children. PMID:27355878

Structured Smoking Cessation Training for Medical Students: A Prospective Study

PubMed Central

Herold, Ronja; Schiekirka, Sarah; Brown, Jamie; Bobak, Alex; McEwen, Andy

2016-01-01

Introduction: Physician adherence to guideline recommendations regarding the provision of counseling and support for smokers willing to quit is low. A lack of training during undergraduate medical education has been identified as a potential cause. This prospective intervention study evaluated a novel teaching module for medical students. Methods: As part of a 6-week cardiovascular course, 125 fourth-year undergraduate medical students received a multimodal and interactive teaching module on smoking cessation, including online learning material, lectures, seminars, and practical skills training. Short- and medium-term effects on knowledge, skills, attitudes, and self-reported practice were measured using written examinations and an objective structured clinical examination at the end of the module and 6 months later. Results were compared to data obtained from a historical control cohort (n = 70) unexposed to the intervention. Results: At the 6-month follow-up, scores in the knowledge test were significantly higher in the intervention than the control group (61.1% vs. 51.7%; p < .001). A similar pattern was observed in the objective structured clinical examination (71.5% vs. 60.5%; p < .001). More students in the intervention than control group agreed that smoking was a chronic disease (83.1% vs. 68.1%; p = .045). The control group was more likely to report recording smoking status (p = .018), but no group difference was detected regarding the report of advising to quit (p = .154). Conclusions: A novel teaching module for undergraduate medical students produced a sustained learning outcome in terms of knowledge, skills, and attitudes but not self-reported practice. Implications: Studies across the world have identified considerable knowledge gaps and deficits in practical training with regard to smoking cessation counseling in undergraduate medical students. This paper describes a teaching intervention informed by current recommendations for the design of educational activities aimed at enabling medical students to deliver adequate behavior change counseling. The teaching module was tailored to the needs of a specific healthcare system. Given its effectiveness as demonstrated in this prospective study, a rollout of this intervention in medical schools might have the potential to substantially improve medical students’ knowledge, skills, and attitudes in relation to smoking cessation counseling. PMID:27613926

3D Surface Reconstruction for Lower Limb Prosthetic Model using Radon Transform

NASA Astrophysics Data System (ADS)

Sobani, S. S. Mohd; Mahmood, N. H.; Zakaria, N. A.; Razak, M. A. Abdul

2018-03-01

This paper describes the idea to realize three-dimensional surfaces of objects with cylinder-based shapes where the techniques adopted and the strategy developed for a non-rigid three-dimensional surface reconstruction of an object from uncalibrated two-dimensional image sequences using multiple-view digital camera and turntable setup. The surface of an object is reconstructed based on the concept of tomography with the aid of performing several digital image processing algorithms on the two-dimensional images captured by a digital camera in thirty-six different projections and the three-dimensional structure of the surface is analysed. Four different objects are used as experimental models in the reconstructions and each object is placed on a manually rotated turntable. The results shown that the proposed method has successfully reconstruct the three-dimensional surface of the objects and practicable. The shape and size of the reconstructed three-dimensional objects are recognizable and distinguishable. The reconstructions of objects involved in the test are strengthened with the analysis where the maximum percent error obtained from the computation is approximately 1.4 % for the height whilst 4.0%, 4.79% and 4.7% for the diameters at three specific heights of the objects.

Does research through Structured Operational Research and Training (SORT IT) courses impact policy and practice?

PubMed Central

Shewade, H. D.; Tripathy, J. P.; Guillerm, N.; Tayler-Smith, K.; Berger, S. Dar; Bissell, K.; Reid, A. J.; Zachariah, R.; Harries, A. D.

2016-01-01

Setting: Structured Operational Research and Training Initiative (SORT IT) courses are well known for their output, with nearly 90% of participants completing the course and publishing in scientific journals. Objective: We assessed the impact of research papers on policy and practice that resulted from six SORT IT courses initiated between July 2012 and March 2013. Design: This was a cross-sectional study involving e-mail-based, self-administered questionnaires and telephone/skype/in-person responses from first and/or senior co-authors of course papers. A descriptive content analysis of the responses was performed and categorised into themes. Results: Of 72 participants, 63 (88%) completed the course. Course output included 81 submitted papers, of which 76 (94%) were published. Of the 81 papers assessed, 45 (55%) contributed to a change in policy and/or practice: 29 contributed to government policy/practice change (20 at national, 4 at subnational and 5 at hospital level), 11 to non-government organisational policy change and 5 to reinforcing existing policy. The changes ranged from modifications of monitoring and evaluation tools, to redrafting of national guidelines, to scaling up existing policies. Conclusion: More than half of the SORT IT course papers contributed to a change in policy and/or practice. Future assessments should include more robust and independent verification of the reported change(s) with all stakeholders. PMID:27051612

Social and organizational factors affecting implementation of evidence-informed practice in a public health department in Ontario: a network modelling approach

PubMed Central

2014-01-01

Objective The objective of this study is to develop a statistical model to assess factors associated with information seeking in a Canadian public health department. Methods Managers and professional consultants of a public health department serving a large urban population named whom they turned to for help, whom they considered experts in evidence-informed practice, and whom they considered friends. Multilevel regression analysis and exponential random graph modeling were used to predict the formation of information seeking and expertise-recognition connections by personal characteristics of the seeker and source, and the structural attributes of the social networks. Results The respondents were more likely to recognize the members of the supervisory/administrative division as experts. The extent to which an individual implemented evidence-based practice (EBP) principles in daily practice was a significant predictor of both being an information source and being recognized as expert by peers. Friendship was a significant predictor of both information seeking and expertise-recognition connections. Conclusion The analysis showed a communication network segregated by organizational divisions. Managers were identified frequently as information sources, even though this is not a part of their formal role. Self-perceived implementation of EBP in practice was a significant predictor of being an information source or an expert, implying a positive atmosphere towards implementation of evidence-informed decision making in this public health organization. Results also implied that the perception of accessibility and trust were significant predictors of expertise recognition. PMID:24565228

Exploring personality dimensions that influence practice and performance of a simulated laparoscopic task in the objective structured clinical examination.

PubMed

Malhotra, Neha; Poolton, Jamie M; Wilson, Mark R; Leung, Gilberto; Zhu, Frank; Fan, Joe K M; Masters, Rich S W

2015-01-01

Surgical educators have encouraged the investigation of individual differences in aptitude and personality in surgical performance. An individual personality difference that has been shown to influence laparoscopic performance under time pressure is movement specific reinvestment. Movement specific reinvestment has 2 dimensions, movement self-consciousness (MS-C) (i.e., the propensity to consciously monitor movements) and conscious motor processing (CMP) (i.e., the propensity to consciously control movements), which have been shown to differentially influence laparoscopic performance in practice but have yet to be investigated in the context of psychological stress (e.g., the objective structured clinical examination [OSCE]). This study investigated the role of individual differences in propensity for MS-C and CMP in practice of a fundamental laparoscopic skill and in laparoscopic performance during the OSCE. Furthermore, this study examined whether individual differences during practice of a fundamental laparoscopic skill were predictive of laparoscopic performance during the OSCE. Overall, 77 final-year undergraduate medical students completed the movement specific reinvestment scale, an assessment tool that quantifies the propensity for MS-C and CMP. Participants were trained to proficiency on a fundamental laparoscopic skill. The number of trials to reach proficiency was measured, and completion times were recorded during early practice, later practice, and the OSCE. There was a trend for CMP to be negatively associated with the number of trials to reach proficiency (p = 0.064). A higher propensity for CMP was associated with fewer trials to reach proficiency (β = -0.70, p = 0.023). CMP and MS-C did not significantly predict completion times in the OSCE (p > 0.05). Completion times in early practice (β = 0.05, p = 0.016) and later practice (β = 0.47, p < 0.001) and number of trials to reach proficiency (β = 0.23, p = 0.003) significantly predicted completion times in the OSCE. It appears that a higher propensity for CMP predicts faster rates of learning of a fundamental laparoscopic skill. Furthermore, laparoscopic performance during practice is indicative of laparoscopic performance in the challenging conditions of the OSCE. The lack of association between the 2 dimensions of movement specific reinvestment and performance during the OSCE is explained using the theory of reinvestment as a framework. Overall, consideration of personality differences and individual differences in ability during practice could help inform the development of individualized surgical training programs. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Optics-Only Calibration of a Neural-Net Based Optical NDE Method for Structural Health Monitoring

NASA Technical Reports Server (NTRS)

Decker, Arthur J.

2004-01-01

A calibration process is presented that uses optical measurements alone to calibrate a neural-net based NDE method. The method itself detects small changes in the vibration mode shapes of structures. The optics-only calibration process confirms previous work that the sensitivity to vibration-amplitude changes can be as small as 10 nanometers. A more practical value in an NDE service laboratory is shown to be 50 nanometers. Both model-generated and experimental calibrations are demonstrated using two implementations of the calibration technique. The implementations are based on previously published demonstrations of the NDE method and an alternative calibration procedure that depends on comparing neural-net and point sensor measurements. The optics-only calibration method, unlike the alternative method, does not require modifications of the structure being tested or the creation of calibration objects. The calibration process can be used to test improvements in the NDE process and to develop a vibration-mode-independence of damagedetection sensitivity. The calibration effort was intended to support NASA s objective to promote safety in the operations of ground test facilities or aviation safety, in general, by allowing the detection of the gradual onset of structural changes and damage.

Characteristics of Medical Practices in Three Developed Managed Care Markets

PubMed Central

Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard; McNeil, Barbara J

2005-01-01

Objective To describe physician practices, ranging from solo and two-physician practices to large medical groups, in three geographically diverse parts of the country with strong managed care presences. Data Sources/Study Design Surveys of medical practices in three managed care markets conducted in 2000–2001. Study Design We administered questionnaires to all medical practices affiliated with two large health plans in Boston, MA, and Portland, OR, and to all practices providing primary care for cardiovascular disease patients admitted to five large hospitals in Minneapolis, MN. We offer data on how physician practices are structured under managed care in these geographically diverse regions of the country with a focus on the structural characteristics, financial arrangements, and care management strategies adopted by practices. Data Collection A two-staged survey consisting of an initial telephone survey that was undertaken using CATI (computerized assisted telephone interviewing) techniques followed by written modules triggered by specific responses to the telephone survey. Principal Findings We interviewed 468 practices encompassing 668 distinct sites of care (overall response rate 72 percent). Practices had an average of 13.9 member physicians (range: 1–125). Most (80.1 percent) medium- (four to nine physicians) and large-size (10 or more physicians) groups regularly scheduled meetings to discuss resource utilization and referrals. Almost 90 percent of the practices reported that these meetings occurred at least once per month. The predominant method for paying practices was via fee-for-service payments. Most other payments were in the form of capitation. Overall, 75 percent of physician practices compensated physicians based on productivity, but there was substantial variation related to practice size. Nonetheless, of the practices that did not use straight productivity methods (45 percent of medium-sized practices and 54 percent of large practices), most used arrangements consisting of combinations of salary and productivity formulas. Conclusions We found diversity in the characteristics and capabilities of medical practices in these three markets with high managed care involvement. Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped. PMID:15960686

Finding and estimating chemical property data for environmental assessment.

PubMed

Boethling, Robert S; Howard, Philip H; Meylan, William M

2004-10-01

The ability to predict the behavior of a chemical substance in a biological or environmental system largely depends on knowledge of the physicochemical properties and reactivity of that substance. We focus here on properties, with the objective of providing practical guidance for finding measured values and using estimation methods when necessary. Because currently available computer software often makes it more convenient to estimate than to retrieve measured values, we try to discourage irrational exuberance for these tools by including comprehensive lists of Internet and hard-copy data resources. Guidance for assessors is presented in the form of a process to obtain data that includes establishment of chemical identity, identification of data sources, assessment of accuracy and reliability, substructure searching for analogs when experimental data are unavailable, and estimation from chemical structure. Regarding property estimation, we cover estimation from close structural analogs in addition to broadly applicable methods requiring only the chemical structure. For the latter, we list and briefly discuss the most widely used methods. Concluding thoughts are offered concerning appropriate directions for future work on estimation methods, again with an emphasis on practical applications.

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

PubMed Central

Wall, Melanie; Yu, Gary; Penido, Cláudia; Schmidt, Clecy

2012-01-01

Objectives. We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice. Methods. We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience. Results. Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated. Conclusions. Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries. PMID:22994254

Management Systems, Patient Quality Improvement, Resource Availability, and Substance Abuse Treatment Quality

PubMed Central

Fields, Dail; Roman, Paul M; Blum, Terry C

2012-01-01

Objective To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data Sources/Study Setting Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). Study Design The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Data Collection Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007–2008. Principal Findings Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Conclusions Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. PMID:22098342

Best practices of Building Information Modelling (BIM) implementation in design phase for construction project

NASA Astrophysics Data System (ADS)

Kasim, N.; Zainal Abidin, N. A.; Zainal, R.; Sarpin, N.; Rahim, M. H. I. Abd; Saikah, M.

2017-11-01

Implementation of Building Information Modelling (BIM) was expected to bring improvement in current practices of Malaysian construction industry. In the design phase, there is a lack of a ready pool of skilled workers who are able to develop BIM strategic plan and effectively utilise it. These create boundaries for BIM nature in Malaysian construction industry specifically in the design phase to achieve its best practices. Therefore, the objectives of this research are to investigate the current practices of BIM implementation in the design phase as well as the best practices factors of BIM implementation in the design phase. The qualitative research approach is carried out through semi-structured interviews with the designers of different organisations which adopt BIM in the design phase. Data collection is analysed by executing content analysis method. From the findings, the best practices factors of BIM implementation in design phase such as the incentive for BIM training, formal approach to monitoring automated Level of Detailing (LOD), run a virtual meeting and improve Industry Foundation Class (IFC). Thus, best practices factors which lead to practices improvements in the design phase of project development which subsequently improves the implementation of BIM in the design phase of Malaysian construction industry.

Subwavelength resolution from multilayered structure (Conference Presentation)

NASA Astrophysics Data System (ADS)

Cheng, Bo Han; Jen, Yi-Jun; Liu, Wei-Chih; Lin, Shan-wen; Lan, Yung-Chiang; Tsai, Din Ping

2016-10-01

Breaking optical diffraction limit is one of the most important issues needed to be overcome for the demand of high-density optoelectronic components. Here, a multilayered structure which consists of alternating semiconductor and dielectric layers for breaking optical diffraction limitation at THz frequency region are proposed and analyzed. We numerically demonstrate that such multilayered structure not only can act as a hyperbolic metamaterial but also a birefringence material via the control of the external temperature (or magnetic field). A practical approach is provided to control all the diffraction signals toward a specific direction by using transfer matrix method and effective medium theory. Numerical calculations and computer simulation (based on finite element method, FEM) are carried out, which agree well with each other. The temperature (or magnetic field) parameter can be tuned to create an effective material with nearly flat isofrequency feature to transfer (project) all the k-space signals excited from the object to be resolved to the image plane. Furthermore, this multilayered structure can resolve subwavelength structures at various incident THz light sources simultaneously. In addition, the resolution power for a fixed operating frequency also can be tuned by only changing the magnitude of external magnetic field. Such a device provides a practical route for multi-functional material, photolithography and real-time super-resolution image.

A national survey of organizational transfer practices in chronic disease prevention in Canada.

PubMed

Hanusaik, Nancy; O'Loughlin, Jennifer L; Paradis, Gilles; Kishchuk, Natalie

2011-08-01

Underuse of best practices in chronic disease prevention (CDP) represents missed opportunities to promote healthy living and prevent chronic disease. Better understanding of how CDP programs, practices and policies (PPPs) are transferred from 'resource' organizations that develop them to 'user' organizations that implement them is crucial. The objectives of this work were to develop psychometrically sound measures of transfer practices occurring within resource organizations; describe the use of these transfer practices and identify correlates of the transfer process. Cross-sectional data were collected in structured telephone interviews with the person most knowledgeable about PPP transfer in 77 Canadian organizations that develop PPPs. Independent correlates of transfer were identified using multiple linear regression. The transfer practices most commonly used included: identification of barriers to PPP adoption/implementation, tailoring transfer strategies and designing a transfer plan. Skill at planning/implementing transfer, external sources of funding specifically allocated for transfer, type of resource organization, attitude toward process of collaboration and user-centeredness were all positively associated with the transfer process. These factors represent possible targets for interventions to improve transfer of CDP PPPs.

The future of employer-sponsored retiree medical plans.

PubMed

Rappaport, A M; Kalman, R W

1987-01-01

Complex issues cloud the economic security of people who are covered by employer-sponsored retiree medical plans. The future stability of these plans is especially confusing. In their paper, the authors carefully analyze the current structure of retiree medical plans, including the effect of certain laws. Their clarifications are objective and concise. Of particular timeliness and practicality--particularly for public policy markers--is the authors' four-point strategy to help stabilize the future.

Innovative approach to patient-centered care coordination in primary care practices.

PubMed

Clarke, Robin; Bharmal, Nazleen; Di Capua, Paul; Tseng, Chi-Hong; Mangione, Carol M; Mittman, Brian; Skootsky, Samuel A

2015-09-01

Although care coordination is an essential component of the patient-centered medical home structure, current case manager models have limited usefulness to population health because they typically serve a small group of patients defined based on disease or utilization. Our objective was to support our health system's population health by implementing and evaluating a program that embedded nonlicensed coordinators within our primary care practices to support physicians in executing care plans and communicating with patients. Matched case-control differences-in-differences. Comprehensive care coordinators (CCC) were introduced into 14 of the system's 28 practice sites in 2 waves. After a structured training program, CCCs identified, engaged, and intervened among patients within the practice in conjunction with practice primary care providers. We counted and broadly coded CCC activities that were documented in the intervention database. We examined the impact of CCC intervention on emergency department (ED) utilization at the practice level using a negative binomial multivariate regression model controlling for age, gender, and medical complexity. CCCs touched 10,500 unique patients over a 1-year period. CCC interventions included execution of care (38%), coordination of transitions (32%), self-management support/link to community resources (15%), monitor and follow-up (10%), and patient assessment (1%). The CCC intervention group had a 20% greater reduction in its prepost ED visit rate compared with the control group (P < .0001). Our CCC intervention demonstrated a significant reduction in ED visits by focusing on the centrality of the primary care provider and practice. Our model may serve as a cost-effective and scalable alternative for care coordination in primary care.

Measuring Professional Behaviour in Canadian Physical Therapy Students' Objective Structured Clinical Examinations: An Environmental Scan

PubMed Central

Ellerton, Cindy; Evans, Cathy

2015-01-01

ABSTRACT Purpose: To identify professional behaviours measured in objective structured clinical examinations (OSCEs) by Canadian university physical therapy (PT) programs. Method: A cross-sectional telephone survey was conducted to review current practice and determine which OSCE items Canadian PT programs are using to measure PT students' professional behaviours. Telephone interviews using semi-structured questions were conducted with individual instructors responsible for courses that included an OSCE as part of the assessment component. Results: Nine PT programmes agreed to take part in the study, and all reported conducting at least one OSCE. The number and characteristics of OSCEs varied both within and across programs. Participants identified 31 professional behaviour items for use in an OSCE; these items clustered into four categories: communication (n=14), respect (n=10), patient safety (n=4), and physical therapists' characteristics (n=3). Conclusions: All Canadian entry-level PT programmes surveyed assess professional behaviours in OSCE-type examinations; however, the content and style of assessment is variable. The local environment should be considered when determining what professional behaviours are appropriate to assess in the OSCE context in individual programmes. PMID:25931656

Nursing intensive care skills training: a nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting.

PubMed

De Silva, A Pubudu; Stephens, Tim; Welch, John; Sigera, Chathurani; De Alwis, Sunil; Athapattu, Priyantha; Dharmagunawardene, Dilantha; Olupeliyawa, Asela; de Abrew, Ashwini; Peiris, Lalitha; Siriwardana, Somalatha; Karunathilake, Indika; Dondorp, Arjen; Haniffa, Rashan

2015-04-01

To assess the impact of a nurse-led, short, structured training program for intensive care unit (ICU) nurses in a resource-limited setting. A training program using a structured approach to patient assessment and management for ICU nurses was designed and delivered by local nurse tutors in partnership with overseas nurse trainers. The impact of the course was assessed using the following: pre-course and post-course self-assessment, a pre-course and post-course Multiple Choice Questionnaire (MCQ), a post-course Objective Structured Clinical Assessment station, 2 post-course Short Oral Exam (SOE) stations, and post-course feedback questionnaires. In total, 117 ICU nurses were trained. Post-MCQ scores were significantly higher when compared with pre-MCQ (P < .0001). More than 95% passed the post-course Objective Structured Clinical Assessment (patient assessment) and SOE 1 (arterial blood gas analysis), whereas 76.9% passed SOE 2 (3-lead electrocardiogram analysis). The course was highly rated by participants, with 98% believing that this was a useful experience. Nursing Intensive Care Skills Training was highly rated by participants and was effective in improving the knowledge of the participants. This sustainable short course model may be adaptable to other resource-limited settings. Copyright © 2014 Elsevier Inc. All rights reserved.

Structural Design of Glass and Ceramic Components for Space System Safety

NASA Technical Reports Server (NTRS)

Bernstein, Karen S.

2007-01-01

Manned space flight programs will always have windows as part of the structural shell of the crew compartment. Astronauts and cosmonauts need to and enjoy looking out of the spacecraft windows at Earth, at approaching vehicles, at scientific objectives and at the stars. With few exceptions spacecraft windows have been made of glass, and the lessons learned over forty years of manned space flight have resulted in a well-defined approach for using this brittle, unforgiving material in NASA's vehicles, in windows and other structural applications. This chapter will outline the best practices that have developed at NASA for designing, verifying and accepting glass (and ceramic) windows and other components for safe and reliable use in any space system.

HIV/AIDS knowledge and its implications on dentists

PubMed Central

Prabhu, Anand; Rao, Arun Prasad; Reddy, Venugopal; Krishnakumar, Ramalingam; Thayumanavan, Shanmugam; Swathi, Silla Swarna

2014-01-01

Aims and Objectives: The aim of the present study was to evaluate the knowledge of dentists regarding human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Materials and Methods: A structured questionnaire to evaluate the knowledge, fears, and attitudes was self administered to 102 dentists. The data was then evaluated using Chi-square test and a P < 0.05 was considered statistically significant. Results and Conclusion: The findings of the present study suggest that dentists in private practice and affiliated with teaching institutions, had better knowledge than their counterparts who were into private practice alone. It was concluded that despite good knowledge many of the dentists expressed some hesitation in treating patients with HIV/AIDS. PMID:25097403

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

PubMed Central

2010-01-01

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

The influence of care provider access to structural empowerment on individualized care in long-term-care facilities.

PubMed

Caspar, Sienna; O'Rourke, Norm

2008-07-01

Implementing management initiatives that enable formal caregivers to provide quality, individualized care to older adults in long-term-care (LTC) facilities is increasingly important given that the number of LTC residents is projected to triple by 2031. The objective of this study was to explore the relationship between care provider access to structural empowerment and the provision of individualized care in LTC. We computed structural equation models separately for registered nurses and licensed practical nurses (n = 242) and care aides (n = 326) to examine the relationship between access to empowerment structures (i.e., informal power, formal power, information, support, resources, opportunity) and the provision of individualized care. We subsequently undertook invariance analyses to determine if the association between empowerment structures and reported provision of individualized care differed between caregiver groups. Access to structural empowerment had a statistically significant, positive association with provision of individualized care for both groups. For registered nurses/licensed practical nurses and care aides, empowerment explained 50% and 45% of observed variance in individualized care, respectively. These notable percentages did not differ significantly between caregiver groups. Of the empowerment structures, support, especially in the form of access to educational opportunities and recognition for a job well done, seems to be particularly significant to care providers. Findings from this study suggest that provision of individualized care in LTC may be enhanced when formal caregivers have appreciable access to empowerment structures.

Structure of deformed silicon and implications for low cost solar cells

NASA Technical Reports Server (NTRS)

Mardesich, N.; Leipold, M. H.; Turner, G. B.; Digges, T. G., Jr.

1978-01-01

The microstructure and minority carrier lifetime of silicon were investigated in uniaxially compressed silicon samples. The objective of the investigation was to determine if it is feasible to produce silicon solar cells from sheet formed by high temperature rolling. The initial structure of the silicon samples ranged from single crystal to fine-grained polycrystals. The samples had been deformed at strain rates of 0.1 to 8.5/sec and temperatures of 1270-1380 C with subsequent annealing at 1270-1380 C. The results suggest that high temperature rolling of silicon to produce sheet for cells of high efficiency is not practical.

Optimel: Software for selecting the optimal method

NASA Astrophysics Data System (ADS)

Popova, Olga; Popov, Boris; Romanov, Dmitry; Evseeva, Marina

Optimel: software for selecting the optimal method automates the process of selecting a solution method from the optimization methods domain. Optimel features practical novelty. It saves time and money when conducting exploratory studies if its objective is to select the most appropriate method for solving an optimization problem. Optimel features theoretical novelty because for obtaining the domain a new method of knowledge structuring was used. In the Optimel domain, extended quantity of methods and their properties are used, which allows identifying the level of scientific studies, enhancing the user's expertise level, expand the prospects the user faces and opening up new research objectives. Optimel can be used both in scientific research institutes and in educational institutions.

A new evaluation method research for fusion quality of infrared and visible images

NASA Astrophysics Data System (ADS)

Ge, Xingguo; Ji, Yiguo; Tao, Zhongxiang; Tian, Chunyan; Ning, Chengda

2017-03-01

In order to objectively evaluate the fusion effect of infrared and visible image, a fusion evaluation method for infrared and visible images based on energy-weighted average structure similarity and edge information retention value is proposed for drawbacks of existing evaluation methods. The evaluation index of this method is given, and the infrared and visible image fusion results under different algorithms and environments are made evaluation experiments on the basis of this index. The experimental results show that the objective evaluation index is consistent with the subjective evaluation results obtained from this method, which shows that the method is a practical and effective fusion image quality evaluation method.

Preliminary Development of an Object-Oriented Optimization Tool

NASA Technical Reports Server (NTRS)

Pak, Chan-gi

2011-01-01

The National Aeronautics and Space Administration Dryden Flight Research Center has developed a FORTRAN-based object-oriented optimization (O3) tool that leverages existing tools and practices and allows easy integration and adoption of new state-of-the-art software. The object-oriented framework can integrate the analysis codes for multiple disciplines, as opposed to relying on one code to perform analysis for all disciplines. Optimization can thus take place within each discipline module, or in a loop between the central executive module and the discipline modules, or both. Six sample optimization problems are presented. The first four sample problems are based on simple mathematical equations; the fifth and sixth problems consider a three-bar truss, which is a classical example in structural synthesis. Instructions for preparing input data for the O3 tool are presented.

Strategies for teaching object-oriented concepts with Java

NASA Astrophysics Data System (ADS)

Sicilia, Miguel-Ángel

2006-03-01

A considerable amount of experiences in teaching object-oriented concepts using the Java language have been reported to date, some of which describe language pitfalls and concrete learning difficulties. In this paper, a number of additional issues that have been experienced as difficult for students to master, along with approaches intended to overcome them, are addressed. Concretely, practical issues regarding associations, interfaces, genericity and exceptions are described. These issues suggest that more emphasis is required on presenting Java programs as derivations of conceptual models, in order to guarantee that a thorough design of the object structure actually precedes implementation issues. In addition, common student misunderstandings about the uses of interfaces and exceptions point to the necessity of introducing both specific design philosophies and also a clear distinction between design-for-reuse and more specific implementation issues.

[Adolescense pregnancy in a marginalized rural community in Mexico].

PubMed

Jiménez-González, Alberto; Granados-Cosme, José Arturo; Rosales-Flores, Roselia Arminda

2017-01-01

To identify objective and subjective conditions in the lives of pregnant teens within a highly-marginalized community in the state of Puebla, Mexico. Objective and subjective conditions of pregnant teens were evaluated through a mixed methodology (surveys, observation guides and a structured interview guide). The main family characteristic is the absence of a father due to migration, no desire to study or work and the new meaning of pregnancy: the initial social stigma for engaging in a sexual activity and then, the stigma for being a young mother. Objective conditions show family disintegration, lack of access to education at the community, high school and college level as well as unemployment as processes linked to teen pregnancy; thus, making it practically impossible to develop life goals. Subjective conditions center around the reproduction of gender stereotypes related to maternity.

OTEC cold water pipe design for problems caused by vortex-excited oscillations

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

Griffin, O. M.

1980-03-14

Vortex-excited oscillations of marine structures result in reduced fatigue life, large hydrodynamic forces and induced stresses, and sometimes lead to structural damage and to diestructive failures. The cold water pipe of an OTEC plant is nominally a bluff, flexible cylinder with a large aspect ratio (L/D = length/diameter), and is likely to be susceptible to resonant vortex-excited oscillations. The objective of this report is to survey recent results pertaining to the vortex-excited oscillations of structures in general and to consider the application of these findings to the design of the OTEC cold water pipe. Practical design calculations are given asmore » examples throughout the various sections of the report. This report is limited in scope to the problems of vortex shedding from bluff, flexible structures in steady currents and the resulting vortex-excited oscillations. The effects of flow non-uniformities, surface roughness of the cylinder, and inclination to the incident flow are considered in addition to the case of a smooth cyliner in a uniform stream. Emphasis is placed upon design procedures, hydrodynamic coefficients applicable in practice, and the specification of structural response parameters relevant to the OTEC cold water pipe. There are important problems associated with in shedding of vortices from cylinders in waves and from the combined action of waves and currents, but these complex fluid/structure interactions are not considered in this report.« less

Supporting nurse practitioners' practice in primary healthcare settings: a three-level qualitative model.

PubMed

Chouinard, Véronique; Contandriopoulos, Damien; Perroux, Mélanie; Larouche, Catherine

2017-06-26

While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners' integration. This study's main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner's practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices. This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches. This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels. Based on these findings, we suggest that support practices should be adapted to each organization's environment and experience and be modified as needed throughout the integration process. We also stress the importance of combining this approach with a strong coordination mechanism involving managers who have in-depth understanding of nursing professional roles and scopes of practice. Making primary healthcare nurse practitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing managers could be the key to successful integration.

Automated detection of qualitative spatio-temporal features in electrocardiac activation maps.

PubMed

Ironi, Liliana; Tentoni, Stefania

2007-02-01

This paper describes a piece of work aiming at the realization of a tool for the automated interpretation of electrocardiac maps. Such maps can capture a number of electrical conduction pathologies, such as arrhytmia, that can be missed by the analysis of traditional electrocardiograms. But, their introduction into the clinical practice is still far away as their interpretation requires skills that belongs to very few experts. Then, an automated interpretation tool would bridge the gap between the established research outcome and clinical practice with a consequent great impact on health care. Qualitative spatial reasoning can play a crucial role in the identification of spatio-temporal patterns and salient features that characterize the heart electrical activity. We adopted the spatial aggregation (SA) conceptual framework and an interplay of numerical and qualitative information to extract features from epicardial maps, and to make them available for reasoning tasks. Our focus is on epicardial activation isochrone maps as they are a synthetic representation of spatio-temporal aspects of the propagation of the electrical excitation. We provide a computational SA-based methodology to extract, from 3D epicardial data gathered over time, (1) the excitation wavefront structure, and (2) the salient features that characterize wavefront propagation and visually correspond to specific geometric objects. The proposed methodology provides a robust and efficient way to identify salient pieces of information in activation time maps. The hierarchical structure of the abstracted geometric objects, crucial in capturing the prominent information, facilitates the definition of general rules necessary to infer the correlation between pathophysiological patterns and wavefront structure and propagation.

Insoluble Coatings for Stirling Engine Heat Pipe Condenser Surfaces

NASA Technical Reports Server (NTRS)

Dussinger, Peter M.; Lindemuth, James E.

1997-01-01

The principal objective of this Phase 2 SBIR program was to develop and demonstrate a practically insoluble coating for nickel-based superalloys for Stirling engine heat pipe applications. Specific technical objectives of the program were: (1) Determine the solubility corrosion rates for Nickel 200, Inconel 718, and Udimet 72OLI in a simulated Stirling engine heat pipe environment, (2) Develop coating processes and techniques for capillary groove and screen wick structures, (3) Evaluate the durability and solubility corrosion rates for capillary groove and screen wick structures coated with an insoluble coating in cylindrical heat pipes operating under Stirling engine conditions, and (4) Design and fabricate a coated full-scale, partial segment of the current Stirling engine heat pipe for the Stirling Space Power Convertor program. The work effort successfully demonstrated a two-step nickel aluminide coating process for groove wick structures and interior wall surfaces in contact with liquid metals; demonstrated a one-step nickel aluminide coating process for nickel screen wick structures; and developed and demonstrated a two-step aluminum-to-nickel aluminide coating process for nickel screen wick structures. In addition, the full-scale, partial segment was fabricated and the interior surfaces and wick structures were coated. The heat pipe was charged with sodium, processed, and scheduled to be life tested for up to ten years as a Phase 3 effort.

[Structural elements of critical thinking of nurses in emergency care].

PubMed

Crossetti, Maria da Graça Oliveira; Bittencourt, Greicy Kelly Gouveia Dias; Lima, Ana Amélia Antunes; de Góes, Marta Georgina Oliveira; Saurin, Gislaine

2014-09-01

The objective of this study was to analyze the structural elements of critical thinking (CT) of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

Identification challenges for large space structures

NASA Technical Reports Server (NTRS)

Pappa, Richard S.

1990-01-01

The paper examines the on-orbit modal identification of large space structures, stressing the importance of planning and experience, in preparation for the Space Station Structural Characterization Experiment (SSSCE) for the Space Station Freedom. The necessary information to foresee and overcome practical difficulties is considered in connection with seven key factors, including test objectives, dynamic complexity of the structure, data quality, extent of exploratory studies, availability and understanding of software tools, experience with similar problems, and pretest analytical conditions. These factors affect identification success in ground tests. Comparisons with similar ground tests of assembled systems are discussed, showing that the constraints of space tests make these factors more significant. The absence of data and experiences relating to on-orbit modal identification testing is shown to make identification a uniquely mathematical problem, although all spacecraft are constructed and verified by proven engineering methods.

Structure Detection of Nonlinear Aeroelastic Systems with Application to Aeroelastic Flight Test Data. Part 2

NASA Technical Reports Server (NTRS)

Kukreja, Sunil L.; Brenner, martin J.

2006-01-01

This viewgraph presentation reviews the 1. Motivation for the study 2. Nonlinear Model Form 3. Structure Detection 4. Least Absolute Shrinkage and Selection Operator (LASSO) 5. Objectives 6. Results 7. Assess LASSO as a Structure Detection Tool: Simulated Nonlinear Models 8. Applicability to Complex Systems: F/A-18 Active Aeroelastic Wing Flight Test Data. The authors conclude that 1. this is a novel approach for detecting the structure of highly over-parameterised nonlinear models in situations where other methods may be inadequate 2. that it is a practical significance in the analysis of aircraft dynamics during envelope expansion and could lead to more efficient control strategies and 3. this could allow greater insight into the functionality of various systems dynamics, by providing a quantitative model which is easily interpretable

Laser-based structural sensing and surface damage detection

NASA Astrophysics Data System (ADS)

Guldur, Burcu

Damage due to age or accumulated damage from hazards on existing structures poses a worldwide problem. In order to evaluate the current status of aging, deteriorating and damaged structures, it is vital to accurately assess the present conditions. It is possible to capture the in situ condition of structures by using laser scanners that create dense three-dimensional point clouds. This research investigates the use of high resolution three-dimensional terrestrial laser scanners with image capturing abilities as tools to capture geometric range data of complex scenes for structural engineering applications. Laser scanning technology is continuously improving, with commonly available scanners now capturing over 1,000,000 texture-mapped points per second with an accuracy of ~2 mm. However, automatically extracting meaningful information from point clouds remains a challenge, and the current state-of-the-art requires significant user interaction. The first objective of this research is to use widely accepted point cloud processing steps such as registration, feature extraction, segmentation, surface fitting and object detection to divide laser scanner data into meaningful object clusters and then apply several damage detection methods to these clusters. This required establishing a process for extracting important information from raw laser-scanned data sets such as the location, orientation and size of objects in a scanned region, and location of damaged regions on a structure. For this purpose, first a methodology for processing range data to identify objects in a scene is presented and then, once the objects from model library are correctly detected and fitted into the captured point cloud, these fitted objects are compared with the as-is point cloud of the investigated object to locate defects on the structure. The algorithms are demonstrated on synthetic scenes and validated on range data collected from test specimens and test-bed bridges. The second objective of this research is to combine useful information extracted from laser scanner data with color information, which provides information in the fourth dimension that enables detection of damage types such as cracks, corrosion, and related surface defects that are generally difficult to detect using only laser scanner data; moreover, the color information also helps to track volumetric changes on structures such as spalling. Although using images with varying resolution to detect cracks is an extensively researched topic, damage detection using laser scanners with and without color images is a new research area that holds many opportunities for enhancing the current practice of visual inspections. The aim is to combine the best features of laser scans and images to create an automatic and effective surface damage detection method, which will reduce the need for skilled labor during visual inspections and allow automatic documentation of related information. This work enables developing surface damage detection strategies that integrate existing condition rating criteria for a wide range damage types that are collected under three main categories: small deformations already existing on the structure (cracks); damage types that induce larger deformations, but where the initial topology of the structure has not changed appreciably (e.g., bent members); and large deformations where localized changes in the topology of the structure have occurred (e.g., rupture, discontinuities and spalling). The effectiveness of the developed damage detection algorithms are validated by comparing the detection results with the measurements taken from test specimens and test-bed bridges.

What works in genomics education: outcomes of an evidenced-based instructional model for community-based physicians.

PubMed

Reed, E Kate; Johansen Taber, Katherine A; Ingram Nissen, Therese; Schott, Suzanna; Dowling, Lynn O; O'Leary, James C; Scott, Joan A

2016-07-01

Education of practicing health professionals is likely to be one factor that will speed appropriate integration of genomics into routine clinical practice. Yet many health professionals, including physicians, find it difficult to keep up with the rapid pace of clinical genomic advances and are often uncomfortable using genomic information in practice. Having identified the genomics educational needs of physicians in a Silicon Valley-area community hospital, we developed, implemented, and evaluated an educational course entitled Medicine's Future: Genomics for Practicing Doctors. The course structure and approach were based on best practices in adult learning, including interactivity, case-based learning, skill-focused objectives, and sequential monthly modules. Approximately 20-30 physicians attended each module. They demonstrated significant gains in genomics knowledge and confidence in practice skills that were sustained throughout and following the course. Six months following the course, the majority of participants reported that they had changed their practice to incorporate skills learned during the course. We believe the adult-learning principles underlying the development and delivery of Medicine's Future were responsible for participants' outcomes. These principles form a model for the development and delivery of other genomics educational programs for health professionals.Genet Med 18 7, 737-745.

Margins of freedom: a field-theoretic approach to class-based health dispositions and practices.

PubMed

Burnett, Patrick John; Veenstra, Gerry

2017-09-01

Pierre Bourdieu's theory of practice situates social practices in the relational interplay between experiential mental phenomena (habitus), resources (capitals) and objective social structures (fields). When applied to class-based practices in particular, the overarching field of power within which social classes are potentially made manifest is the primary field of interest. Applying relational statistical techniques to original survey data from Toronto and Vancouver, Canada, we investigated whether smoking, engaging in physical activity and consuming fruit and vegetables are dispersed in a three-dimensional field of power shaped by economic and cultural capitals and cultural dispositions and practices. We find that aesthetic dispositions and flexibility of developing and established dispositions are associated with positioning in the Canadian field of power and embedded in the logics of the health practices dispersed in the field. From this field-theoretic perspective, behavioural change requires the disruption of existing relations of harmony between the habitus of agents, the fields within which the practices are enacted and the capitals that inform and enforce the mores and regularities of the fields. The three-dimensional model can be explored at: http://relational-health.ca/margins-freedom. © 2017 Foundation for the Sociology of Health & Illness.

Familiarity with and advocacy of Healthy People 2010 goals by Mississippi Chiropractic Association members.

PubMed

Leach, Robert A; Cossman, Ronald E; Yates, Joyce M

2011-01-01

The purpose of this study was to determine the familiarity with and stated advocacy of Healthy People 2010 objectives by member doctors of the Mississippi Chiropractic Association. Peer experts established face validity of a questionnaire regarding the Leading Health Indicators. This survey was distributed to 157 Mississippi Chiropractic Association members in 2009 during a conference and a follow-up by postal mail. Most doctors of chiropractic in the sample (n = 68, or 43% response) consider themselves wellness-oriented health care providers. Forty-two percent had read, 29% had not read, and another 29% were unsure whether they had read the Healthy People 2010 national objectives. Almost half (44%) strongly or somewhat agreed that their office practice reflects support for the Healthy People 2010 objective. In contrast, 27% disagree and 29% were unsure if their practice reflects the Healthy People 2010 objectives. There were differences between support and practice behaviors for some of the objectives. Chiropractors who have read the objectives tend to be more supportive of the national goals. Doctors of chiropractic in this sample are supportive of most Leading Health Indicators, and the majority reports that they incorporate these public health goals into their practices. Familiarity with reading the Health People objectives seems to be related to reported practice behaviors. There is a need to improve the percentage of practicing doctors of chiropractic who are familiar with Healthy People objectives. Future health education initiatives may assist doctors of chiropractic in further incorporating public health objectives into their practice behaviors and improving quality health care. Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

38 CFR 21.7674 - Measurement of practical training courses.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...

38 CFR 21.7674 - Measurement of practical training courses.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...

38 CFR 21.7674 - Measurement of practical training courses.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...

38 CFR 21.7674 - Measurement of practical training courses.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...

38 CFR 21.7674 - Measurement of practical training courses.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... (1) Courses for the objective of registered nurse or registered professional nurse will be measured...) Courses offered by institutions of higher learning which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be measured on credit hours or clock hours of...

What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study

PubMed Central

Dunham, Annette H; Dunbar, James A; Johnson, Julie K; Fuller, Jeff; Morgan, Mark; Ford, Dale

2018-01-01

Objectives To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. Design Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. Setting Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. Participants Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. Results Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. Conclusions Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision. PMID:29643162

Comparison of sine dwell and broadband methods for modal testing

NASA Technical Reports Server (NTRS)

Chen, Jay-Chung

1989-01-01

The objectives of modal tests for large complex spacecraft structural systems are outlined. The comparison criteria for the modal test methods, namely, the broadband excitation and the sine dwell methods, are established. Using the Galileo spacecraft modal test and the Centaur G Prime upper stage vehicle modal test as examples, the relative advantage or disadvantage of each method is examined. The usefulness or shortcomings of the methods are given from a practical engineering viewpoint.

Some consideration for evaluation of structural integrity of aging aircraft

NASA Astrophysics Data System (ADS)

Terada, Hiroyuki; Asada, Hiroo

The objective of this paper is to examine the achievement and the limitation of state-of-the-art of the methodology of damage tolerant design and the subjects to be solved for further improvement. The topics discussed are: the basic concept of full-scale fatigue testing, fracture mechanics applications, repair of detected damages, inspection technology, and determination of inspection intervals, reliability assessment for practical application, and the importance of various kinds of data acquisition.

Evaluating learning among undergraduate medical students in schools with traditional and problem-based curricula.

PubMed

Meo, Sultan Ayoub

2013-09-01

This study aimed to assess knowledge and skills in a respiratory physiology course in traditional versus problem-based learning (PBL) groups in two different medical schools. Two different undergraduate medical schools were selected for this study. The first medical school followed the traditional [lecture-based learning (LBL)] curriculum, and the second medical school followed the PBL curriculum. Sixty first-year male medical students (30 students from each medical school) volunteered; they were apparently healthy and of the same age, sex, nationality, and regional and cultural background. Students were taught respiratory physiology according to their curriculum for a period of 2 wk. At the completion of the study period, knowledge was measured based on a single best multiple-choice question examination, and skill was measured based on the objective structured practical examination in the lung function laboratory (respiratory physiology). A Student's t-test was applied for the analysis of the data, and the level of significance was set at P < 0.05. Students belonging to the PBL curriculum obtained a higher score in the multiple-choice question examination (P = 0.001) and objective structured practical examination (P = 0.0001) compared with traditional (LBL) students. Students in the PBL group obtained significantly higher knowledge and skill scores in the respiratory physiology course compared with students in the traditional (LBL) style of medical schools.

An immersogeometric variational framework for fluid–structure interaction: application to bioprosthetic heart valves

PubMed Central

Kamensky, David; Hsu, Ming-Chen; Schillinger, Dominik; Evans, John A.; Aggarwal, Ankush; Bazilevs, Yuri; Sacks, Michael S.; Hughes, Thomas J. R.

2014-01-01

In this paper, we develop a geometrically flexible technique for computational fluid–structure interaction (FSI). The motivating application is the simulation of tri-leaflet bioprosthetic heart valve function over the complete cardiac cycle. Due to the complex motion of the heart valve leaflets, the fluid domain undergoes large deformations, including changes of topology. The proposed method directly analyzes a spline-based surface representation of the structure by immersing it into a non-boundary-fitted discretization of the surrounding fluid domain. This places our method within an emerging class of computational techniques that aim to capture geometry on non-boundary-fitted analysis meshes. We introduce the term “immersogeometric analysis” to identify this paradigm. The framework starts with an augmented Lagrangian formulation for FSI that enforces kinematic constraints with a combination of Lagrange multipliers and penalty forces. For immersed volumetric objects, we formally eliminate the multiplier field by substituting a fluid–structure interface traction, arriving at Nitsche’s method for enforcing Dirichlet boundary conditions on object surfaces. For immersed thin shell structures modeled geometrically as surfaces, the tractions from opposite sides cancel due to the continuity of the background fluid solution space, leaving a penalty method. Application to a bioprosthetic heart valve, where there is a large pressure jump across the leaflets, reveals shortcomings of the penalty approach. To counteract steep pressure gradients through the structure without the conditioning problems that accompany strong penalty forces, we resurrect the Lagrange multiplier field. Further, since the fluid discretization is not tailored to the structure geometry, there is a significant error in the approximation of pressure discontinuities across the shell. This error becomes especially troublesome in residual-based stabilized methods for incompressible flow, leading to problematic compressibility at practical levels of refinement. We modify existing stabilized methods to improve performance. To evaluate the accuracy of the proposed methods, we test them on benchmark problems and compare the results with those of established boundary-fitted techniques. Finally, we simulate the coupling of the bioprosthetic heart valve and the surrounding blood flow under physiological conditions, demonstrating the effectiveness of the proposed techniques in practical computations. PMID:25541566

Psychometrics of the preschooler physical activity parenting practices instrument among a Latino sample.

PubMed

O'Connor, Teresia M; Cerin, Ester; Hughes, Sheryl O; Robles, Jessica; Thompson, Deborah I; Mendoza, Jason A; Baranowski, Tom; Lee, Rebecca E

2014-01-15

Latino preschoolers (3-5 year old children) have among the highest rates of obesity. Low levels of physical activity (PA) are a risk factor for obesity. Characterizing what Latino parents do to encourage or discourage their preschooler to be physically active can help inform interventions to increase their PA. The objective was therefore to develop and assess the psychometrics of a new instrument: the Preschooler Physical Activity Parenting Practices (PPAPP) among a Latino sample, to assess parenting practices used to encourage or discourage PA among preschool-aged children. Cross-sectional study of 240 Latino parents who reported the frequency of using PA parenting practices. 95% of respondents were mothers; 42% had more than a high school education. Child mean age was 4.5 (±0.9) years (52% male). Test-retest reliability was assessed in 20%, 2 weeks later. We assessed the fit of a priori models using Confirmatory factor analyses (CFA). In a separate sub-sample (35%), preschool-aged children wore accelerometers to assess associations with their PA and PPAPP subscales. The a-priori models showed poor fit to the data. A modified factor structure for encouraging PPAPP had one multiple-item scale: engagement (15 items), and two single-items (have outdoor toys; not enroll in sport-reverse coded). The final factor structure for discouraging PPAPP had 4 subscales: promote inactive transport (3 items), promote screen time (3 items), psychological control (4 items) and restricting for safety (4 items). Test-retest reliability (ICC) for the two scales ranged from 0.56-0.85. Cronbach's alphas ranged from 0.5-0.9. Several sub-factors correlated in the expected direction with children's objectively measured PA. The final models for encouraging and discouraging PPAPP had moderate to good fit, with moderate to excellent test-retest reliabilities. The PPAPP should be further evaluated to better assess its associations with children's PA and offers a new tool for measuring PPAPP among Latino families with preschool-aged children.

Ethical Sensitivity in Nursing Ethical Leadership: A Content Analysis of Iranian Nurses Experiences

PubMed Central

Esmaelzadeh, Fatemeh; Abbaszadeh, Abbas; Borhani, Fariba; Peyrovi, Hamid

2017-01-01

Background: Considering that many nursing actions affect other people’s health and life, sensitivity to ethics in nursing practice is highly important to ethical leaders as a role model. Objective: The study aims to explore ethical sensitivity in ethical nursing leaders in Iran. Method: This was a qualitative study based on the conventional content analysis in 2015. Data were collected using deep and semi-structured interviews with 20 Iranian nurses. The participants were chosen using purposive sampling. Data were analyzed using conventional content analysis. In order to increase the accuracy and integrity of the data, Lincoln and Guba's criteria were considered. Results: Fourteen sub-categories and five main categories emerged. Main categories consisted of sensitivity to care, sensitivity to errors, sensitivity to communication, sensitivity in decision making and sensitivity to ethical practice. Conclusion: Ethical sensitivity appears to be a valuable attribute for ethical nurse leaders, having an important effect on various aspects of professional practice and help the development of ethics in nursing practice. PMID:28584564

A prospective, blinded evaluation of a video-assisted '4-stage approach' during undergraduate student practical skills training.

PubMed

Schwerdtfeger, Katrin; Wand, Saskia; Schmid, Oliver; Roessler, Markus; Quintel, Michael; Leissner, Kay B; Russo, Sebastian G

2014-05-22

The 4-stage approach (4-SA) is used as a didactic method for teaching practical skills in international courses on resuscitation and the structured care of trauma patients. The aim of this study was to evaluate objective and subjective learning success of a video-assisted 4-SA in teaching undergraduate medical students. The participants were medical students learning the principles of the acute treatment of trauma patients in their multidiscipline course on emergency and intensive care medicine. The participants were quasi- randomly divided into two groups. The 4-SA was used in both groups. In the control group, all four steps were presented by an instructor. In the study group, the first two steps were presented as a video. At the end of the course a 5-minute objective, structured clinical examination (OSCE) of a simulated trauma patient was conducted. The test results were divided into objective results obtained through a checklist with 9 dichotomous items and the assessment of the global performance rated subjectively by the examiner on a Likert scale from 1 to 6. 313 students were recruited; the results of 256 were suitable for analysis. The OSCE results were excellent in both groups and did not differ significantly (control group: median 9, interquantil range (IQR) 8-9, study group: median 9, IQR 8-9; p = 0.29). The global performance was rated significantly better for the study group (median 1, IQR 1-2 vs. median 2, IQR 1-3; p < 0.01). The relative knowledge increase, stated by the students in their evaluation after the course, was greater in the study group (85% vs. 80%). It is possible to employ video assistance in the classical 4-SA with comparable objective test results in an OSCE. The global performance was significantly improved with use of video assistance.

Evaluation of Nosocomial Infection Control Programs in health services 1

PubMed Central

Menegueti, Mayra Gonçalves; Canini, Silvia Rita Marin da Silva; Bellissimo-Rodrigues, Fernando; Laus, Ana Maria

2015-01-01

OBJECTIVES: to evaluate the Nosocomial Infection Control Programs in hospital institutions regarding structure and process indicators. METHOD: this is a descriptive, exploratory and quantitative study conducted in 2013. The study population comprised 13 Nosocomial Infection Control Programs of health services in a Brazilian city of the state of São Paulo. Public domain instruments available in the Manual of Evaluation Indicators of Nosocomial Infection Control Practices were used. RESULTS: The indicators with the highest average compliance were "Evaluation of the Structure of the Nosocomial Infection Control Programs" (75%) and "Evaluation of the Epidemiological Surveillance System of Nosocomial Infection" (82%) and those with the lowest mean compliance scores were "Evaluation of Operational Guidelines" (58.97%) and "Evaluation of Activities of Control and Prevention of Nosocomial Infection" (60.29%). CONCLUSION: The use of indicators identified that, despite having produced knowledge about prevention and control of nosocomial infections, there is still a large gap between the practice and the recommendations. PMID:25806637

Flexible single-layer ionic organic-inorganic frameworks towards precise nano-size separation

NASA Astrophysics Data System (ADS)

Yue, Liang; Wang, Shan; Zhou, Ding; Zhang, Hao; Li, Bao; Wu, Lixin

2016-02-01

Consecutive two-dimensional frameworks comprised of molecular or cluster building blocks in large area represent ideal candidates for membranes sieving molecules and nano-objects, but challenges still remain in methodology and practical preparation. Here we exploit a new strategy to build soft single-layer ionic organic-inorganic frameworks via electrostatic interaction without preferential binding direction in water. Upon consideration of steric effect and additional interaction, polyanionic clusters as connection nodes and cationic pseudorotaxanes acting as bridging monomers connect with each other to form a single-layer ionic self-assembled framework with 1.4 nm layer thickness. Such soft supramolecular polymer frameworks possess uniform and adjustable ortho-tetragonal nanoporous structure in pore size of 3.4-4.1 nm and exhibit greatly convenient solution processability. The stable membranes maintaining uniform porous structure demonstrate precisely size-selective separation of semiconductor quantum dots within 0.1 nm of accuracy and may hold promise for practical applications in selective transport, molecular separation and dialysis systems.

Implementing clinical governance in English primary care groups/trusts: reconciling quality improvement and quality assurance

PubMed Central

Campbell, S; Sheaff, R; Sibbald, B; Marshall, M; Pickard, S; Gask, L; Halliwell, S; Rogers, A; Roland, M

2002-01-01

Objectives: To investigate the concept of clinical governance being advocated by primary care groups/trusts (PCG/Ts), approaches being used to implement clinical governance, and potential barriers to its successful implementation in primary care. Design: Qualitative case studies using semi-structured interviews and documentation review. Setting: Twelve purposively sampled PCG/Ts in England. Participants: Fifty senior staff including chief executives, clinical governance leads, mental health leads, and lay board members. Main outcome measures: Participants' perceptions of the role of clinical governance in PCG/Ts. Results: PCG/Ts recognise that the successful implementation of clinical governance in general practice will require cultural as well as organisational changes, and the support of practices. They are focusing their energies on supporting practices and getting them involved in quality improvement activities. These activities include, but move beyond, conventional approaches to quality assessment (audit, incentives) to incorporate approaches which emphasise corporate and shared learning. PCG/Ts are also engaged in setting up systems for monitoring quality and for dealing with poor performance. Barriers include structural barriers (weak contractual levers to influence general practices), resource barriers (perceived lack of staff or money), and cultural barriers (suspicion by practice staff or problems overcoming the perceived blame culture associated with quality assessment). Conclusion: PCG/Ts are focusing on setting up systems for implementing clinical governance which seek to emphasise developmental and supportive approaches which will engage health professionals. Progress is intentionally incremental but formidable challenges lie ahead, not least reconciling the dual role of supporting practices while monitoring (and dealing with poor) performance. PMID:12078380

Effect of a structured course involving goal management training in older adults: A randomised controlled trial

PubMed Central

van Hooren, Susan A.H.; Valentijn, Susanne A.M.; Bosma, Hans; Ponds, Rudolf W.H.M.; van Boxtel, Martin P.J.; Levine, Brian; Robertson, Ian; Jolles, Jelle

2007-01-01

Objective The objective of this study was to investigate the effects of a structured 6-week neuropsychological course on the executive functioning of older adults with cognitive complaints. Methods A randomised controlled design was used involving 69 community dwelling individuals aged 55 years and older. Both objective and subjective measures were included to assess executive functioning. General linear model with repeated measures analysis of variance was used to examine the intervention effects. Results After the intervention, the participants in the intervention group were significantly less annoyed by their cognitive failures, were better able to manage their executive failures and reported less anxiety symptoms than those in the waiting list control group. Conclusion These findings indicate that a combination of psycho-education and training has the potential to change the attitude of older individuals towards their cognitive functioning. Practice implications Because this training focussed on cognitive functions that are among the first to decline in older adults and the subjective evaluation of the people after training was quite favourable, the proposed intervention may be considered a valuable contribution to cognitive interventions for older adults. PMID:16956743

Validation of an educative manual for patients with head and neck cancer submitted to radiation therapy 1

PubMed Central

da Cruz, Flávia Oliveira de Almeida Marques; Ferreira, Elaine Barros; Vasques, Christiane Inocêncio; da Mata, Luciana Regina Ferreira; dos Reis, Paula Elaine Diniz

2016-01-01

Abstract Objective: develop the content and face validation of an educative manual for patients with head and neck cancer submitted to radiation therapy. Method: descriptive methodological research. The Theory of Psychometrics was used for the validation process, developed by 15 experts in the theme area of the educative manual and by two language and publicity professionals. A minimum agreement level of 80% was considered to guarantee the validity of the material. Results: the items addressed in the assessment tool of the educative manual were divided in three blocks: objectives, structure and format, and relevance. Only one item, related to the sociocultural level of the target public, obtained an agreement rate <80%, and was reformulated based on the participants' suggestions. All other items were considered appropriate and/or complete appropriate in the three blocks proposed: objectives - 92.38%, structure and form - 89.74%, and relevance - 94.44%. Conclusion: the face and content validation of the educative manual proposed were attended to. This can contribute to the understanding of the therapeutic process the head and neck cancer patient is submitted to during the radiation therapy, besides supporting clinical practice through the nursing consultation. PMID:27305178

Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience.

PubMed

Takach, Mary

2016-10-01

Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes-all core attributes of a medical home. This qualitative study looked at 4 different PHCO models-3 from the United States and 1 from Australia-with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system.

Evaluation of a 2 to 1 peer placement supervision model by physiotherapy students and their educators.

PubMed

Alpine, Lucy M; Caldas, Francieli Tanji; Barrett, Emer M

2018-04-02

The objective of the study was to investigate student and practice educator evaluations of practice placements using a structured 2 to 1 supervision and implementation model. Cross-sectional pilot study set in clinical sites providing placements for physiotherapy students in Ireland. Students and practice educators completing a 2.1 peer placement between 2013 and 2015 participated. A self-reported questionnaire which measured indicators linked to quality assured placements was used. Three open-ended questions captured comments on the benefits and challenges associated with the 2 to 1 model. Ten students (10/20; 50% response rate) and 10 practice educators (10/10; 100% response rate) responded to the questionnaire. Student responses included four pairs of students and one student from a further two pairs. There was generally positive agreement with the questionnaire indicating that placements using the 2 to 1 model were positively evaluated by participants. There were no significant differences between students and practice educators. The main benefits of the 2 to 1 model were shared learning experiences, a peer supported environment, and the development of peer evaluation and feedback skills by students. A key component of the model was the peer scripting process which provided time for reflection, self-evaluation, and peer review. 2 to 1 placements were positively evaluated by students and educators when supported by a structured supervision model. Clear guidance to students on the provision of peer feedback and support for educators providing feedback to two different students is recommended.

Artefacts for optical surface measurement

NASA Astrophysics Data System (ADS)

Robson, Stuart; Beraldin, J.-Angelo; Brownhill, Andrew; MacDonald, Lindsay

2011-07-01

Flexible manufacturing technologies are supporting the routine production of components with freeform surfaces in a wide variety of materials and surface finishes. Such surfaces may be exploited for both aesthetic and performance criteria for a wide range of industries, for example automotive, aircraft, small consumer goods and medial components. In order to ensure conformance between manufactured part and digital design it is necessary to understand, validate and promote best practice of the available measurement technologies. Similar, but currently less quantifiable, measurement requirements also exist in heritage, museum and fine art recording where objects can be individually hand crafted to extremely fine levels of detail. Optical 3D measurement systems designed for close range applications are typified by one or more illumination sources projecting a spot, line or structured light pattern onto a surface or surfaces of interest. Reflections from the projected light are detected in one or more imaging devices and measurements made concerning the location, intensity and optionally colour of the image. Coordinates of locations on the surface may be computed either directly from an understanding of the illumination and imaging geometry or indirectly through analysis of the spatial frequencies of the projected pattern. Regardless of sensing configuration some independent means is necessary to ensure that measurement capability will meet the requirements of a given level of object recording and is consistent for variations in surface properties and structure. As technologies mature, guidelines for best practice are emerging, most prominent at the current time being the German VDI/VDE 2634 and ISO/DIS 10360-8 guidelines. This considers state of the art capabilities for independent validation of optical non-contact measurement systems suited to the close range measurement of table top sized manufactured or crafted objects.

Multi-indicator Evaluation System for Broadsword, Rod, Sword and Spear Athletes Based on Analytic Hierarchy Process

NASA Astrophysics Data System (ADS)

Luo, Lin

2017-08-01

In the practical selection of Wushu athletes, the objective evaluation of the level of athletes lacks sufficient technical indicators and often relies on the coach’s subjective judgments. It is difficult to accurately and objectively reflect the overall quality of the athletes without a fully quantified indicator system, thus affecting the level improvement of Wushu competition. The analytic hierarchy process (AHP) is a systemic analysis method combining quantitative and qualitative analysis. This paper realizes structured, hierarchized and quantified decision-making process of evaluating broadsword, rod, sword and spear athletes in the AHP. Combing characteristics of the athletes, analysis is carried out from three aspects, i.e., the athlete’s body shape, physical function and sports quality and 18 specific evaluation indicators established, and then combining expert advice and practical experience, pairwise comparison matrix is determined, and then the weight of the indicators and comprehensive evaluation coefficient are obtained to establish the evaluation model for the athletes, thus providing a scientific theoretical basis for the selection of Wushu athletes. The evaluation model proposed in this paper has realized the evaluation system of broadsword, rod, sword and spear athletes, which has effectively improved the scientific level of Wushu athletes selection in practical application.

Model Based Mission Assurance in a Model Based Systems Engineering (MBSE) Framework: State-of-the-Art Assessment

NASA Technical Reports Server (NTRS)

Cornford, Steven L.; Feather, Martin S.

2016-01-01

This report explores the current state of the art of Safety and Mission Assurance (S&MA) in projects that have shifted towards Model Based Systems Engineering (MBSE). Its goal is to provide insight into how NASA's Office of Safety and Mission Assurance (OSMA) should respond to this shift. In MBSE, systems engineering information is organized and represented in models: rigorous computer-based representations, which collectively make many activities easier to perform, less error prone, and scalable. S&MA practices must shift accordingly. The "Objective Structure Hierarchies" recently developed by OSMA provide the framework for understanding this shift. Although the objectives themselves will remain constant, S&MA practices (activities, processes, tools) to achieve them are subject to change. This report presents insights derived from literature studies and interviews. The literature studies gleaned assurance implications from reports of space-related applications of MBSE. The interviews with knowledgeable S&MA and MBSE personnel discovered concerns and ideas for how assurance may adapt. Preliminary findings and observations are presented on the state of practice of S&MA with respect to MBSE, how it is already changing, and how it is likely to change further. Finally, recommendations are provided on how to foster the evolution of S&MA to best fit with MBSE.

Lost in translation? Theory, policy and practice in systems-based environmental approaches to obesity prevention in the Healthy Towns programme in England.

PubMed

Sautkina, Elena; Goodwin, Denise; Jones, Andy; Ogilvie, David; Petticrew, Mark; White, Martin; Cummins, Steven

2014-09-01

This paper explores how system-wide approaches to obesity prevention were 'theorised' and translated into practice in the 'Healthy Towns' programme implemented in nine areas in England. Semi-structured interviews with 20 informants, purposively selected to represent national and local programme development, management and delivery were undertaken. Results suggest that informants articulated a theoretical understanding of a system-wide approach to obesity prevention, but simplifying this complex task in the context of uncertainty over programme aims and objectives, and absence of a clear direction from the central government, resulted in local programmes relying on traditional multi-component approaches to programme delivery. The development of clear, practical guidance on implementation should form a central part of future system-wide approaches to obesity prevention. Copyright © 2014 Elsevier Ltd. All rights reserved.

Education, outreach, and inclusive engagement: Towards integrated indicators of successful program outcomes in participatory science.

PubMed

Haywood, Benjamin K; Besley, John C

2014-01-01

The use and utility of science in society is often influenced by the structure, legitimacy, and efficacy of the scientific research process. Public participation in scientific research (PPSR) is a growing field of practice aimed at enhancing both public knowledge and understanding of science (education outreach) and the efficacy and responsiveness of scientific research, practice, and policy (participatory engagement). However, PPSR objectives focused on "education outreach" and "participatory engagement" have each emerged from diverse theoretical traditions that maintain distinct indicators of success used for program development and evaluation. Although areas of intersection and overlap among these two traditions exist in theory and practice, a set of comprehensive standards has yet to coalesce that supports the key principles of both traditions in an assimilated fashion. To fill this void, a comprehensive indicators framework is proposed with the goal of promoting a more integrative and synergistic PPSR program development and assessment process.

An Advanced Professional Pharmacy Experience in a Community Setting Using an Experiential Manual

PubMed Central

Lee, Karen W.; Machado, Matthew R.; Wenzel, Marie M.; Gagnon, James M.; Calomo, Joseph M.

2006-01-01

Objectives To determine the usefulness of a teaching and learning tool used to create structure for advanced pharmacy practice experiences (APPEs) in community pharmacy settings, and to identify differences between respondents' perspectives on the relevance and practicality of implementing specific community pharmacy-related topics during the experience. Design Community practice faculty members designed a manual that outlined a week-by-week schedule of student activities, consistent with the Center for the Advancement of Pharmaceutical Education (CAPE) outcome-based goals, and included associated teaching, documentation, and assessment tools. The manual was distributed to site preceptors and students. Assessment Eighty-six PharmD students responded to a questionnaire upon completion of their community APPE. Student feedback concerning the impact of the manual relative to interactions with site preceptors and their overall learning experience was relatively positive. Conclusion The manual was an effective teaching and learning tool for students completing a community APPE. PMID:17149421

No-Fault Compensation for Adverse Events Following Immunization: A Review of Chinese Law And Practice.

PubMed

Fei, Lanfang; Peng, Zhou

2017-02-01

In 2005, China introduced an administrative no-fault one-time compensation scheme for adverse events following immunization (AEFI). The scheme aims to ensure fair compensation for those injured by adverse reactions following immunization. These individuals bear a significant burden for the benefits of widespread immunization. However, there is little empirical evidence of how the scheme has been implemented and how it functions in practice. The article aims to fill this gap. Based on an analysis of the legal basis of the scheme and of practical compensation cases, this article examines the structuring, function, and effects of the scheme; evaluates loopholes in the scheme; evaluates the extent to which the scheme has achieved its intended objectives; and discusses further development of the scheme. © The Author 2017. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.

Women, weight, poverty and menopause: understanding health practices in a context of chronic disease prevention.

PubMed

Audet, Mélisa; Dumas, Alex; Binette, Rachelle; Dionne, Isabelle J

2017-11-01

Socioeconomic inequalities in health persist despite major investments in illness prevention campaigns and universal healthcare systems. In this context, the increased risks of chronic diseases of specific sub-groups of vulnerable populations should be further investigated. The objective of this qualitative study is to examine the interaction between socioeconomic status (SES) and body weight in order to understand underprivileged women's increased vulnerability to chronic diseases after menopause. By drawing specifically on Pierre Bourdieu's sociocultural theory of practice, 20 semi-structured interviews were conducted from May to December of 2013 to investigate the health practices of clinically overweight, postmenopausal women living an underprivileged life in Canada. Findings emphasise that poor life conditions undermine personal investment in preventive health and weight loss, showing the importance for policy makers to bring stronger consideration on upstream determinants of health. © 2017 Foundation for the Sociology of Health & Illness.

[Students' physical activity: an analysis according to Pender's health promotion model].

PubMed

Guedes, Nirla Gomes; Moreira, Rafaella Pessoa; Cavalcante, Tahissa Frota; de Araujo, Thelma Leite; Ximenes, Lorena Barbosa

2009-12-01

The objective of this study was to describe the everyday physical activity habits of students and analyze the practice of physical activity and its determinants, based on the first component of Pender's health promotion model. This cross-sectional study was performed from 2004 to 2005 with 79 students in a public school in Fortaleza, Ceará, Brazil. Data collection was performed by interviews and physical examinations. The data were analyzed according to the referred theoretical model. Most students (n=60) were physically active. Proportionally, adolescents were the most active (80.4%). Those with a sedentary lifestyle had higher rates for overweight and obesity (21.1%). Many students practiced outdoor physical activities, which did not require any physical structure and good financial conditions. The results show that it is possible to associate the first component of Pender's health promotion model with the everyday lives of students in terms of the physical activity practice.

Semantics and technologies in modern design of interior stairs

NASA Astrophysics Data System (ADS)

Kukhta, M.; Sokolov, A.; Pelevin, E.

2015-10-01

Use of metal in the design of interior stairs presents new features for shaping, and can be implemented using different technologies. The article discusses the features of design and production technologies of forged metal spiral staircase considering the image semantics based on the historical and cultural heritage. To achieve the objective was applied structural- semantic method (to identify the organization of structure and semantic features of the artistic image), engineering methods (to justify the construction of the object), anthropometry method and ergonomics (to provide usability), methods of comparative analysis (to reveale the features of the way the ladder in different periods of culture). According to the research results are as follows. Was revealed the semantics influence on the design of interior staircase that is based on the World Tree image. Also was suggested rational calculation of steps to ensure the required strength. And finally was presented technology, providing the realization of the artistic image. In the practical part of the work is presented version of forged staircase.

Impact of the rate of the additive process of forming a heavy structure deforming in creep on the development of its technological stresses

NASA Astrophysics Data System (ADS)

Parshin, Dmitry A.

2018-05-01

The additive process of forming a semicircular arched structure by means of layer-by-layer addition of material to its inner surface is simulated. The impact of this process running mode on the development of the technological stresses fields in the structure being formed under the action of gravity under properties of the material creep and aging is examined. In the framework of the linear mechanics of accreted solids a mathematical model of the process under study is offered and numerical experiments are conducted. It is shown that the stress-strain state of the additively formed heavy objects decisively depends on their formation mode. Various practically important trends and features of this dependence are studied.

A case-based, small-group cooperative learning course in preclinical veterinary science aimed at bridging basic science and clinical literacy.

PubMed

Schoeman, J P; van Schoor, M; van der Merwe, L L; Meintjes, R A

2009-03-01

In 1999 a dedicated problem-based learning course was introduced into the lecture-based preclinical veterinary curriculum of the University of Pretoria. The Introduction to Clinical Studies Course combines traditional lectures, practical sessions, student self-learning and guided tutorials. The self-directed component of the course utilises case-based, small-group cooperative learning as an educational vehicle to link basic science with clinical medicine. The aim of this article is to describe the objectives and structure of the course and to report the results of the assessment of the students' perceptions on some aspects of the course. Students reacted very positively to the ability of the course to equip them with problem-solving skills. Students indicated positive perceptions about the workload of the course. There were, however, significantly lower scores for the clarity of the course objectives. Although the study guide for the course is very comprehensive, the practice regarding the objectives is still uncertain. It is imperative to set clear objectives in non-traditional, student-centred courses. The objectives have to be explained at the outset and reiterated throughout the course. Tutors should also communicate the rationale behind problem-based learning as a pedagogical method to the students. Further research is needed to verify the effectiveness of this course in bridging the gap between basic science and clinical literacy in veterinary science. Ongoing feedback and assessment of the management and content are important to refine this model for integrating basic science with clinical literacy.

Audit in general practice: factors influencing participation.

PubMed Central

Baker, R.; Robertson, N.; Farooqi, A.

1995-01-01

OBJECTIVE--To identify the factors influencing participation in a single topic audit initiated by a medical audit advisory group. DESIGN--Interview and questionnaire survey of general practitioners who had been invited to take part in an audit of vitamin B-12. SETTING--All 147 general practices in Leicestershire. MAIN OUTCOME MEASURES--Aspects of structure, attitude, and behaviour that influenced participation or non-participation. RESULTS--75 practices completed the audit, 49 withdrew after initial agreement, and 23 refused to take part at the outset. Participants were more likely than those who refused to view the advisory group as useful or a threat and to have positive thoughts about audit but less likely to have previously undertaken audit entailing implementation of change. Participants were more likely than those who withdrew to have positive thoughts about audit and to have discussed whether to take part within the practice but were less likely to view the advisory group as useful. The most common reason given for withdrawal was lack of time. CONCLUSIONS--Participation was influenced by attitudes towards audit in general and the advisory group in particular and by aspects of behaviour such as communication within the practice. Practical support and resources may help some practices undertake audit, but advisory groups must also deal with attitudes and unsatisfactory communication in practice teams. PMID:7613323

General practitioners’ experiences using cognitive behavioural therapy in general practice: A qualitative study

PubMed Central

Aschim, Bente; Lundevall, Sverre; Martinsen, Egil W.; Frich, Jan C.

2011-01-01

Objective To explore GPs’ experiences using cognitive behavioural therapy (CBT), with a focus on factors that promote or limit the use of CBT in general practice. Design Qualitative study using data from written evaluation reports and focus-group interviews. Setting Norwegian general practice. Subjects GPs who participated in a longitudinal CBT course in the continuous medical education (CME) programme for GPs in Norway, of whom 19 filled in evaluation forms and 15 participated in focus-group interviews. Main outcome measures Experiences with the use of CBT in general practice. Results GPs used CBT mainly in the treatment of patients with anxiety disorders and depression. Factors that promoted the use of CBT in general practice were structured supervision and group counselling, receiving feedback on individual video-recorded consultations, and experiencing that one mastered the therapeutic techniques. Limiting factors were that it took some time before one mastered the techniques, lack of eligible patients, constraints related to attending group supervision during office hours, and the lack of financial incentives to use CBT in general practice. Conclusion Tailored training programmes in CBT for GPs may contribute to more frequent use of CBT in general practice. A formal recognition of CBT in the reimbursement scheme for GPs might counter limiting factors to an increased use of CBT in general practice. PMID:21861599

Iterative Region-of-Interest Reconstruction from Limited Data Using Prior Information

NASA Astrophysics Data System (ADS)

Vogelgesang, Jonas; Schorr, Christian

2017-12-01

In practice, computed tomography and computed laminography applications suffer from incomplete data. In particular, when inspecting large objects with extremely different diameters in longitudinal and transversal directions or when high resolution reconstructions are desired, the physical conditions of the scanning system lead to restricted data and truncated projections, also known as the interior or region-of-interest (ROI) problem. To recover the searched-for density function of the inspected object, we derive a semi-discrete model of the ROI problem that inherently allows the incorporation of geometrical prior information in an abstract Hilbert space setting for bounded linear operators. Assuming that the attenuation inside the object is approximately constant, as for fibre reinforced plastics parts or homogeneous objects where one is interested in locating defects like cracks or porosities, we apply the semi-discrete Landweber-Kaczmarz method to recover the inner structure of the object inside the ROI from the measured data resulting in a semi-discrete iteration method. Finally, numerical experiments for three-dimensional tomographic applications with both an inherent restricted source and ROI problem are provided to verify the proposed method for the ROI reconstruction.

Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes.

PubMed

Chung, Gladys W; Wu, Jia En; Yeo, Chay Leng; Chan, Douglas; Hsu, Li Yang

2013-02-15

Antimicrobial stewardship is an emerging field currently defined by a series of strategies and interventions aimed toward improving appropriate prescription of antibiotics in humans in all healthcare settings. The ultimate goal is the preservation of current and future antibiotics against the threat of antimicrobial resistance, although improving patient safety and reducing healthcare costs are important concurrent aims. Prospective audit and feedback interventions are probably the most widely practiced of all antimicrobial stewardship strategies. Although labor-intensive, they are more easily accepted by physicians compared with formulary restriction and preauthorization strategies and have a higher potential for educational opportunities. Objective evaluation of antimicrobial stewardship is critical for determining the success of such programs. Nonetheless, there is controversy over which outcomes to measure and there is a pressing need for novel study designs that can objectively assess antimicrobial stewardship interventions despite the limitations inherent in the structure of most such programs.

An evaluation of transit procurement training.

PubMed

Noland, Robert B; Weiner, Marc D; Klein, Nicholas J; Puniello, Orin D

2017-04-01

We evaluated a training course called "Orientation to Transit Procurement", designed and conducted by the National Transit Institute. This course is designed to provide Federal Transit Administration (FTA) grantees an overview of regulations and best practices related to the procurement process. Our objective in conducting the evaluation was to understand how transit agency staff made changes in procurement practices in response to the course training. The evaluation was mixed mode: an Internet survey followed by in-depth interviews with a small group of respondents. Survey respondents were also provided with an open-ended question providing us with additional context for our evaluation. Results show that the training is substantially successful at meeting the goal of improving procurement practices at transit agencies; indeed, most respondents report making changes at their agencies as the proximate result of the training. This was at odds with our exploration of knowledge of procurement topics, as most respondents gave inaccurate answers on multiple-choice "knowledge questions". This may have been due to question structure or, more likely, the nature of online surveys. Suitable training on the procurement of information technology was also a main concern. The lack of training in this area is indicative of the broader challenge facing public transit agencies in how to incorporate new forms of technology into their existing practices and bureaucratic structures. Copyright © 2016 Elsevier Ltd. All rights reserved.

A digital peer-to-peer learning platform for clinical skills development.

PubMed

Basnak, Jesse; Ortynski, Jennifer; Chow, Meghan; Nzekwu, Emeka

2017-02-01

Due to constraints in time and resources, medical curricula may not provide adequate opportunities for pre-clerkship students to practice clinical skills. To address this, medical students at the University of Alberta developed a digital peer-to-peer learning initiative. The initiative assessed if students can learn clinical skills from their peers in co-curricular practice objective structured clinical exams (OSCEs). A total of 144 first-year medical students participated. Students wrote case scenarios that were reviewed by physicians. Students enacted the cases in practice OSCEs, acting as the patient, physician, and evaluator. Verbal and electronic evaluations were completed. A digital platform was used to automate the process. Surveys were disseminated to assess student perceptions of their experience. Seventy-five percent of participants said they needed opportunities to practice patient histories and physical exams in addition to those provided in the medical school curriculum. All participants agreed that the co-curricular practice OSCEs met this need. The majority of participants also agreed that the digital platform was efficient and easy to use. Students found the practice OSCEs and digital platform effective for learning clinical skills. Thus, peer-to-peer learning and computer automation can be useful adjuncts to traditional medical curricula.

Tuberculosis Management Practices by Private Practitioners in Andhra Pradesh, India

PubMed Central

Achanta, Shanta; Jaju, Jyoti; Kumar, Ajay M. V.; Nagaraja, Sharath Burugina; Shamrao, Srinivas Rao Motta; Bandi, Sasidhar Kumar; Kumar, Ashok; Satyanarayana, Srinath; Harries, Anthony David; Nair, Sreenivas Achutan; Dewan, Puneet K.

2013-01-01

Setting Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India. Objectives To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC. Design Cross- sectional survey using semi-structured interviews. Results Of 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine. Conclusion Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance. PMID:23967158

Effectiveness of vaginal breech birth training strategies: An integrative review of the literature.

PubMed

Walker, Shawn; Breslin, Eamonn; Scamell, Mandie; Parker, Pam

2017-06-01

The safety of vaginal breech birth depends on the skill of the attendant. The objective of this review was to identify, synthesize, and report the findings of evaluated breech birth training strategies. A systematic search of the following on-line databases: Medline, CINAHL Plus, PsychINFO, EBM Reviews/Cochrane Library, EMBASE, Maternity and Infant Care, and Pubmed, using a structured search strategy. Studies were included in the review if they evaluated the efficacy of a breech birth training program or particular strategies, including obstetric emergency training evaluations that reported differentiated outcomes for breech. Out of 1040 original citings, 303 full-text articles were assessed for eligibility, and 17 methodologically diverse studies met the inclusion criteria. A data collection form was used to extract relevant information. Data were synthesized, using an evaluation levels framework, including reaction, learning (subjective and objective assessment), and behavioral change. No evaluations included clinical outcome data. Improvements in self-assessed skill and confidence were not associated with improvements in objective assessments or behavioral change. Inclusion of breech birth as part of an obstetric emergencies training package without support in practice was negatively associated with subsequent attendance at vaginal breech births. As a result of the heterogeneity of the studies available, and the lack of evidence concerning neonatal or maternal outcomes, no conclusive practice recommendations can be made. However, the studies reviewed suggest that vaginal breech birth training may be enhanced by reflection, repetition, and experienced clinical support in practice. Further evaluation studies should prioritize clinical outcome data. © 2017 Wiley Periodicals, Inc.

Building a global business continuity programme.

PubMed

Lazcano, Michael

2014-01-01

Business continuity programmes provide an important function within organisations, especially when aligned with and supportive of the organisation's goals, objectives and organisational culture. Continuity programmes for large, complex international organisations, unlike those for compact national companies, are more difficult to design, build, implement and maintain. Programmes for international organisations require attention to structural design, support across organisational leadership and hierarchy, seamless integration with the organisation's culture, measured success and demonstrated value. This paper details practical, but sometimes overlooked considerations for building successful global business continuity programmes.

The combination of simulation and response methodology and its application in an aggregate production plan

NASA Astrophysics Data System (ADS)

Chen, Zhiming; Feng, Yuncheng

1988-08-01

This paper describes an algorithmic structure for combining simulation and optimization techniques both in theory and practice. Response surface methodology is used to optimize the decision variables in the simulation environment. A simulation-optimization software has been developed and successfully implemented, and its application to an aggregate production planning simulation-optimization model is reported. The model's objective is to minimize the production cost and to generate an optimal production plan and inventory control strategy for an aircraft factory.

Community pharmacists' views of the use of oral rehydration salt in Nigeria.

PubMed

Oyetunde, Olubukola; Williams, Veronika

2018-06-01

Background Oral rehydration salt (ORS) is an affordable and effective intervention for the management of acute watery diarrhoea (AWD), especially in children under 5 years. A knowledge/practice gap exists among community pharmacists (CPs) in Lagos, Nigeria, and in many low to middle income countries. This gap results in underutilization of ORS for diarrhoea management. Objective The objective was to explore CPs' views of the barriers and facilitators to the use of ORS in practice. Setting Community pharmacy practices, Lagos, Nigeria. Methods Qualitative methods were used to explore pharmacists' views. Recruitment of participants were mainly at zonal meetings. A total of ten CPs participated based on maximum variation and snowballing sampling. Semi-structured interviews conducted covered knowledge, experiences and contextual issues. Interviews were audiorecorded, transcribed and analysed using framework approach to thematic analysis. Main outcome measure Pharmacists' views of barriers and facilitators to the use of ORS. Results Barriers to the use of ORS include caregivers' expectation for an antimicrobial, which was often explicitly and specifically for metronidazole. Also, CPs seemed to doubt applicability of ORS alone, therefore, responded to caregivers' complaints about ORS, by dispensing metronidazole. These barriers appeared to have normalised metronidazole for AWD treatment in this setting. Current facilitators include the caregivers' improved awareness of ORS and access to primary health centers that often resulted in increased demand for ORS in pharmacies. Conclusion CPs' views showed that caregivers' expectations for an antimicrobial may be the main barrier to the use of ORS in their practices.

Interactions of structurally modified surfactants with reservoir minerals: Calorimetric, spectroscopic and electrokinetic study

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

Somasundaran, P.; Sivakumar, A.; Xu, Q.

1991-03-01

The objective of this project is to elucidate mechanisms of adsorption of structurally modified surfactants on reservoir minerals and to develop a full understanding of the effect of the surfactant structure on the nature of the adsorbed layers at the molecular level. An additional aim is to study the adsorption of surfactant mixtures on simple well-characterized minerals and on complex minerals representing real conditions. The practical goal of these studies is the identification of the optimum surfactant structures and their combinations for micellar flooding. In this work, the experiments on adsorption were focussed on the position of sulfonate and methylmore » groups on the aromatic ring of alkyl xylene sulfonates. A multi-pronged approach consisting of calorimetry, electrokinetics, wettability and spectroscopy is planned to elucidate the adsorption mechanism of surfactants and their mixtures on minerals such as alumina and kaolinite. 32 refs., 15 figs., 7 tabs.« less

Patterns in PARTNERing across Public Health Collaboratives.

PubMed

Bevc, Christine A; Retrum, Jessica H; Varda, Danielle M

2015-10-05

Inter-organizational networks represent one of the most promising practice-based approaches in public health as a way to attain resources, share knowledge, and, in turn, improve population health outcomes. However, the interdependencies and effectiveness related to the structure, management, and costs of these networks represents a critical item to be addressed. The objective of this research is to identify and determine the extent to which potential partnering patterns influence the structure of collaborative networks. This study examines data collected by PARTNER, specifically public health networks (n = 162), to better understand the structured relationships and interactions among public health organizations and their partners, in relation to collaborative activities. Combined with descriptive analysis, we focus on the composition of public health collaboratives in a series of Exponential Random Graph (ERG) models to examine the partnerships between different organization types to identify the attribute-based effects promoting the formation of network ties within and across collaboratives. We found high variation within and between these collaboratives including composition, diversity, and interactions. The findings of this research suggest common and frequent types of partnerships, as well as opportunities to develop new collaborations. The result of this analysis offer additional evidence to inform and strengthen public health practice partnerships.

Practice Models and Challenges in Teledermatology: A Study of Collective Experiences from Teledermatologists

PubMed Central

Armstrong, April W.; Kwong, Mei W.; Ledo, Lynda; Nesbitt, Thomas S.; Shewry, Sandra L.

2011-01-01

Background Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied. Methods The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California. Results Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers. Conclusion Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices. PMID:22194887

A Receptor-Grounded Approach to Teaching Nonsteroidal Antiinflammatory Drug Chemistry and Structure-Activity Relationships

PubMed Central

2009-01-01

Objective To describe a receptor-based approach to promote learning about nonsteroidal anti-inflammatory drug (NSAID) chemistry, structure-activity relationships, and therapeutic decision-making. Design Three lessons on cyclooxygenase (COX) and NSAID chemistry, and NSAID therapeutic utility, were developed using text-based resources and primary medicinal chemistry and pharmacy practice literature. Learning tools were developed to assist students in content mastery. Assessment Student learning was evaluated via performance on quizzes and examinations that measured understanding of COX and NSAID chemistry, and the application of that knowledge to therapeutic problem solving. Conclusion Student performance on NSAID-focused quizzes and examinations documented the success of this approach. PMID:20221336

Development of structural model of adaptive training complex in ergatic systems for professional use

NASA Astrophysics Data System (ADS)

Obukhov, A. D.; Dedov, D. L.; Arkhipov, A. E.

2018-03-01

The article considers the structural model of the adaptive training complex (ATC), which reflects the interrelations between the hardware, software and mathematical model of ATC and describes the processes in this subject area. The description of the main components of software and hardware complex, their interaction and functioning within the common system are given. Also the article scrutinizers a brief description of mathematical models of personnel activity, a technical system and influences, the interactions of which formalize the regularities of ATC functioning. The studies of main objects of training complexes and connections between them will make it possible to realize practical implementation of ATC in ergatic systems for professional use.

On actuator placement for robust time-optimal control of uncertain flexible spacecraft

NASA Technical Reports Server (NTRS)

Wie, Bong; Sinha, Ravi; Liu, Qiang

1992-01-01

The problem of computing open-loop, on-off jet firing logic for flexible spacecraft in the face of plant modeling uncertainty is investigated. The primary control objective is to achieve a fast maneuvering time with a minimum of structural vibrations during and/or after a maneuver. This paper is also concerned with the problem of selecting a proper pair of jets for practical trade-offs among the maneuvering time, fuel consumption, structural mode excitation, and performance robustness. A time-optimal control problem subject to parameter robustness constraints is formulated. A three-mass-spring model of flexible spacecraft with a rigid-body mode and two flexible modes is used to illustrate the concept.

Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

PubMed

Phuong, Nguyen Khanh; Oanh, Tran Thi Mai; Phuong, Hoang Thi; Tien, Tran Van; Cashin, Cheryl

2015-01-01

Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

Computerization of guidelines: towards a "guideline markup language".

PubMed

Dart, T; Xu, Y; Chatellier, G; Degoulet, P

2001-01-01

Medical decision making is one of the most difficult daily tasks for physicians. Guidelines have been designed to reduce variance between physicians in daily practice, to improve patient outcomes and to control costs. In fact, few physicians use guidelines in daily practice. A way to ease the use of guidelines is to implement computerised guidelines (computer reminders). We present in this paper a method of computerising guidelines. Our objectives were: 1) to propose a generic model that can be instantiated for any specific guidelines; 2) to use eXtensible Markup Language (XML) as a guideline representation language to instantiate the generic model for a specific guideline. Our model is an object representation of a clinical algorithm, it has been validated by running two different guidelines issued by a French official Agency. In spite of some limitations, we found that this model is expressive enough to represent complex guidelines devoted to diabetes and hypertension management. We conclude that XML can be used as a description format to structure guidelines and as an interface between paper-based guidelines and computer applications.

Near-infrared fluorescence image quality test methods for standardized performance evaluation

NASA Astrophysics Data System (ADS)

Kanniyappan, Udayakumar; Wang, Bohan; Yang, Charles; Ghassemi, Pejhman; Wang, Quanzeng; Chen, Yu; Pfefer, Joshua

2017-03-01

Near-infrared fluorescence (NIRF) imaging has gained much attention as a clinical method for enhancing visualization of cancers, perfusion and biological structures in surgical applications where a fluorescent dye is monitored by an imaging system. In order to address the emerging need for standardization of this innovative technology, it is necessary to develop and validate test methods suitable for objective, quantitative assessment of device performance. Towards this goal, we develop target-based test methods and investigate best practices for key NIRF imaging system performance characteristics including spatial resolution, depth of field and sensitivity. Characterization of fluorescence properties was performed by generating excitation-emission matrix properties of indocyanine green and quantum dots in biological solutions and matrix materials. A turbid, fluorophore-doped target was used, along with a resolution target for assessing image sharpness. Multi-well plates filled with either liquid or solid targets were generated to explore best practices for evaluating detection sensitivity. Overall, our results demonstrate the utility of objective, quantitative, target-based testing approaches as well as the need to consider a wide range of factors in establishing standardized approaches for NIRF imaging system performance.

75 FR 6079 - Culturally Significant Objects Imported for Exhibition

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-05

... DEPARTMENT OF STATE [PUBLIC NOTICE 6894] Culturally Significant Objects Imported for Exhibition Determinations: ``Compass and Rule: Architecture as Mathematical Practice in England, 1500-1750'' SUMMARY: Notice... objects to be included in the exhibition ``Compass and Rule: Architecture as Mathematical Practice in...

Equivalent circuit models for interpreting impedance perturbation spectroscopy data

NASA Astrophysics Data System (ADS)

Smith, R. Lowell

2004-07-01

As in-situ structural integrity monitoring disciplines mature, there is a growing need to process sensor/actuator data efficiently in real time. Although smaller, faster embedded processors will contribute to this, it is also important to develop straightforward, robust methods to reduce the overall computational burden for practical applications of interest. This paper addresses the use of equivalent circuit modeling techniques for inferring structure attributes monitored using impedance perturbation spectroscopy. In pioneering work about ten years ago significant progress was associated with the development of simple impedance models derived from the piezoelectric equations. Using mathematical modeling tools currently available from research in ultrasonics and impedance spectroscopy is expected to provide additional synergistic benefits. For purposes of structural health monitoring the objective is to use impedance spectroscopy data to infer the physical condition of structures to which small piezoelectric actuators are bonded. Features of interest include stiffness changes, mass loading, and damping or mechanical losses. Equivalent circuit models are typically simple enough to facilitate the development of practical analytical models of the actuator-structure interaction. This type of parametric structure model allows raw impedance/admittance data to be interpreted optimally using standard multiple, nonlinear regression analysis. One potential long-term outcome is the possibility of cataloging measured viscoelastic properties of the mechanical subsystems of interest as simple lists of attributes and their statistical uncertainties, whose evolution can be followed in time. Equivalent circuit models are well suited for addressing calibration and self-consistency issues such as temperature corrections, Poisson mode coupling, and distributed relaxation processes.

Rural-Urban Differences in Consumer Governance at Community Health Centers

PubMed Central

Wright, David Bradley

2017-01-01

Context Community health centers (CHCs) are primary care clinics that serve mostly low-income patients in rural and urban areas. They are required to be governed by a consumer majority. What little is known about the structure and function of these boards in practice, suggests that CHC boards in rural areas may look and act differently than CHC boards in urban areas. Purpose To identify differences in the structure and function of consumer governance at CHCs in rural and urban areas. Methods Semi-structured telephone interviews were conducted with 30 CHC board members from 14 different states. Questions focused on board members’ perceptions of board composition and the role of consumers on the board. Findings CHCs in rural areas are more likely to have representative boards, are better able to convey confidence in the organization, and are better able to assess community needs than CHCs in urban areas. However, CHCs in rural areas often have problems achieving objective decision-making, and may have fewer means for objectively evaluating quality of care due to the lack of patient board member anonymity. Conclusions Consumer governance is implemented differently in rural and urban communities, and the advantages and disadvantages in each setting are unique. PMID:23551642

Challenges in Scale-Resolving Simulations of turbulent wake flows with coherent structures

NASA Astrophysics Data System (ADS)

Pereira, Filipe S.; Eça, Luís; Vaz, Guilherme; Girimaji, Sharath S.

2018-06-01

The objective of this work is to investigate the challenges encountered in Scale-Resolving Simulations (SRS) of turbulent wake flows driven by spatially-developing coherent structures. SRS of practical interest are expressly intended for efficiently computing such flows by resolving only the most important features of the coherent structures and modelling the remainder as stochastic field. The success of SRS methods depends upon three important factors: i) ability to identify key flow mechanisms responsible for the generation of coherent structures; ii) determine the optimum range of resolution required to adequately capture key elements of coherent structures; and iii) ensure that the modelled part is comprised nearly exclusively of fully-developed stochastic turbulence. This study considers the canonical case of the flow around a circular cylinder to address the aforementioned three key issues. It is first demonstrated using experimental evidence that the vortex-shedding instability and flow-structure development involves four important stages. A series of SRS computations of progressively increasing resolution (decreasing cut-off length) are performed. An a priori basis for locating the origin of the coherent structures development is proposed and examined. The criterion is based on the fact that the coherent structures are generated by the Kelvin-Helmholtz (KH) instability. The most important finding is that the key aspects of coherent structures can be resolved only if the effective computational Reynolds number (based on total viscosity) exceeds the critical value of the KH instability in laminar flows. Finally, a quantitative criterion assessing the nature of the unresolved field based on the strain-rate ratio of mean and unresolved fields is examined. The two proposed conditions and rationale offer a quantitative basis for developing "good practice" guidelines for SRS of complex turbulent wake flows with coherent structures.

Negotiating markets for health: an exploration of physicians' engagement in dual practice in three African capital cities.

PubMed

Russo, Giuliano; McPake, Barbara; Fronteira, Inês; Ferrinho, Paulo

2014-09-01

Scarce evidence exists on the features, determinants and implications of physicians' dual practice, especially in resource-poor settings. This study considered dual practice patterns in three African cities and the respective markets for physician services, with the objective of understanding the influence of local determinants on the practice. Forty-eight semi-structured qualitative interviews were conducted in the three cities to understand features of the practice and the respective markets. A survey was carried out in a sample of 331 physicians to explore their characteristics and decisions to work in public and private sectors. Descriptive analysis and inferential statistics were employed to explore differences in physicians' engagement in dual practice across the three locations. Different forms of dual practice were found to exist in the three cities, with public physicians engaging in private practice outside but also inside public facilities, in regulated as well as unregulated ways. Thirty-four per cent of the respondents indicated that they worked in public practice only, and 11% that they engaged exclusively in private practice. The remaining 55% indicated that they engaged in some form of dual practice, 31% 'outside' public facilities, 8% 'inside' and 16% both 'outside' and 'inside'. Local health system governance and the structure of the markets for physician services were linked to the forms of dual practice found in each location, and to their prevalence. Our analysis suggests that physicians' decisions to engage in dual practice are influenced by supply and demand factors, but also by how clearly separated public and private markets are. Where it is possible to provide little-regulated services within public infrastructure, less incentive seems to exist to engage in the formal private sector, with equity and efficiency implications for service provision. The study shows the value of analysing health markets to understand physicians' engagement in professional activities, and contributes to an evidence base for its regulation. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013.

Effects of Rainfall-Induced Topsoil Structure Changes on Root-Zone Moisture Regime during the Dry Period

NASA Astrophysics Data System (ADS)

Wang, Feng; Chen, Jiazhou; Lin, Lirong

2018-01-01

Rainfall erosion and subsequent intermittent drought are serious barriers for agricultural production in the subtropical red soil region of China. Although it is widely recognized that rainfall-induced soil structure degradation reduced soil water storage and water-holding capacity, the effects of variation of the rainfall-induced topsoil structure on the subsequent soil water regime during the dry period is still rarely considered. The objective of this study was to ascertain the way of rainfall-induced topsoil structure changes on the subsequent soil water regime during the dry period. In a three-year-long experiment, six practices (CK, only crop; SM, straw mulching; PAM, polyacrylamide surface application; B, contour Bahia-grass strip; SPAM, straw mulching and polyacrylamide surface application; and BPAM, contour Bahia-grass strip and polyacrylamide surface application) were conducted at an 8° farmland with planting summer maize resulting in different topsoil structure and root-zone moisture, to establish and reveal the quantitatively relationship between the factors of topsoil structure and soil drought. Rainfall erosion significantly increased the soil crust coverage, and decreased the WSA 0.25, 0-30 mm soil porosity and mean pore size. There was no significant difference during the raining stage of root-zone water storage between CK and other practices. An index of soil drought intensity ( I) and degree ( D) was established using soil water loss rate and soil drought severity. The larger value of I means a higher rate of water loss. The larger value of D means more severe drought. During the dry period, I and D were significantly higher in CK than in other practices. I and D had significantly positively correlation with the crust size and crust coverage, and negatively with WSA 0.25, 15-30 mm soil porosity and mean pore size. Among of soil structure factors, the soil porosity had the largest effect on I and D. The rainfall-induced topsoil structure changes greatly deteriorated the root-zone regime during the dry period mainly due to significant increasing soil water loss but little improving the raining stage of soil water storage. Straw mulching had greater effects than other practices in alleviating rainfall-induced erosion and intermittent drought, and could be a better strategy applied for this region.

The psychiatric interview: validity, structure, and subjectivity.

PubMed

Nordgaard, Julie; Sass, Louis A; Parnas, Josef

2013-06-01

There is a glaring gap in the psychiatric literature concerning the nature of psychiatric symptoms and signs, and a corresponding lack of epistemological discussion of psycho-diagnostic interviewing. Contemporary clinical neuroscience heavily relies on the use of fully structured interviews that are historically rooted in logical positivism and behaviorism. These theoretical approaches marked decisively the so-called "operational revolution in psychiatry" leading to the creation of DSM-III. This paper attempts to examine the theoretical assumptions that underlie the use of a fully structured psychiatric interview. We address the ontological status of pathological experience, the notions of symptom, sign, prototype and Gestalt, and the necessary second-person processes which are involved in converting the patient's experience (originally lived in the first-person perspective) into an "objective" (third person), actionable format, used for classification, treatment, and research. Our central thesis is that psychiatry targets the phenomena of consciousness, which, unlike somatic symptoms and signs, cannot be grasped on the analogy with material thing-like objects. We claim that in order to perform faithful distinctions in this particular domain, we need a more adequate approach, that is, an approach that is guided by phenomenologically informed considerations. Our theoretical discussion draws upon clinical examples derived from structured and semi-structured interviews. We conclude that fully structured interview is neither theoretically adequate nor practically valid in obtaining psycho-diagnostic information. Failure to address these basic issues may have contributed to the current state of malaise in the study of psychopathology.

`Let your data tell a story:' climate change experts and students navigating disciplinary argumentation in the classroom

NASA Astrophysics Data System (ADS)

Walsh, Elizabeth Mary; McGowan, Veronica Cassone

2017-01-01

Science education trends promote student engagement in authentic knowledge in practice to tackle personally consequential problems. This study explored how partnering scientists and students on a social media platform supported students' development of disciplinary practice knowledge through practice-based learning with experts during two pilot enactments of a project-based curriculum focusing on the ecological impacts of climate change. Through the online platform, scientists provided feedback on students' infographics, visual argumentation artifacts that use data to communicate about climate change science. We conceptualize the infographics and professional data sets as boundary objects that supported authentic argumentation practices across classroom and professional contexts, but found that student generated data was not robust enough to cross these boundaries. Analysis of the structure and content of the scientists' feedback revealed that when critiquing argumentation, scientists initiated engagement in multiple scientific practices, supporting a holistic rather than discrete model of practice-based learning. While traditional classroom inquiry has emphasized student experimentation, we found that engagement with existing professional data sets provided students with a platform for developing expertise in systemic scientific practices during argument construction. We further found that many students increased the complexity and improved the visual presentation of their arguments after feedback.

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

PubMed Central

Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

2015-01-01

Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

A cross-sectional study assessing the association between online ratings and structural and quality of care measures: results from two German physician rating websites.

PubMed

Emmert, Martin; Adelhardt, Thomas; Sander, Uwe; Wambach, Veit; Lindenthal, Jörg

2015-09-24

Even though physician rating websites (PRWs) have been gaining in importance in both practice and research, little evidence is available on the association of patients' online ratings with the quality of care of physicians. It thus remains unclear whether patients should rely on these ratings when selecting a physician. The objective of this study was to measure the association between online ratings and structural and quality of care measures for 65 physician practices from the German Integrated Health Care Network "Quality and Efficiency" (QuE). Online reviews from two German PRWs were included which covered a three-year period (2011 to 2013) and included 1179 and 991 ratings, respectively. Information for 65 QuE practices was obtained for the year 2012 and included 21 measures related to structural information (N = 6), process quality (N = 10), intermediate outcomes (N = 2), patient satisfaction (N = 1), and costs (N = 2). The Spearman rank coefficient of correlation was applied to measure the association between ratings and practice-related information. Patient satisfaction results from offline surveys and the patients per doctor ratio in a practice were shown to be significantly associated with online ratings on both PRWs. For one PRW, additional significant associations could be shown between online ratings and cost-related measures for medication, preventative examinations, and one diabetes type 2-related intermediate outcome measure. There again, results from the second PRW showed significant associations with the age of the physicians and the number of patients per practice, four process-related quality measures for diabetes type 2 and asthma, and one cost-related measure for medication. Several significant associations were found which varied between the PRWs. Patients interested in the satisfaction of other patients with a physician might select a physician on the basis of online ratings. Even though our results indicate associations with some diabetes and asthma measures, but not with coronary heart disease measures, there is still insufficient evidence to draw strong conclusions. The limited number of practices in our study may have weakened our findings.

Use of evidence in the process of practice change in a clinical team: a study-forming part of the Autocontrol Project.

PubMed

Mehta, V; Kushniruk, A; Gauthier, S; Richard, Y; Deland, E; Veilleux, M; Grant, A

1998-01-01

The Autocontrol Project is concerned with the accessing, processing and communication of high quality information so that a clinical team can make and implement decisions for practice change, and then evaluate if improvement has been achieved. High quality information is used as evidence for change. In this study, we have evaluated how evidence is used by a clinical team to explain an identified problem of inappropriate use of blood gas tests. In an experimental study of the Surgical Intensive Care Unit, video recordings of team meetings of nurses and doctors were undertaken, structured according to a problem-based format. Evidence of current practice patterns derived from the hospital information system, as well as the results of a questionnaire to the unit's staff about knowledge and use of blood gas measurements, were supplied to the participants beforehand. At the second meeting, the output of the first meetings and a summarised analysis of pertinent literature were made available. This second meeting was required to finalise the list of causes of inappropriate blood gas use and propose pragmatic strategies for practice change. The video data of the meetings were coded to analyse the use of evidence, the categories of causes, issues and solutions proposed, and the quality of team interaction. The results indicate that in order to achieve consensus, the team used different types of evidence, including objective evidence of practice patterns, personal experience about direct and indirect organisational influences, and literature-based research evidence of best practice. Furthermore, group dynamics were favoured by the problem-based meeting structure, and a high level of cognitive critiquing between team members was observed. This research suggests that a combination of approaches involving identification of both operational factors (e.g. appropriate access to different types of evidence and meeting structure) and cognitive and behavioural approaches (e.g. ensuring expression of different viewpoints) is needed to support strategic decision-making for practice change in a clinical unit. This combined approach should favourably influence the provision of an effective and efficient evidence support environment for the clinical team.

Identification of major factors in Australian primary care pharmacists' practice environment that have a bearing on the implementation of professional models of practice.

PubMed

Jackson, John K; Hussainy, Safeera Y; Kirkpatrick, Carl M J

2017-08-01

Objective The aim of the present study was to describe an environmental framework for pharmacists in primary care in Australia and determine the major factors within that environment that have the greatest bearing on their capacity to implement patient-focused models of professional practice. Methods A draft framework for pharmacists' practice was developed by allocating structures, systems and related factors known to the researchers or identified from the literature as existing within pharmacists' internal, operational and external environments to one of five domains: Social, Technological, Economic, Environmental or Political [STEEP]. Focus groups of pharmacists used an adapted nominal group technique to assess the draft and add factors where necessary. Where applicable, factors were consolidated into groups to establish a revised framework. The three major factors or groups in each domain were identified. The results were compared with the enabling factors described in the profession's vision statement. Results Seventy-eight individual factors were ultimately identified, with 86% able to be grouped. The three dominant groups in each of the five domains that had a bearing on the implementation of professional models of practice were as follows: (1) Social: the education of pharmacists, their beliefs and the capacity of the pharmacist workforce; (2) Technological: current and future practice models, technology and workplace structures; (3) Economic: funding of services, the viability of practice and operation of the Pharmaceutical Benefits Scheme; (4) Environmental: attitudes and expectations of stakeholders, including consumers, health system reform and external competition; and (5) Political: regulation of practice, representation of the profession and policies affecting practice. Conclusions The three dominant groups of factors in each of the five STEEP environmental domains, which have a bearing on pharmacists' capacity to implement patient-focused models of practice, correlate well with the enabling factors identified in the profession's vision statement, with the addition of three factors in the Environmental domain of stakeholder attitudes, health system reform and external competition. What is known about the topic? The extensive range of patient-focused professional programs developed for application by pharmacists in primary care in Australia has yet to be widely implemented. What does this paper add? Factors both within and beyond the pharmacists' immediate practice environment that have a bearing on the uptake of professional programs have been identified and prioritised using a structured thematic approach. What are the implications for practitioners? The results demonstrate the need for a multifactorial approach to the implementation of professional models of practice in this setting.

Recommendations for Infant Feeding Policy and Programs in Dzimauli Region, South Africa: Results From the MAL-ED Birth Cohort

PubMed Central

Mushaphi, Lindelani Fhumudzani; Mahopo, Tjale Cloupas; Nesamvuni, Cebisa Noxolo; Baloyi, Brenda; Mashau, Ellen; Richardson, Jeniata; Dillingham, Rebecca; Guerrant, Richard; Ambikapathi, Ramya; Bessong, Pascal

2018-01-01

Background There is strong evidence that exclusive breastfeeding (EBF) in the first 6 months of life reduces the risk of diseases in infancy and in later life. Objective To understand the maternal reasoning that influences optimum infant feeding practices of caregivers in semirural communities of Limpopo province. Methods Nested qualitative study among mothers in an ongoing birth cohort study was conducted; structured and semi-structured interviews were used to collect data. Data from 234 infants after 6 months of follow-up was included for quantitative analysis. Four focus discussion groups comprising 7 to 10 caregivers were used to obtain perception of mothers on breastfeeding. A semi-structured interview guide was used to stimulate discussions. Thematic content analyses were conducted to identify the main themes that influence breastfeeding practices of caregivers. Results Over 90% of the caregivers initiated breastfeeding after delivery. However, less than 1% of mothers practiced EBF by 3 months, and none of the children were exclusively breastfed for up to 6 months. All caregivers introduced non–breast milk liquids and solids by the second month of child’s life. Common reasons for introducing non–breast milk foods included insufficiency of breast milk production, going back to work or school, and influence by elderly women (mothers/mothers-in-law) and church members. Conclusion Exclusive breastfeeding was not practiced in this community due to cultural and religious beliefs and misinformation. The involvement of elderly women and church members in infant feeding education and promotion programs and the dissemination of breastfeeding information through mobile phones to younger mothers are recommended. PMID:28958169

Effects of Objectives, Practice, and Review in Multimedia Instruction

ERIC Educational Resources Information Center

Martin, Florence; Klein, James

2008-01-01

This study examined the effects of instructional elements (objectives, information, practice with feedback, and review) on achievement, attitude, and time in a computer-based, multimedia program. Undergraduate college students used the multimedia lesson to learn about artists and their painting styles. Results indicated that practice had a…

Perceptions of Breast Cancer Survivors on the Supporting Practices of Their Supervisors in the Return-to-Work Process: A Qualitative Descriptive Study.

PubMed

Caron, Maryse; Durand, Marie-José; Tremblay, Dominique

2018-03-01

Purpose Supervisors are known to be key actors in ensuring the success of absent employees in their return-to-work process. However, to date, little is known about the perceptions of breast cancer survivors on the practices put in place by their supervisors to support them during this process. The objective of this study was to describe the perceptions of breast cancer survivors on the practices put in place by their supervisors to support them during their return-to-work process. Method A qualitative descriptive study was conducted. Semi-structured interviews were carried out with breast cancer survivors (n = 10) who had returned to work after treatment and were still at work more than 18 months later. Each interview was audio recorded and then transcribed verbatim for qualitative thematic content analysis using a semi-open codification framework. Results Participants identified three main practices put in place by their supervisors to support them and which they perceived as particularly helpful during the return-to-work process: (1) maintaining communication during their period of absence; (2) working with them to structure their return-to-work process before their actual return; and (3) allowing them flexibility in their schedule for a certain period, particularly at the beginning of the return-to-work process. Breast cancer survivors also identified an omission in the practice of employers: lack of follow-up over time. Conclusion Knowledge about the practices perceived as helpful by breast cancer survivors during their return-to-work process lays the groundwork for the eventual development of services to help breast cancer survivors in their return to work.

The Proximal Lilly Collection: Mapping, Exploring and Exploiting Feasible Chemical Space.

PubMed

Nicolaou, Christos A; Watson, Ian A; Hu, Hong; Wang, Jibo

2016-07-25

Venturing into the immensity of the small molecule universe to identify novel chemical structure is a much discussed objective of many methods proposed by the chemoinformatics community. To this end, numerous approaches using techniques from the fields of computational de novo design, virtual screening and reaction informatics, among others, have been proposed. Although in principle this objective is commendable, in practice there are several obstacles to useful exploitation of the chemical space. Prime among them are the sheer number of theoretically feasible compounds and the practical concern regarding the synthesizability of the chemical structures conceived using in silico methods. We present the Proximal Lilly Collection initiative implemented at Eli Lilly and Co. with the aims to (i) define the chemical space of small, drug-like compounds that could be synthesized using in-house resources and (ii) facilitate access to compounds in this large space for the purposes of ongoing drug discovery efforts. The implementation of PLC relies on coupling access to available synthetic knowledge and resources with chemo/reaction informatics techniques and tools developed for this purpose. We describe in detail the computational framework supporting this initiative and elaborate on the characteristics of the PLC virtual collection of compounds. As an example of the opportunities provided to drug discovery researchers by easy access to a large, realistically feasible virtual collection such as the PLC, we describe a recent application of the technology that led to the discovery of selective kinase inhibitors.

A systematic review on the neural effects of music on emotion regulation: implications for music therapy practice.

PubMed

Moore, Kimberly Sena

2013-01-01

Emotion regulation (ER) is an internal process through which a person maintains a comfortable state of arousal by modulating one or more aspects of emotion. The neural correlates underlying ER suggest an interplay between cognitive control areas and areas involved in emotional reactivity. Although some studies have suggested that music may be a useful tool in ER, few studies have examined the links between music perception/production and the neural mechanisms that underlie ER and resulting implications for clinical music therapy treatment. Objectives of this systematic review were to explore and synthesize what is known about how music and music experiences impact neural structures implicated in ER, and to consider clinical implications of these findings for structuring music stimuli to facilitate ER. A comprehensive electronic database search resulted in 50 studies that met predetermined inclusion and exclusion criteria. Pertinent data related to the objective were extracted and study outcomes were analyzed and compared for trends and common findings. Results indicated there are certain music characteristics and experiences that produce desired and undesired neural activation patterns implicated in ER. Desired activation patterns occurred when listening to preferred and familiar music, when singing, and (in musicians) when improvising; undesired activation patterns arose when introducing complexity, dissonance, and unexpected musical events. Furthermore, the connection between music-influenced changes in attention and its link to ER was explored. Implications for music therapy practice are discussed and preliminary guidelines for how to use music to facilitate ER are shared.

Genetics objective structured clinical exams at the Maimonides Infants & Children's Hospital of Brooklyn, New York.

PubMed

Altshuler, Lisa; Kachur, Elizabeth; Krinshpun, Shifra; Sullivan, Deborah

2008-11-01

In 2003, the Maimonides Infants & Children's Hospital received a Title VII Residency Training in Primary Care grant to integrate genetic-specific competencies into postgraduate pediatrics education. As part of that endeavor, mandatory yearly genetics objective structured clinical exams (OSCEs) were instituted for third-year residents. This article reports on the first three years of experience with this innovative educational tool.After an overview of genetic concepts, dysmorphology, and communication styles, residents complete a five-station OSCE and receive feedback from standardized patients and from the faculty who observe them. After this clinical exercise, the residents participate in a small-group debriefing session to share strategies for effective communication and clinical case management and to discuss the ethical issues that arise with these genetic cases.In three years, 60 residents have completed the genetics OSCE program. Evaluation data demonstrate that the program has been effective in both introducing genetic-specific challenges and assessing residents' clinical skills. It has helped trainees self-identify both strengths and further training needs. Pre- and postsurveys among the trainees show increased comfort levels in performing 5 of 12 genetic-related clinical tasks.We conclude that genetics OSCEs are an enriching educational tool. Merely providing trainees and practicing physicians with the latest scientific information is unlikely to prepare them for counseling patients about complex genetic issues. Developing proficiency requires focused practice and effective feedback.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

A core competency-based objective structured clinical examination (OSCE) can predict future resident performance.

PubMed

Wallenstein, Joshua; Heron, Sheryl; Santen, Sally; Shayne, Philip; Ander, Douglas

2010-10-01

This study evaluated the ability of an objective structured clinical examination (OSCE) administered in the first month of residency to predict future resident performance in the Accreditation Council for Graduate Medical Education (ACGME) core competencies. Eighteen Postgraduate Year 1 (PGY-1) residents completed a five-station OSCE in the first month of postgraduate training. Performance was graded in each of the ACGME core competencies. At the end of 18 months of training, faculty evaluations of resident performance in the emergency department (ED) were used to calculate a cumulative clinical evaluation score for each core competency. The correlations between OSCE scores and clinical evaluation scores at 18 months were assessed on an overall level and in each core competency. There was a statistically significant correlation between overall OSCE scores and overall clinical evaluation scores (R = 0.48, p < 0.05) and in the individual competencies of patient care (R = 0.49, p < 0.05), medical knowledge (R = 0.59, p < 0.05), and practice-based learning (R = 0.49, p < 0.05). No correlation was noted in the systems-based practice, interpersonal and communication skills, or professionalism competencies. An early-residency OSCE has the ability to predict future postgraduate performance on a global level and in specific core competencies. Used appropriately, such information can be a valuable tool for program directors in monitoring residents' progress and providing more tailored guidance. © 2010 by the Society for Academic Emergency Medicine.

Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice

PubMed Central

Coughlin, Mary; Gibbins, Sharyn; Hoath, Steven

2009-01-01

Title Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice. Aim This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Background Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America’s Joint Commission’s concept of ‘core measures’ for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Data sources Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Discussion Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Conclusion Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes. PMID:19686402

Policy Levers Key for Primary Health Care Organizations to Support Primary Care Practices in Meeting Medical Home Expectations: Comparing Leading States to the Australian Experience

PubMed Central

2016-01-01

Abstract Several countries with highly ranked delivery systems have implemented locally-based, publicly-funded primary health care organizations (PHCOs) as vehicles to strengthen their primary care foundations. In the United States, state governments have started down a similar pathway with models that share similarities with international PHCOs. The objective of this study was to determine if these kinds of organizations were working with primary care practices to improve their ability to provide comprehensive, coordinated, and accessible patient-centered care that met quality, safety, and efficiency outcomes—all core attributes of a medical home. This qualitative study looked at 4 different PHCO models—3 from the United States and 1 from Australia—with similar objectives and scope. Primary and secondary data included semi-structured interviews with 26 PHCOs and a review of government documents. The study found that the 4 PHCO models were engaging practices to meet a number of medical home expectations, but the US PHCOs were more uniform in efforts to work with practices and focused on arranging services to meet the needs of complex patients. There was significant variation in level of effort between the Australian PHCOs. These differences can be explained through the state governments' selection of payment models and use of data frameworks to support collaboration and incentivize performance of both PHCOs and practices. These findings offer policy lessons to inform health reform efforts under way to better capitalize on the potential of PHCOs to support a high-functioning primary health foundation as an essential component to a reformed health system. PMID:26636485

Estimating soil erosion risk and evaluating erosion control measures for soil conservation planning at Koga watershed in the highlands of Ethiopia

NASA Astrophysics Data System (ADS)

Molla, Tegegne; Sisheber, Biniam

2017-01-01

Soil erosion is one of the major factors affecting sustainability of agricultural production in Ethiopia. The objective of this paper is to estimate soil erosion using the universal soil loss equation (RUSLE) model and to evaluate soil conservation practices in a data-scarce watershed region. For this purpose, soil data, rainfall, erosion control practices, satellite images and topographic maps were collected to determine the RUSLE factors. In addition, measurements of randomly selected soil and water conservation structures were done at three sub-watersheds (Asanat, Debreyakob and Rim). This study was conducted in Koga watershed at upper part of the Blue Nile basin which is affected by high soil erosion rates. The area is characterized by undulating topography caused by intensive agricultural practices with poor soil conservation practices. The soil loss rates were determined and conservation strategies have been evaluated under different slope classes and land uses. The results showed that the watershed is affected by high soil erosion rates (on average 42 t ha-1 yr-1), greater than the maximum tolerable soil loss (18 t ha-1 yr-1). The highest soil loss (456 t ha-1 yr-1) estimated from the upper watershed occurred on cultivated lands of steep slopes. As a result, soil erosion is mainly aggravated by land-use conflicts and topographic factors and the rugged topographic land forms of the area. The study also demonstrated that the contribution of existing soil conservation structures to erosion control is very small due to incorrect design and poor management. About 35 % out of the existing structures can reduce soil loss significantly since they were constructed correctly. Most of the existing structures were demolished due to the sediment overload, vulnerability to livestock damage and intense rainfall. Therefore, appropriate and standardized soil and water conservation measures for different erosion-prone land uses and land forms need to be implemented in Koga watershed.

Social and structural conditions for the avoidance of advance care planning in neuro-oncology: a qualitative study

PubMed Central

Llewellyn, Henry; Neerkin, Jane; Thorne, Lewis; Wilson, Elena; Jones, Louise; Sampson, Elizabeth L; Townsley, Emma; Low, Joseph T S

2018-01-01

Background Primary brain tumours newly affect >260 000 people each year worldwide. In the UK, every year >10 000 people are diagnosed with a brain tumour while >5000 die annually from the disease. Prognoses are poor, cognitive deterioration common and patients have prolonged palliative needs. Advance care planning (ACP) may enable early discussion of future care decisions. Although a core commitment in the UK healthcare strategy, and the shared responsibility of clinical teams, ACP appears uncommon in practice. Evidence around ACP practice in neuro-oncology is limited. Objectives We aimed to elicit key social and structural conditions contributing to the avoidance of ACP in neuro-oncology. Design A cross-sectional qualitative study design was used. Setting One tertiary care hospital in the UK. Participants Fifteen healthcare professionals working in neuro-oncology participated in this study, including neuro-oncologists, neurosurgeons, clinical nurse specialists, allied healthcare professionals and a neurologist. Method Semi-structured interviews were conducted with participants to explore their assumptions and experiences of ACP. Data were analysed thematically using the well-established framework method. Results Participants recognised the importance of ACP but few had ever completed formal ACP documentation. We identified eight key factors, which we suggest comprise three main conditions for avoidance: (1) difficulties being a highly emotive, time-intensive practice requiring the right ‘window of opportunity’ and (2) presence and availability of others; (3) ambiguities in ACP definition, purpose and practice. Combined, these created a ‘culture of shared avoidance’. Conclusion In busy clinical environments, ‘shared responsibility’ is interpreted as ‘others’ responsibility’ laying the basis for a culture of avoidance. To address this, we suggest a ‘generalists and specialists’ model of ACP, wherein healthcare professionals undertake particular responsibilities. Healthcare professionals are already adopting this model informally, but without formalised structure it is likely to fail given a tendency for people to assume a generalist role. PMID:29391365

A scoping review about conference objectives and evaluative practices: how do we get more out of them?

PubMed

Neves, Justin; Lavis, John N; Ranson, M Kent

2012-08-02

Large multi-day conferences have often been criticized as ineffective ways to improve social outcomes and to influence policy or practice. Unfortunately, many conference evaluations have also been inadequate in determining the impact of a conference on its associated social sector, with little evidence gathered or analyzed to substantiate or refute these criticisms. The aim of this scoping review is to investigate and report stakeholders' objectives for planning or participating in large multi-day conferences and how these objectives are being evaluated. We conducted a scoping review supplemented by a small number of key informant interviews. Eight bibliographic databases were systematically searched to identify papers describing conference objectives and/or evaluations. We developed a conference evaluation framework based on theoretical models and empirical findings, which structured the descriptive synthesis of the data. We identified 3,073 potential papers for review, of which 44 were included in this study. Our evaluation framework connects five key elements in planning a conference and its evaluation (number in brackets refers to number of themes identified): conference objectives (8), purpose of evaluation (7), evaluation methods (5), indicators of success (9) and theories/models (8). Further analysis of indicators of success identified three categories of indicators with differing scopes (i.e. immediate, prospective or follow-up) as well as empirical links between the purpose of evaluations and these indicators. Conference objectives and evaluations were largely correlated with the type of conference (i.e. academic, political/governmental or business) but diverse overall. While much can be done to improve the quality and usefulness of conference evaluations, there are innovative assessments that are currently being utilized by some conferences and warrant further investigation. This review provides conference evaluators and organizers a simple resource to improve their own assessments by highlighting and categorizing potential objectives and evaluation strategies.

A scoping review about conference objectives and evaluative practices: how do we get more out of them?

PubMed Central

2012-01-01

Large multi-day conferences have often been criticized as ineffective ways to improve social outcomes and to influence policy or practice. Unfortunately, many conference evaluations have also been inadequate in determining the impact of a conference on its associated social sector, with little evidence gathered or analyzed to substantiate or refute these criticisms. The aim of this scoping review is to investigate and report stakeholders’ objectives for planning or participating in large multi-day conferences and how these objectives are being evaluated. We conducted a scoping review supplemented by a small number of key informant interviews. Eight bibliographic databases were systematically searched to identify papers describing conference objectives and/or evaluations. We developed a conference evaluation framework based on theoretical models and empirical findings, which structured the descriptive synthesis of the data. We identified 3,073 potential papers for review, of which 44 were included in this study. Our evaluation framework connects five key elements in planning a conference and its evaluation (number in brackets refers to number of themes identified): conference objectives (8), purpose of evaluation (7), evaluation methods (5), indicators of success (9) and theories/models (8). Further analysis of indicators of success identified three categories of indicators with differing scopes (i.e. immediate, prospective or follow-up) as well as empirical links between the purpose of evaluations and these indicators. Conference objectives and evaluations were largely correlated with the type of conference (i.e. academic, political/governmental or business) but diverse overall. While much can be done to improve the quality and usefulness of conference evaluations, there are innovative assessments that are currently being utilized by some conferences and warrant further investigation. This review provides conference evaluators and organizers a simple resource to improve their own assessments by highlighting and categorizing potential objectives and evaluation strategies. PMID:22857399

Correlation of the Care by Design primary care practice redesign model and the principles of the patient-centered medical home.

PubMed

Egger, Marlene J; Day, Julie; Scammon, Debra L; Li, Yao; Wilson, Andrew; Magill, Michael K

2012-01-01

Health care reform requires major changes in the organization and delivery of primary care. In 2003, the University of Utah Community Clinics began developing Care by Design (CBD), a primary care model emphasizing access, care teams, and planned care. In 2007, leading primary care organizations published joint principles of the patient-centered medical home (PCMH), the basis for recognition of practices as PCMHs by the National Committee for Quality Assurance (NCQA). The objective of this study was to compare CBD and PCMH metrics conceptually and statistically. This was an observational study in 10 urban and rural primary care clinics including 56 providers. A self-evaluation included the CBD Extent of Use survey and self-estimated PCMH values. The main and secondary outcome measures were CBD scores and PCMH values, respectively. CBD and PCMH principles share common themes such as appropriate access, team-based care, the use of an augmented electronic medical record, planned care, and self-management support. CBD focuses more on the process of practice transformation. The NCQA PCMH standards focus more on structure, including policy, capacity, and populated electronic medical record fields. The Community Clinics' clinic-level PCMH/CBD correlations were low (P > .05.) Practice redesign requires an ability to assess uptake of the redesign as a transformation progresses. The correlation of CBD and PCMH is substantial conceptually but low statistically. PCMH and CBD focus on complementary aspects of redesign: PCMH on structure and CBD on process. Both domains should be addressed in practice reform. Both metrics are works in progress.

Contractor-, steward-, and coworker-safety practice: associations with musculoskeletal pain and injury-related absence among construction apprentices

PubMed Central

Dutra, Lauren M.; Okechukwu, Cassandra A.

2013-01-01

Objectives This paper sought to assess organizational safety practices at three different levels of hierarchical workplace structure and to examine their association with injury outcomes among construction apprentices. Methods Using a cross-sectional sample of 1,775 construction apprentices, three measures of organizational safety practice were assessed: contractor-, steward-, and coworker-safety practice. Each safety practice measure was assessed using three similar questions (i.e., on-the-job safety commitment, following required or recommended safe work practices, and correcting unsafe work practices); the summed average of the responses ranged from 1 to 4, with a higher score indicating poorer safety practice. Outcome variables included the prevalence of four types of musculoskeletal pain (i.e., neck, shoulder, hand, and back pain) and injury-related absence. Results In adjusted analyses, contractor-safety practice was associated with both hand pain (OR: 1.27, 95 % CI: 1.04, 1.54) and back pain (OR: 1.40, 95 % CI: 1.17, 1.68); coworker-safety practice was related to back pain (OR: 1.42, 95 % CI: 1.18, 1.71) and injury-related absence (OR: 1.36, 95 % CI: 1.11, 1.67). In an analysis that included all three safety practice measures simultaneously, the association between coworker-safety practice and injury-related absence remained significant (OR: 1.68, 95 % CI: 1.20, 2.37), whereas all other associations became non-significant. Conclusions This study suggests that organizational safety practice, particularly coworker-safety practice, is associated with injury outcomes among construction apprentices. PMID:23748366

A Characterization of Student Reflections in an Introductory Pharmacy Practice Experience Discussion Course.

PubMed

Dinkins, Melissa M; Haltom, Wesley R

2018-04-01

Objective. To characterize weekly student reflections in an introductory pharmacy practice experience (IPPE) discussion course meeting concurrently with IPPE rotations in institutional pharmacy. Methods. A qualitative analysis was conducted to identify themes within weekly reflective statements submitted by second year pharmacy students (P2) enrolled in an IPPE rotation and concurrent discussion course. Weekly reflections from the 2015-2016 offering of the course were reviewed by investigators to identify common themes via an iterative process. Subsequently, investigators coded each submission into one of the identified categories. Initial agreement between investigators was assessed using the Cohen kappa coefficient. Discrepancies between coding were resolved through discussion to reach consensus. Results. A total of 402 reflection assignments were reviewed from 85 P2 students enrolled in the IPPE course. Ten themes were identified, with the most common themes being interprofessional teamwork, pharmacist and technician roles and responsibilities, and policies and procedures. Substantial initial agreement between investigators was found, with the most discrepancies arising within the themes of medication distribution and pharmacy administration/organizational structure. Conclusion. Student reflections on IPPEs centered on 10 key topics, primarily related to distributive, legal, and regulatory functions of institutional pharmacy practice. Structuring an IPPE rotation longitudinally in an academic term, with a concurrent discussion course, builds a framework for regular student reflection.

Valued Social Roles and Measuring Mental Health Recovery: Examining the Structure of the Tapestry

PubMed Central

Hunt, Marcia G.; Stein, Catherine H.

2014-01-01

The complexity of the concept of mental health recovery often makes it difficult to systematically examine recovery processes and outcomes. The concept of social role is inherent within many acknowledged dimensions of recovery such as community integration, family relationships, and peer support and can deepen our understanding of these dimensions when social roles are operationalized in ways that directly relate to recovery research and practice. Objective This paper reviews seminal social role theories and operationalizes aspects of social roles: role investment, role perception, role loss, and role gain. The paper provides a critical analysis of the ability of social role concepts to inform mental health recovery research and practice. Method PubMed and PsychInfo databases were used for the literature review. Results A more thorough examination of social role aspects allows for a richer picture of recovery domains that are structured by the concept social roles. Increasing understanding of consumers’ investment and changes in particular roles, perceptions of consumers’ role performance relative to peers, and consumers’ hopes for the future with regards to the different roles that they occupy could generate tangible, pragmatic approaches in addressing complex recovery domains. Conclusions and Implications for Practice This deeper understanding allows a more nuanced approach to recovery-related movements in mental health system transformation. PMID:23276237

Boundary objects in complementary and alternative medicine: acupuncture vs. Christian Science.

PubMed

Owens, Kellie

2015-03-01

Nearly four in ten American use complementary or alternative medicine (CAM) each year. Even with a large number of patients, CAM practitioners face scrutiny from physicians and biomedical researchers who, in an era of evidence-based medicine, argue there is little evidence to support CAM treatments. Examining how CAM has or has not been integrated into American health care is crucial in understanding the contemporary boundaries of healthcare systems. An analytical tool from science and technology studies, boundary objects, can help scholars of medicine understand which practices become integrated into these systems. Using a comparative analysis based on archival and interview data, this paper examines the use of boundary objects in two alternative medical practices - acupuncture and Christian Science. While boundary objects alone cannot explain what health practices succeed or fail, juxtaposing the use of boundary objects by different CAM groups identifies the work boundary objects do to facilitate integration and the conditions under which they "work." I find that acupuncturists' use of sterile needles as a boundary objects assists in their effective integration into U.S. healthcare because needles are both a symbol of biomedical prowess and a potentially unsafe device requiring regulation. Christian Scientists' use of the placebo effect as a boundary object has not succeeded because they fail to acknowledge the different contextual definitions of the placebo effect in biomedical communities. This comparative analysis highlights how context affects which boundary objects "work" for CAM practices and theorizes why alternative health practices succeed or fail to become integrated into healthcare systems. Copyright © 2014 Elsevier Ltd. All rights reserved.

High pressure hydrogen stabilised by quantum nuclear motion

NASA Astrophysics Data System (ADS)

Needs, Richard; Monserrat, Bartomeu; Pickard, Chris

Hydrogen under extreme pressures is of fundamental interest, as it might exhibit exotic physical phenomena, and of practical interest, as it is a major component of many astrophysical objects. Structure searches have been successful at identifying promising candidates for the known phases of high pressure hydrogen. However, these searches have so far been restricted to the location of minima of the potential energy landscape. In this talk, we will describe a new structure searching method, ``saddle-point ab initio random structure searching'' (sp-AIRSS), that allows us to identify structures associated with saddle points of the potential energy landscape. Using sp-AIRSS, we find two new high-pressure hydrogen structures that exhibit a harmonic dynamical instability, but quantum and thermal anharmonic motion render them dynamically stable. These structures are formed by mixed layers of strongly and softly bound hydrogen molecules, and become thermodynamically competitive at the highest pressures reached in experiment. The experimental implications of these new structures will also be discussed. BM is supported by Robinson College, Cambridge, and the Cambridge Philosophical Society. RJN and CJP are supported by the Engineering and Physical Sciences Research Council (EPSRC) of the UK.

Protection of Workers and Third Parties during the Construction of Linear Structures

NASA Astrophysics Data System (ADS)

Vlčková, Jitka; Venkrbec, Václav; Henková, Svatava; Chromý, Adam

2017-12-01

The minimization of risk in the workplace through a focus on occupational health and safety (OHS) is one of the primary objectives for every construction project. The most serious accidents in the construction industry occur during work on earthworks and linear structures. The character of such structures places them among those posing the greatest threat to the public (referred to as “third parties”). They can be characterized as large structures whose construction may involve the building site extending in a narrow lane alongside previously constructed objects currently in use by the public. Linear structures are often directly connected to existing objects or buildings, making it impossible to guard the whole construction site. However, many OHS problems related to linear structures can be prevented during the design stage. The aim of this article is to introduce a new methodology which has been implemented into a computer program that deals with safety measures at construction sites where work is performed on linear structures. Based on existing experience with the design of such structures and their execution and supervision by safety coordinators, the basic types of linear structures, their location in the terrain, the conditions present during their execution and other marginal conditions and influences were modelled. Basic safety information has been assigned to this elementary information, which is strictly necessary for the construction process. The safety provisions can be grouped according to type, e.g. technical, organizational and other necessary documentation, or into sets of provisions concerning areas such as construction site safety, transport safety, earthworks safety, etc. The selection of the given provisions takes place using multiple criteria. The aim of creating this program is to provide a practical tool for designers, contractors and construction companies. The model can contribute to the sufficient awareness of these participants about technical and organizational provisions that can help them to meet workplace safety requirements. The software for the selection of safety provisions also contains module that can calculate necessary cost estimates using a calculation formula chosen by the user. All software data conform to European standards harmonized for the Czech Republic.

Severe acute malnutrition and infection

PubMed Central

Jones, Kelsey D J; Berkley, James A

2014-01-01

Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. The brief addresses antimicrobials; antipyretics; tuberculosis; HIV; malaria; pneumonia; diarrhoea; sepsis; measles; urinary tract infection; nosocomial Infections; soil transmitted helminths; skin infections and pharmacology in the context of SAM. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice. PMID:25475887

[Psychosocial rehabilitation: perceptions of the mental health staff].

PubMed

Jorge, Maria Salete Bessa; Randemark, Norma Faustino Rocha; Queiroz, Maria Veraci Oliveira; Ruiz, Erasmo Miessa

2006-01-01

This study is inserted in assumptions of research's analysis qualitative which objective was to interpretate the Mental Health professional's perspectives about psychosocial rehabilitation of mental disorder's porter to know as them proceed it in their professional practice. Data collection came up by the application of semi-structured interviews to 8 Mental Health professionals that work in the Center of Psychosocial Attention. After the readings, notes of pieces of talk, subcategories and categories were composed after the interpretation based on the literature. The results pointed that psychosocial rehabilitation is a process which implementation and still needs effective overcome of traditional paradigma of health mental disease, that form conception and therapeutic practices and requires trust of professionals about the users' capacity of live as citizen in the most variable segments of social life.

Using Social Cognitive Theory to Explain the Intention of Final-year Pharmacy Students to Undertake a Higher Degree in Pharmacy Practice Research.

PubMed

Carter, Stephen R; Moles, Rebekah J; Krass, Ines; Kritikos, Vicki S

2016-08-25

Objective. To develop and test a conceptual model that hypothesized student intention to undertake a higher degree in pharmacy practice research (PPR) would be increased by self-efficacy, outcome expectancy, and the social influence of faculty members. Methods. Cross-sectional surveys were completed by 387 final-year pharmacy undergraduates enrolled in 2012 and 2013. Structural equation modeling was used to explore relationships between variables and intention. Results. Fit indices were good. The model explained 55% of the variation in intention. As hypothesized, faculty social influence increased self-efficacy and indirectly increased outcome expectancy and intention. Conclusion. To increase pharmacy students' orientation towards a career in PPR, faculty members could use their social influence by highlighting PPR in their teaching.

Organization of professional practices against intrafamily violence against children and adolescents in the institutional context 1

PubMed Central

Schek, Gabriele; da Silva, Mara Regina Santos; Lacharité, Carl; Bueno, Maria Emília Nunes

2017-01-01

ABSTRACT Objective: to analyze based on the practitioners' discourse, the way they organize their practices confronting situations of intra-family violence against children and adolescents. Method: qualitative research carried out with 15 professionals who work in social and health services located in the southernmost of Brazil. Data were collected through semi-structured interviews, performed at the participants' workplace. We used a theoretical matrix to analyze the data, based on Institutional Ethnography and the technique of discursive textual analysis. Results: the practitioners' practices developed in situations of intra-family violence against children and adolescents are organized on the basis of: power relations that take place in services that respond to violence situations; routines instituted to meet the demands of care in services; and the interplay between the conception of violence as a public health problem and the conception of violence as a social problem. Conclusion: the way these practices are organized is reflected in actions that are not protective against situations of intra-family violence against children and adolescents. PMID:28591297

A survey validation and analysis of undergraduate medical biochemistry practical curriculum in maharashtra, India.

PubMed

Dandekar, Sucheta P; Maksane, Shalini N; McKinley, Danette

2012-01-01

In order to review the strengths and weaknesses of medical biochemistry practical curriculum for undergraduates and to generate ideas to improve it, a questionnaire was sent to 50 biochemistry faculty members selected (through simple random sampling method) from 42 medical colleges of Maharashtra, India. 39 responded to the questionnaire, representing a 78% response rate. The internal consistency of the questionnaire sections was found to be satisfactory (>0.7). The respondents did not agree that the ongoing curriculum was in alignment with learning outcomes (8%), that it encouraged active learning (28%), helped to apply knowledge to clinical situations (18%) and promoted critical thinking and problem solving skills (28%). There were a number of qualitative experiments that were rated 'irrelevant'. Qualitative and quantitative experiments related to recent advances were suggested to be introduced by the respondents. Checklists for the practicals and new curriculum objectives provided in the questionnaire were also approved. The results of the curriculum evaluation suggest a need for re-structuring of practical biochemistry curriculum and introduction of a modified curriculum with more clinical relevance.

Maintenance of Certification: How Performance in Practice Changes Improve Tobacco Cessation in Addiction Psychiatrists’ Practice

PubMed Central

Ford, James H.; Oliver, Karen A.; Giles, Miriam; Cates-Wessel, Kathryn; Krahn, Dean; Levin, Frances R.

2017-01-01

Background and Objectives In 2000, the American Board of Medical Specialties implemented the Maintenance of Certification (MOC), a structured process to help physicians identify and implement a quality improvement project to improve patient care. This study reports on findings from an MOC Performance in Practice (PIP) module designed and evaluated by addiction psychiatrists who are members of the American Academy of Addiction Psychiatry (AAAP). Method A 3-phase process was utilized to recruit AAAP members to participate in the study. The current study utilized data from 154 self-selected AAAP members who evaluated the effectiveness of the MOC Tobacco Cessation PIP. Results Of the physicians participating, 76% (n 120) completed the Tobacco PIP. A paired t-test analysis revealed that reported changes in clinical measure documentation were significant across all six measures. Targeted improvement efforts focused on a single clinical measure. Results found that simple change projects designed to improve clinical practice led to substantial changes in self-reported chart documentation for the selected measure. Conclusions The current findings suggest that addiction psychiatrists can leverage the MOC process to improve clinical care. PMID:27973746

The influence of deliberate practice on musical achievement: a meta-analysis.

PubMed

Platz, Friedrich; Kopiez, Reinhard; Lehmann, Andreas C; Wolf, Anna

2014-01-01

Deliberate practice (DP) is a task-specific structured training activity that plays a key role in understanding skill acquisition and explaining individual differences in expert performance. Relevant activities that qualify as DP have to be identified in every domain. For example, for training in classical music, solitary practice is a typical training activity during skill acquisition. To date, no meta-analysis on the quantifiable effect size of deliberate practice on attained performance in music has been conducted. Yet the identification of a quantifiable effect size could be relevant for the current discussion on the role of various factors on individual difference in musical achievement. Furthermore, a research synthesis might enable new computational approaches to musical development. Here we present the first meta-analysis on the role of deliberate practice in the domain of musical performance. A final sample size of 13 studies (total N = 788) was carefully extracted to satisfy the following criteria: reported durations of task-specific accumulated practice as predictor variables and objectively assessed musical achievement as the target variable. We identified an aggregated effect size of r c = 0.61; 95% CI [0.54, 0.67] for the relationship between task-relevant practice (which by definition includes DP) and musical achievement. Our results corroborate the central role of long-term (deliberate) practice for explaining expert performance in music.

Using Objective Structured Teaching Encounters (OSTEs) to prepare chief residents to be emotionally intelligent leaders

PubMed Central

Cerrone, Sara Ann; Adelman, Patti; Akbar, Salaahuddin; Yacht, Andrew C.; Fornari, Alice

2017-01-01

ABSTRACT Background: Chief Residents must lead, manage and mentor a diverse and often large group of residents, however there is a lack of formal leadership training throughout graduate medical education. Objective: Development of a 3-part Chief Resident (CR) Program focused on leading, managing and mentoring. Design: Each participant completes an Emotional Intelligence (EI) Inventory prior to the day-long event. Participants receive their EI scores at the beginning of the program, which features interactive sessions on leadership, management, and feedback skills. The program then reinforces the application of their new knowledge about EI through a four station OSTE (Observed Structured Teaching Encounter). CRs practice feedback and coaching skills in a simulated environment where they need to provide the context of formative feedback to a standardized resident. Results: The aggregated mean pre-session EI score for all participants was 76.9 (an ideal score is >85). An independent-samples t-test compared the CRs’ leadership and feedback performance on their first and second OSTE performance within a single afternoon session. There was a significant difference between the first OSTE performance (M = 47.92, SD = 7.8) and the second OSTE performance (M = 51.22, SD = 6.9); t (68) = 1.99, p = 0.006. These results suggest that participating in multiple OSTEs positively reinforces the core interpersonal and communication skills discussed in the didactic and practiced in the interactive portions of the program. Conclusion: The low mean pre-session EI score achieved by our participants supports the idea that CRs enter their new roles with a level of EI that can be enhanced. CRs had an overall positive reaction to EI and its application to the core skills addressed in the program, highlighting the fact that similar programs could be used to train early career physicians to be more skilled and comfortable with leading, managing and mentoring. Abbreviations: CR: Chief resident; EI: Emotional intelligence; GME: Graduate medical education; OSTE: Objective structured teaching encounter PMID:28460596

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

Siauw, Timmy; Cunha, Adam; Berenson, Dmitry

Purpose: In this study, the authors introduce skew line needle configurations for high dose rate (HDR) brachytherapy and needle planning by integer program (NPIP), a computational method for generating these configurations. NPIP generates needle configurations that are specific to the anatomy of the patient, avoid critical structures near the penile bulb and other healthy structures, and avoid needle collisions inside the body. Methods: NPIP consisted of three major components: a method for generating a set of candidate needles, a needle selection component that chose a candidate needle subset to be inserted, and a dose planner for verifying that the finalmore » needle configuration could meet dose objectives. NPIP was used to compute needle configurations for prostate cancer data sets from patients previously treated at our clinic. NPIP took two user-parameters: a number of candidate needles, and needle coverage radius, {delta}. The candidate needle set consisted of 5000 needles, and a range of {delta} values was used to compute different needle configurations for each patient. Dose plans were computed for each needle configuration. The number of needles generated and dosimetry were analyzed and compared to the physician implant. Results: NPIP computed at least one needle configuration for every patient that met dose objectives, avoided healthy structures and needle collisions, and used as many or fewer needles than standard practice. These needle configurations corresponded to a narrow range of {delta} values, which could be used as default values if this system is used in practice. The average end-to-end runtime for this implementation of NPIP was 286 s, but there was a wide variation from case to case. Conclusions: The authors have shown that NPIP can automatically generate skew line needle configurations with the aforementioned properties, and that given the correct input parameters, NPIP can generate needle configurations which meet dose objectives and use as many or fewer needles than the current HDR brachytherapy workflow. Combined with robot assisted brachytherapy, this system has the potential to reduce side effects associated with treatment. A physical trial should be done to test the implant feasibility of NPIP needle configurations.« less

An effective and comprehensive model for optimal rehabilitation of separate sanitary sewer systems.

PubMed

Diogo, António Freire; Barros, Luís Tiago; Santos, Joana; Temido, Jorge Santos

2018-01-15

In the field of rehabilitation of separate sanitary sewer systems, a large number of technical, environmental, and economic aspects are often relevant in the decision-making process, which may be modelled as a multi-objective optimization problem. Examples are those related with the operation and assessment of networks, optimization of structural, hydraulic, sanitary, and environmental performance, rehabilitation programmes, and execution works. In particular, the cost of investment, operation and maintenance needed to reduce or eliminate Infiltration from the underground water table and Inflows of storm water surface runoff (I/I) using rehabilitation techniques or related methods can be significantly lower than the cost of transporting and treating these flows throughout the lifespan of the systems or period studied. This paper presents a comprehensive I/I cost-benefit approach for rehabilitation that explicitly considers all elements of the systems and shows how the approximation is incorporated as an objective function in a general evolutionary multi-objective optimization model. It takes into account network performance and wastewater treatment costs, average values of several input variables, and rates that can reflect the adoption of different predictable or limiting scenarios. The approach can be used as a practical and fast tool to support decision-making in sewer network rehabilitation in any phase of a project. The fundamental aspects, modelling, implementation details and preliminary results of a two-objective optimization rehabilitation model using a genetic algorithm, with a second objective function related to the structural condition of the network and the service failure risk, are presented. The basic approach is applied to three real world cases studies of sanitary sewerage systems in Coimbra and the results show the simplicity, suitability, effectiveness, and usefulness of the approximation implemented and of the objective function proposed. Copyright © 2017 Elsevier B.V. All rights reserved.

U.S. Hardwood sawmill log procurement practices

Treesearch

Adrienn Andersch; Iris Montague; Urs Buehlmann; Janice K. Wiedenbeck

2015-01-01

U.S. hardwood sawmill log procurement practices are evolving because of the recent economic recession, market and supply chain shifts, and changing landowner objectives, among other factors. The objective of this study was to characterize the log procurement practices of hardwood sawmills and to characterize the role that log brokers play in supplying the sawmill...

[Quality evaluation of the orthodontic practice for certification by ISO 9001. A procedure beneficial for medical, medico-dental or hospital service].

PubMed

Becker, G

2001-01-01

The accreditation of the ISO 9001 certification (ISO = International Standard Organization) is an external evaluation procedure carried out by independent experts, whose object is the analysis of the operational methods and practices of a medical care facility (e.g. hospital, private clinic, general practitioner's or dentist's practice) which decided to assume the concept, implementation and control of its own quality policy. The whole accreditation procedure represents the basic structure of a continuous dynamic progressiveness within a cabinet eager to offer outstanding quality. Moreover, it guarantees active and voluntary participation of every single member of the medical administration or technical team involved in the realization of this primary objective. In other words, we are talking about a very strong dynamic innovation leading to a change of views and the improvement of communication means, while simultaneously enhancing the security and quality aspects of medical care. The continuous guarantee of high quality medical care calls for precise planning and systematization of actions. First of all, these actions are defined, analyzed and listed in precise work procedures. As they are defined with the agreement of the whole team, they implicate respect and self control. This requires of course transparency of the treatment methods, whose different steps and procedures are described in detail in a logogramm set up in common.

3D Reconstruction in the Presence of Glass and Mirrors by Acoustic and Visual Fusion.

PubMed

Zhang, Yu; Ye, Mao; Manocha, Dinesh; Yang, Ruigang

2017-07-06

We present a practical and inexpensive method to reconstruct 3D scenes that include transparent and mirror objects. Our work is motivated by the need for automatically generating 3D models of interior scenes, which commonly include glass. These large structures are often invisible to cameras. Existing 3D reconstruction methods for transparent objects are usually not applicable in such a room-sized reconstruction setting. Our simple hardware setup augments a regular depth camera with a single ultrasonic sensor, which is able to measure the distance to any object, including transparent surfaces. The key technical challenge is the sparse sampling rate from the acoustic sensor, which only takes one point measurement per frame. To address this challenge, we take advantage of the fact that the large scale glass structures in indoor environments are usually either piece-wise planar or simple parametric surfaces. Based on these assumptions, we have developed a novel sensor fusion algorithm that first segments the (hybrid) depth map into different categories such as opaque/transparent/infinity (e.g., too far to measure) and then updates the depth map based on the segmentation outcome. We validated our algorithms with a number of challenging cases, including multiple panes of glass, mirrors, and even a curved glass cabinet.

Internet Mindfulness Meditation Intervention for the General Public: Pilot Randomized Controlled Trial

PubMed Central

2016-01-01

Background Mindfulness meditation interventions improve a variety of health conditions and quality of life, are inexpensive, easy to implement, have minimal if any side effects, and engage patients to take an active role in their treatment. However, the group format can be an obstacle for many to take structured meditation programs. Internet Mindfulness Meditation Intervention (IMMI) is a program that could make mindfulness meditation accessible to all people who want and need to receive it. However, the feasibility, acceptability, and ability of IMMI to increase meditation practice have yet to be evaluated. Objectives The primary objectives of this pilot randomized controlled study were to (1) evaluate the feasibility and acceptability of IMMIs in the general population and (2) to evaluate IMMI’s ability to change meditation practice behavior. The secondary objective was to collect preliminary data on health outcomes. Methods Potential participants were recruited from online and offline sources. In a randomized controlled trial, participants were allocated to IMMI or Access to Guided Meditation arm. IMMI included a 1-hour Web-based training session weekly for 6 weeks along with daily home practice guided meditations between sessions. The Access to Guided Meditation arm included a handout on mindfulness meditation and access to the same guided meditation practices that the IMMI participants received, but not the 1-hour Web-based training sessions. The study activities occurred through the participants’ own computer and Internet connection and with research-assistant telephone and email contact. Feasibility and acceptability were measured with enrollment and completion rates and participant satisfaction. The ability of IMMI to modify behavior and increase meditation practice was measured by objective adherence of daily meditation practice via Web-based forms. Self-report questionnaires of quality of life, self-efficacy, depression symptoms, sleep disturbance, perceived stress, and mindfulness were completed before and after the intervention period via Web-based surveys. Results We enrolled 44 adults were enrolled and 31 adults completed all study activities. There were no group differences on demographics or important variables at baseline. Participants rated the IMMI arm higher than the Access to Guided Meditation arm on Client Satisfaction Questionnaire. IMMI was able to increase home practice behavior significantly compared to the Access to Guided Meditation arm: days practiced (P=.05), total minutes (P=.01), and average minutes (P=.05). As expected, there were no significant differences on health outcomes. Conclusions In conclusion, IMMI was found to be feasible and acceptable. The IMMI arm had increased daily meditation practice compared with the Access to Guided Meditation control group. More interaction through staff and/or through built-in email or text reminders may increase daily practice even more. Future studies will examine IMMI’s efficacy at improving health outcomes in the general population and also compare it directly to the well-studied mindfulness-based group interventions to evaluate relative efficacy. Trial Registration Clinicaltrials.gov NCT02655835; http://clinicaltrials.gov/ct2/show/NCT02655835 (Archived by WebCite at http://www.webcitation/ 6jUDuQsG2) PMID:27502759

Variation in Expert Source Selection According to Different Objectivity Standards

ERIC Educational Resources Information Center

Albaek, Erik

2011-01-01

Several scholars have tried to clarify how journalists handle and implement the abstract objectivity norm in daily practice. Less research attention has been paid to how common abstract professional norms and values, "in casu" the objectivity norm, may systematically vary when interpreted and implemented in daily journalistic practice. Allgaier's…

[Culinary as an object of study and intervention in the field of Food and Nutrition].

PubMed

Diez-Garcia, Rosa Wanda; de Castro, Inês Rugani Ribeiro

2011-01-01

Culinary is approached here as an object of food and nutritional studies and interventions aimed at dietary changes. In order to explore the culinary potential, two studies are presented: one qualitative, focusing on dietary intake, with subjects from two socioeconomic sectors submitted to salt restrictions; the other uses cooking as structural axis of an educational method for promoting healthy eating. In both studies one can observe the potential of culinary: in the first, as a medium which allows access to information about food procedures that can improve the quality of information about food intake and food practices and, in the second, as an effective space for interventions aimed at food habit changes by addressing their sensorial, cognitive, symbolic and procedural dimensions.

Vegetable parenting practices scale. Item response modeling analyses

PubMed Central

Chen, Tzu-An; O’Connor, Teresia; Hughes, Sheryl; Beltran, Alicia; Baranowski, Janice; Diep, Cassandra; Baranowski, Tom

2015-01-01

Objective To evaluate the psychometric properties of a vegetable parenting practices scale using multidimensional polytomous item response modeling which enables assessing item fit to latent variables and the distributional characteristics of the items in comparison to the respondents. We also tested for differences in the ways item function (called differential item functioning) across child’s gender, ethnicity, age, and household income groups. Method Parents of 3–5 year old children completed a self-reported vegetable parenting practices scale online. Vegetable parenting practices consisted of 14 effective vegetable parenting practices and 12 ineffective vegetable parenting practices items, each with three subscales (responsiveness, structure, and control). Multidimensional polytomous item response modeling was conducted separately on effective vegetable parenting practices and ineffective vegetable parenting practices. Results One effective vegetable parenting practice item did not fit the model well in the full sample or across demographic groups, and another was a misfit in differential item functioning analyses across child’s gender. Significant differential item functioning was detected across children’s age and ethnicity groups, and more among effective vegetable parenting practices than ineffective vegetable parenting practices items. Wright maps showed items only covered parts of the latent trait distribution. The harder- and easier-to-respond ends of the construct were not covered by items for effective vegetable parenting practices and ineffective vegetable parenting practices, respectively. Conclusions Several effective vegetable parenting practices and ineffective vegetable parenting practices scale items functioned differently on the basis of child’s demographic characteristics; therefore, researchers should use these vegetable parenting practices scales with caution. Item response modeling should be incorporated in analyses of parenting practice questionnaires to better assess differences across demographic characteristics. PMID:25895694

8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice - A systematic review.

PubMed

Gotink, Rinske A; Meijboom, Rozanna; Vernooij, Meike W; Smits, Marion; Hunink, M G Myriam

2016-10-01

The objective of the current study was to systematically review the evidence of the effect of secular mindfulness techniques on function and structure of the brain. Based on areas known from traditional meditation neuroimaging results, we aimed to explore a neuronal explanation of the stress-reducing effects of the 8-week Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) program. We assessed the effect of MBSR and MBCT (N=11, all MBSR), components of the programs (N=15), and dispositional mindfulness (N=4) on brain function and/or structure as assessed by (functional) magnetic resonance imaging. 21 fMRI studies and seven MRI studies were included (two studies performed both). The prefrontal cortex, the cingulate cortex, the insula and the hippocampus showed increased activity, connectivity and volume in stressed, anxious and healthy participants. Additionally, the amygdala showed decreased functional activity, improved functional connectivity with the prefrontal cortex, and earlier deactivation after exposure to emotional stimuli. Demonstrable functional and structural changes in the prefrontal cortex, cingulate cortex, insula and hippocampus are similar to changes described in studies on traditional meditation practice. In addition, MBSR led to changes in the amygdala consistent with improved emotion regulation. These findings indicate that MBSR-induced emotional and behavioral changes are related to functional and structural changes in the brain. Copyright © 2016 Elsevier Inc. All rights reserved.

Public health in transition: views of the specialist workforce.

PubMed

Griffiths, Sian; Thorpe, Allison

2007-09-01

The constant structural changes to the NHS in England have created instability and lack of job security within the public health workforce in the U.K. Since posts are linked to structures which keep changing, recent years have seen constant changes in titles, responsibilities and expectations. Effective public health practice involves teamwork across sectors and strong relationships with local communities, and this constant change has posed professional challenges. The changes in 2002 offered the Faculty of Public Health the opportunity to work with the Department of Health to consult with specialists, the main objective being to reach agreement on future roles and ways of working. The lessons learnt from this exercise are described here as they remain relevant as the structural changes continue. Key messages are that if the many opportunities of the current policy agenda are to be realized, the public health profession needs to be supported to play its full role in the three domains of practice: health improvement, health protection and developing better health services. This challenge needs professional bodies to be clear on expected competence of their members; employers to be clear on the potential contribution of public health specialists not only in promoting and protecting health in communities but also within the acute sector; organizational arrangements to be in place to sustain the capacity of the workforce whatever the structural changes occurring. This lesson has yet to be learnt.

Conscientious objection to sexual and reproductive health services: international human rights standards and European law and practice.

PubMed

Zampas, Christina; Andión-Ibañez, Ximena

2012-06-01

The practice of conscientious objection often arises in the area of individuals refusing to fulfil compulsory military service requirements and is based on the right to freedom of thought, conscience and religion as protected by national, international and regional human rights law. The practice of conscientious objection also arises in the field of health care, when individual health care providers or institutions refuse to provide certain health services based on religious, moral or philosophical objections. The use of conscientious objection by health care providers to reproductive health care services, including abortion, contraceptive prescriptions, and prenatal tests, among other services is a growing phenomena throughout Europe. However, despite recent progress from the European Court of Human Rights on this issue (RR v. Poland, 2011), countries and international and regional bodies generally have failed to comprehensively and effectively regulate this practice, denying many women reproductive health care services they are legally entitled to receive. The Italian Ministry of Health reported that in 2008 nearly 70% of gynaecologists in Italy refuse to perform abortions on moral grounds. It found that between 2003 and 2007 the number of gynaecologists invoking conscientious objection in their refusal to perform an abortion rose from 58.7 percent to 69.2 percent. Italy is not alone in Europe, for example, the practice is prevalent in Poland, Slovakia, and is growing in the United Kingdom. This article outlines the international and regional human rights obligations and medical standards on this issue, and highlights some of the main gaps in these standards. It illustrates how European countries regulate or fail to regulate conscientious objection and how these regulations are working in practice, including examples of jurisprudence from national level courts and cases before the European Court of Human Rights. Finally, the article will provide recommendations to national governments as well as to international and regional bodies on how to regulate conscientious objection so as to both respect the practice of conscientious objection while protecting individual's right to reproductive health care.

Communication skills assessment in the final postgraduate years to established practice: a systematic review.

PubMed

Gillis, Amy E; Morris, Marie C; Ridgway, Paul F

2015-01-01

Communication breakdown is a factor in the majority of all instances of medical error. Despite the importance, a relative paucity of time is invested in communication skills in postgraduate curricula. Our objective is to systematically review the literature to identify the current tools used to assess communication skills in postgraduate trainees in the latter 2 years of training and in established practice. Two reviewers independently reviewed the literature identifying communication skill assessment tools, for postgraduate trainees in the latter 2 years of training and in established practice following Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, and inclusion/exclusion criteria from January 1990 to 15 August 2014. PubMed/CINAHL/ERIC/EMBASE/PsycInfo/Psyc Articles/Cochrane. 222 articles were identified; after review, 34 articles fulfilled criteria for complete evaluation; the majority (26) had a high level of evidence scoring 3 or greater on the Best Evidence Medical Education guide. 22 articles used objective structured clinical examination/standardised patient (SP)-based formats in an assessment or training capacity. Evaluation tools included author-developed questionnaires and validated tools. Nineteen articles demonstrated an educational initiative. The reviewed literature is heterogeneous for objectives and measurement techniques for communication. Observed interactions, with patients or SPs, is the current favoured method of evaluation using author-developed questionnaires. The role of self-evaluation of skill level is questioned. The need for a validated assessment tool for communication skills is highlighted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The pseudo-Boolean optimization approach to form the N-version software structure

NASA Astrophysics Data System (ADS)

Kovalev, I. V.; Kovalev, D. I.; Zelenkov, P. V.; Voroshilova, A. A.

2015-10-01

The problem of developing an optimal structure of N-version software system presents a kind of very complex optimization problem. This causes the use of deterministic optimization methods inappropriate for solving the stated problem. In this view, exploiting heuristic strategies looks more rational. In the field of pseudo-Boolean optimization theory, the so called method of varied probabilities (MVP) has been developed to solve problems with a large dimensionality. Some additional modifications of MVP have been made to solve the problem of N-version systems design. Those algorithms take into account the discovered specific features of the objective function. The practical experiments have shown the advantage of using these algorithm modifications because of reducing a search space.

A Multilevel Conceptual Framework to Understand the Role of Food Insecurity on Antiretroviral Therapy Adherence in Low-Resource Settings: From Theory to Practice

PubMed Central

Masa, Rainier; Chowa, Gina

2018-01-01

The objective of this study was to describe a multilevel conceptual framework to understand the role of food insecurity on antiretroviral therapy adherence. The authors illustrated an example of how they used the multilevel framework to develop an intervention for poor people living with HIV in a rural and low-resource community. The framework incorporates intra-personal, interpersonal, and structural-level theories of understanding and changing health behaviors. The framework recognizes the role of personal, social, and environmental factors on cognition and behavior, with particular attention to ways in which treatment adherence is enabled or prevented by structural conditions, such as food insecurity. PMID:28368779

A qualitative inquiry into the effects of visualization on high school chemistry students' learning process of molecular structure

NASA Astrophysics Data System (ADS)

Deratzou, Susan

This research studies the process of high school chemistry students visualizing chemical structures and its role in learning chemical bonding and molecular structure. Minimal research exists with high school chemistry students and more research is necessary (Gabel & Sherwood, 1980; Seddon & Moore, 1986; Seddon, Tariq, & Dos Santos Veiga, 1984). Using visualization tests (Ekstrom, French, Harman, & Dermen, 1990a), a learning style inventory (Brown & Cooper, 1999), and observations through a case study design, this study found visual learners performed better, but needed more practice and training. Statistically, all five pre- and post-test visualization test comparisons were highly significant in the two-tailed t-test (p > .01). The research findings are: (1) Students who tested high in the Visual (Language and/or Numerical) and Tactile Learning Styles (and Social Learning) had an advantage. Students who learned the chemistry concepts more effectively were better at visualizing structures and using molecular models to enhance their knowledge. (2) Students showed improvement in learning after visualization practice. Training in visualization would improve students' visualization abilities and provide them with a way to think about these concepts. (3) Conceptualization of concepts indicated that visualizing ability was critical and that it could be acquired. Support for this finding was provided by pre- and post-Visualization Test data with a highly significant t-test. (4) Various molecular animation programs and websites were found to be effective. (5) Visualization and modeling of structures encompassed both two- and three-dimensional space. The Visualization Test findings suggested that the students performed better with basic rotation of structures as compared to two- and three-dimensional objects. (6) Data from observations suggest that teaching style was an important factor in student learning of molecular structure. (7) Students did learn the chemistry concepts. Based on the Visualization Test results, which showed that most of the students performed better on the post-test, the visualization experience and the abstract nature of the content allowed them to transfer some of their chemical understanding and practice to non-chemical structures. Finally, implications for teaching of chemistry, students learning chemistry, curriculum, and research for the field of chemical education were discussed.

Confirmatory factor analysis of the Chinese Breast Cancer Screening Beliefs Questionnaire.

PubMed

Kwok, Cannas; Fethney, Judith; White, Kate

2012-01-01

Chinese women have been consistently reported as having low breast cancer screening practices. The Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) was designed to assess Chinese Australian women's beliefs, knowledge, and attitudes toward breast cancer and screening practices. The objectives of the study were to confirm the factor structure of the CBCSB with a new, larger sample of immigrant Chinese Australian women and to report its clinical validity. A convenience sample of 785 Chinese Australian women was recruited from Chinese community organizations and shopping malls. Cronbach α was used to assess internal consistency reliability, and Amos v18 was used for confirmatory factor analysis. Clinical validity was assessed through linear regression using SPSS v18. The 3-factor structure of the CBCSB was confirmed, although the model required respecification to arrive at a suitable model fit as measured by the goodness-of-fit index (0.98), adjusted goodness-of-fit index (0.97), normed fit index (0.95), and root mean square error of approximation (0.031). Internal consistency reliability coefficients were satisfactory (>.6). Women who engaged in all 3 types of screening had more proactive attitudes to health checkups and perceived less barriers to mammographic screening. The CBCSB is a valid and reliable tool for assessing Chinese women's beliefs, knowledge, and attitudes about breast cancer and breast cancer screening practices. The CBCSB can be used for providing practicing nurses with insights into the provision of culturally sensitive breast health education.

Conscientious objection to referrals for abortion: pragmatic solution or threat to women’s rights?

PubMed Central

2014-01-01

Background Conscientious objection has spurred impassioned debate in many Western countries. Some Norwegian general practitioners (GPs) refuse to refer for abortion. Little is know about how the GPs carry out their refusals in practice, how they perceive their refusal to fit with their role as professionals, and how refusals impact patients. Empirical data can inform subsequent normative analysis. Methods Qualitative research interviews were conducted with seven GPs, all Christians. Transcripts were analysed using systematic text condensation. Results Informants displayed a marked ambivalence towards their own refusal practices. Five main topics emerged in the interviews: 1) carrying out conscientious objection in practice, 2) justification for conscientious objection, 3) challenges when relating to colleagues, 4) ambivalence and consistency, 5) effects on the doctor-patient relationship. Conclusions Norwegian GP conscientious objectors were given to consider both pros and cons when evaluating their refusal practices. They had settled on a practical compromise, the precise form of which would vary, and which was deemed an acceptable middle way between competing interests. PMID:24571955

Balance Assessment in Deaf Children and Teenagers Prior to and Post Capoeira Practice through the Berg Balance Scale.

PubMed

Lima, Rubianne

2017-12-01

Hearing loss changes the functionality and body structure a disability that limits activity and restricts the participation of the individual in situations of daily life. It is believed that capoeira can help people with visual disabilities to minimize these deficits. BSE is a low specificity scale that evaluates objectively and functionally aspects of balance and risk of falls in the elderly and children, including the effect of environment on balance function. The objective of the research is to analyze deaf children and adolescents prior to and post-practice of capoeira using the Berg Balance Scale (BBS). Quantitative, clinical and observational studies. Twenty five deaf children between 10 and 16 years old of both genders were assessed. BBS was applied in two stages: before starting capoeira and after 6 months of training. The one-hour classes were held once a week for quantitative evaluation purposes. The subjects were divided and evaluated in two groups (10-13 years old and 14-16 years old). There was a significant statistical difference in BBS scores. The general group and the group of 10-13 years old (p = 0.0251) showed an increase in scores after practicing capoeira (p = 0.0039). There were no statistically significant differences in the group from 14 to 16 years of age (p = 0.0504). Using the Berg Balance Scale, it was possible to observe an improvement in the balance of the group of children and adolescents who practiced capoeira, and consequently, a decrease in the risk of falling.

Using a teaching OSCE to prompt learners to engage with patients who talk about religion and/or spirituality.

PubMed

Ledford, Christy J W; Seehusen, Dean A; Canzona, Mollie Rose; Cafferty, Lauren A

2014-01-01

The objective structured clinical examination (OSCE) has only occasionally been used as a teaching tool. The authors describe the initial use of an educational innovation consisting of a teaching OSCE used as "sensitizing practice," followed by personal, guided, and group reflection. Staff and resident physicians and one medical student (N = 28) at a community hospital's family medicine residency participated in the innovation during August 2012. The initial use of the educational innovation allowed learners to engage in a potentially challenging conversation with a standardized patient about religion and/or spirituality (R/S). The aim of the innovation was not to equip learners with a particular tactic to introduce or discuss R/S but, rather, to prompt learners to engage in mindful practice with patients who identify R/S as part of their biopsychosocial contexts. Written, dyadic, and group reflection added value to the OSCE by allowing participants to reflect on a difficult learning objective over time. Participants moved along the stages-of-change continuum when engaging in guided reflection compared with personal reflection. Additionally, all participants provided evidence of at least the preparation stage at the time of guided reflection. By following the OSCE's sensitizing practice with three periods of reflection, learners were enabled first, to recognize the need for readiness to address challenging communication topics (in this case, R/S) and, second, to reflect on practiced strategies for those conversations. The educational innovation can help learners become more aware of and skillful in dealing with difficult physician-patient communication topics.

Sizing Single Cantilever Beam Specimens for Characterizing Facesheet/Core Peel Debonding in Sandwich Structure

NASA Technical Reports Server (NTRS)

Ratcliffe, James G.

2010-01-01

This technical publication details part of an effort focused on the development of a standardized facesheet/core peel debonding test procedure. The purpose of the test is to characterize facesheet/core peel in sandwich structure, accomplished through the measurement of the critical strain energy release rate associated with the debonding process. Following an examination of previously developed tests and a recent evaluation of a selection of these methods, a single cantilever beam (SCB) specimen was identified as being a promising candidate for establishing such a standardized test procedure. The objective of the work described here was to begin development of a protocol for conducting a SCB test that will render the procedure suitable for standardization. To this end, a sizing methodology was developed to ensure appropriate SCB specimen dimensions are selected for a given sandwich system. Application of this method to actual sandwich systems yielded SCB specimen dimensions that would be practical for use. This study resulted in the development of a practical SCB specimen sizing method, which should be well-suited for incorporation into a standardized testing protocol.

Perioperative feedback in surgical training: A systematic review.

PubMed

McKendy, Katherine M; Watanabe, Yusuke; Lee, Lawrence; Bilgic, Elif; Enani, Ghada; Feldman, Liane S; Fried, Gerald M; Vassiliou, Melina C

2017-07-01

Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperative teaching and feedback. A systematic literature search identified articles from 1994 to 2014 that addressed teaching, feedback, guidance, or debriefing in the perioperative period. Data was extracted according to ENTREQ guidelines, and a qualitative analysis was performed. Thematic analysis of the 26 included studies identified four major topics. Observation of teaching behaviors in the OR described current teaching practices. Identification of effective teaching strategies analyzed teaching behaviors, differentiating positive and negative teaching strategies. Perceptions of teaching behaviors described resident and attending satisfaction with teaching in the OR. Finally models for delivering structured feedback cited examples of feedback strategies and measured their effectiveness. This study provides an overview of perioperative teaching and feedback for surgical trainees and identifies a need for improved quality and quantity of structured feedback. Copyright © 2016 Elsevier Inc. All rights reserved.

Embedding Agile Practices within a Plan-Driven Hierarchical Project Life Cycle

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

Millard, W. David; Johnson, Daniel M.; Henderson, John M.

2014-07-28

Organizations use structured, plan-driven approaches to provide continuity, direction, and control to large, multi-year programs. Projects within these programs vary greatly in size, complexity, level of maturity, technical risk, and clarity of the development objectives. Organizations that perform exploratory research, evolutionary development, and other R&D activities can obtain the benefits of Agile practices without losing the benefits of their program’s overarching plan-driven structure. This paper describes application of Agile development methods on a large plan-driven sensor integration program. While the client employed plan-driven, requirements flow-down methodologies, tight project schedules and complex interfaces called for frequent end-to-end demonstrations to provide feedbackmore » during system development. The development process maintained the many benefits of plan-driven project execution with the rapid prototyping, integration, demonstration, and client feedback possible through Agile development methods. This paper also describes some of the tools and implementing mechanisms used to transition between and take advantage of each methodology, and presents lessons learned from the project management, system engineering, and developer’s perspectives.« less

Administrators’ Perspectives on Changing Practice in End-of-Life Care in a State Prison System

PubMed Central

Penrod, Janice; Loeb, Susan J.; Smith, Carol A.

2013-01-01

Objective Sentencing trends have created a demographic shift in prison populations. Greater numbers of inmates are aging and dying in prison, creating a demand for enhanced end-of-life care. Changing practice to meet escalating care demands in corrections settings is complicated by economic constraints, attitudinal barriers, and organizational features. This study explored perspectives of end-of-life care held by administrators in a state prison system to reveal challenges to changing practice to meet the needs of inmates suffering advanced illness and dying in prison. Design and Sample Qualitative interviews were conducted with 12 administrators from the central office of a state department of corrections. Results Key influences impacting end-of-life care services included: local prison culture; treatment versus security focus; case-by-case consideration; public sentiment; budget neutral approaches; and conflicting views of service targets. Conclusions These findings revealed the organizational structures, attitudes, and beliefs held by the administrative echelon of a state prison system and were used to guide the derivation of discrete approaches to changing practice in this complex system. Contextual evaluation permitted a much deeper understanding of the influences on changing practice in this hierarchical bureaucracy. This type of preliminary evaluation is crucial to infusing new practice initiatives in complex organizations caring for stigmatized, at-risk populations. PMID:24588128

Design search and optimization in aerospace engineering.

PubMed

Keane, A J; Scanlan, J P

2007-10-15

In this paper, we take a design-led perspective on the use of computational tools in the aerospace sector. We briefly review the current state-of-the-art in design search and optimization (DSO) as applied to problems from aerospace engineering, focusing on those problems that make heavy use of computational fluid dynamics (CFD). This ranges over issues of representation, optimization problem formulation and computational modelling. We then follow this with a multi-objective, multi-disciplinary example of DSO applied to civil aircraft wing design, an area where this kind of approach is becoming essential for companies to maintain their competitive edge. Our example considers the structure and weight of a transonic civil transport wing, its aerodynamic performance at cruise speed and its manufacturing costs. The goals are low drag and cost while holding weight and structural performance at acceptable levels. The constraints and performance metrics are modelled by a linked series of analysis codes, the most expensive of which is a CFD analysis of the aerodynamics using an Euler code with coupled boundary layer model. Structural strength and weight are assessed using semi-empirical schemes based on typical airframe company practice. Costing is carried out using a newly developed generative approach based on a hierarchical decomposition of the key structural elements of a typical machined and bolted wing-box assembly. To carry out the DSO process in the face of multiple competing goals, a recently developed multi-objective probability of improvement formulation is invoked along with stochastic process response surface models (Krigs). This approach both mitigates the significant run times involved in CFD computation and also provides an elegant way of balancing competing goals while still allowing the deployment of the whole range of single objective optimizers commonly available to design teams.

Summary of Session Activities: Coordination of Environmental Education Projects

NASA Technical Reports Server (NTRS)

Keeler, Michael; Mahootian, Farzad

1995-01-01

In this session, we address four fundamental questions related to environmental fields with emphasis on education. These are: What are the goals, objectives, and practical opportunities for coordinating our projects? How can we improve awareness of, interest in, access to, and support the products of our work? How can we build relationships between projects for scientific, educational, technical, and programmatic benefit? How can we evaluate the effectiveness of coordination efforts. In this working session, we produced answers to these questions and proposed a structure for future collaboration.

An Audiovisual Teaching Module to Assist Examiners in the Administration of a Practical Performance Examination for the Emergency Medical Technician-Ambulance (EMT-A). Consisting of a 90-Minute Audiovisual Presentation In Either 16mm Sound or 3/4" Video-Cassette Plus a "User's Guide" Describing in Detail the Total Examination Procedure. Final Report.

ERIC Educational Resources Information Center

National Registry of Emergency Medical Technicians, Columbus, OH.

A structured, time-referenced, performance examination was designed as part of the certification procedure for Emergency Medical Technicians-Ambulance in an attempt to increase objectivity and standardization. This examination is based on a model developed by the University of Southern California, School of Medicine, Department of Emergency…

The naphthalene state of the science symposium: objectives, organization, structure, and charge.

PubMed

Belzer, Richard B; Bus, James S; Cavalieri, Ercole L; Lewis, Steven C; North, D Warner; Pleus, Richard C

2008-07-01

This report provides a summary of the objectives, organization, structure and charge for the naphthalene state of the science symposium (NS(3)), Monterey, CA, October 9-12, 2006. A 1-day preliminary conference was held followed by a 3-day state of the science symposium covering four topics judged by the Planning Committee to be crucial for developing valid and reliable scientific estimates of low-dose human cancer risk from naphthalene. The Planning Committee reviewed the relevant scientific literature to identify singularly knowledgeable researchers and a pool of scientists qualified to serve as expert panelists. In two cases, independent scientists were commissioned to develop comprehensive reviews of the relevant science in a specific area for which no leading researcher could be identified. Researchers and expert panelists alike were screened for conflicts of interest. All policy issues related to risk assessment practices and risk management were scrupulously excluded. NS(3) was novel in several ways and provides an innovative model for the effective use of peer review to identify scientific uncertainties and propose research strategies for reducing or eliminating them prior to the conduct of risk assessment.

Understanding intercultural transitions of medical students

PubMed Central

Mansour, Nasser; Fisher, Ros

2015-01-01

Objectives The aim of this research was to explore the transition of medical students to an international branch campus of a medical university established in Bahrain. Methods In order to gain insights into this transition, we explored two culturally diverse systems of learning of the university and the local schools in Bahrain, using Communities of Practice as a lens for understanding transitions. Focus groups were conducted with secondary school teachers and first year medical students. Additionally, semi-structured interviews were conducted with university lecturers.   Results The findings suggest that, while Communities of Practice have been influential in contextualising transitions to university, this model does not seem to help us to fully understand intercultural transitions to the case-study university. Conclusions The research emphasises that more attention should be given to learner individual agency within this theory as a framework for understanding transitions. It also challenges approaches within medical education that attempt to standardise systems of learning through acquisition of established practices. PMID:25725207

Influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria.

PubMed

Ajao, K O; Ojofeitimi, E O; Adebayo, A A; Fatusi, A O; Afolabi, O T

2010-12-01

Fertility pattern and reproductive behaviours affect infant death in Nigeria. Household food insecurity and poor care practices also place children at risk of morbidity and mortality. The objectives of this study were to assess the influence of family size, household food security status, and child care practices on the nutritional status of under-five children in Ile-Ife, Nigeria. The study employed a descriptive cross-sectional design. A semi-structured questionnaire was used to collect data from 423 mothers of under-five children and their children in the households selected through multistage sampling methods. Food-insecure households were five times more likely than secure households to have wasted children (crude OR = 5.707, 95 percent CI = 1.31-24.85). Children with less educated mothers were significantly more likely to be stunted. The prevalence of food insecurity among households in Ile-Ife was high. Households with food insecurity and less educated mothers were more likely to have malnourished children.

Maternal beliefs and parenting practices regarding their preschool child's TV viewing: An exploration in a sample of low-income Mexican-origin mothers

PubMed Central

Thompson, Darcy A.; Polk, Sarah; Cheah, Charissa S.L.; Vandewater, Elizabeth A.; Johnson, Susan L.; Chrismer, Marilyn Camacho; Tschann, Jeanne M.

2014-01-01

Objective To explore maternal beliefs about TV viewing and related parenting practices in low-income Mexican-origin mothers of preschoolers. Methods Semi-structured interviews were conducted with 21 low-income Mexican-origin mothers of preschoolers. Interviews were audio recorded and analyzed using a theoretically based thematic analytic approach. Results Mothers described strong beliefs about the positive and negative impact of television content. Mothers emphasized the educational value of specific programming. Content restrictions were common. Time restrictions were not clearly defined; however, many mothers preferred short versus long episodes of viewing. Mothers spoke positively about family viewing and the role of TV viewing in enabling mothers to accomplish household tasks. Discussion These findings have implications for intervening in this population. Interventionists should consider the value mothers place on the educational role of TV viewing, the direct benefit to mothers of viewing time, the lack of clear time limits, and the common practice of family co-viewing. PMID:25724994

[The micropolitics of desire: the clinic of the individual in the mental health institution].

PubMed

Rinaldi, Doris Luz

2015-02-01

The scope of this article is to discuss clinical practice issues in public mental health institutions, their predicaments and potential conditions, focusing especially on the practice "among others" of the psycho analyst in this clinic. The mental health field is a field in permanent revitalization, marked by the heterogeneity and plurality of guidelines, permeated by tensions between old models of care, new political objectives to redeem the minimum rights of a population traditionally excluded from social coexistence and proposals for a new clinical practice that concentrates on the individual. Based on clinical perceptions, I intend to approach the clinical treatment of the individual in a mental health institution, as well as the challenges of working in a team, bearing in mind the impositions of mental health policy arounnd which the services are structured. Our proposal is to think of the clinic as the micro politics of desire that sustains the daily work of monitoring the course of treatment for each individual.

Breast feeding practices among health care professionals in a tertiary care hospital from South India.

PubMed

Renitha, Raghavan; Babu, Thirunavukkarasu Arun; Kumar, Manish; Srinivasan, Sadagopan

2012-01-01

Personal breastfeeding experiences of health care professionals play a major role in influencing their attitudes and expertise regarding counseling and managing breastfeeding issues in patients. This study was done with an objective of studying the current breastfeeding practices among health care professionals (HP) and their spouses and the factors influencing them. All children < 5 years of age, residing in hospital's residential quarters, were included. A detailed breastfeeding history demographic data were obtained following a semi-structured interview with mothers. Among 81 children included for analysis, in 73 children (90.1%), an initiation of breastfeeding was within 24 hours of birth and in 36 children (44.4%), it was within first hour of life. 43 children (58.1%) were exclusively breast fed for 6 months. Mean duration of EBF was 5.3 months and total duration of breastfeeding was 13.2 months. Gender of HP, gender of the child and socio-economic factors were not found to significantly affect breastfeeding practices among HP.

A concise guide to clinical reasoning.

PubMed

Daly, Patrick

2018-04-30

What constitutes clinical reasoning is a disputed subject regarding the processes underlying accurate diagnosis, the importance of patient-specific versus population-based data, and the relation between virtue and expertise in clinical practice. In this paper, I present a model of clinical reasoning that identifies and integrates the processes of diagnosis, prognosis, and therapeutic decision making. The model is based on the generalized empirical method of Bernard Lonergan, which approaches inquiry with equal attention to the subject who investigates and the object under investigation. After identifying the structured operations of knowing and doing and relating these to a self-correcting cycle of learning, I correlate levels of inquiry regarding what-is-going-on and what-to-do to the practical and theoretical elements of clinical reasoning. I conclude that this model provides a methodical way to study questions regarding the operations of clinical reasoning as well as what constitute significant clinical data, clinical expertise, and virtuous health care practice. © 2018 John Wiley & Sons, Ltd.

Psychometrics of the preschooler physical activity parenting practices instrument among a Latino sample

PubMed Central

2014-01-01

Background Latino preschoolers (3-5 year old children) have among the highest rates of obesity. Low levels of physical activity (PA) are a risk factor for obesity. Characterizing what Latino parents do to encourage or discourage their preschooler to be physically active can help inform interventions to increase their PA. The objective was therefore to develop and assess the psychometrics of a new instrument: the Preschooler Physical Activity Parenting Practices (PPAPP) among a Latino sample, to assess parenting practices used to encourage or discourage PA among preschool-aged children. Methods Cross-sectional study of 240 Latino parents who reported the frequency of using PA parenting practices. 95% of respondents were mothers; 42% had more than a high school education. Child mean age was 4.5 (±0.9) years (52% male). Test-retest reliability was assessed in 20%, 2 weeks later. We assessed the fit of a priori models using Confirmatory factor analyses (CFA). In a separate sub-sample (35%), preschool-aged children wore accelerometers to assess associations with their PA and PPAPP subscales. Results The a-priori models showed poor fit to the data. A modified factor structure for encouraging PPAPP had one multiple-item scale: engagement (15 items), and two single-items (have outdoor toys; not enroll in sport-reverse coded). The final factor structure for discouraging PPAPP had 4 subscales: promote inactive transport (3 items), promote screen time (3 items), psychological control (4 items) and restricting for safety (4 items). Test-retest reliability (ICC) for the two scales ranged from 0.56-0.85. Cronbach’s alphas ranged from 0.5-0.9. Several sub-factors correlated in the expected direction with children’s objectively measured PA. Conclusion The final models for encouraging and discouraging PPAPP had moderate to good fit, with moderate to excellent test-retest reliabilities. The PPAPP should be further evaluated to better assess its associations with children’s PA and offers a new tool for measuring PPAPP among Latino families with preschool-aged children. PMID:24428935

A survey of medicinal plants used by the Deb barma clan of the Tripura tribe of Moulvibazar district, Bangladesh.

PubMed

Kabir, Mohammad Humayun; Hasan, Nur; Rahman, Md Mahfuzur; Rahman, Md Ashikur; Khan, Jakia Alam; Hoque, Nazia Tasnim; Bhuiyan, Md Ruhul Quddus; Mou, Sadia Moin; Jahan, Rownak; Rahmatullah, Mohammed

2014-02-06

The number of tribes present within Bangladesh has been estimated to approximate one hundred and fifty. Information on traditional medicinal practices, particularly of the smaller tribes and their clans is lacking. It was the objective of the study to document the tribal medicinal practices of the Deb barma clan of the Tripura tribe, which clan can be found residing in Dolusora Tripura Palli of Moulvibazar district of Bangladesh. A further objective was to determine the extent of the community households who still prefer traditional treatment to other forms of treatment, particularly allopathic treatment. Interviews of the tribal healer and the tribal community regarding their ethnomedicinal practices were carried out with the help of a semi-structured questionnaire and the guided field-walk method. All together 67 clan members were interviewed including the Headman, tribal healer, 19 Heads of households and 46 other adult members of the clan. Information on number of members of household, their age, gender, educational status, occupation of working household members and preferred mode of treatment was obtained through the semi-structured questionnaire. In the guided field-walk method, the healer took the interviewers on field-walks through areas from where he collected his medicinal plants, pointed out the plants, and described their uses. The clan had a total of 135 people distributed into 20 households and had only one traditional healer. Use of medicinal plants, wearing of amulets, and worship of the evil god 'Bura debta' constituted the traditional medicinal practices of the clan for treatment of diseases. The healer used a total of 44 medicinal plants distributed into 34 families for treatment of various ailments like pain, coughs, cold, gastrointestinal disorders, cuts and wounds, diabetes, malaria, heart disorders, and paralysis. Available scientific reports validate the use of a number of plants by the traditional healer. A number of the plants used by the clan healer had reported similar uses in Ayurveda, but differ considerably in their therapeutic uses from that reported for other tribes in Bangladesh. The present survey also indicated that in recent years the Deb barma clan members are inclining more towards allopathic medicine.

The introspective may achieve more: Enhancing existing Geoscientific models with native-language emulated structural reflection

NASA Astrophysics Data System (ADS)

Ji, Xinye; Shen, Chaopeng

2018-01-01

Geoscientific models manage myriad and increasingly complex data structures as trans-disciplinary models are integrated. They often incur significant redundancy with cross-cutting tasks. Reflection, the ability of a program to inspect and modify its structure and behavior at runtime, is known as a powerful tool to improve code reusability, abstraction, and separation of concerns. Reflection is rarely adopted in high-performance Geoscientific models, especially with Fortran, where it was previously deemed implausible. Practical constraints of language and legacy often limit us to feather-weight, native-language solutions. We demonstrate the usefulness of a structural-reflection-emulating, dynamically-linked metaObjects, gd. We show real-world examples including data structure self-assembly, effortless input/output (IO) and upgrade to parallel I/O, recursive actions and batch operations. We share gd and a derived module that reproduces MATLAB-like structure in Fortran and C++. We suggest that both a gd representation and a Fortran-native representation are maintained to access the data, each for separate purposes. Embracing emulated reflection allows generically-written codes that are highly re-usable across projects.

Fairbairn's Theory of Change.

PubMed

Celani, David P

2016-06-01

Fairbairn's unique structural theory with its three pairs of selves and objects has proven to be a highly usable and practical model of the human psyche, yet it has remained a minor player in the world of psychoanalysis. There are a number of factors that account for its lack of popularity, foremost among them the timing of the model's introduction to the analytic community. Fairbairn's four successive papers that described his metapsychology (1940, 1941, 1943, and 1944) were published just after Freud's death, when his theory was the dominant model of psychoanalysis. Additionally, Fairbairn's model was incomplete, used unfamiliar terminology, and, in its singularity, forced the analyst to abandon drive theory, the heart of Freud's metapsychology. This paper will examine and update Fairbairn's unique model of change-from the outset of pathology that begins with attachment to bad objects, to their metamorphosis into internal structures and finally to techniques of treatment that reduce their influence on the patients' internal world. The treatment section carefully follows Fairbairn's metapsychology, and focuses first on the analyst becoming a good object in the eyes of the patient, then unearthing bad object memories in a safe and compassionate interpersonal environment, engaging the patient's substructures in a manner that does not intensify preexisting internal templates, and finally aiding the patient in resuming his or her stalled emotional development. This exegesis of Fairbairn original model, along with recent modifications that have been made to it, demonstrates the consistency, clear focus, and utility of this little-known metapsychology.

Strategic Environmental Assessment of Greenhouse Gas Mitigation Options in the Canadian Agricultural Sector

NASA Astrophysics Data System (ADS)

Noble, Bram F.; Christmas, Lisa M.

2008-01-01

This article presents a methodological framework for strategic environmental assessment (SEA) application. The overall objective is to demonstrate SEA as a systematic and structured policy, plan, and program (PPP) decision support tool. In order to accomplish this objective, a stakeholder-based SEA application to greenhouse gas (GHG) mitigation policy options in Canadian agriculture is presented. Using a mail-out impact assessment exercise, agricultural producers and nonproducers from across the Canadian prairie region were asked to evaluate five competing GHG mitigation options against 13 valued environmental components (VECs). Data were analyzed using multi-criteria and exploratory analytical techniques. The results suggest considerable variation in perceived impacts and GHG mitigation policy preferences, suggesting that a blanket policy approach to GHG mitigation will create gainers and losers based on soil type and associate cropping and on-farm management practices. It is possible to identify a series of regional greenhouse gas mitigation programs that are robust, socially meaningful, and operationally relevant to both agricultural producers and policy decision makers. The assessment demonstrates the ability of SEA to address, in an operational sense, environmental problems that are characterized by conflicting interests and competing objectives and alternatives. A structured and systematic SEA methodology provides the necessary decision support framework for the consideration of impacts, and allows for PPPs to be assessed based on a much broader set of properties, objectives, criteria, and constraints whereas maintaining rigor and accountability in the assessment process.

Towards Augmented Human Memory: Retrieval-Induced Forgetting and Retrieval Practice in an Interactive, End-of-Day Review

PubMed Central

2018-01-01

The authors report 6 experiments that examined the contention that an end-of-day review could lead to augmentation in human memory. In Experiment 1, participants in the study phase were presented with a campus tour of different to-be-remembered objects in different university locations. Each to-be-remembered object was presented with an associated specific comment. Participants were then shown the location name and photographs of half of the objects from half of the locations, and they were asked to try to name the object and recall the associated comment specific to each item. Following a filled delay, participants were presented with the name of each campus location and were asked to free recall the to-be-remembered objects. Relative to the recall from the unpracticed location categories, participants recalled the names of significantly more objects that they practiced (retrieval practice) and significantly fewer unpracticed objects from the practiced locations (retrieval-induced forgetting, RIF). These findings were replicated in Experiment 2 using a campus scavenger hunt in which participants selected their own stimuli from experimenter’s categories. Following an examination of factors that maximized the effects of RIF and retrieval practice in the laboratory (Experiment 3), the authors applied these findings to the campus scavenger hunt task to create different retrieval practice schedules to maximize and minimize recall of items based on experimenter-selected (Experiment 4) and participant-selected items using both category-cued free recall (Experiment 5) and item-specific cues (Experiment 6). Their findings support the claim that an interactive, end-of-day review could lead to augmentation in human memory. PMID:29745709

Towards augmented human memory: Retrieval-induced forgetting and retrieval practice in an interactive, end-of-day review.

PubMed

Cinel, Caterina; Cortis Mack, Cathleen; Ward, Geoff

2018-05-01

The authors report 6 experiments that examined the contention that an end-of-day review could lead to augmentation in human memory. In Experiment 1, participants in the study phase were presented with a campus tour of different to-be-remembered objects in different university locations. Each to-be-remembered object was presented with an associated specific comment. Participants were then shown the location name and photographs of half of the objects from half of the locations, and they were asked to try to name the object and recall the associated comment specific to each item. Following a filled delay, participants were presented with the name of each campus location and were asked to free recall the to-be-remembered objects. Relative to the recall from the unpracticed location categories, participants recalled the names of significantly more objects that they practiced (retrieval practice) and significantly fewer unpracticed objects from the practiced locations (retrieval-induced forgetting, RIF). These findings were replicated in Experiment 2 using a campus scavenger hunt in which participants selected their own stimuli from experimenter's categories. Following an examination of factors that maximized the effects of RIF and retrieval practice in the laboratory (Experiment 3), the authors applied these findings to the campus scavenger hunt task to create different retrieval practice schedules to maximize and minimize recall of items based on experimenter-selected (Experiment 4) and participant-selected items using both category-cued free recall (Experiment 5) and item-specific cues (Experiment 6). Their findings support the claim that an interactive, end-of-day review could lead to augmentation in human memory. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Quality criteria for medical device registries: best practice approaches for improving patient safety - a systematic review of international experiences.

PubMed

Niederländer, Charlotte Susanne; Kriza, Christine; Kolominsky-Rabas, Peter

2017-01-01

As the benefit of medical device registries (MDRs) depends on their content and quality, it is important to ensure that MDRs have a robust and adequate structure to fulfill their objectives. However, no requirements are specified for the design and content of MDRs. The aim of this work is to analyze different MDRs in the field of implants and to give best practice recommendations for quality criteria regarding their design and development. Areas covered: A systematic literature search performed in databases (Medline, Cochrane Library, Scopus, Embase, CRD York), selected journals and websites identified 66 articles describing either a general MDR structure or the development process of specific registries. Extracted information about MDRs served as the basis for recommendations: MDRs should deliver a minimal data set and report information about the geographical area, data collection, numbers of patients enrolled, registry staff, and security and confidentiality of data. Expert commentary: Well-structured registries are a cornerstone of the regulatory process of medical devices and a major tool for decision makers. A future goal is to establish agreed minimal data sets for different devices - overcoming national borders. By establishing clear guidelines, the outcomes as well as registry comparability can be fundamentally improved.

An efficient and practical approach to obtain a better optimum solution for structural optimization

NASA Astrophysics Data System (ADS)

Chen, Ting-Yu; Huang, Jyun-Hao

2013-08-01

For many structural optimization problems, it is hard or even impossible to find the global optimum solution owing to unaffordable computational cost. An alternative and practical way of thinking is thus proposed in this research to obtain an optimum design which may not be global but is better than most local optimum solutions that can be found by gradient-based search methods. The way to reach this goal is to find a smaller search space for gradient-based search methods. It is found in this research that data mining can accomplish this goal easily. The activities of classification, association and clustering in data mining are employed to reduce the original design space. For unconstrained optimization problems, the data mining activities are used to find a smaller search region which contains the global or better local solutions. For constrained optimization problems, it is used to find the feasible region or the feasible region with better objective values. Numerical examples show that the optimum solutions found in the reduced design space by sequential quadratic programming (SQP) are indeed much better than those found by SQP in the original design space. The optimum solutions found in a reduced space by SQP sometimes are even better than the solution found using a hybrid global search method with approximate structural analyses.

Understanding practice change in community pharmacy: a qualitative research instrument based on organisational theory.

PubMed

Roberts, Alison S; Hopp, Trine; Sørensen, Ellen Westh; Benrimoj, Shalom I; Chen, Timothy F; Herborg, Hanne; Williams, Kylie; Aslani, Parisa

2003-10-01

The past decade has seen a notable shift in the practice of pharmacy, with a strong focus on the provision of cognitive pharmaceutical services (CPS) by community pharmacists. The benefits of these services have been well documented, yet their uptake appears to be slow. Various strategies have been developed to overcome barriers to the implementation of CPS, with varying degrees of success, and little is known about the sustainability of the practice changes they produce. Furthermore, the strategies developed are often specific to individual programs or services, and their applicability to other CPS has not been explored. There seems to be a need for a flexible change management model for the implementation and dissemination of a range of CPS, but before it can be developed, a better understanding of the change process is required. This paper describes the development of a qualitative research instrument that may be utilised to investigate practice change in community pharmacy. Specific objectives included gaining knowledge about the circumstances surrounding attempts to implement CPS, and understanding relationships that are important to the change process. Organisational theory provided the conceptual framework for development of the qualitative research instrument, within which two theories were used to give insight into the change process: Borum's theory of organisational change, which categorizes change strategies as rational, natural, political or open; and Social Network Theory, which helps identify and explain the relationships between key people involved in the change process. A semi-structured affecting practice change found in the literature that warranted further investigation with the theoretical perspectives of organisational change and social networks. To address the research objectives, the instrument covered four broad themes: roles, experiences, strategies and networks. The qualitative research instrument developed in this study provides a starting point for future research to lead to a description and understanding of practice change in community pharmacy, and subsequent development of models for the sustainable implementation of CPS.

Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol.

PubMed

Gould, Natalie J; Lorencatto, Fabiana; Stanworth, Simon J; Michie, Susan; Prior, Maria E; Glidewell, Liz; Grimshaw, Jeremy M; Francis, Jill J

2014-07-29

Audits of blood transfusion demonstrate around 20% transfusions are outside national recommendations and guidelines. Audit and feedback is a widely used quality improvement intervention but effects on clinical practice are variable, suggesting potential for enhancement. Behavioural theory, theoretical frameworks of behaviour change and behaviour change techniques provide systematic processes to enhance intervention. This study is part of a larger programme of work to promote the uptake of evidence-based transfusion practice. The objectives of this study are to design two theoretically enhanced audit and feedback interventions; one focused on content and one on delivery, and investigate the feasibility and acceptability. Study A (Content): A coding framework based on current evidence regarding audit and feedback, and behaviour change theory and frameworks will be developed and applied as part of a structured content analysis to specify the key components of existing feedback documents. Prototype feedback documents with enhanced content and also a protocol, describing principles for enhancing feedback content, will be developed. Study B (Delivery): Individual semi-structured interviews with healthcare professionals and observations of team meetings in four hospitals will be used to specify, and identify views about, current audit and feedback practice. Interviews will be based on a topic guide developed using the Theoretical Domains Framework and the Consolidated Framework for Implementation Research. Analysis of transcripts based on these frameworks will form the evidence base for developing a protocol describing an enhanced intervention that focuses on feedback delivery. Study C (Feasibility and Acceptability): Enhanced interventions will be piloted in four hospitals. Semi-structured interviews, questionnaires and observations will be used to assess feasibility and acceptability. This intervention development work reflects the UK Medical Research Council's guidance on development of complex interventions, which emphasises the importance of a robust theoretical basis for intervention design and recommends systematic assessment of feasibility and acceptability prior to taking interventions to evaluation in a full-scale randomised study. The work-up includes specification of current practice so that, in the trials to be conducted later in this programme, there will be a clear distinction between the control (usual practice) conditions and the interventions to be evaluated.

Enhancing implementation science by applying best principles of systems science.

PubMed

Northridge, Mary E; Metcalf, Sara S

2016-10-04

Implementation science holds promise for better ensuring that research is translated into evidence-based policy and practice, but interventions often fail or even worsen the problems they are intended to solve due to a lack of understanding of real world structures and dynamic complexity. While systems science alone cannot possibly solve the major challenges in public health, systems-based approaches may contribute to changing the language and methods for conceptualising and acting within complex systems. The overarching goal of this paper is to improve the modelling used in dissemination and implementation research by applying best principles of systems science. Best principles, as distinct from the more customary term 'best practices', are used to underscore the need to extract the core issues from the context in which they are embedded in order to better ensure that they are transferable across settings. Toward meaningfully grappling with the complex and challenging problems faced in adopting and integrating evidence-based health interventions and changing practice patterns within specific settings, we propose and illustrate four best principles derived from our systems science experience: (1) model the problem, not the system; (2) pay attention to what is important, not just what is quantifiable; (3) leverage the utility of models as boundary objects; and (4) adopt a portfolio approach to model building. To improve our mental models of the real world, system scientists have created methodologies such as system dynamics, agent-based modelling, geographic information science and social network simulation. To understand dynamic complexity, we need the ability to simulate. Otherwise, our understanding will be limited. The practice of dynamic systems modelling, as discussed herein, is the art and science of linking system structure to behaviour for the purpose of changing structure to improve behaviour. A useful computer model creates a knowledge repository and a virtual library for internally consistent exploration of alternative assumptions. Among the benefits of systems modelling are iterative practice, participatory potential and possibility thinking. We trust that the best principles proposed here will resonate with implementation scientists; applying them to the modelling process may abet the translation of research into effective policy and practice.

A New Glaucoma Severity Score Combining Structural and Functional Defects.

PubMed

Wachtl, J; Töteberg-Harms, M; Frimmel, S; Kniestedt, C

2017-04-01

Background In order to assess glaucoma severity and to compare the success of surgical and medical therapy and study outcomes, an objective and independent staging tool is necessary. A combination of information from both structural and functional testing is probably the best approach to stage glaucomatous damage. There has been no universally accepted standard for glaucoma staging. The aim of this study was to develop a Glaucoma Severity Score (GSS) for objective assessment of a patient's glaucoma severity, combining both functional and structural information. Materials and methods The Glaucoma Severity Score includes the following 3 criteria: superior and inferior Retinal Nerve Fibre Layer (RNFL) thickness, perimetric mean defect (MD), and agreement of anatomical and perimetric defects, as assessed by two glaucoma specialists. The specialists defined a staging tool for each of the 3 criteria in a consensus process, assigning specific characteristics to a scale value between 0 and 2 or 0 and 3, respectively. The GSS ranges between 0 and 10 points. In a prospective observational study, the data of 112 glaucoma patients were assessed independently by the two specialists according to this staging tool. Results The GSS was applied to 112 eyes and patients (59.8 % female) with a mean age of 66.3 ± 13.1 years. Mean GSS was 4.73 points. Cohen's kappa coefficient was determined to measure inter-rater agreement between glaucoma specialists for the third criterion. With κ = 0.83, the agreement was very good. Thus, all 3 criteria of the GSS may be regarded as objective. Conclusions The Glaucoma Severity Score is an objective tool, combining both structural and functional characteristics, and permitting comparison of different patients, populations and studies. The Glaucoma Severity Score has proven effective in the objective assessment of 112 glaucoma patients and is relatively user-friendly in clinical practice. A comparative study of the GSS with the results of the FORUM® Glaucoma Workplace (Carl Zeiss Meditec AG, Jena, Germany) will be the next step. If outcomes match, the Glaucoma Severity Score can be accepted as a promising tool to stage glaucoma and monitor changes objectively in patients when comparing glaucoma progression in study analyses. Georg Thieme Verlag KG Stuttgart · New York.

First year physics practicals in distance education in South Africa

NASA Astrophysics Data System (ADS)

Cilliers, Johanna Albertha

Although the merits of practical work in physics is often questioned, it remains part of physics curricula word- wide. In distance education the incorporation of practical work into the curriculum is considerably complicated by the unique logistics of the setting and the high cost involved. The research reported in this thesis emanated from the need to improve the practical work module for first year physics at the University of South Africa, one of the largest distance education universities in the world. Specifically, the home-based component which, up to the commencement of the research had been entirely text-based, needed to be addressed. To this end it was necessary to identify a valid and attainable set of objectives and to determine the characteristics, abilities and needs of the students in the target group. A survey polling the viewpoints of South African physics lecturers and students about the objectives of practical work was conducted and an extensive student profile comprising a biographic, cognitive and affective component was compiled. Biographically, the target group is unique in the sense that it consists mainly of adult learners, a large percentage of whom study in a second language. The cognitive component of the profile covered aptitude, proficiency in English, mathematics and the integrated science process skills and level of cognitive development, all of which were investigated for possible influence on performance in practical work. On an affective level, students displayed a very positive attitude towards practical work, seated mainly in their need for concrete exploration of the theory. A practical work module structured around an experiential learning cycle adapted to the distance education environment was subsequently designed. The study material developed for the module comprised an interactive study guide on data processing and experimental procedure, a home experiment kit with accompanying workbook and a laboratory manual. From the pilot study forming part of the development process, it was found that students performed significantly better in an assignment based on home- experimentation than in any of the pen-and-paper assignments preceding it. Based on the results of the pilot study, a full home experiment kit was designed, evaluated, refined and implemented.

Identifying, studying and making good use of macromolecular crystals

PubMed Central

Calero, Guillermo; Cohen, Aina E.; Luft, Joseph R.; Newman, Janet; Snell, Edward H.

2014-01-01

Structural biology has contributed tremendous knowledge to the understanding of life on the molecular scale. The Protein Data Bank, a depository of this structural knowledge, currently contains over 100 000 protein structures, with the majority stemming from X-ray crystallography. As the name might suggest, crystallography requires crystals. As detectors become more sensitive and X-ray sources more intense, the notion of a crystal is gradually changing from one large enough to embellish expensive jewellery to objects that have external dimensions of the order of the wavelength of visible light. Identifying these crystals is a prerequisite to their study. This paper discusses developments in identifying these crystals during crystallization screening and distinguishing them from other potential outcomes. The practical aspects of ensuring that once a crystal is identified it can then be positioned in the X-ray beam for data collection are also addressed. PMID:25084371

A reverse engineering approach to optimize experiments for the construction of biological regulatory networks.

PubMed

Zhang, Xiaomeng; Shao, Bin; Wu, Yangle; Qi, Ouyang

2013-01-01

One of the major objectives in systems biology is to understand the relation between the topological structures and the dynamics of biological regulatory networks. In this context, various mathematical tools have been developed to deduct structures of regulatory networks from microarray expression data. In general, from a single data set, one cannot deduct the whole network structure; additional expression data are usually needed. Thus how to design a microarray expression experiment in order to get the most information is a practical problem in systems biology. Here we propose three methods, namely, maximum distance method, trajectory entropy method, and sampling method, to derive the optimal initial conditions for experiments. The performance of these methods is tested and evaluated in three well-known regulatory networks (budding yeast cell cycle, fission yeast cell cycle, and E. coli. SOS network). Based on the evaluation, we propose an efficient strategy for the design of microarray expression experiments.

Between timelessness and historiality: on the dynamics of the epistemic objects of mathematics.

PubMed

Epple, Moritz

2011-09-01

In order to discuss the temporal structure of mathematical research, this essay offers four related definitions of a mathematical object from different times and places. It is argued that in order to appreciate the differences between these definitions, the historian needs to understand that none of them made sense in mathematical practice without a technical framework, referred to but not explained in the definitions themselves (an "epistemic configuration of research"); that the dynamics of the epistemic objects of mathematical research are secondary to the dynamics of these epistemic configurations as a whole; and that the dynamics of epistemic configurations of mathematical research do not follow law-like processes. Very different types of change may happen, and some of them link the dynamics of epistemic configurations with events and developments far beyond the bounds of the research field in question. These insights have historiographical consequences that require us to rethink the kind of temporality ascribed to mathematics.

Providing Epistemic Support For Assessments Through Mobile-Supported Sharing Activities1

PubMed Central

Raclaw, Joshua; Robles, Jessica S.; DiDomenico, Stephen M.

2017-01-01

This paper examines how participants in face-to-face conversation employ mobile phones as a resource for social action. We focus on what we call mobile-supported sharing activities, in which participants use a mobile phone to share text or images with others by voicing text aloud from their mobile or providing others with visual access to the device’s display screen. Drawing from naturalistic video recordings, we focus on how mobile-supported sharing activities invite assessments by providing access to an object that is not locally accessible to the participants. Such practices make relevant co-participants’ assessment of these objects and allow for different forms of co-participation across sequence types. We additionally examine how the organization of assessments during these sharing activities displays sensitivity to preference structure. The analysis illustrates the relevance of embodiment, local objects, and new communicative technologies to the production of action in co-present interaction. Data are in American English. PMID:28936031

Contract Quality Assurance and Pricing Practices for Patriot Missile Procurements

DTIC Science & Technology

1995-06-26

The audit objectives were to evaluate DoD and Raytheon quality assurance and pricing practices for Patriot missile circuit boards. We also evaluated the management control program as it applied to the audit objectives.

Peyton's four-step approach for teaching complex spinal manipulation techniques - a prospective randomized trial.

PubMed

Gradl-Dietsch, Gertraud; Lübke, Cavan; Horst, Klemens; Simon, Melanie; Modabber, Ali; Sönmez, Tolga T; Münker, Ralf; Nebelung, Sven; Knobe, Matthias

2016-11-03

The objectives of this prospective randomized trial were to assess the impact of Peyton's four-step approach on the acquisition of complex psychomotor skills and to examine the influence of gender on learning outcomes. We randomly assigned 95 third to fifth year medical students to an intervention group which received instructions according to Peyton (PG) or a control group, which received conventional teaching (CG). Both groups attended four sessions on the principles of manual therapy and specific manipulative and diagnostic techniques for the spine. We assessed differences in theoretical knowledge (multiple choice (MC) exam) and practical skills (Objective Structured Practical Examination (OSPE)) with respect to type of intervention and gender. Participants took a second OSPE 6 months after completion of the course. There were no differences between groups with respect to the MC exam. Students in the PG group scored significantly higher in the OSPE. Gender had no additional impact. Results of the second OSPE showed a significant decline in competency regardless of gender and type of intervention. Peyton's approach is superior to standard instruction for teaching complex spinal manipulation skills regardless of gender. Skills retention was equally low for both techniques.

Defining Health Diplomacy: Changing Demands in the Era of Globalization

PubMed Central

Katz, Rebecca; Kornblet, Sarah; Arnold, Grace; Lief, Eric; Fischer, Julie E

2011-01-01

Context: Accelerated globalization has produced obvious changes in diplomatic purposes and practices. Health issues have become increasingly preeminent in the evolving global diplomacy agenda. More leaders in academia and policy are thinking about how to structure and utilize diplomacy in pursuit of global health goals. Methods: In this article, we describe the context, practice, and components of global health diplomacy, as applied operationally. We examine the foundations of various approaches to global health diplomacy, along with their implications for the policies shaping the international public health and foreign policy environments. Based on these observations, we propose a taxonomy for the subdiscipline. Findings: Expanding demands on global health diplomacy require a delicate combination of technical expertise, legal knowledge, and diplomatic skills that have not been systematically cultivated among either foreign service or global health professionals. Nonetheless, high expectations that global health initiatives will achieve development and diplomatic goals beyond the immediate technical objectives may be thwarted by this gap. Conclusions: The deepening links between health and foreign policy require both the diplomatic and global health communities to reexamine the skills, comprehension, and resources necessary to achieve their mutual objectives. PMID:21933277

[How the information system can contribute to the implementation of a risk management program in a hospital?].

PubMed

Staccini, P; Quaranta, J F; Staccini-Myx, A; Veyres, P; Jambou, P

2003-09-01

Nowadays, information system is recognised as one of the key points of the management strategy. An information system is regarded conceptualised as a mean to link 3 aspects of a firm (structure, organisation rules and staff). Its design and implementation have to meet the objectives of medical and economical evaluation, especially risk management objectives. In order to identify, analyse, reduce and prevent the occurrence of adverse events, and also to measure the efficacy and efficiency of the production of care services, the design of information systems should be based on a process analysis in order to describe and classify all the working practices within the hospital. According to various methodologies (usually top-down analysis), each process can be divided into activities. Each activity (especially each care activity) can be described according to its potential risks and expected results. For care professionals performing a task, the access to official or internal guidelines and the adverse events reporting forms has also to be defined. Putting together all the elements of such a process analysis will contribute to integrate, into daily practice, the management of risks, supported by the information system.

Oral Health Knowledge, Attitude, and Practices Among Dental and Medical Students in Eastern India – A Comparative Study

PubMed Central

Kumar, Harish; Behura, Shyam Sundar; Ramachandra, Sujatha; Nishat, Roquaiya; Dash, Kailash C.; Mohiddin, Gouse

2017-01-01

Objectives: To compare oral health knowledge, attitude, and practices among dental and medical students in a Health care centre at Bhubaneswar, Odisha, India. Materials and Methods: One hundred and fifty BDS and MBBS students each from Kalinga Institute of Dental Sciences and Kalinga Institute of Medical Sciences of KIIT University, Bhubaneswar respectively, were invited to participate in this survey using a self-administered structured questionnaire in English comprising 27 questions, which was designed to evaluate the oral health knowledge, attitude, and practices. The obtained data was analyzed using the Statistical Package for the Social Sciences version 20 software. Results: On comparison of the scores of knowledge, attitude, and practice, the mean knowledge score was significantly higher among dental students than medical students. The study also showed that female students (both dental and medical) had better oral health knowledge and showed better oral health practices than male students. Karl Pearson's correlation coefficient test showed that, although dental students had better knowledge and attitude towards oral health, there was a lack of adequate practice among them. Conclusion: Further emphasis on oral health is necessary in undergraduate training to improve oral health knowledge, attitude, and practice among dental and medical students as they will act as role models for oral health education among individuals and community at large. PMID:28316951

Religion, culture, and discrimination against persons with disabilities in Nigeria

PubMed Central

Omiegbe, Odirin

2016-01-01

Background There is not a lot in the literature on disability in Nigeria concerning the role that religion, culture and beliefs play in sustaining discriminatory practices against persons with disabilities. Objectives Many of these practices are exclusionary in nature and unfair. They are either embedded in or sustained by religion, culture and beliefs about disability and persons with disabilities. Methods Drawing on various resources and research on disability, this paper looks at these practices in respect of these sustaining factors. Some of the discriminatory practices that constitute the main focus of the paper are the trafficking and killing of people with mental illness, oculocutaneous albinism and angular kyphosis, raping of women with mental illness and the employment of children with disabilities for alms-begging. Results The examination of these practices lends some significant weight and substance to the social model of disability, which construes disability in the context of oppression and the failure of social environments and structures to adjust to the needs and aspirations of people with disabilities. Conclusion Given the unfairness and wrongness of these practices they ought to be deplored. Moreover, the Nigerian government needs to push through legislation that targets cultural and religious practices which are discriminatory against persons with disabilities as well as undertake effective and appropriate measures aimed at protecting and advancing the interests of persons with disabilities. PMID:28730043

Estimating the resolution limit of the map equation in community detection

NASA Astrophysics Data System (ADS)

Kawamoto, Tatsuro; Rosvall, Martin

2015-01-01

A community detection algorithm is considered to have a resolution limit if the scale of the smallest modules that can be resolved depends on the size of the analyzed subnetwork. The resolution limit is known to prevent some community detection algorithms from accurately identifying the modular structure of a network. In fact, any global objective function for measuring the quality of a two-level assignment of nodes into modules must have some sort of resolution limit or an external resolution parameter. However, it is yet unknown how the resolution limit affects the so-called map equation, which is known to be an efficient objective function for community detection. We derive an analytical estimate and conclude that the resolution limit of the map equation is set by the total number of links between modules instead of the total number of links in the full network as for modularity. This mechanism makes the resolution limit much less restrictive for the map equation than for modularity; in practice, it is orders of magnitudes smaller. Furthermore, we argue that the effect of the resolution limit often results from shoehorning multilevel modular structures into two-level descriptions. As we show, the hierarchical map equation effectively eliminates the resolution limit for networks with nested multilevel modular structures.

Optimal design of high-rise buildings with respect to fundamental eigenfrequency

NASA Astrophysics Data System (ADS)

Alavi, Arsalan; Rahgozar, Reza; Torkzadeh, Peyman; Hajabasi, Mohamad Ali

2017-12-01

In modern tall and slender structures, dynamic responses are usually the dominant design requirements, instead of strength criteria. Resonance is often a threatening phenomenon for such structures. To avoid this problem, the fundamental eigenfrequency, an eigenfrequency of higher order, should be maximized. An optimization problem with this objective is constructed in this paper and is applied to a high-rise building. Using variational method, the objective function is maximized, contributing to a particular profile for the first mode shape. Based on this preselected profile, a parametric formulation for flexural stiffness is calculated. Due to some near-zero values for stiffness, the obtained formulation will be modified by adding a lower bound constraint. To handle this constraint some new parameters are introduced; thereby allowing for construction of a model relating the unknown parameters. Based on this mathematical model, a design algorithmic procedure is presented. For the sake of convenience, a single-input design graph is presented as well. The main merit of the proposed method, compared to previous researches, is its hand calculation aspect, suitable for parametric studies and sensitivity analysis. As the presented formulations are dimensionless, they are applicable in any dimensional system. Accuracy and practicality of the proposed method is illustrated at the end by applying it to a real-life structure.

Topological framework for local structure analysis in condensed matter

PubMed Central

Lazar, Emanuel A.; Han, Jian; Srolovitz, David J.

2015-01-01

Physical systems are frequently modeled as sets of points in space, each representing the position of an atom, molecule, or mesoscale particle. As many properties of such systems depend on the underlying ordering of their constituent particles, understanding that structure is a primary objective of condensed matter research. Although perfect crystals are fully described by a set of translation and basis vectors, real-world materials are never perfect, as thermal vibrations and defects introduce significant deviation from ideal order. Meanwhile, liquids and glasses present yet more complexity. A complete understanding of structure thus remains a central, open problem. Here we propose a unified mathematical framework, based on the topology of the Voronoi cell of a particle, for classifying local structure in ordered and disordered systems that is powerful and practical. We explain the underlying reason why this topological description of local structure is better suited for structural analysis than continuous descriptions. We demonstrate the connection of this approach to the behavior of physical systems and explore how crystalline structure is compromised at elevated temperatures. We also illustrate potential applications to identifying defects in plastically deformed polycrystals at high temperatures, automating analysis of complex structures, and characterizing general disordered systems. PMID:26460045

Image quality affected by diffraction of aperture structure arrangement in transparent active-matrix organic light-emitting diode displays.

PubMed

Tsai, Yu-Hsiang; Huang, Mao-Hsiu; Jeng, Wei-de; Huang, Ting-Wei; Lo, Kuo-Lung; Ou-Yang, Mang

2015-10-01

Transparent display is one of the main technologies in next-generation displays, especially for augmented reality applications. An aperture structure is attached on each display pixel to partition them into transparent and black regions. However, diffraction blurs caused by the aperture structure typically degrade the transparent image when the light from a background object passes through finite aperture window. In this paper, the diffraction effect of an active-matrix organic light-emitting diode display (AMOLED) is studied. Several aperture structures have been proposed and implemented. Based on theoretical analysis and simulation, the appropriate aperture structure will effectively reduce the blur. The analysis data are also consistent with the experimental results. Compared with the various transparent aperture structure on AMOLED, diffraction width (zero energy position of diffraction pattern) of the optimize aperture structure can be reduced 63% and 31% in the x and y directions in CASE 3. Associated with a lenticular lens on the aperture structure, the improvement could reach to 77% and 54% of diffraction width in the x and y directions. Modulation transfer function and practical images are provided to evaluate the improvement of image blurs.

Geometrical structure of Neural Networks: Geodesics, Jeffrey's Prior and Hyper-ribbons

NASA Astrophysics Data System (ADS)

Hayden, Lorien; Alemi, Alex; Sethna, James

2014-03-01

Neural networks are learning algorithms which are employed in a host of Machine Learning problems including speech recognition, object classification and data mining. In practice, neural networks learn a low dimensional representation of high dimensional data and define a model manifold which is an embedding of this low dimensional structure in the higher dimensional space. In this work, we explore the geometrical structure of a neural network model manifold. A Stacked Denoising Autoencoder and a Deep Belief Network are trained on handwritten digits from the MNIST database. Construction of geodesics along the surface and of slices taken from the high dimensional manifolds reveal a hierarchy of widths corresponding to a hyper-ribbon structure. This property indicates that neural networks fall into the class of sloppy models, in which certain parameter combinations dominate the behavior. Employing this information could prove valuable in designing both neural network architectures and training algorithms. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant No . DGE-1144153.

Preparation, characterization and application of novel proton conducting ceramics

NASA Astrophysics Data System (ADS)

Wang, Siwei

Due to the immediate energy shortage and the requirement of environment protection nowadays, the efficient, effective and environmental friendly use of current energy sources is urgent. Energy conversion and storage is thus an important focus both for industry and academia. As one of the hydrogen energy related materials, proton conducting ceramics can be applied in solid oxide fuel cells and steam electrolysers, as well as high temperature hydrogen separation membranes and hydrogen sensors. For most of the practical applications, both high proton conductivity and chemical stability are desirable. However, the state-of-the-art proton conducting ceramics are facing great challenges in simultaneously fulfilling conductivity and stability requirements for practical applications. Consequently, understanding the properties for the proton conducting ceramics and developing novel materials that possess both high proton conductivity and enhanced chemical stability have both scientific and practical significances. The objective of this study is to develop novel proton conducting ceramics, either by evaluating the doping effects on the state-of-the-art simple perovskite structured barium cerates, or by investigating novel complex perovskite structured Ba3Ca1.18Nb1.82O 9-delta based proton conductors as potential proton conducting ceramics with improved proton conductivity and enhanced chemical stability. Different preparation methods were compared, and their influence on the structure, including the bulk and grain boundary environment has been investigated. In addition, the effects of microstructure on the electrical properties of the proton conducting ceramics have also been characterized. The solid oxide fuel cell application for the proton conducting ceramics performed as electrolyte membranes has been demonstrated.

Tailoring Green Infrastructure Implementation Scenarios based on Stormwater Management Objectives

EPA Science Inventory

Green infrastructure (GI) refers to stormwater management practices that mimic nature by soaking up, storing, and controlling onsite. GI practices can contribute reckonable benefits towards meeting stormwater management objectives, such as runoff peak shaving, volume reduction, f...

Optimal Allocation of Restoration Practices Using Indexes for Stream Health

EPA Science Inventory

Methodologies that allocate the placement of agricultural and urban green infrastructure management practices with the intent to achieve both economic and environmental objectives typically use objectives related to individual intermediary environmental outputs, yet guidance is n...

The Ottawa Model of Research Use: a guide to clinical innovation in the NICU.

PubMed

Hogan, Debora L; Logan, Jo

2004-01-01

To improve performance of a neonatal transport team by implementing a research-based family assessment instrument. Objectives included providing a structure for evaluating families and fostering the healthcare relationship. Neonatal transports are associated with family crises. Transport teams require a comprehensive framework to accurately assess family responses to adversity and tools to guide their practice toward parental mastery of the event. Currently, there are no assessment tools that merge family nursing expertise with neonatal transport. A family assessment tool grounded in contemporary family nursing theory and research was developed by a clinical nurse specialist. The Ottawa Model of Research Use guided the process of piloting the innovation with members of a transport team. Focus groups, interviews, and surveys were conducted to create profiles of barriers and facilitators to research use by team members. Tailored research transfer strategies were enacted based on the profile results. Formative evaluations demonstrated improvements in team members' perceptions of their knowledge, family centeredness, and ability to assess and intervene with families. The family assessment tool is currently being incorporated into Clinical Practice Guidelines for Transport and thus will be considered standard care. Use of a family assessment tool is an effective way of appraising families and addressing suffering. The Ottawa Model of Research Use provided a framework for implementing the clinical innovation. A key role of the clinical nurse specialist is to influence nursing practice by fostering research use by practitioners. When developing and implementing a clinical innovation, input from end users and consumers is pivotal. Incorporating the innovation into a practice guideline provides a structure to imbed research evidence into practice.

Development and participant assessment of a practical quality improvement educational initiative for surgical residents.

PubMed

Sellers, Morgan M; Hanson, Kristi; Schuller, Mary; Sherman, Karen; Kelz, Rachel R; Fryer, Jonathan; DaRosa, Debra; Bilimoria, Karl Y

2013-06-01

As patient-safety and quality efforts spread throughout health care, the need for physician involvement is critical, yet structured training programs during surgical residency are still uncommon. Our objective was to develop an extended quality-improvement curriculum for surgical residents that included formal didactics and structured practical experience. Surgical trainees completed an 8-hour didactic program in quality-improvement methodology at the start of PGY3. Small teams developed practical quality-improvement projects based on needs identified during clinical experience. With the assistance of the hospital's process-improvement team and surgical faculty, residents worked through their selected projects during the following year. Residents were anonymously surveyed after their participation to assess the experience. During the first 3 years of the program, 17 residents participated, with 100% survey completion. Seven quality-improvement projects were developed, with 57% completing all DMAIC (Define, Measure, Analyze, Improve, Control) phases. Initial projects involved issues of clinical efficiency and later projects increasingly focused on clinical care questions. Residents found the experience educationally important (65%) and believed they were well equipped to lead similar initiatives in the future (70%). Based on feedback, the timeline was expanded from 12 to 24 months and changed to start in PGY2. Developing an extended curriculum using both didactic sessions and applied projects to teach residents the theory and implementation of quality improvement is possible and effective. It addresses the ACGME competencies of practice-based improvement and learning and systems-based practice. Our iterative experience during the past 3 years can serve as a guide for other programs. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Gastroenterology training in a resource-limited setting: Zambia, Southern Africa

PubMed Central

Asombang, Akwi W; Turner-Moss, Eleanor; Seetharam, Anil; Kelly, Paul

2013-01-01

AIM: To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. METHODS: A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised workshops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Pre- and post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at the symposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums. RESULTS: There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others. CONCLUSION: The beneficial effect of a structured symposium in developing countries warrants further attention as a mechanism to improve disease awareness in areas where resources are limited. PMID:23840144

Gastroenterology training in a resource-limited setting: Zambia, Southern Africa.

PubMed

Asombang, Akwi W; Turner-Moss, Eleanor; Seetharam, Anil; Kelly, Paul

2013-07-07

To evaluate need for and efficacy of a structured gastroenterology didactic session in expanding awareness and understanding of digestive disorders. A four-day symposium was developed with didactic sessions (days 1, 2) and practical endoscopy (days 3, 4). Didactic sessions included case presentations highlighting pathophysiology and management. One nurse and four practicing gastroenterologists from the United Kingdom led lectures and supervised workshops with audience participation. Practical endoscopy focused on diagnostic and therapeutic procedures and their application to diagnosis and treatment of ailments of the gastrointestinal tract. Pre- and post-workshop questionnaires were distributed to participants during didactic sessions. A pre-workshop questionnaire gauged expectations and identified objectives to be met at the symposium. Post-workshop questionnaires were administered to assess efficacy of each session. Participants graded sessions from 1 (poor) to 5 (excellent) on quality of case presentations, knowledge, clarity and mode of presentation. We assessed if time allotted to each topic was sufficient, value of sessions, impact on practice and interest in future symposiums. There were 46 attendees on day 1: 41% undergraduates, 41% residents, 11% consultants and 4% unspecified. Day 2 (a Saturday) had 24 participants: 17% undergraduates, 71% residents, 9% consultants, 4% unspecified. Primary pre-workshop symposium expectation was to gain knowledge in: general gastroenterology (55.5%), practical endoscopy (13.8%), pediatric gastroenterology (5%), epidemiology of gastrointestinal disorders specific to Zambia (6%), and interaction with international speakers (6%). The post-symposium questionnaire was answered by 19 participants, of whom 95% felt specific aims were met; all would attend future conferences and recommend to others. The beneficial effect of a structured symposium in developing countries warrants further attention as a mechanism to improve disease awareness in areas where resources are limited.

The Place of Faith for Consultant Obstetricians Following Stillbirth: A Qualitative Exploratory Study.

PubMed

Nuzum, Daniel; Meaney, Sarah; O'Donoghue, Keelin

2016-10-01

Stillbirth remains among the most challenging areas in obstetric practice. The objectives of this study were to explore the impact of stillbirth on the faith of obstetricians. Semi-structured in-depth qualitative interviews were conducted with obstetricians focusing on the impact of stillbirth on their faith. Data were analyzed using interpretative phenomenological analysis. Stillbirth was identified as one of the most difficult experiences, and most consultants were unable to engage with their personal beliefs when dealing with death at work. The major study themes were conflict of personal faith and incongruence between personal faith and professional practice. This study highlights a gap in how obstetricians see their own faith and feeling able to respond to the faith needs of bereaved parents. Participating obstetricians did not demonstrate that spirituality was an integrated part of their professional life.

A multilevel analysis of the effects of the Practice Environment Scale of the Nursing Work Index on nurse outcomes.

PubMed

Gabriel, Allison S; Erickson, Rebecca J; Moran, Christina M; Diefendorff, James M; Bromley, Gail E

2013-12-01

Few researchers have examined how the components of the Practice Environment Scale of the Nursing Work Index (PES-NWI) relate to nurses' well-being at multiple organizational levels. The objective of the study was to perform a multilevel assessment of the relationships of the PES-NWI subscales with three nurse outcomes: job satisfaction, emotional exhaustion, and turnover intentions. Additionally, we tested the multilevel factor structure of the PES-NWI. In a sample of 699 full-time registered nurses in 79 units and 9 branches of a hospital system, relationships of the NWI with nurse outcomes were fairly consistent across levels of analysis. However, subscales contributed differently to the three outcomes, demonstrating the complexity of environmental influences on nurses' work experience. © 2013 Wiley Periodicals, Inc.

Marine polysaccharides in microencapsulation and application to aquaculture: "from sea to sea".

PubMed

Borgogna, Massimiliano; Bellich, Barbara; Cesàro, Attilio

2011-12-01

This review's main objective is to discuss some physico-chemical features of polysaccharides as intrinsic determinants for the supramolecular structures that can efficiently provide encapsulation of drugs and other biological entities. Thus, the general characteristics of some basic polysaccharides are outlined in terms of their conformational, dynamic and thermodynamic properties. The analysis of some polysaccharide gelling properties is also provided, including the peculiarity of the charged polysaccharides. Then, the way the basic physical chemistry of polymer self-assembly is made in practice through the laboratory methods is highlighted. A description of the several literature procedures used to influence molecular interactions into the macroscopic goal of the encapsulation is given with an attempt at classification. Finally, a practical case study of specific interest, the use of marine polysaccharide matrices for encapsulation of vaccines in aquaculture, is reported.

Some practical considerations for economical back contact formation on high efficiency solar cells

NASA Technical Reports Server (NTRS)

Lesk, I. A.

1985-01-01

The back contact can detract from solar cell performance in a number of ways: high recombination, barrier, photovoltaic, minority carrier collection, resistance. These effects may act in a nonuniform fashion over the cell area, and complicate the analysis of photovoltaic performance aimed at a better understanding of the effects of device geometry and material and/or processing parameters. The back contact is tested by reproducing it on both sides of a substrate. The objective is to find a back contact which performs well as a back contact, can be applied cheaply to large area solar cells, fits well into a practical process sequence, does not introduce structural damage or undesirable impurities into the silicon substrate, is compatible with an effective front contact technology, permits low temperature solder contacting, adheres well to silicon, and is reliable.

[Nurses' knowledge about Nursing Care Systematization: from theory to practice].

PubMed

Silva, Elisama Gomes Correia; de Oliveira, Viviane Carla; Neves, Giselda Bezerra Correia; Guimarães, Tânia Maria Rocha

2011-12-01

The objective of this study is to analyze the knowledge that nurses from a large hospital in Recife, Pernambuco, have about Nursing Care Systematization (NCS). This is a descriptive, exploratory, quantitative study. The study population consisted of 107 clinical nurses, with a sample of 73 (68%). Data collection was performed in June 2008, using a semi-structured questionnaire that was filled out by the subjects. We found that 50 (69%) nurses had no knowledge about NCS, especially about nursing diagnoses. We identified the absence of forms in most hospitalization units. The nurses gave several justifications for their not working with NCS, including work overload and the scarcity of forms. We concluded that there is a need for more incentives by the institution and through policies, so as to permit nurses a greater autonomy in their practice.

A framework to support preceptors' evaluation and development of new nurses' clinical judgment.

PubMed

Nielsen, Ann; Lasater, Kathie; Stock, Mary

2016-07-01

In today's complex, fast-paced world of hospital nursing, new graduate nurses do not have well-developed clinical judgment skills. Nurse preceptors are charged with bridging the gap between new graduates' learning in school and their autonomous practice as RNs. In one large, urban medical center in the U.S., a clinical judgment model and rubric were used as a framework for a new evaluation and orientation process. Preceptors of new graduate nurses who had used the former and new processes described their experiences using the framework. The findings indicated that having a structured framework provided objective ways to evaluate and help develop new graduate nurses' clinical judgment. It is hypothesized that academic clinical supervisors may find such a framework useful to prepare students for transition to practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Qualitative Study to Identify Skills and Competency Required for Hospital Managers

PubMed Central

Barati, Omid; Sadeghi, Ahmad; Khammarnia, Mohammad; Siavashi, Elham; Oskrochi, Gholamreza

2016-01-01

Introduction Hospital managers aim to improve the efficiency and effectiveness of their institutions through leadership and guidance of medical personnel. Fulfilling these objectives requires a holistic approach to both the management of people and institutional prioritization. The aim of this study was to identify the skills and competencies that hospital managers must demonstrate in order to achieve their objectives. Methods In 2015, a regional, multi-center qualitative study was undertaken in Shiraz, Iran. Interviews and focus group discussions were conducted with university hospital managers, senior managers, faculty members, and post-graduate students, and the results were analyzed using the content analysis method by MAXQDA software. Results Eight key skill themes (communication, experience, appreciation of institution logistics/infrastructure, management skills, motivation, systematic problem solving, ethics, and financial/legal awareness) were identified among the hospital managers. The common challenges that face hospital institutions include problems with hierarchical and organizational structure, excessive rules and regulations, lack of resources, poor post-graduate education, and overall management. Recurring themes with respect to how these could be addressed included changing the culture and belief structure of the hospital, restructuring the organizational hierarchy, and empowering the people. Conclusion In our cohort, practical skills, such as communication and experience, were considered more important than theoretical skills for the effective management and administration of hospitals. Therefore, we suggest that practical, skill-based training should be emphasized for students of these disciplines so they will be better suited to deal with real world challenges. Further organizational improvements also can be attained by the active and constructive involvement of senior university managers. PMID:27504159

The dialysis orders objective structured clinical examination (OSCE): a formative assessment for nephrology fellows.

PubMed

Prince, Lisa K; Campbell, Ruth C; Gao, Sam W; Kendrick, Jessica; Lebrun, Christopher J; Little, Dustin J; Mahoney, David L; Maursetter, Laura A; Nee, Robert; Saddler, Mark; Watson, Maura A; Yuan, Christina M

2018-04-01

Few quantitative nephrology-specific simulations assess fellow competency. We describe the development and initial validation of a formative objective structured clinical examination (OSCE) assessing fellow competence in ordering acute dialysis. The three test scenarios were acute continuous renal replacement therapy, chronic dialysis initiation in moderate uremia and acute dialysis in end-stage renal disease-associated hyperkalemia. The test committee included five academic nephrologists and four clinically practicing nephrologists outside of academia. There were 49 test items (58 points). A passing score was 46/58 points. No item had median relevance less than 'important'. The content validity index was 0.91. Ninety-five percent of positive-point items were easy-medium difficulty. Preliminary validation was by 10 board-certified volunteers, not test committee members, a median of 3.5 years from graduation. The mean score was 49 [95% confidence interval (CI) 46-51], κ = 0.68 (95% CI 0.59-0.77), Cronbach's α = 0.84. We subsequently administered the test to 25 fellows. The mean score was 44 (95% CI 43-45); 36% passed the test. Fellows scored significantly less than validators (P < 0.001). Of evidence-based questions, 72% were answered correctly by validators and 54% by fellows (P = 0.018). Fellows and validators scored least well on the acute hyperkalemia question. In self-assessing proficiency, 71% of fellows surveyed agreed or strongly agreed that the OSCE was useful. The OSCE may be used to formatively assess fellow proficiency in three common areas of acute dialysis practice. Further validation studies are in progress.

A Qualitative Study to Identify Skills and Competency Required for Hospital Managers.

PubMed

Barati, Omid; Sadeghi, Ahmad; Khammarnia, Mohammad; Siavashi, Elham; Oskrochi, Gholamreza

2016-06-01

Hospital managers aim to improve the efficiency and effectiveness of their institutions through leadership and guidance of medical personnel. Fulfilling these objectives requires a holistic approach to both the management of people and institutional prioritization. The aim of this study was to identify the skills and competencies that hospital managers must demonstrate in order to achieve their objectives. In 2015, a regional, multi-center qualitative study was undertaken in Shiraz, Iran. Interviews and focus group discussions were conducted with university hospital managers, senior managers, faculty members, and post-graduate students, and the results were analyzed using the content analysis method by MAXQDA software. Eight key skill themes (communication, experience, appreciation of institution logistics/infrastructure, management skills, motivation, systematic problem solving, ethics, and financial/legal awareness) were identified among the hospital managers. The common challenges that face hospital institutions include problems with hierarchical and organizational structure, excessive rules and regulations, lack of resources, poor post-graduate education, and overall management. Recurring themes with respect to how these could be addressed included changing the culture and belief structure of the hospital, restructuring the organizational hierarchy, and empowering the people. In our cohort, practical skills, such as communication and experience, were considered more important than theoretical skills for the effective management and administration of hospitals. Therefore, we suggest that practical, skill-based training should be emphasized for students of these disciplines so they will be better suited to deal with real world challenges. Further organizational improvements also can be attained by the active and constructive involvement of senior university managers.

Generalization and transfer of advanced Ukrainian expertise in dynamic aerospace design to students

NASA Astrophysics Data System (ADS)

Konyukhov, Stanislav; Igdalov, Iosif; Polyakov, Nikolai; Sheptun, Yuory

2009-01-01

The presentation of the textbooks, A launch Vehicle as a Control Object (2004) and Launch Vehicles and Space Stages as Control Objects (2007, an updated and structured edition of the first book in Ukrainian), is discussed here. The textbooks are edited by Academician S.N. Konyukhov and the authors are I.M. Igdalov, L.D. Kuchma, N.V. Polyakov, and Yu.D. Sheptun. The textbooks are devoted to the problems of the theory and practice of dynamic design of long-range ballistic missiles (LRBM) and launch vehicles designed using "unconventional" approaches or original engineering solutions by a team of specialized companies lead by the Dniepropetrovsk Aerospace Center at Yuzhnoye SDO and Yuzhmash, with the participation of scientists of the Dniepropetrovsk National University (DNU) and the Institute of Technical Mechanics (ITM) at the National Academy of Science of Ukraine.

Elective Self-Care Course Emphasizing Critical Reasoning Principles

PubMed Central

2011-01-01

Objectives. To create, implement, and assess a self-directed online course based on 3 critical reasoning principles to develop pharmacy students’ skills in literature appraisal, content, metacognition, and assessment. Design. Students completed 3 assignments for the course: compile a literature appraisal on a healthcare topic; plan learning objectives and meta-cognitive skills for a learning module; and create a case-based online lesson with multi-structured feedback. Assessment. An online exit survey evaluated students’ perceptions regarding development of ACE (agency, collaboration, expertise) principles and preparation for competency. Students reported acquisition of ACE principles and noted improvements in their learning approaches, sense of responsibility for individual and community learning, skills, and confidence. Conclusions. An online elective course in self-care addressed practice standards for patient safety, maintenance of competency, and interprofessional education by emphasizing critical reasoning skills. PMID:22171110

A Qualitative Study Exploring Community Yoga Practice in Adults with Rheumatoid Arthritis.

PubMed

Greysen, Heather M; Greysen, S Ryan; Lee, Kathryn A; Hong, Oi Saeng; Katz, Patricia; Leutwyler, Heather

2017-06-01

Yoga may improve physical function and reduce disease symptoms in adults with rheumatoid arthritis (RA). However, little is known about how patients with RA are practicing yoga in the community. The objective of this qualitative study was to explore community yoga practice characteristics and thoughts about yoga practice for adults with RA. Participants completed a semi-structured telephone interview with open-ended questions. Thematic analysis was used to analyze interview transcripts. A convenience sample of 17 adults with rheumatologist-diagnosed RA who had participated in yoga within the past year were asked about the decision to start, continue, and stop yoga; the perceived benefits of yoga; components of yoga sessions; and general thoughts about yoga as it relates to RA. Although eight different styles of yoga were practiced, commonalities in yoga class components (such as stretching, strengthening, deep breathing, meditation, and positive messaging from the instructor) reveal examples of preferred types of yoga for patients with RA. Three main themes emerged, each with multiple subthemes: (1) motivators (physical fitness, influence of others, reduced price), (2) barriers (cost, symptom burden, class difficulty), and (3) benefits of yoga practice (mind-body, a tool for coping, pride/achievement, social, and "yoga meets you where you are"). In this study, patients with RA described how yoga practice helped improve physical and psychosocial symptoms related to their disease. Yoga practice, a dynamic exercise, encompassing many different styles, can provide many benefits for adults with RA; however, yoga may not be beneficial for every adult with RA.

Improving educational environment in medical colleges through transactional analysis practice of teachers

PubMed Central

Rajan, Marina

2012-01-01

Context: A FAIMER (Foundation for Advancement in International Medical Education and Research) fellow organized a comprehensive faculty development program to improve faculty awareness resulting in changed teaching practices and better teacher student relationships using Transactional Analysis (TA). Practicing TA tools help development of ‘awareness’ about intrapersonal and interpersonal processes. Objectives: To improve self-awareness among medical educators.To bring about self-directed change in practices among medical educators.To assess usefulness of TA tools for the same. Methods: An experienced trainer conducted a basic course (12 hours) in TA for faculty members. The PAC model of personality structure, functional fluency model of personal functioning, stroke theory on motivation, passivity and script theories of adult functional styles were taught experientially with examples from the Medical Education Scenario. Self-reported improvement in awareness and changes in practices were assessed immediately after, at three months, and one year after training. Findings: The mean improvement in self-'awareness' is 13.3% (95% C.I 9.3-17.2) among nineteen participants. This persists one year after training. Changes in practices within a year include, collecting feedback, new teaching styles and better relationship with students. Discussion and Conclusions: These findings demonstrate sustainable and measurable improvement in self-awareness by practice of TA tools. Improvement in self-'awareness' of faculty resulted in self-directed changes in teaching practices. Medical faculty has judged the TA tools effective for improving self-awareness leading to self-directed changes. PMID:24358808

A case series study of the neurophysiological effects of altered states of mind during intense Islamic prayer.

PubMed

Newberg, Andrew B; Wintering, Nancy A; Yaden, David B; Waldman, Mark R; Reddin, Janet; Alavi, Abass

2015-12-01

This paper presents a case series with preliminary data regarding the neurophysiological effects of specific prayer practices associated with the Islamic religion. Such practices, like other prayer practices, are likely associated with several coordinated cognitive activities and a complex pattern of brain physiology. However, there may also be changes specific to the goals of Islamic prayer which has, as its most fundamental concept, the surrendering of one's self to God. To evaluate Islamic prayer practices, we measured changes in cerebral blood flow (CBF) using single photon emission computed tomography (SPECT) in three Islamic individuals while practicing two different types of Islamic prayer. In this case series, intense Islamic prayer practices generally showed decreased CBF in the prefrontal cortex and related frontal lobe structures, and the parietal lobes. However, there were also several regions that differed between the two types of prayer practices including increased CBF in the caudate nucleus, insula, thalamus, and globus pallidus. These patterns also appear distinct from concentrative techniques in which an individual focuses on a particular idea or object. It is hypothesized that the changes in brain activity may be associated with feelings of "surrender" and "connectedness with God" described to be experienced during these intense Islamic prayer practices. Overall, these results suggest that several coordinated cognitive processes occur during intense Islamic prayer. Methodological issues and implications of the results are also discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

The future of practical skills in undergraduate medical education – an explorative Delphi-Study

PubMed Central

Dannenberg, Katja Anne; Stroben, Fabian; Schröder, Therese; Thomas, Anke; Hautz, Wolf E.

2016-01-01

Background: 64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of “outcome-orientated training” is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) – the German OF – the “Consensus Statement of Practical Skills in Undergraduate Medical Education” (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the “Clinical-Practical Skills” chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students’ graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. Methodology: Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. Results: 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. Discussion: The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the “Clinical-Practical Skills” NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement. PMID:27579362

The future of practical skills in undergraduate medical education - an explorative Delphi-Study.

PubMed

Dannenberg, Katja Anne; Stroben, Fabian; Schröder, Therese; Thomas, Anke; Hautz, Wolf E

2016-01-01

64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of "outcome-orientated training" is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) - the German OF - the "Consensus Statement of Practical Skills in Undergraduate Medical Education" (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the "Clinical-Practical Skills" chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students' graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the "Clinical-Practical Skills" NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement.

Spectral-Domain Optical Coherence Tomography for Glaucoma Diagnosis

PubMed Central

Gracitelli, Carolina P.B; Abe, Ricardo Y; Medeiros, Felipe A

2015-01-01

Identification of structural damage to the optic nerve and retinal nerve fiber layer (RNFL) is an essential component of diagnosis and management of glaucoma. The introduction of spectral-domain OCT (SD-OCT) has allowed objective quantification of damage to these structures with unprecedented resolution. In addition, recent attention has been directed towards imaging the macular area for quantifying loss of neural tissue caused by the disease. Many studies have evaluated and compared the diagnostic accuracies of a variety of parameters that can be obtained from imaging these areas of the ocular fundus. In this article, we critically review the existing literature evaluating the diagnostic accuracy of SD-OCT in glaucoma and we discuss issues related to how SD-OCT results should be incorporated into clinical practice. PMID:26069519

A Study on the Rural Residence in the Northern Area of Zhejiang Province from the Perspective of Green Living Environment

NASA Astrophysics Data System (ADS)

Wang, J.; Gao, W. J.; Wang, C.

2018-05-01

At present, owing to the rapid development of rural construction, it lacks corresponding theories and practices and damages to the features of rural area, ignoring the geography, suitability and green living environment factors. The research selects rural residence as the object, defining “courtyard” as the basic unit for rural residence. It utilizes the principle of topology as the expanding media, by the method of principle of cellular structure and green living environment design strategy. The essay establishes the design and construction system of “rural basic unit”, combining functions and structures, prototype menu, chamber space and compound interface, from the perspective of green living environment. It aims to guide rural construction and protect the ruralliving environment.

Mars Environmental Survey (MESUR): Science objectives and mission description

NASA Technical Reports Server (NTRS)

Hubbard, G. Scott; Wercinski, Paul F.; Sarver, George L.; Hanel, Robert P.; Ramos, Ruben

1992-01-01

In-situ observations and measurements of Mars are objectives of a feasibility study beginning at the Ames Research Center for a mission called the Mars Environmental SURvey (MESUR). The purpose of the MESUR mission is to emplace a pole-to-pole global distribution of landers on the Martian surface to make both short- and long-term observations of the atmosphere and surface. The basic concept is to deploy probes which would directly enter the Mars atmosphere, provide measurements of the upper atmospheric structure, image the local terrain before landing, and survive landing to perform meteorology, seismology, surface imaging, and soil chemistry measurements. MESUR is intended to be a relatively low-cost mission to advance both Mars science and human presence objectives. Mission philosophy is to: (1) 'grow' a network over a period of years using a series of launch opportunities, thereby minimizing the peak annual costs; (2) develop a level-of-effort which is flexible and responsive to a broad set of objectives; (3) focus on science while providing a solid basis for human exploration; and (4) minimize project cost and complexity wherever possible. In order to meet the diverse scientific objectives, each MESUR lander will carry the following strawman instrument payload consisting of: (1) Atmospheric structure experiment, (2) Descent and surface imagers, (3) Meteorology package, (4) Elemental composition instrument, (5) 3-axis seismometer, and (6) Thermal analyzer/evolved gas analyzer. The feasibility study is primarily to show a practical way to design an early capability for characterizing Mars' surface and atmospheric environment on a global scale. The goals are to answer some of the most urgent questions to advance significantly our scientific knowledge about Mars, and for planning eventual exploration of the planet by robots and humans.

Advanced Technology Composite Fuselage-Structural Performance

NASA Technical Reports Server (NTRS)

Walker, T. H.; Minguet, P. J.; Flynn, B. W.; Carbery, D. J.; Swanson, G. D.; Ilcewicz, L. B.

1997-01-01

Boeing is studying the technologies associated with the application of composite materials to commercial transport fuselage structure under the NASA-sponsored contracts for Advanced Technology Composite Aircraft Structures (ATCAS) and Materials Development Omnibus Contract (MDOC). This report addresses the program activities related to structural performance of the selected concepts, including both the design development and subsequent detailed evaluation. Design criteria were developed to ensure compliance with regulatory requirements and typical company objectives. Accurate analysis methods were selected and/or developed where practical, and conservative approaches were used where significant approximations were necessary. Design sizing activities supported subsequent development by providing representative design configurations for structural evaluation and by identifying the critical performance issues. Significant program efforts were directed towards assessing structural performance predictive capability. The structural database collected to perform this assessment was intimately linked to the manufacturing scale-up activities to ensure inclusion of manufacturing-induced performance traits. Mechanical tests were conducted to support the development and critical evaluation of analysis methods addressing internal loads, stability, ultimate strength, attachment and splice strength, and damage tolerance. Unresolved aspects of these performance issues were identified as part of the assessments, providing direction for future development.

Fossil Microorganisms in Archaean

NASA Technical Reports Server (NTRS)

Astafleva, Marina; Hoover, Richard; Rozanov, Alexei; Vrevskiy, A.

2006-01-01

Ancient Archean and Proterozoic rocks are the model objects for investigation of rocks comprising astromaterials. The first of Archean fossil microorganisms from Baltic shield have been reported at the last SPIE Conference in 2005. Since this confeence biomorphic structures have been revealed in Archean rocks of Karelia. It was determined that there are 3 types of such bion structures: 1. structures found in situ, in other words microorganisms even-aged with rock matrix, that is real Archean fossils biomorphic structures, that is to say forms inhabited early formed rocks, and 3. younger than Archean-Protherozoic minerali microorganisms, that is later contamination. We made attempt to differentiate these 3 types of findings and tried to understand of burial of microorganisms. The structures belongs (from our point of view) to the first type, or real Archean, forms were under examination. Practical investigation of ancient microorganisms from Green-Stone-Belt of Northern Karelia turns to be very perspective. It shows that even in such ancient time as Archean ancient diverse world existed. Moreover probably such relatively highly organized cyanobacteria and perhaps eukaryotic formes existed in Archean world.

Virtual reality training improves students' knowledge structures of medical concepts.

PubMed

Stevens, Susan M; Goldsmith, Timothy E; Summers, Kenneth L; Sherstyuk, Andrei; Kihmm, Kathleen; Holten, James R; Davis, Christopher; Speitel, Daniel; Maris, Christina; Stewart, Randall; Wilks, David; Saland, Linda; Wax, Diane; Panaiotis; Saiki, Stanley; Alverson, Dale; Caudell, Thomas P

2005-01-01

Virtual environments can provide training that is difficult to achieve under normal circumstances. Medical students can work on high-risk cases in a realistic, time-critical environment, where students practice skills in a cognitively demanding and emotionally compelling situation. Research from cognitive science has shown that as students acquire domain expertise, their semantic organization of core domain concepts become more similar to those of an expert's. In the current study, we hypothesized that students' knowledge structures would become more expert-like as a result of their diagnosing and treating a patient experiencing a hematoma within a virtual environment. Forty-eight medical students diagnosed and treated a hematoma case within a fully immersed virtual environment. Student's semantic organization of 25 case-related concepts was assessed prior to and after training. Students' knowledge structures became more integrated and similar to an expert knowledge structure of the concepts as a result of the learning experience. The methods used here for eliciting, representing, and evaluating knowledge structures offer a sensitive and objective means for evaluating student learning in virtual environments and medical simulations.

bcl::Cluster : A method for clustering biological molecules coupled with visualization in the Pymol Molecular Graphics System.

PubMed

Alexander, Nathan; Woetzel, Nils; Meiler, Jens

2011-02-01

Clustering algorithms are used as data analysis tools in a wide variety of applications in Biology. Clustering has become especially important in protein structure prediction and virtual high throughput screening methods. In protein structure prediction, clustering is used to structure the conformational space of thousands of protein models. In virtual high throughput screening, databases with millions of drug-like molecules are organized by structural similarity, e.g. common scaffolds. The tree-like dendrogram structure obtained from hierarchical clustering can provide a qualitative overview of the results, which is important for focusing detailed analysis. However, in practice it is difficult to relate specific components of the dendrogram directly back to the objects of which it is comprised and to display all desired information within the two dimensions of the dendrogram. The current work presents a hierarchical agglomerative clustering method termed bcl::Cluster. bcl::Cluster utilizes the Pymol Molecular Graphics System to graphically depict dendrograms in three dimensions. This allows simultaneous display of relevant biological molecules as well as additional information about the clusters and the members comprising them.

Large-area, freestanding, single-layer graphene-gold: a hybrid plasmonic nanostructure.

PubMed

Iyer, Ganjigunte R Swathi; Wang, Jian; Wells, Garth; Guruvenket, Srinivasan; Payne, Scott; Bradley, Michael; Borondics, Ferenc

2014-06-24

Graphene-based plasmonic devices have recently drawn great attention. However, practical limitations in fabrication and device architectures prevent studies from being carried out on the intrinsic properties of graphene and their change by plasmonic structures. The influence of a quasi-infinite object (i.e., the substrate) on graphene, being a single sheet of carbon atoms, and the plasmonic device is overwhelming. To address this and put the intrinsic properties of the graphene-plasmonic nanostructures in focus, we fabricate large-area, freestanding, single-layer graphene-gold (LFG-Au) sandwich structures and Au nanoparticle decorated graphene (formed via thermal treatment) hybrid plasmonic nanostructures. We observed two distinct plasmonic enhancement routes of graphene unique to each structure via surface-enhanced Raman spectroscopy. The localized electronic structure variation in the LFG due to graphene-Au interaction at the nanoscale is mapped using scanning transmission X-ray microscopy. The measurements show an optical density of ∼0.007, which is the smallest experimentally determined for single-layer graphene thus far. Our results on freestanding graphene-Au plasmonic structures provide great insight for the rational design and future fabrication of graphene plasmonic hybrid nanostructures.

Different Measures of Structural Similarity Tap Different Aspects of Visual Object Processing

PubMed Central

Gerlach, Christian

2017-01-01

The structural similarity of objects has been an important variable in explaining why some objects are easier to categorize at a superordinate level than to individuate, and also why some patients with brain injury have more difficulties in recognizing natural (structurally similar) objects than artifacts (structurally distinct objects). In spite of its merits as an explanatory variable, structural similarity is not a unitary construct, and it has been operationalized in different ways. Furthermore, even though measures of structural similarity have been successful in explaining task and category-effects, this has been based more on implication than on direct empirical demonstrations. Here, the direct influence of two different measures of structural similarity, contour overlap and within-item structural diversity, on object individuation (object decision) and superordinate categorization performance is examined. Both measures can account for performance differences across objects, but in different conditions. It is argued that this reflects differences between the measures in whether they tap: (i) global or local shape characteristics, and (ii) between- or within-category structural similarity. PMID:28861027

Perceptions and experiences of financial incentives: a qualitative study of dialysis care in England

PubMed Central

Abma, Inger; Jayanti, Anuradha; Bayer, Steffen; Mitra, Sandip; Barlow, James

2014-01-01

Objective The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices. Design The study followed a qualitative design. Data collection involved 32 in-depth semistructured interviews with healthcare professionals and managers, focusing on their subjective experience of payment structures. Participants Participants were kidney healthcare professionals, clinical directors, kidney centre managers and finance managers. Healthcare commissioners from different parts of England were also interviewed. Setting Participants worked at five kidney centres from across England. The selection was based on the prevalence of home haemodialysis, ranging from low (<3%), medium (5–8%) and high (>8%) prevalence, with at least one centre in each one of these categories at the time of selection. Results While the tariff for home haemodialysis is not a clear incentive for its adoption due to uncertainty about operational costs, Commissioning for Quality and Innovation (CQUIN) targets and the Best Practice Tariff for vascular access were seen by our case study centres as a motivator to change practices. Conclusions The impact of financial incentives designed at a policy level is influenced by the understanding of cost and benefits at the local operational level. In a situation where costs are unclear, incentives which are based on the improvement of profit margins have a smaller impact than incentives which provide an additional direct payment, even if this extra financial support is relatively small. PMID:24523426

Conflict between object structural and functional affordances in peripersonal space.

PubMed

Kalénine, Solène; Wamain, Yannick; Decroix, Jérémy; Coello, Yann

2016-10-01

Recent studies indicate that competition between conflicting action representations slows down planning of object-directed actions. The present study aims to assess whether similar conflict effects exist during manipulable object perception. Twenty-six young adults performed reach-to-grasp and semantic judgements on conflictual objects (with competing structural and functional gestures) and non-conflictual objects (with similar structural and functional gestures) presented at difference distances in a 3D virtual environment. Results highlight a space-dependent conflict between structural and functional affordances. Perceptual judgments on conflictual objects were slower that perceptual judgments on non-conflictual objects, but only when objects were presented within reach. Findings demonstrate that competition between structural and functional affordances during object perception induces a processing cost, and further show that object position in space can bias affordance competition. Copyright © 2016 Elsevier B.V. All rights reserved.

Knowledge, Attitude, and Practice on Menstrual Hygiene Management among School Adolescents.

PubMed

Yadav, Ram Naresh; Joshi, Shrijana; Poudel, Rajesh; Pandeya, Pawan

2018-01-01

Menstrual hygiene management remains a taboo in many communities in Nepal. Cultural beliefs about menstruation such as food taboos and untouchability have negative impact on dignity, health and education of adolescent girls. The objective of the study was to assess the current knowledge, attitude and practice of school adolescents on menstrual hygiene management in Doti District in Far-Western Nepal. This cross-sectional study was carried out from October to December 2016 at seven village development committees in Doti district, Nepal. This study was done among 276 students from grade seven and eight of 11 schools. Self-administered structured questionnaire was used to obtain information from school students. Descriptive analysis was done to analyse the knowledge, attitude and practice of school adolescents on menstrual hygiene management. 67.4% respondents had fair knowledge and 26.4% respondents had good knowledge on menstrual hygiene management. However, out of 141 female adolescent respondents, only 56 (40%) were engaged in good menstrual hygiene practices. Around half of the respondents had positive attitude towards menstrual hygiene management related issues. Although knowledge on menstrual hygiene management among school adolescents is fair, still attitude and practice need to improve. Findings indicate the need of behavior change communication campaigns along with frequent reinforcement of school health education programs.

Links between maternal feeding practices and children's eating difficulties. Validation of French tools.

PubMed

Rigal, Natalie; Chabanet, Claire; Issanchou, Sylvie; Monnery-Patris, Sandrine

2012-04-01

The main objectives of the present study were to validate measures of young children's eating difficulties and maternal feeding practices in a French sample, as well as to assess the links between these practices and children's eating difficulties. Mothers (n=502) of French children aged 20-36 months completed four questionnaires that were validated using a Structural Equation Modelling approach. Links between children and maternal components were investigated using a PLS regression. The Children's Eating Difficulties Questionnaire yielded a 4-dimension solution: Neophobia, Pickiness, Low Appetite and Low Enjoyment in food. The Feeding Style Questionnaire assessed three dimensions: Authoritarian, Authoritative and Permissive Styles. The Feeding Strategy Questionnaire, designed to evaluate strategies used by mothers to make their child taste rejected foods, resulted in four factors: Coercion, Explanation, Contingency and Preference. The Questionnaire relating to Parental Motivations when buying food for children presented a 6-dimension solution: Convenience, Weight-control, Natural, Health-concern, Preference and Price. The factors associated positively with the four dimensions of the Children's Eating Difficulties Questionnaire were on the one hand Permissive Style and Practices to fulfil child's desires, and on the other hand Authoritarian Style, Contingent and Coercive Practices aimed at forcing children to taste rejected foods. Copyright © 2012 Elsevier Ltd. All rights reserved.

The hospital component of general practice vocational training--the Irish experience.

PubMed

Murphy, A W

1992-12-01

All second and third year general practice vocational trainees in the Irish Republic in 1991 were invited to complete a questionnaire concerning the hospital component of their training. The questionnaire was based on specific recommendations published by the I.C.G.P. regarding hospital training posts. Replies were received from 39 trainees constituting 70% of the total number of eligible trainees. In general, hospital posts were perceived to be of relevance and to offer adequate exposure to outpatient management and to the development of useful practical skills. More than 70% of the trainees were free to attend at least 75% of the study release course. Everyone entitled to study leave for examination purposes obtained it. However, 95% of trainees found their hospital teachers unfamiliar with the aims and objectives of Vocational Training. Two-thirds of trainees received less than two hours a week of formal or informal teaching. More than two-thirds did not participate in an introductory general practice period and less than a quarter had their individual needs assessed early on. Substantial realisation of the guidelines issued by the ICGP has been achieved. Further work is necessary in the areas of individual needs assessment, relevant structured teaching and general practice liaison. Three specific recommendations are made to achieve these aims.

Teaching the basics of echocardiography in the undergraduate: Students as mentors.

PubMed

Arias Felipe, A; Doménech García, J; Sánchez Los Arcos, I; Luordo, D; García Sánchez, F J; Villanueva Martínez, J; Forero de la Sotilla, A; Villena Garrido, V; Torres Macho, J; García de Casasola Sánchez, G

To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. The students' weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Application of core-shell-structured CdTe@SiO2 quantum dots synthesized via a facile solution method for improving latent fingerprint detection

NASA Astrophysics Data System (ADS)

Gao, Feng; Han, Jiaxing; Lv, Caifeng; Wang, Qin; Zhang, Jun; Li, Qun; Bao, Liru; Li, Xin

2012-10-01

Fingerprint detection is important in criminal investigation. This paper reports a facile powder brushing technique for improving latent fingerprint detection using core-shell-structured CdTe@SiO2 quantum dots (QDs) as fluorescent labeling marks. Core-shell-structured CdTe@SiO2 QDs are prepared via a simple solution-based approach using NH2NH2·H2O as pH adjustor and stabilizer, and their application for improving latent fingerprint detection is explored. The obtained CdTe@SiO2 QDs show spherical shapes with well-defined core-shell structures encapsulating different amounts of QDs depending on the type of the pH adjustor and stabilizer. Moreover, the fluorescence of CdTe@SiO2 QDs is largely enhanced by surface modification of the SiO2 shell. The CdTe@SiO2 QDs overcome the oxidation problem of pure CdTe QDs in air, thus affording better variability with strong adhesive ability, better resolution, and bright emission colors for practical application in latent fingerprint detection. In comparison with the conventional fluorescence powders, silver powders, and others, the effectiveness of CdTe@SiO2 QD powders for detection of latent fingerprints present on a large variety of object surfaces is greatly improved. The synthesis method for CdTe@SiO2 QDs is simple, cheap, and easy for large-scale production, and thus offers many advantages in the practical application of fingerprint detection.

Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial.

PubMed

Bischoff, Erik W M A; Akkermans, Reinier; Bourbeau, Jean; van Weel, Chris; Vercoulen, Jan H; Schermer, Tjard R J

2012-11-28

To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. 15 general practices in the eastern part of the Netherlands. Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58). Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group. Clinical trials NCT00128765.

Everyday uses of standardized test information in a geriatric setting: a qualitative study exploring occupational therapist and physiotherapist test administrators' justifications.

PubMed

Krohne, Kariann; Torres, Sandra; Slettebø, Åshild; Bergland, Astrid

2014-02-17

Health professionals are required to collect data from standardized tests when assessing older patients' functional ability. Such data provide quantifiable documentation on health outcomes. Little is known, however, about how physiotherapists and occupational therapists who administer standardized tests use test information in their daily clinical work. This article aims to investigate how test administrators in a geriatric setting justify the everyday use of standardized test information. Qualitative study of physiotherapists and occupational therapists on two geriatric hospital wards in Norway that routinely tested their patients with standardized tests. Data draw on seven months of fieldwork, semi-structured interviews with eight physiotherapists and six occupational therapists (12 female, two male), as well as observations of 26 test situations. Data were analyzed using Systematic Text Condensation. We identified two test information components in everyday use among physiotherapist and occupational therapist test administrators. While the primary component drew on the test administrators' subjective observations during testing, the secondary component encompassed the communication of objective test results and test performance. The results of this study illustrate the overlap between objective and subjective data in everyday practice. In clinical practice, by way of the clinicians' gaze on how the patient functions, the subjective and objective components of test information are merged, allowing individual characteristics to be noticed and made relevant as test performance justifications and as rationales in the overall communication of patient needs.

Participatory approach to the development of a knowledge base for problem-solving in diabetes self-management

PubMed Central

Cole-Lewis, Heather J.; Smaldone, Arlene M.; Davidson, Patricia R.; Kukafka, Rita; Tobin, Jonathan N.; Cassells, Andrea; Mynatt, Elizabeth D.; Hripcsak, George; Mamykina, Lena

2015-01-01

Objective To develop an expandable knowledge base of reusable knowledge related to self-management of diabetes that can be used as a foundation for patient-centric decision support tools. Materials and methods The structure and components of the knowledge base were created in participatory design with academic diabetes educators using knowledge acquisition methods. The knowledge base was validated using scenario-based approach with practicing diabetes educators and individuals with diabetes recruited from Community Health Centers (CHCs) serving economically disadvantaged communities and ethnic minorities in New York. Results The knowledge base includes eight glycemic control problems, over 150 behaviors known to contribute to these problems coupled with contextual explanations, and over 200 specific action-oriented self-management goals for correcting problematic behaviors, with corresponding motivational messages. The validation of the knowledge base suggested high level of completeness and accuracy, and identified improvements in cultural appropriateness. These were addressed in new iterations of the knowledge base. Discussion The resulting knowledge base is theoretically grounded, incorporates practical and evidence-based knowledge used by diabetes educators in practice settings, and allows for personally meaningful choices by individuals with diabetes. Participatory design approach helped researchers to capture implicit knowledge of practicing diabetes educators and make it explicit and reusable. Conclusion The knowledge base proposed here is an important step towards development of new generation patient-centric decision support tools for facilitating chronic disease self-management. While this knowledge base specifically targets diabetes, its overall structure and composition can be generalized to other chronic conditions. PMID:26547253

How do interprofessional student teams interact in a primary care clinic? A qualitative analysis using activity theory.

PubMed

Kent, Fiona; Francis-Cracknell, Alison; McDonald, Rachael; Newton, Jennifer M; Keating, Jennifer L; Dodic, Miodrag

2016-10-01

Practice based interprofessional education opportunities are proposed as a mechanism for health professionals to learn teamwork skills and gain an understanding of the roles of others. Primary care is an area of practice that offers a promising option for interprofessional student learning. In this study, we investigated what and how students from differing professions learn together. Our findings inform the design of future interprofessional education initiatives. Using activity theory, we conducted an ethnographic investigation of interprofessional education in primary care. During a 5 months period, we observed 14 clinic sessions involving mixed discipline student teams who interviewed people with chronic disease. Teams were comprised of senior medicine, nursing, occupational therapy, pharmacy and physiotherapy entry level students. Semi-structured interviews were also conducted with seven clinical educators. Data were analysed to ascertain the objectives, tools, rules and division of labour. Two integrated activity systems were identified: (1) student teams gathering information to determine patients' health care needs and (2) patients either as health consumers or student educators. Unwritten rules regarding 'shared contribution', 'patient as key information source' and 'time constraints' were identified. Both the significance of software literacy on team leadership, and a pre-determined structure of enquiry, highlighted the importance of careful consideration of the tools used in interprofessional education, and the way they can influence practice. The systems of practice identified provide evidence of differing priorities and values, and multiple perspectives of how to manage health. The work reinforced the value of the patients' voice in clinical and education processes.

Figure ground discrimination in age-related macular degeneration.

PubMed

Tran, Thi Ha Chau; Guyader, Nathalie; Guerin, Anne; Despretz, Pascal; Boucart, Muriel

2011-03-01

To investigate impairment in discriminating a figure from its background and to study its relation to visual acuity and lesion size in patients with neovascular age-related macular degeneration (AMD). Seventeen patients with neovascular AMD and visual acuity <20/50 were included. Seventeen age-matched healthy subjects participated as controls. Complete ophthalmologic examination was performed on all participants. The stimuli were photographs of scenes containing animals (targets) or other objects (distractors), displayed on a computer monitor screen. Performance was compared in four background conditions: the target in the natural scene; the target isolated on a white background; the target separated by a white space from a structured scene; the target separated by a white space from a nonstructured, shapeless background. Target discriminability (d') was recorded. Performance was lower for patients than for controls. For the patients, it was easier to detect the target when it was separated from its background (under isolated, structured, and nonstructured conditions) than it was when located in a scene. Performance was improved in patients with increasing exposure time but remained lower in controls. Correlations were found between visual acuity, lesion size, and sensitivity for patients. Figure/ground segregation is impaired in patients with AMD. A white space surrounding an object is sufficient to improve the object's detection and to facilitate figure/ground segregation. These results may have practical applications to the rehabilitation of the environment in patients with AMD.

Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force.

PubMed

Marsh, Kevin; IJzerman, Maarten; Thokala, Praveen; Baltussen, Rob; Boysen, Meindert; Kaló, Zoltán; Lönngren, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Devlin, Nancy

2016-01-01

Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Medical Home Implementation Gaps for Seniors: Perceptions and Experiences of Primary Care Medical Practices.

PubMed

Hoff, Timothy; DePuccio, Matthew

2018-07-01

The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation. Qualitative data from 51 in-depth, semi-structured interviews across six different National Committee for Quality Assurance (NCQA)-accredited primary care practices were collected and analyzed. Physicians and staff identified PCMH implementation gaps for their seniors: (a) performing in-depth clinical assessments, (b) identifying seniors' life needs and linking them with community resources, and (c) care management and coordination, in particular self-management support for seniors. Prior experiences trying to perform these aspects of PCMH care for older adults produced collective understandings that led to inaction and avoidance by medical practices around the first two gaps, and proactive behavior that took strategic advantage of external incentives for addressing the third gap. Greater understanding of physician and staff's PCMH implementation experiences, and the learning that accumulates from these experiences, allows for a deeper understanding of how primary care practices choose to enact the medical home model for seniors on an everyday basis.

Management practices and performance of mergers and acquisitions in Pakistan: mediating role of psychological contract.

PubMed

Bari, Muhammad Waseem; Fanchen, Meng; Baloch, Muhammad Awais

2016-01-01

The objective of this study is to examine the direct and indirect effect of management practices (procedural justice, coordination approach, communication system, integration strategy, and coping programs) on merger and acquisition (M&A) performance in the Pakistan banking industry. Psychological contract (PC) acts as a mediator between Management practices and M&A performance. The Present study distributes a structured questionnaire to 700 bank employees of different management cadres. The useful response rate is 76 % (536 employees). It uses PLS-SEM technique for data analysis. (1) procedural justice is a key strategy which has highly significant direct and indirect effect on M&A performance; however integration strategy and the communication system have an only direct effect. (2) PC performs partial mediation at different levels between management practices and M&A financial and non-financial performance. This study provides an effective solution to solve the soft issues during and post-M&A process. This is one of the few studies which effectively integrate the five constructs into a single framework to study their effects on M&A performance. Limitations and future research directions are presented in the last section of the study.

Overview of a pharmacist anticoagulation certificate program.

PubMed

Kirk, Julienne K; Edwards, Rebecca; Brewer, Andrew; Miller, Cathey; Bray, Bryan; Groce, James B

2017-07-01

To describe the design of an ongoing anticoagulation certificate program and annual renewal update for pharmacists. Components of the anticoagulation certificate program include home study, pre- and posttest, live sessions, case discussions with evaluation and presentation, an implementation plan, and survey information (program evaluation and use in practice). Clinical reasoning skills were assessed through case work-up and evaluation prior to live presentation. An annual renewal program requires pharmacists to complete home study and case evaluations. A total of 361 pharmacists completed the anticoagulation certificate program between 2002 and 2015. Most (62%) practiced in ambulatory care and 38% in inpatient care settings (8% in both). In the past four years, 71% were working in or starting anticoagulation clinics in ambulatory and inpatient settings. In their evaluations of the program, an average of 90% of participants agreed or strongly agreed the lecture material was relevant and objectives were met. Pharmacists are able to apply knowledge and skills in management of anticoagulation. This structured practice-based continuing education program was intended to enhance pharmacy practice and has achieved that goal. The certificate program in anticoagulation was relevant to pharmacists who attended the program. Copyright © 2017. Published by Elsevier Inc.

Evaluation of the AHRQ Patient Safety Initiative: Synthesis of Findings

PubMed Central

Farley, Donna O; Damberg, Cheryl L

2009-01-01

Objective To present overall findings from the 4-year evaluation of the national patient safety initiative operated by the Agency for Healthcare Research and Quality (AHRQ). Data Sources Interviews with AHRQ staff, grantees, and other patient safety stakeholders; published materials; and internal AHRQ documents. Study Design The evaluation was structured to address a system framework of five components involved in improving safety. The initiative's contributions to improving each system component were assessed qualitatively, comparing results from three separate analyses—AHRQ's achievement of its patient safety goals, our own assessment of the initiative's activities, and independent stakeholder ratings of AHRQ's contributions. Findings and Conclusions AHRQ has faced a daunting challenge for improving patient safety, given the complex problems of the U.S. health care system and the limited resources AHRQ has had to address them. The patient safety initiative achieved strongest progress for its contributions to knowledge of patient safety epidemiology and effective practices, where AHRQ has considerable experience, and to strengthening infrastructure to support adoption of safe practices. Progress was slower in establishing a national monitoring capability and dissemination of safe practices for adoption. AHRQ needs to expand efforts to apply new knowledge for stimulating use of safe practices in the field. PMID:21456115

Resuscitation skills after Helping Babies Breathe training: a comparison of varying practice frequency and impact on retention of skills in different types of providers.

PubMed

Tabangin, M E; Josyula, S; Taylor, K K; Vasquez, J C; Kamath-Rayne, B D

2018-05-01

Helping Babies Breathe (HBB), a basic neonatal resuscitation curriculum, improves early neonatal mortality in low-resource settings. Our goal was to determine retention of resuscitation skills by different cadres of providers using the approved HBB Spanish translation in a rural clinic and community hospital in Honduras. Twelve clinic and 37 hospital providers were trained in 1 d HBB workshops and followed from July 2012 to February 2014. Resuscitation skills were evaluated by objective structured clinical evaluations (OSCEs) at regular intervals. Clinic providers practiced monthly, whereas hospital providers were randomized to monthly practice for 6 months vs three consecutive practices at 3, 5 and 6 months. In the rural clinic, follow-up OSCE assessment showed rapid loss of skills by 1 month after HBB training. For all providers, repeated monthly testing resulted in improvements and maintenance of OSCE performance. In the community hospital, over all time points, the group with monthly OSCEs had 2.9 greater odds of passing compared with the group who practiced less frequently. Physicians were found to have 4.3 times greater odds of passing compared with nurses. Rapid loss of resuscitation skills occurs after an initial training. Repeated practice leads to retention of skills in all types of providers. Further investigation is warranted to determine the clinical correlation of neonatal outcomes after HBB training.