"What Works": Recommendations on Improving Academic Experiences and Outcomes for Black Males

ERIC Educational Resources Information Center

Howard, Tyrone C.; Douglas, Ty-Ron, M. O.; Warren, Chezare A.

2016-01-01

This brief presents the most significant recommendations based on a review of key findings from research presented in this special issue. The authors offer what they believe to be the most important considerations of what works for improving Black male school achievement in the domains of research, practice, and policy.

An Algorithm for Automated Rating of Reviewers.

ERIC Educational Resources Information Center

Riggs, Tracy; Wilensky, Robert

The current system for scholarly information dissemination may be amenable to significant improvement. In particular, going from the current system of journal publication to one of self-distributed documents offers significant cost and timeliness advantages. A major concern with such alternatives is how to provide the value currently afforded by…

The use of acuity and frailty measures for district nursing workforce plans.

PubMed

David, Ami; Saunders, Mary

2018-02-02

This article discusses the use of Quest acuity and frailty measures for community nursing interventions to quantify and qualify the contributions of district nursing teams. It describes the use of a suite of acuity and frailty tools tested in 8 UK community service trusts over the past 5years. In addition, a competency assessment tool was used to gauge both capacity and capability of individual nurses. The consistency of the results obtained from the Quest audits offer significant evidence and potential for realigning community nursing services to offer improvements in efficiency and cost-effectiveness. The National Quality Board (NQB) improvement resource for the district nursing services ( NQB, 2017 ) recommends a robust method for classifying patient acuity/frailty/dependency. It is contended the Quest tools and their usage articulated here offer a suitable methodology.

A Transferrable Belief Model Representation for Physical Security of Nuclear Materials

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

David Gerts

This work analyzed various probabilistic methods such as classic statistics, Bayesian inference, possibilistic theory, and Dempster-Shafer theory of belief functions for the potential insight offered into the physical security of nuclear materials as well as more broad application to nuclear non-proliferation automated decision making theory. A review of the fundamental heuristic and basic limitations of each of these methods suggested that the Dempster-Shafer theory of belief functions may offer significant capability. Further examination of the various interpretations of Dempster-Shafer theory, such as random set, generalized Bayesian, and upper/lower probability demonstrate some limitations. Compared to the other heuristics, the transferrable beliefmore » model (TBM), one of the leading interpretations of Dempster-Shafer theory, can improve the automated detection of the violation of physical security using sensors and human judgment. The improvement is shown to give a significant heuristic advantage over other probabilistic options by demonstrating significant successes for several classic gedanken experiments.« less

School-Based Mentoring Programs: Using Volunteers to Improve the Academic Outcomes of Underserved Students

ERIC Educational Resources Information Center

Bayer, Amanda; Grossman, Jean Baldwin; DuBois, David L.

2013-01-01

Previous research suggests that school-based mentoring programs like those offered by Big Brothers Big Sisters of America (BBBSA) yield small but statistically significant improvements in the academic performance of mentored students and in their beliefs in their own scholastic efficacy. The present study uses data from a randomized control trial…

Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study.

PubMed

Lokkerbol, Joran; Adema, Dirk; Cuijpers, Pim; Reynolds, Charles F; Schulz, Richard; Weehuizen, Rifka; Smit, Filip

2014-03-01

Depressive disorders are significant causes of disease burden and are associated with substantial economic costs. It is therefore important to design a healthcare system that can effectively manage depression at sustainable costs. This article computes the benefit-to-cost ratio of the current Dutch healthcare system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compared a base case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome was the benefit-to-cost ratio, also known as return-on-investment (ROI). In terms of ROI, a healthcare system with preventive telemedicine for depressive disorders offers better value for money than a healthcare system without Internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base case scenario to €1.76 ($2.09) in the alternative scenario in which preventive telemedicine is offered. In a scenario in which the costs of offering preventive telemedicine are balanced by reducing the expenditures for curative interventions, ROI increases to €1.77 ($2.10), while keeping the healthcare budget constant. For a healthcare system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Ka-band MMIC subarray technology program (Ka-Mist)

NASA Technical Reports Server (NTRS)

Pottenger, Warren

1995-01-01

The broad objective of this program was to demonstrate a proof of concept insertion of Monolithic Microwave Integrated Circuit (MMIC) device technology into an innovative (tile architecture) active phased array antenna application supporting advanced EHF communication systems. Ka-band MMIC arrays have long been considered as having high potential for increasing the capability of space, aircraft, and land mobile communication systems in terms of scan performance, data rate, link margin, and flexibility while offering a significant reduction in size, weight, and power consumption. Insertion of MMIC technology into antenna systems, particularly at millimeter wave frequencies using low power and low noise amplifiers in close proximity to the radiating elements, offers a significant improvement in the array transmit efficiency, receive system noise figure, and overall array reliability. Application of active array technology also leads to the use of advanced beamforming techniques that can improve beam agility, diversity, and adaptivity to complex signal environments.

Pre-medication to improve esophagogastroduodenoscopic visibility: a meta-analysis and systemic review.

PubMed

Chen, Hsuan-Wei; Hsu, Hsuang-Chun; Hsieh, Tsai-Yuan; Yeh, Ming-Kung; Chang, Wei-Kuo

2014-09-01

The use of pre-medication to improve visibility in gastrointestinal endoscopy has not been well addressed and remains controversial. The aim is to evaluate the effects of current pre-medication on endoscopic visualization. We made the overall strategies to search the different databases and assessed the quality of included studies according to the included and excluded standard. 1541 patients were treated with pre-medication. Ten prospective studies involving 1541 patients were included. There was improved visibility in patients treated with Simethicone (weighted mean difference -4.3; 95% confidence interval (CI), -4.94 to -3.67), compared to those who did not use Simethicone. In the Simethicone based regiment, administration of Pronase was noted with significantly improved visibility in the location of antrum and fundus, compared to those who did not use; however, administration of N-acetyl-L-cysteine could not lead to significantly improved visibility. Simethicone offered better visibility than N-acetyl-L-cysteine and Pronase alone. There is improved visibility with pre-medication using Simethicone before esophagogastroduodenoscopy. In the Simethicone based regimen, administration of Pronase or N-acetyl-Lcysteine may be of little use in improving visibility. Based on the literature review, Simethicone dissolved in the water with the acceptably lowest ratio of 0.7 can still offer the good visibility but 30 mL of water should be avoided.

Impact of clinical fellowships on academic productivity in departments of surgery.

PubMed

Valsangkar, Nakul P; Liang, Tiffany W; Martin, Paul J; Mayo, John S; Rosati, Carlo Maria; Feliciano, David V; Zimmers, Teresa A; Koniaris, Leonidas G

2016-12-01

Research and innovation are crucial to advancements in medicine and improvements in patient care. The contribution of surgical fellowships to scholarly productivity is unclear. The objective of this study was to determine the impact of subspecialty fellowships on academic output in departments of surgery. This cross-sectional study examined fellowships offered at the top 50 university-based National Institutes of Health-funded and top 5 academically prolific hospital-based departments of surgery. Publications, citations, and National Institutes of Health funding history were determined for 4,015 faculty. χ 2 and t tests were used as appropriate. Cardiothoracic surgery fellowships are offered at all departments, while other surgical fellowships are offered in 52 of 55 departments (96.4%). Median department publications/citations increased with the number of fellowships offered in addition to cardiothoracic surgery: no fellowship (27 ± 93/437 ± 2,509), 1-3 fellowships (34 ± 90/559 ± 3,046), and 4 or more fellowships (40 ± 97/716 ± 3,200, P < .05). Significant divisional improvements in publications/citations and National Institutes of Health funding were observed for those with fellowship programs in pediatric, breast, and plastic surgery (P < .05). No differences in departmental National Institutes of Health funding rates were observed based on number of fellowships offered. Based on publications/citations and National Institutes of Health funding, it seems that select fellowships are associated with improved scholarly activity. Departments may wish to consider the academic benefits of offering these fellowship types. Copyright © 2016 Elsevier Inc. All rights reserved.

Activity groups for people with schizophrenia: a randomized controlled trial.

PubMed

Dean, Madeleine; Weston, Adam R W; Osborn, David P; Willis, Suzie; Patterson, Sue; Killaspy, Helen; Leurent, Baptiste; Crawford, Mike J

2014-08-01

UK guidelines recommend that patients with schizophrenia are offered access to social activities, however, the impact of such interventions have not been examined in a large randomized trial. To investigate the effect of an activity group intervention on mental health and global functioning 12 months after randomization compared to standard care alone. Secondary analysis of data from the MATISSE study. Primary outcomes were global functioning, assessed using the Global Assessment of Functioning (GAF), and mental health symptoms measured using the Positive and Negative Syndrome Scale (PANSS). About 140 participants were randomized to activity groups and 137 to standard care alone. Follow-up data were collected from 242 (87%) participants. Mental health improved significantly among those offered activity groups (change in PANSS score = -6.0, 95% CI -2.3 to -9.8) but global functioning did not (change in GAF score = 0.8, 95% CI -1.7 to 3.3). No significant differences were found between treatment arms. Offering activity groups to patients with schizophrenia was not associated with any additional clinical benefits. There was poor uptake and attendance at activity groups. Interventions that aim to improve negative symptoms may be useful in enabling engagement in psychosocial interventions.

Performance of broiler chickens given whey in the food and/or drinking water.

PubMed

Shariatmadari, F; Forbes, J M

2005-08-01

1. The effects on food intake and weight gain of offering broiler chickens (2 to 7 weeks of age) dry food, wet food, wet food containing whey, whey as drinking liquid and combinations of two of these were studied in 5 experiments. 2. Wet feed generally improved both weight gain and feed efficiencies significantly. Feeding whey also improved weight gain and feed conversion efficiency, but whey offered as a drinking fluid had an adverse effect on broiler performance. 3. When whey was offered both as drinking liquid and added to the food it had a deleterious effect. 4. When whey was offered from 4 or 6 weeks of age, it had a better effect than when offered from 2 weeks of age. 5. There was better performance when whey in the drinking water was diluted and/or offered on alternate days or half-days. 6. Broilers allowed to choose between wet and dry feed when water was freely available chose mostly dry feed; in the absence of drinking water they chose mostly wet food. Birds offered water and liquid whey avoided whey completely. 7. It is concluded that whey can be used in diets for broiler chickens by incorporating it in the food as long as drinking water is offered ad libitum. Whey may be offered as a drink if the food is mixed with 1.8 times its weight of water but it is better to dilute the whey with an equal volume of water whether it is added to food or given as drink. Good results can also be obtained when undiluted whey is offered alternately with water, either in half-day or full-day periods.

Practice guideline update summary: Corticosteroid treatment of Duchenne muscular dystrophy

PubMed Central

Gloss, David; Moxley, Richard T.; Ashwal, Stephen; Oskoui, Maryam

2016-01-01

Objective: To update the 2005 American Academy of Neurology (AAN) guideline on corticosteroid treatment of Duchenne muscular dystrophy (DMD). Methods: We systematically reviewed the literature from January 2004 to July 2014 using the AAN classification scheme for therapeutic articles and predicated recommendations on the strength of the evidence. Results: Thirty-four studies met inclusion criteria. Recommendations: In children with DMD, prednisone should be offered for improving strength (Level B) and pulmonary function (Level B). Prednisone may be offered for improving timed motor function (Level C), reducing the need for scoliosis surgery (Level C), and delaying cardiomyopathy onset by 18 years of age (Level C). Deflazacort may be offered for improving strength and timed motor function and delaying age at loss of ambulation by 1.4–2.5 years (Level C). Deflazacort may be offered for improving pulmonary function, reducing the need for scoliosis surgery, delaying cardiomyopathy onset, and increasing survival at 5–15 years of follow-up (Level C for each). Deflazacort and prednisone may be equivalent in improving motor function (Level C). Prednisone may be associated with greater weight gain in the first years of treatment than deflazacort (Level C). Deflazacort may be associated with a greater risk of cataracts than prednisone (Level C). The preferred dosing regimen of prednisone is 0.75 mg/kg/d (Level B). Over 12 months, prednisone 10 mg/kg/weekend is equally effective (Level B), with no long-term data available. Prednisone 0.75 mg/kg/d is associated with significant risk of weight gain, hirsutism, and cushingoid appearance (Level B). PMID:26833937

Potential for Flexicab Services : Innovative Uses of Taxis and Jitneys for Public Transportation

DOT National Transportation Integrated Search

1975-12-01

Taxis and jitneys can be significant urban transportation resource. Used innovatively to provide public transit services, they can offer mobility in low density areas where mass transit is not feasible, supplement mass transit economically to improve...

ABC's of HOV : the Texas experience

DOT National Transportation Integrated Search

1999-09-01

The implementation of High Occupancy Vehicle (HOV) lanes is a very important decision. Done right they offer a great opportunity for improving person-movement in a corridor. Done the wrong way or in the wrong place, they can be a significant public r...

Impact of stance phase microprocessor-controlled knee prosthesis on ramp negotiation and community walking function in K2 level transfemoral amputees.

PubMed

Burnfield, Judith M; Eberly, Valerie J; Gronely, Joanne K; Perry, Jacquelin; Yule, William Jared; Mulroy, Sara J

2012-03-01

Microprocessor controlled prosthetic knees (MPK) offer opportunities for improved walking stability and function, but some devices' swing phase features may exceed needs of users with invariable cadence. One MPK offers computerized control of only stance (C-Leg Compact). To assess Medicare Functional Classification Level K2 walkers' ramp negotiation performance, function and balance while using a non-MPK (NMPK) compared to the C-Leg Compact. Crossover. Gait while ascending and descending a ramp (stride characteristics, kinematics, electromyography) and function were assessed in participant's existing NMPK and again in the C-Leg Compact following accommodation. Ramp ascent and descent were markedly faster in the C-Leg Compact compared to the NMPK (p ≤ 0.006), owing to increases in stride length (p ≤ 0.020) and cadence (p ≤ 0.020). Residual limb peak knee flexion and ankle dorsiflexion were significantly greater (12.9° and 4.9° more, respectively) during single limb support while using the C-Leg Compact to descend ramps. Electromyography (mean, peak) did not differ significantly between prosthesis. Function improved in the C-Leg Compact as evidenced by a significantly faster Timed Up and Go and higher functional questionnaire scores. Transfemoral K2 walkers exhibited significantly improved function and balance while using the stance-phase only MPK compared to their traditional NMPK.

Evaluation of a fiberglass instrument glare shield for protection against head injury.

DOT National Transportation Integrated Search

1972-02-01

An all fiberglass prototype glare shield has been evaluated in terms of head injury protection. In 30-ft./sec. head impacts, a protrusion is designed to fold down over the heavy instruments, offering significant improvement in head injury protection ...

The Abc's Of Hov: The Texas Experience

DOT National Transportation Integrated Search

1999-09-01

The implementation of High Occupancy Vehicle (HOV) lanes is a very important decision. Done right they offer a great opportunity for improving person-movement in a corridor. Done the wrong way or in the wrong place, they can be a significant public r...

Aggressive Treatment of Performance Status 1 and 2 HCC Patients Significantly Improves Survival - an Egyptian Retrospective Cohort Study of 524 Cases.

PubMed

Aziz, Ashraf Omar Abdel; Omran, Dalia; Nabeel, Mohamed Mahmoud; Elbaz, Tamer Mahmoud; Abdelmaksoud, Ahmed Hosni; Attar, Inas El; Shousha, Hend Ibrahim

2016-01-01

In the Barcelona Clinic Liver Cancer (BCLC) system, only sorafenib is suggested for HCC patients having performance status (PS) 1 or 2 even if they have treatable lesions. In the current study, we aimed to explore the outcome of using aggressive treatment for HCC patients with PS 1 and 2. Five hundred and twenty four patients with HCC were enrolled in this study and divided into 2 groups: 404 PS 1 and 120 PS 2. Of the included 524 patients, 136 recceived non-aggressive supportive treatment and sorafenib, while 388 patients were offered aggressive treatment in the form of surgical resection, transplantation, percutaneous ablation, trans-arterial chemoembolization and/or chemoperfusion. All the patients were followed up for a period of 2 years to determine their survival. Most HCC patients were CHILD A and B grades (89.4% versus 85.0%, for PS1 and PS2, respectively). Patients with PS1 were significantly younger. Out of the enrolled 524 patients, 388 were offered aggressive treatment, 253 (65.2%) having their lesions fully ablated, 94 (24.2%) undergoing partial ablation and 41 patients with no ablation (10.6%). The median survival of the patients with PS 1 who were offered aggressive treatment was 20 months versus 9 months only for those who were offered supportive treatment and sorafenib (<0.001). Regarding HCC patients with PS 2, the median survivals were similarly 19.7 months versus 8.7 months only (<0.001). Aggressive treatment of HCC patients with PS 1 and 2 significantly improves their survival. Revising the BCLC guidelines regarding such patients is recommended.

Commander’s (Executive officer’s) Guide for Detecting and Deterring Procurement Frauds in Military Unit (Organization) of Armed Forces of Ukraine

DTIC Science & Technology

2009-06-01

suggest various explanations of the nature of fraud. The most significant , from their perspectives, are psychological and sociological explanations. 2...performing managerial functions. To improve the economic management of the military unit, managerial control offers significant advantages. A...models. First, over the last decades, federal agencies have been the subject of significant internal control discussions and legislation. The “Office

An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders.

PubMed

Gale, Corinne; Gilbert, Paul; Read, Natalie; Goss, Ken

2014-01-01

This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology. Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99). There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders). This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. CFT offers new ways to conceptualize and formulate some of the self-critical and shame-based difficulties associated with eating disorders. CFT offers a framework that can enable people with eating disorders to conceptualize their difficulties in different ways. CFT can be combined with standard therapies especially cognitive behavioural therapy. CFT can be especially useful in a group context where the relationships between members can become increasingly compassionate, validating, supportive and encouraging. Copyright © 2012 John Wiley & Sons, Ltd.

Practice guideline update summary: Corticosteroid treatment of Duchenne muscular dystrophy: Report of the Guideline Development Subcommittee of the American Academy of Neurology.

PubMed

Gloss, David; Moxley, Richard T; Ashwal, Stephen; Oskoui, Maryam

2016-02-02

To update the 2005 American Academy of Neurology (AAN) guideline on corticosteroid treatment of Duchenne muscular dystrophy (DMD). We systematically reviewed the literature from January 2004 to July 2014 using the AAN classification scheme for therapeutic articles and predicated recommendations on the strength of the evidence. Thirty-four studies met inclusion criteria. In children with DMD, prednisone should be offered for improving strength (Level B) and pulmonary function (Level B). Prednisone may be offered for improving timed motor function (Level C), reducing the need for scoliosis surgery (Level C), and delaying cardiomyopathy onset by 18 years of age (Level C). Deflazacort may be offered for improving strength and timed motor function and delaying age at loss of ambulation by 1.4-2.5 years (Level C). Deflazacort may be offered for improving pulmonary function, reducing the need for scoliosis surgery, delaying cardiomyopathy onset, and increasing survival at 5-15 years of follow-up (Level C for each). Deflazacort and prednisone may be equivalent in improving motor function (Level C). Prednisone may be associated with greater weight gain in the first years of treatment than deflazacort (Level C). Deflazacort may be associated with a greater risk of cataracts than prednisone (Level C). The preferred dosing regimen of prednisone is 0.75 mg/kg/d (Level B). Over 12 months, prednisone 10 mg/kg/weekend is equally effective (Level B), with no long-term data available. Prednisone 0.75 mg/kg/d is associated with significant risk of weight gain, hirsutism, and cushingoid appearance (Level B). © 2016 American Academy of Neurology.

Development, evaluation, and demonstration of a tractor trailer intelligent communication and power link

DOT National Transportation Integrated Search

1998-01-01

Technology offers a significant potential to improve the productivity and safety of the motor carrier industry. To date, the application of new technology to commercial vehicles has been limited to single unit trucks and truck tractors because of con...

This Rock 'n' Roll Video Teaches Math

ERIC Educational Resources Information Center

Niess, Margaret L.; Walker, Janet M.

2009-01-01

Mathematics is a discipline that has significantly advanced through the use of digital technologies with improved computational, graphical, and symbolic capabilities. Digital videos can be used to present challenging mathematical questions for students. Video clips offer instructional possibilities for moving students from a passive mode of…

Trade and commerce in improved crops and food: an essay on food security.

PubMed

Kershen, Drew L

2010-11-30

Agricultural trade between nations is a significant proportion of total international trade. Agricultural trade in transgenic crops faces extra complications due to the existence of domestic and international regimes that focus specifically on agricultural biotechnology. These specialized regimes create legal and commercial challenges for trade in transgenic crops that have significant implications for the food security of the nations of the world. By food security, one should understand not just the available supply of food, but also the quality of the food and the environmental impact of agricultural production systems. These specialized regimes for transgenic crops can either encourage or hinder the adoption of agricultural biotechnology as a sustainable intensive agriculture. Sustainable intensive agriculture offers hope for agronomic improvements for agricultural production, socio-economic betterment for farmers and environmental benefits for societies. Sustainable intensive agriculture offers particular hope for the poorest farmers of the world because agricultural biotechnology is a technology in the seed. Copyright © 2010 Elsevier B.V. All rights reserved.

Nanofluid Types, Their Synthesis, Properties and Incorporation in Direct Solar Thermal Collectors: A Review

PubMed Central

Chamsa-ard, Wisut; Brundavanam, Sridevi; Fung, Chun Che; Fawcett, Derek; Poinern, Gerrard

2017-01-01

The global demand for energy is increasing and the detrimental consequences of rising greenhouse gas emissions, global warming and environmental degradation present major challenges. Solar energy offers a clean and viable renewable energy source with the potential to alleviate the detrimental consequences normally associated with fossil fuel-based energy generation. However, there are two inherent problems associated with conventional solar thermal energy conversion systems. The first involves low thermal conductivity values of heat transfer fluids, and the second involves the poor optical properties of many absorbers and their coating. Hence, there is an imperative need to improve both thermal and optical properties of current solar conversion systems. Direct solar thermal absorption collectors incorporating a nanofluid offers the opportunity to achieve significant improvements in both optical and thermal performance. Since nanofluids offer much greater heat absorbing and heat transfer properties compared to traditional working fluids. The review summarizes current research in this innovative field. It discusses direct solar absorber collectors and methods for improving their performance. This is followed by a discussion of the various types of nanofluids available and the synthesis techniques used to manufacture them. In closing, a brief discussion of nanofluid property modelling is also presented. PMID:28561802

Nanofluid Types, Their Synthesis, Properties and Incorporation in Direct Solar Thermal Collectors: A Review.

PubMed

Chamsa-Ard, Wisut; Brundavanam, Sridevi; Fung, Chun Che; Fawcett, Derek; Poinern, Gerrard

2017-05-31

The global demand for energy is increasing and the detrimental consequences of rising greenhouse gas emissions, global warming and environmental degradation present major challenges. Solar energy offers a clean and viable renewable energy source with the potential to alleviate the detrimental consequences normally associated with fossil fuel-based energy generation. However, there are two inherent problems associated with conventional solar thermal energy conversion systems. The first involves low thermal conductivity values of heat transfer fluids, and the second involves the poor optical properties of many absorbers and their coating. Hence, there is an imperative need to improve both thermal and optical properties of current solar conversion systems. Direct solar thermal absorption collectors incorporating a nanofluid offers the opportunity to achieve significant improvements in both optical and thermal performance. Since nanofluids offer much greater heat absorbing and heat transfer properties compared to traditional working fluids. The review summarizes current research in this innovative field. It discusses direct solar absorber collectors and methods for improving their performance. This is followed by a discussion of the various types of nanofluids available and the synthesis techniques used to manufacture them. In closing, a brief discussion of nanofluid property modelling is also presented.

Combining radiation plus immunotherapy to improve systemic immune response.

PubMed

Cushman, Taylor R; Gomez, Daniel; Kumar, Rachit; Likacheva, Anna; Chang, Joe Y; Cadena, Alex P; Paris, Sebastien; Welsh, James W

2018-02-01

Over the past decade, the fields of oncology have made great strides in therapies. The development of new therapeutics and increased understanding of the role of the immune system in the development and treatment of cancer has led to increased collaboration between oncologic fields. Recent technologic advancements in radiation therapy (RT), including stereotactic beam radiation therapy (SBRT), have improved local control and offer an alternative to surgery for the control of oligometastatic disease. Immunotherapy has proven a promising therapeutic in the treatment of metastatic disease but treatment resistance remains a significant obstacle in the majority of patients. Together, radiation and immunotherapy offer potential to eliminate metastatic disease, reduce time to recurrence and improve overall survival. Major obstacles to these positive outcomes include high tumor burden, intratumoral heterogeneity, and the negative effects of tumor stroma, to name a few. Multimodality treatments are under heavy investigation. Promising data from clinical trials is emerging to highlight the value of RT in combination with immunotherapy. However, the mechanisms behind their synergistic effects remain to be fully elucidated. This review aims to highlight the existing literature and offers hypotheses to explain mechanisms behind the synergy of RT and immunotherapy.

Software Defined GPS API: Development and Implementation of GPS Correlator Architectures Using MATLAB with Focus on SDR Implementations

DTIC Science & Technology

2014-05-18

intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved techniques...with the intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved...intention of offering improved software libraries for GNSS signal acquisition. It has been the team mission to implement new and improved techniques to

Active controls for ride smoothing

NASA Technical Reports Server (NTRS)

Conner, D. W.; Thompson, G. O.

1976-01-01

Active controls technology offers great promise for significantly smoothing the ride, and thus improving public and air carrier acceptance, of certain types of transport aircraft. Recent findings which support this promise are presented in the following three pertinent areas: (1) Ride quality versus degree of traveler satisfaction; (2) significant findings from a feasibility study of a ride smoothing system; and (3) potential ride problems identified for several advanced transport concepts.

Improved Indentation Test for Measuring Nonlinear Elasticity

NASA Technical Reports Server (NTRS)

Eldridge, Jeffrey I.

2004-01-01

A cylindrical-punch indentation technique has been developed as a means of measuring the nonlinear elastic responses of materials -- more specifically, for measuring the moduli of elasticity of materials in cases in which these moduli vary with applied loads. This technique offers no advantage for characterizing materials that exhibit purely linear elastic responses (constant moduli of elasticity, independent of applied loads). However, the technique offers a significant advantage for characterizing such important materials as plasma-sprayed thermal-barrier coatings, which, in cyclic loading, exhibit nonlinear elasticity with hysteresis related to compaction and sliding within their microstructures.

Ambulance ride: fixed or floating stretcher?

PubMed Central

Snook, R; Pacifico, R

1976-01-01

The alternatives of a purpose-bult ambulance and a specially designed stretcher suspension system were considered and the features of the latter assessed by subjective and objective tests. The results showed a significant improvement in the quality of the ride offered to the patient. Images FIG 2 PMID:947448

42 CFR 438.202 - State responsibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... strategy whenever significant changes are made. (2) Regular reports on the implementation and effectiveness... written strategy for assessing and improving the quality of managed care services offered by all MCOs and PIHPs. (b) Obtain the input of recipients and other stakeholders in the development of the strategy and...

The potential for nanotechnology to improve delivery of therapy to the acute ischemic heart.

PubMed

Evans, Cameron W; Iyer, K Swaminathan; Hool, Livia C

2016-04-01

Treatment of acute cardiac ischemia remains an area in which there are opportunities for therapeutic improvement. Despite significant advances, many patients still progress to cardiac hypertrophy and heart failure. Timely reperfusion is critical in rescuing vulnerable ischemic tissue and is directly related to patient outcome, but reperfusion of the ischemic myocardium also contributes to damage. Overproduction of reactive oxygen species, initiation of an inflammatory response and deregulation of calcium homeostasis all contribute to injury, and difficulties in delivering a sufficient quantity of drug to the affected tissue in a controlled manner is a limitation of current therapies. Nanotechnology may offer significant improvements in this respect. Here, we review recent examples of how nanoparticles can be used to improve delivery to the ischemic myocardium, and suggest some approaches that may lead to improved therapies for acute cardiac ischemia.

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

Kristine Barrett; Shannon Bragg-Sitton

The Advanced Light Water Reactor (LWR) Nuclear Fuel Development Research and Development (R&D) Pathway encompasses strategic research focused on improving reactor core economics and safety margins through the development of an advanced fuel cladding system. To achieve significant operating improvements while remaining within safety boundaries, significant steps beyond incremental improvements in the current generation of nuclear fuel are required. Fundamental improvements are required in the areas of nuclear fuel composition, cladding integrity, and the fuel/cladding interaction to allow power uprates and increased fuel burn-up allowance while potentially improving safety margin through the adoption of an “accident tolerant” fuel system thatmore » would offer improved coping time under accident scenarios. With a development time of about 20 – 25 years, advanced fuel designs must be started today and proven in current reactors if future reactor designs are to be able to use them with confidence.« less

Better Evidence, Better Choices, Better Schools: State Supports for Evidence-Based School Improvement and the Every Student Succeeds Act. Series on Implementation of the Every Student Succeeds Act

ERIC Educational Resources Information Center

Fleischman, Steve; Scott, Caitlin; Sargrad, Scott

2016-01-01

Signed into law in December 2015, the Every Student Suceeds Act (ESSA) offers state education agencies significant opportunities to use evidence to support the improvement of schools and ensure better outcomes for all students. ESSA replaces the law, regulations, and guidance established through the 2001 No Child Left Behind Act (NCLB), but two…

Network model of project "Lean Production"

NASA Astrophysics Data System (ADS)

Khisamova, E. D.

2018-05-01

Economical production implies primarily new approaches to culture of management and organization of production and offers a set of tools and techniques that allows reducing losses significantly and making the process cheaper and faster. Economical production tools are simple solutions that allow one to see opportunities for improvement of all aspects of the business, to reduce losses significantly, to constantly improve the whole spectrum of business processes, to increase significantly the transparency and manageability of the organization, to take advantage of the potential of each employee of the company, to increase competitiveness, and to obtain significant economic benefits without making large financial expenditures. Each of economical production tools solves a specific part of the problems, and only application of their combination will allow one to solve the problem or minimize it to acceptable values. The research of the governance process project "Lean Production" permitted studying the methods and tools of lean production and developing measures for their improvement.

Evaluation of a Workplace-Based Sleep Education Program.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; McCluskey, Maureen; Erickson, Denise; Barone, Daniel; Lattarulo, Charles; Schultz, Alyssa B

2016-09-01

Poor sleep is common among working adults. Chronic sleep deprivation is associated with health problems. A healthy sleep educational program (using webinars and other intranet-based resources) was offered to employees of a financial services corporation. In 2015, a total of 357 employees (50% completion rate) completed both a pre- and post-program questionnaire assessing sleep quality and workplace productivity. Many aspects of sleep statistically improved from T1 to T2 for program participants. These included improvements in hours of sleep, sleep quality, ease of getting asleep, feeling rested, nights of poor sleep, job performance, days of sleepiness, and others. Employees reporting any limitation in productivity also showed significant improvement. This workplace healthy sleep intervention was associated with significant improvements in sleep quality and quantity among program participants.

Share 35 Changes Center Level Liver Acceptance Practices

PubMed Central

Goldberg, David S.; Levine, Matthew; Karp, Seth; Gilroy, Richard; Peter, L

2017-01-01

Share 35 was implemented to provide improved access to organs for patients with MELD scores ≥35. However, little is known about the impact of Share 35 on organ offer acceptance rates. We evaluated all liver offers to adult patients that were ultimately transplanted between 1/1/2011–12/31/2015. The analyses focused on patients ranked in the top five positions of a given match run, and used multi-level mixed-effects models, clustering on individual waitlist candidate and transplant center. There was a significant interaction between Share 35 era and MELD category (p<0.001). Comparing offers to MELD score ≥35 patients, offers post-Share 35 were 36% less likely to be accepted compared to offers to MELD score ≥35 patients pre-Share 35 (adjusted OR: 0.64). There was no clinically meaningful difference in the DRI of livers that were declined for patients with an allocation MELD score ≥35 in the pre- vs post-Share 35 era. Organ offer acceptance rates for patients with an allocation MELD≥35 decreased in every region post-Share 35; the magnitude of these changes was bigger in regions 2, 3, 4, 5, 6, 7, and 11, compared to regions 8 and 9 that had regional sharing in place pre-Share 35. There were significant changes in organ offer acceptance rates at the center level pre- vs post-Share 35, and these changes varied across centers (p<0.001). Conclusions In liver transplant candidates achieving a MELD score ≥35, liver acceptance of offers declined significantly after implementation of Share 35. The alterations in behavior at the center level suggest that practice patterns changed as a direct result of Share 35. Changes in organ acceptance under even broader organ sharing (redistricting) would likely be even greater, posing major logistical and operational challenges, while potentially increasing discard rates, thus decreasing the total number of transplant nationally. PMID:28240804

Coupling System Design Optimization : A Survey and Assessment of Automatic Coupling Concepts for Rail Freight Cars : Volume 2. Text and Appendices.

DOT National Transportation Integrated Search

1978-05-01

The purpose of this study is to provide an independent identification, classification, and analysis of significant freight car coupling system concepts offering potential for improved safety and operating costs over the present system. The basic meth...

Coupling System Design Optimization : A Survey and Assessment of Automatic Coupling Concepts for Rail Freight Cars : Volume 1. Executive Summary.

DOT National Transportation Integrated Search

1978-05-01

The purpose of this study is to provide an independent identification, classification, and analysis of significant freight car coupling systems concepts offering potential for improved safety and operating costs over the present system. The basic met...

Difficulties associated with predicting forage intake by grazing beef cows

USDA-ARS?s Scientific Manuscript database

The current National Research Council (NRC) model is based on a single equation that relates dry matter intake (DMI) to metabolic size and net energy density of the diet offered and was a significant improvement over previous models. However, observed DMI by grazing animals can be conceptualized by...

Hierarchical Branched Vanadium Oxide Nanorod@Si Nanowire Architecture for High Performance Supercapacitors.

PubMed

Li, Zhaodong; Wang, Fei; Wang, Xudong

2017-01-01

Vanadium oxide (VO x ) nanorods are uniformly synthesized on dense Si nanowire arrays. This 3D hierarchical nanoarchitecture offers a novel high-performance supercapacitor electrode design with significantly improved specific capacitance and high-rate capability. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Commentary--Enlarging Concepts, Refining Methods, Improving Interventions

ERIC Educational Resources Information Center

Palacios, Jesús

2015-01-01

As illustrated by the articles in this special issue, the research into ethnic identity in adoption is making significant progress. At the same time, it faces new challenges in the definition of concepts, the use of appropriate methods of study, and the consideration of implications for professional interventions. This commentary offers additional…

"Banana Starts with Yellow": Curricular Implications of Preschoolers Missing a Concept

ERIC Educational Resources Information Center

Sylvester, Ruth; Kragler, Sherry

2013-01-01

Despite significant investments over the past decade in the expansion and improvement of preschool programs, too many children, particularly poor children, enter kindergarten behind their peers. Because it is critical that voluntary pre-kindergarten (VPK) classrooms offer educational programs that both address the needs and developmental levels of…

Cognitive Load Theory vs. Constructivist Approaches: Which Best Leads to Efficient, Deep Learning?

ERIC Educational Resources Information Center

Vogel-Walcutt, J. J.; Gebrim, J. B.; Bowers, C.; Carper, T. M.; Nicholson, D.

2011-01-01

Computer-assisted learning, in the form of simulation-based training, is heavily focused upon by the military. Because computer-based learning offers highly portable, reusable, and cost-efficient training options, the military has dedicated significant resources to the investigation of instructional strategies that improve learning efficiency…

Data-Enhanced Leadership. The Soul of Educational Leadership Series. Volume 7

ERIC Educational Resources Information Center

Blankstein, Alan M.; Houston, Paul D.; Cole, Robert W.

2010-01-01

Offering key concepts about how the informed use of data can translate into highly effective school leadership, this seventh volume in "The Soul of Educational Leadership" series demonstrates how educational leaders can apply data strategically to strengthen school leadership and significantly improve professional learning, students' learning…

Level System Use in Special Education: Classroom Intervention with Prima Facie Appeal.

ERIC Educational Resources Information Center

Smith, Stephen W.; Farrell, Daniel T.

1993-01-01

This article chronicles the development of level systems designed for students with significant behavior problems, to foster student improvement through self-management and positive reinforcement. The article examines assumptions underlying level systems' concepts and components and offers recommendations to guide future research into the design…

Preparing Future Secondary Computer Science Educators

ERIC Educational Resources Information Center

Ajwa, Iyad

2007-01-01

Although nearly every college offers a major in computer science, many computer science teachers at the secondary level have received little formal training. This paper presents details of a project that could make a significant contribution to national efforts to improve computer science education by combining teacher education and professional…

Metabolomics for Plant Improvement: Status and Prospects

PubMed Central

Kumar, Rakesh; Bohra, Abhishek; Pandey, Arun K.; Pandey, Manish K.; Kumar, Anirudh

2017-01-01

Post-genomics era has witnessed the development of cutting-edge technologies that have offered cost-efficient and high-throughput ways for molecular characterization of the function of a cell or organism. Large-scale metabolite profiling assays have allowed researchers to access the global data sets of metabolites and the corresponding metabolic pathways in an unprecedented way. Recent efforts in metabolomics have been directed to improve the quality along with a major focus on yield related traits. Importantly, an integration of metabolomics with other approaches such as quantitative genetics, transcriptomics and genetic modification has established its immense relevance to plant improvement. An effective combination of these modern approaches guides researchers to pinpoint the functional gene(s) and the characterization of massive metabolites, in order to prioritize the candidate genes for downstream analyses and ultimately, offering trait specific markers to improve commercially important traits. This in turn will improve the ability of a plant breeder by allowing him to make more informed decisions. Given this, the present review captures the significant leads gained in the past decade in the field of plant metabolomics accompanied by a brief discussion on the current contribution and the future scope of metabolomics to accelerate plant improvement. PMID:28824660

Comparison of patients' expectations and experiences at traditional pharmacies and pharmacies offering enhanced advanced pharmacy practice experiences.

PubMed

Kassam, Rosemin; Collins, John B; Berkowitz, Jonathan

2010-06-15

To compare patients' expectations and experiences at pharmacies offering traditional APPE learning opportunities with those offering enhanced APPEs that incorporate pharmaceutical care activities. A survey of anchored measures of patient satisfaction was conducted in 2 groups of APPE- affiliated community pharmacies: those participating in an enhanced APPE model versus those participating in the traditional model. The enhanced intervention included preceptor training, a comprehensive student orientation, and an extended experience at a single pharmacy rather than the traditional 2 x 4-week experience at different pharmacies. While patient expectations were similar in both traditional and enhanced APPE pharmacies, patients in enhanced pharmacies reported significantly higher in-store satisfaction and fewer service gaps. Additionally, satisfaction was significantly higher for patients who had received any form of consultation, from either pharmacist or students, than those reporting no consultations. Including provision of pharmaceutical care services as part of APPEs resulted in direct and measurable improvements in patient satisfaction.

Improving health and safety conditions in agriculture through professional training of Florida farm labor supervisors.

PubMed

Morera, Maria C; Monaghan, Paul F; Tovar-Aguilar, J Antonio; Galindo-Gonzalez, Sebastian; Roka, Fritz M; Asuaje, Cesar

2014-01-01

Because farm labor supervisors (FLSs) are responsible for ensuring safe work environments for thousands of workers, providing them with adequate knowledge is critical to preserving worker health. Yet a challenge to offering professional training to FLSs, many of whom are foreign-born and have received different levels of education in the US and abroad, is implementing a program that not only results in knowledge gains but meets the expectations of a diverse audience. By offering bilingual instruction on safety and compliance, the University of Florida Institute of Food and Agricultural Sciences (UF/IFAS) FLS Training program is helping to improve workplace conditions and professionalize the industry. A recent evaluation of the program combined participant observation and surveys to elicit knowledge and satisfaction levels from attendees of its fall 2012 trainings. Frequency distributions and dependent- and independent-means t-tests were used to measure and compare participant outcomes. The evaluation found that attendees rated the quality of their training experience as either high or very high and scored significantly better in posttraining knowledge tests than in pretraining knowledge tests across both languages. Nonetheless, attendees of the trainings delivered in English had significantly higher posttest scores than attendees of the trainings delivered in Spanish. As a result, the program has incorporated greater standardization of content delivery and staff development. Through assessment of its program components and educational outcomes, the program has documented its effectiveness and offers a replicable approach that can serve to improve the targeted outcomes of safety and health promotion in other states.

LLNL/Lion Precision LVDT amplifier

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

Hopkins, D.J.

1994-04-01

A high-precision, low-noise, LVDT amplifier has been developed which is a significant advancement on the current state of the art in contact displacement measurement. This amplifier offers the dynamic range of a typical LVDT probe but with a resolution that rivals that of non contact displacement measuring systems such as capacitance gauges and laser interferometers. Resolution of 0.1 {mu} in with 100 Hz bandwidth is possible. This level of resolution is over an order of magnitude greater than what is now commercially available. A front panel switch can reduce the bandwidth to 2.5 Hz and attain a resolution of 0.025more » {mu} in. This level of resolution meets or exceeds that of displacement measuring laser interferometry or capacitance gauge systems. Contact displacement measurement offers high part spatial resolution and therefore can measure not only part contour but surface finish. Capacitance gauges and displacement laser interferometry offer poor part spatial resolution and can not provide good surface finish measurements. Machine tool builders, meteorologists and quality inspection departments can immediately utilize the higher accuracy and capabilities that this amplifier offers. The precision manufacturing industry can improve as a result of improved capability to measure parts that help reduce costs and minimize material waste.« less

Premature ejaculation.

PubMed

McMahon, Chris G

2007-04-01

Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggests that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have "definite" PE, while men with IELTs between 1 and 1.5 minutes have "probable" PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (5-hydroxytryptamine, serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains. Investigational drugs such as the ejaculo-selective serotonin transport inhibitor, dapoxetine represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control and sexual satisfaction with minimal adverse effects.

Premature ejaculation

PubMed Central

McMahon, Chris G.

2007-01-01

Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggests that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have “definite” PE, while men with IELTs between 1 and 1.5 minutes have “probable” PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (5-hydroxytryptamine, serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors is well tolerated and offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains. Investigational drugs such as the ejaculo-selective serotonin transport inhibitor, dapoxetine represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control and sexual satisfaction with minimal adverse effects. PMID:19675782

Vacuum plasma coatings for turbine blades

NASA Technical Reports Server (NTRS)

Holmes, R. R.

1985-01-01

Turbine blades, vacuum plasma spray coated with NiCrAlY, CoCrAlY or NiCrAlY/Cr2O3, were evaluated and rated superior to standard space shuttle main engine (SSME) coated blades. Ratings were based primarily on 25 thermal cycles in the MSFC Burner Rig Tester, cycling between 1700 F (gaseous H2) and -423 F (liquid H2). These tests showed no spalling on blades with improved vacuum plasma coatings, while standard blades spalled. Thermal barrier coatings of ZrO2, while superior to standard coatings, lacked the overall performance desired. Fatigue and tensile specimens, machined from MAR-M-246(Hf) test bars identical to the blades were vacuum plasma spray coated, diffusion bond treated, and tested to qualify the vacuum plasma spray process for flight hardware testing and application. While NiCrAlY/Cr2O3 offers significant improvement over standard coatings in durability and thermal protection, studies continue with an objective to develop coatings offering even greater improvements.

Micromechanics and Structural Response of Functionally Graded, Particulate-Matrix, Fiber-Reinforced Composites

PubMed Central

Genin, Guy M.; Birman, Victor

2009-01-01

Reinforcement of fibrous composites by stiff particles embedded in the matrix offers the potential for simple, economical functional grading, enhanced response to mechanical loads, and improved functioning at high temperatures. Here, we consider laminated plates made of such a material, with spherical reinforcement tailored by layer. The moduli for this material lie within relatively narrow bounds. Two separate moduli estimates are considered: a “two-step” approach in which fibers are embedded in a homogenized particulate matrix, and the Kanaun-Jeulin (2001) approach, which we re-derive in a simple way using the Benveniste (1988) method. Optimal tailoring of a plate is explored, and functional grading is shown to improve the performance of the structures considered. In the example of a square, simply supported, cross-ply laminated panel subjected to uniform transverse pressure, a modest functional grading offers significant improvement in performance. A second example suggests superior blast resistance of the panel achieved at the expense of only a small increase in weight. PMID:23874001

Improving Emotional Intelligence through Personality Development: The Effect of the Smart Phone Application based Dharma Life Program on Emotional Intelligence

PubMed Central

Poonamallee, Latha; Harrington, Alex M.; Nagpal, Manisha; Musial, Alec

2018-01-01

Emotional intelligence is established to predict success in leadership effectiveness in various contexts and has been linked to personality factors. This paper introduces Dharma Life Program, a novel approach to improving emotional intelligence by targeting maladaptive personality traits and triggering neuroplasticity through the use of a smart-phone application and mentoring. The program uses neuroplasticity to enable users to create a more adaptive application of their maladaptive traits, thus improving their emotional intelligence. In this study 26 participants underwent the Dharma Life Program in a leadership development setting. We assessed their emotional and social intelligence before and after the Dharma Life Program intervention using the Emotional and Social Competency Inventory (ESCI). The study found a significant improvement in the lowest three competencies and a significant improvement in almost all domains for the entire sample. Our findings suggest that the completion of the Dharma Life Program has a significant positive effect on Emotional and Social Competency scores and offers a new avenue for improving emotional intelligence competencies. PMID:29527182

Improving Emotional Intelligence through Personality Development: The Effect of the Smart Phone Application based Dharma Life Program on Emotional Intelligence.

PubMed

Poonamallee, Latha; Harrington, Alex M; Nagpal, Manisha; Musial, Alec

2018-01-01

Emotional intelligence is established to predict success in leadership effectiveness in various contexts and has been linked to personality factors. This paper introduces Dharma Life Program, a novel approach to improving emotional intelligence by targeting maladaptive personality traits and triggering neuroplasticity through the use of a smart-phone application and mentoring. The program uses neuroplasticity to enable users to create a more adaptive application of their maladaptive traits, thus improving their emotional intelligence. In this study 26 participants underwent the Dharma Life Program in a leadership development setting. We assessed their emotional and social intelligence before and after the Dharma Life Program intervention using the Emotional and Social Competency Inventory (ESCI). The study found a significant improvement in the lowest three competencies and a significant improvement in almost all domains for the entire sample. Our findings suggest that the completion of the Dharma Life Program has a significant positive effect on Emotional and Social Competency scores and offers a new avenue for improving emotional intelligence competencies.

The slab geometry laser. I - Theory

NASA Technical Reports Server (NTRS)

Eggleston, J. M.; Kane, T. J.; Kuhn, K.; Byer, R. L.; Unternahrer, J.

1984-01-01

Slab geometry solid-state lasers offer significant performance improvements over conventional rod-geometry lasers. A detailed theoretical description of the thermal, stress, and beam-propagation characteristics of a slab laser is presented. The analysis includes consideration of the effects of the zig-zag optical path, which eliminates thermal and stress focusing and reduces residual birefringence.

Finite Element Analysis of Morphing Piezoelectric Structures Studied

NASA Technical Reports Server (NTRS)

Lee, Ho-Jun

2002-01-01

The development of morphing aerospace structures that optimize their shape offers the potential to significantly improve the performance of existing airplanes. These morphing vehicles will operate with new capabilities to reduce noise, damp vibrations, manipulate flow, and monitor damage. Piezoelectric materials represent one of the popular materials currently being investigated for applications in morphing structures.

Employee Concerns and Counselor Role: A Factor Analysis.

ERIC Educational Resources Information Center

Mazer, Gilbert E.

A significant step in the direction of improving employee counselor services in an industrial setting is offered. The research combined survey and factor analytic methodology to empirically identify sources of employee concerns or stress and to measure the tendency of employees to use counseling services in connection with these problem areas. The…

ecoSmart landscapes: a versatile SaaS platform for green infrastructure applications in urban environments

Treesearch

Greg McPherson; Qingfu Xiao; Joe Purohit; Mark Dietenberger; Charles (C.R.) Boardman; Jim Simpson; Paula Peper

2014-01-01

The urban environment offers significant opportunities to improve sustainability and optimize water resources. Historically, research and software applications have been focused on the built environment (buildings). Cost-effective, practical tools that can assess the impact of different landscape configurations and their interactions with buildings have not been widely...

Teaching Information Security with Workflow Technology--A Case Study Approach

ERIC Educational Resources Information Center

He, Wu; Kshirsagar, Ashish; Nwala, Alexander; Li, Yaohang

2014-01-01

In recent years, there has been a significant increase in the demand from professionals in different areas for improving the curricula regarding information security. The use of authentic case studies in teaching information security offers the potential to effectively engage students in active learning. In this paper, the authors introduce the…

What Affect Student Cognitive Style in the Development of Hypermedia Learning System?

ERIC Educational Resources Information Center

Lee, Catherine Hui Min; Cheng, Yuk Wing; Rai, Shri; Depickere, Arnold

2005-01-01

Recent developments in learning technology such as hypermedia is becoming widespread and offer significant contribution to improve the delivery of learning and teaching materials. A key factor in the development of hypermedia learning system is cognitive style (CS) as it relates to users' information processing habits, representing individual…

On the EMSC and its roles in the Euro-Med region

NASA Astrophysics Data System (ADS)

Bossu, R.; Godey, S.; Mazet-Roux, G.

2009-04-01

The Euro-Med seismological Centre (EMSC) is a scientific non-profit NGO created back in 1975 by the seismological community to collate data, make them available and provide earthquake information at a Euro-Med and global scales. The aim of this talk is to provide an overview of the EMSC's activities and its roles in the integration of the seismological community. Its first activity has been rapid earthquake information on its web site (www.emsc-csem.org) as well as earthquake notification services (SMS, email) for potentially damaging earthquakes. More recently, online macroseismic questionnaires were introduced in more than 20 different languages as well as tools to collect pictures of the earthquake's effects from the public. An innovative way to map the area where an earthquake was felt within 5 to 8 minutes of its occurrence was developed. It plots the geographical origin of the observed surges of traffic following felt events. This method is now being implemented in several other institutes. The Euro-Med seismological bulletin, which started in 1998, complements this service by offering a reference bulletin for the region. It significantly improved the data availability especially on the fringes of the region and the data collection is now comprehensive. Thanks to its 84 institutes from 55 different countries, EMSC offers a significant networking capacity and it plays a significant role in the integration of our community in close collaboration with ORFEUS, the second European organisation in seismology. It devotes significant efforts to improve collaboration especially towards Northern Africa and the Middle East. For example, it recently led an EC-project to improve coordination of the earthquake surveillance of the Western Mediterranean region and improve data exchanges. It contributes to the initiation of the NERIES project. It is involved, within this framework, in improving accelerometric data availability, developing rapid loss estimates and it it is in charge, jointly with ORFEUS to implement and host the portal to access and explore seismological data and products.

Propulsion system-flight control integration and optimization: Flight evaluation and technology transition

NASA Technical Reports Server (NTRS)

Burcham, Frank W., Jr.; Gilyard, Glenn B.; Myers, Lawrence P.

1990-01-01

Integration of propulsion and flight control systems and their optimization offers significant performance improvements. Research programs were conducted which have developed new propulsion and flight control integration concepts, implemented designs on high-performance airplanes, demonstrated these designs in flight, and measured the performance improvements. These programs, first on the YF-12 airplane, and later on the F-15, demonstrated increased thrust, reduced fuel consumption, increased engine life, and improved airplane performance; with improvements in the 5 to 10 percent range achieved with integration and with no changes to hardware. The design, software and hardware developments, and testing requirements were shown to be practical.

Best practices for learning physiology: combining classroom and online methods.

PubMed

Anderson, Lisa C; Krichbaum, Kathleen E

2017-09-01

Physiology is a requisite course for many professional allied health programs and is a foundational science for learning pathophysiology, health assessment, and pharmacology. Given the demand for online learning in the health sciences, it is important to evaluate the efficacy of online and in-class teaching methods, especially as they are combined to form hybrid courses. The purpose of this study was to compare two hybrid physiology sections in which one section was offered mostly in-class (85% in-class), and the other section was offered mostly online (85% online). The two sections in 2 yr ( year 1 and year 2 ) were compared in terms of knowledge of physiology measured in exam scores and pretest-posttest improvement, and in measures of student satisfaction with teaching. In year 1 , there were some differences on individual exam scores between the two sections, but no significant differences in mean exam scores or in pretest-posttest improvements. However, in terms of student satisfaction, the mostly in-class students in year 1 rated the instructor significantly higher than did the mostly online students. Comparisons between in-class and online students in the year 2 cohort yielded data that showed that mean exam scores were not statistically different, but pre-post changes were significantly greater in the mostly online section; student satisfaction among mostly online students also improved significantly. Education researchers must investigate effective combinations of in-class and online methods for student learning outcomes, while maintaining the flexibility and convenience that online methods provide. Copyright © 2017 the American Physiological Society.

Improving the Yield and Nutritional Quality of Forage Crops

PubMed Central

Capstaff, Nicola M.; Miller, Anthony J.

2018-01-01

Despite being some of the most important crops globally, there has been limited research on forages when compared with cereals, fruits, and vegetables. This review summarizes the literature highlighting the significance of forage crops, the current improvements and some of future directions for improving yield and nutritional quality. We make the point that the knowledge obtained from model plant and grain crops can be applied to forage crops. The timely development of genomics and bioinformatics together with genome editing techniques offer great scope to improve forage crops. Given the social, environmental and economic importance of forage across the globe and especially in poorer countries, this opportunity has enormous potential to improve food security and political stability. PMID:29740468

Citizen Science: The Small World Initiative Improved Lecture Grades and California Critical Thinking Skills Test Scores of Nonscience Major Students at Florida Atlantic University.

PubMed

Caruso, Joseph P; Israel, Natalie; Rowland, Kimberly; Lovelace, Matthew J; Saunders, Mary Jane

2016-03-01

Course-based undergraduate research is known to improve science, technology, engineering, and mathematics student achievement. We tested "The Small World Initiative, a Citizen-Science Project to Crowdsource Novel Antibiotic Discovery" to see if it also improved student performance and the critical thinking of non-science majors in Introductory Biology at Florida Atlantic University (a large, public, minority-dominant institution) in academic year 2014-15. California Critical Thinking Skills Test pre- and posttests were offered to both Small World Initiative (SWI) and control lab students for formative amounts of extra credit. SWI lab students earned significantly higher lecture grades than control lab students, had significantly fewer lecture grades of D+ or lower, and had significantly higher critical thinking posttest total scores than control students. Lastly, more SWI students were engaged while taking critical thinking tests. These results support the hypothesis that utilizing independent course-based undergraduate science research improves student achievement even in nonscience students.

Generator Dynamic Model Validation and Parameter Calibration Using Phasor Measurements at the Point of Connection

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

Huang, Zhenyu; Du, Pengwei; Kosterev, Dmitry

2013-05-01

Disturbance data recorded by phasor measurement units (PMU) offers opportunities to improve the integrity of dynamic models. However, manually tuning parameters through play-back events demands significant efforts and engineering experiences. In this paper, a calibration method using the extended Kalman filter (EKF) technique is proposed. The formulation of EKF with parameter calibration is discussed. Case studies are presented to demonstrate its validity. The proposed calibration method is cost-effective, complementary to traditional equipment testing for improving dynamic model quality.

Tungsten fiber reinforced superalloys: A status review

NASA Technical Reports Server (NTRS)

Petrasek, D. W.; Signorelli, R. A.

1981-01-01

Improved performance of heat engines is largely dependent upon maximum cycle temperatures. Tungsten fiber reinforced superalloys (TFRS) are the first of a family of high temperature composites that offer the potential for significantly raising hot component operating temperatures and thus leading to improved heat engine performance. This status review of TFRS research emphasizes the promising property data developed to date, the status of TFRS composite airfoil fabrication technology, and the areas requiring more attention to assure their applicability to hot section components of aircraft gas turbine engines.

Chemistry, Adhesive and Composite Properties of Low Molecular Weight Phenylethynyl Terminated Oligomers

NASA Technical Reports Server (NTRS)

Connell, John W.

2004-01-01

PETI-5 (1250 and 2500 g/mole) were prepared and characterized. Neat resin, adhesive and composite properties were determined and compared with those of PETI-5 (5000 g/mole). Relative to PETI-5 (5000 g/mole), PETI-5 (2500 g/mole) exhibited improved processability and equivalency in the adhesive and composite properties measured thus far. This resin, in both adhesive film and prepreg form, has the potential to offer significant improvements in the processing of complex structural composite parts.

Fiber reinforced superalloys

NASA Technical Reports Server (NTRS)

Petrasek, Donald W.; Signorelli, Robert A.; Caulfield, Thomas; Tien, John K.

1987-01-01

Improved performance of heat engines is largely dependent upon maximum cycle temperatures. Tungsten fiber reinforced superalloys (TFRS) are the first of a family of high temperature composites that offer the potential for significantly raising hot component operating temperatures and thus leading to improved heat engine performance. This status review of TFRS research emphasizes the promising property data developed to date, the status of TFRS composite airfoil fabrication technology, and the areas requiring more attention to assure their applicability to hot section components of aircraft gas turbine engines.

Server-based enterprise collaboration software improves safety and quality in high-volume PET/CT practice.

PubMed

McDonald, James E; Kessler, Marcus M; Hightower, Jeremy L; Henry, Susan D; Deloney, Linda A

2013-12-01

With increasing volumes of complex imaging cases and rising economic pressure on physician staffing, timely reporting will become progressively challenging. Current and planned iterations of PACS and electronic medical record systems do not offer workflow management tools to coordinate delivery of imaging interpretations with the needs of the patient and ordering physician. The adoption of a server-based enterprise collaboration software system by our Division of Nuclear Medicine has significantly improved our efficiency and quality of service.

Electron beam curing — taking good ideas to the manufacturing floor

NASA Astrophysics Data System (ADS)

Saunders, C.; Lopata, V.; Barnard, J.; Stepanik, T.

2000-03-01

Acsion is exploiting several emerging electron beam EB applications ranging from composite curing and repair to viscose manufacturing. EB curing of composite structures offers several advantages: significantly reduced curing times; improvements in part quality and performance; reduced environmental and health concerns; improvements in material handling; and reduced overall manufacturing costs compared to thermal curing. The aerospace industry is developing EB technology in all of their market sectors, including military aviation and space products. Some specific products include cryogenic fuel tanks, improved canopy frames for jet aircraft, and the all-composite military aircraft. This paper discusses each of these opportunities.

Improved depth perception with three-dimensional auxiliary display and computer generated three-dimensional panoramic overviews in robot-assisted laparoscopy

PubMed Central

Wieringa, Fokko P.; Bouma, Henri; Eendebak, Pieter T.; van Basten, Jean-Paul A.; Beerlage, Harrie P.; Smits, Geert A. H. J.; Bos, Jelte E.

2014-01-01

Abstract. In comparison to open surgery, endoscopic surgery offers impaired depth perception and narrower field-of-view. To improve depth perception, the Da Vinci robot offers three-dimensional (3-D) video on the console for the surgeon but not for assistants, although both must collaborate. We improved the shared perception of the whole surgical team by connecting live 3-D monitors to all three available Da Vinci generations, probed user experience after two years by questionnaire, and compared time measurements of a predefined complex interaction task performed with a 3-D monitor versus two-dimensional. Additionally, we investigated whether the complex mental task of reconstructing a 3-D overview from an endoscopic video can be performed by a computer and shared among users. During the study, 925 robot-assisted laparoscopic procedures were performed in three hospitals, including prostatectomies, cystectomies, and nephrectomies. Thirty-one users participated in our questionnaire. Eighty-four percent preferred 3-D monitors and 100% reported spatial-perception improvement. All participating urologists indicated quicker performance of tasks requiring delicate collaboration (e.g., clip placement) when assistants used 3-D monitors. Eighteen users participated in a timing experiment during a delicate cooperation task in vitro. Teamwork was significantly (40%) faster with the 3-D monitor. Computer-generated 3-D reconstructions from recordings offered very wide interactive panoramas with educational value, although the present embodiment is vulnerable to movement artifacts. PMID:26158026

Regenerative endodontics.

PubMed

Simon, S; Smith, A J

2014-03-01

Significant advances in our understanding of the biological processes involved in tooth development and repair at the cellular and molecular levels have underpinned the newly emerging area of regenerative endodontics. Development of treatment protocols based on exploiting the natural wound healing properties of the dental pulp and applying tissue engineering principles has allowed reporting of case series showing preservation of tissue vitality and apexogenesis. To review current case series reporting regenerative endodontics. Current treatment approaches tend to stimulate more reparative than regenerative responses in respect of the new tissue generated, which often does not closely resemble the physiological structure of dentine-pulp. However, despite these biological limitations, such techniques appear to offer significant promise for improved treatment outcomes. Improved biological outcomes will likely emerge from the many experimental studies being reported and will further contribute to improvements in clinical treatment protocols.

Robotics and Automation for Flight Deck Aircraft Servicing

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

Chesser, J.B.; Draper, J.V.; Pin, F.G.

1999-03-01

One of the missions of the Future Aircraft Carriers Program is to investigate methods that would improve aircraft turnaround servicing activities on carrier decks. The major objectives and criteria for evaluating alternative aircraft servicing methods are to reduce workload requirements, turnaround times (TAT), and life-cycle costs (LCC). Technologies in the field of Robotics and Automation (R and A) have the potential to significantly contribute to these objectives. The objective of this study was to investigate aircraft servicing functions on carrier decks which would offer the potentially most significant payoff if improved by various R and A technologies. Improvement in thismore » case means reducing workload, time and LCC. This objective was accomplished using a ''bottom-up'' formalized approach as described in the following.« less

Aircrew Performance Cutting-Edge Tech: Emerging Human Performance Enhancement Technology Vision in Support of Operational Military Aviation Strategy

DTIC Science & Technology

2002-04-01

Origin and History, (RK, PRK , LASIK ) Refractive surgery was first considered as early as 1898 by a Dutch professor and was unsuccessfully attempted in...Keratomileusis ( LASIK ) LASIK offers the greatest potential for improving aviator vision and is the latest PRK -similar procedure. First, a flap of...showed that after LASIK , subjects did not exhibit a refractive shift of clinical significance.39 Therefore LASIK and PRK , recipients had no significant

Associations among School Characteristics and Foodservice Practices in a Nationally Representative Sample of U.S. Schools

PubMed Central

Thomson, Jessica L.; Tussing-Humphreys, Lisa M.; Martin, Corby K.; LeBlanc, Monique M.; Onufrak, Stephen J.

2012-01-01

Objective Determine school characteristics associated with healthy/unhealthy foodservice offerings or healthy food preparation practices. Design Retrospective analysis of cross-sectional data. Setting Nationally representative sample of public and private elementary, middle and high schools. Participants 526 and 520 schools with valid data from the 2006 School Health Policies and Practices Study (SHPPS) Food Service School Questionnaire. Main Outcome Measure(s) Scores for healthy/unhealthy foodservice offerings and healthy food preparation practices. Analysis Multivariable regression to determine significant associations among school characteristics and offerings/preparation practices. Results Public schools and schools participating in USDA Team Nutrition reported more healthy offerings and preparation than private or non-participating schools, respectively. Elementary schools reported less unhealthy offerings than middle or high schools; middle schools reported less unhealthy offerings than high schools. Schools requiring foodservice managers to have a college education reported more healthy preparation while those requiring completion of a foodservice training program reported less unhealthy offerings and more healthy preparation than schools without these requirements. Conclusions and Implications Results suggest the school nutrition environment may be improved by requiring foodservice managers to hold a nutrition-related college degree and/or successfully pass a foodservice training program, and by participating in a school-based nutrition program, such as USDA Team Nutrition. PMID:22963956

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis.

PubMed

Misra-Hebert, Anita D; Hu, Bo; Taksler, Glen; Zimmerman, Robert; Rothberg, Michael B

2016-08-01

Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse. To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals. Retrospective cohort study using insurance claims linked with electronic medical record data from January 2008-December 2012. Employee patients with diabetes covered by the organization's self-funded insurance and propensity-matched non-employee patient comparison group with diabetes and commercial insurance. Financial incentives for employer-sponsored disease management program participation and achieving goals. Change in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL), systolic blood pressure (SBP), and weight. A total of 1092 employees with diabetes were matched to non-employee patients. With increasing incentives, employee program participation increased (7 % in 2009 to 50 % in 2012, p < 0.001). Longitudinal mixed modeling demonstrated improved diabetes and cardiovascular risk factor control in employees vs. non-employees [HbA1c yearly change -0.05 employees vs. 0.00 non-employees, difference in change (DIC) p <0.001]. In their first participation year, employees had larger declines in HbA1c and weight vs. non-employees (0.33 vs. 0.14, DIC p = 0.04) and (2.3 kg vs. 0.1 kg, DIC p < 0.001), respectively. Analysis of employee cohorts corresponding with incentive offerings showed that fixed incentives (years 1 and 2) or incentives tied to goals (years 3 and 4) were not significantly associated with HbA1c reductions compared to non-employees. For each employee cohort offered incentives, SBP and LDL also did not significantly differ in employees compared with non-employees (DIC p > 0.05). Financial incentives were associated with employee participation in disease management and improved cardiovascular risk factors over 5 years. Improvements occurred primarily in the first year of participation. The relative impact of specific incentives could not be discerned.

The Mobile Aircraft Maintenance Office Concept from a Wide Area Perspective

DTIC Science & Technology

2003-03-01

significant improvements in wireless network data rates, and enhanced mobile application platforms offers an opportunity to effectively integrate m...hardware, and mobile application platforms housing the necessary middleware software comprise the mobile landscape. The m-business network...devices. Lastly, an investigation into mobile application platforms will reveal the middleware functionality required to successfully extend suitable e

Bi-functional ion exchangers for enhanced performance of dye-sensitized solar cells.

PubMed

Kong, Eui-Hyun; Chang, Yong-June; Lim, Jongchul; Kim, Back-Hyun; Lee, Jung-Hoon; Kwon, Do-Kyun; Park, Taiho; Jang, Hyun Myung

2013-07-28

Ion exchange using aerosol OT (AOT) offers dye adsorption twice as fast as known methods. Moreover, it suppresses the dye-agglomeration that may cause insufficient dye-coverage on the photoelectrode surface. Consequently, its dual function of fast dye-loading and higher dye-coverage significantly improves the power conversion efficiency of dye-sensitized solar cells.

Make Your Load Lighter with STARS

ERIC Educational Resources Information Center

Braxton, Barbara

2005-01-01

The Student Teaching and Research Services (STARS) program that is in place in a particular elementary school has proven very successful, not only in improving the services that are offered, but also in helping its participants to build their self-esteem. Those who seek a safe haven in the library during breaks make such a significant and visible…

Want to Improve Undergraduate Thesis Writing? Engage Students and Their Faculty Readers in Scientific Peer Review

ERIC Educational Resources Information Center

Reynolds, Julie A.; Thompson, Robert J., Jr.

2011-01-01

One of the best opportunities that undergraduates have to learn to write like a scientist is to write a thesis after participating in faculty-mentored undergraduate research. But developing writing skills doesn't happen automatically, and there are significant challenges associated with offering writing courses and with individualized mentoring.…

"Active Science": Integrating Physical Activity and Science Learning into the Afterschool Environment

ERIC Educational Resources Information Center

Finn, Kevin E.; Yan, Zi; McInnis, Kyle J.

2015-01-01

Background: Afterschool programs offer significant opportunities to increase physical activity levels and improve academic performance of children. Purpose: This study assessed an innovative approach to embed physical activity into science lessons in an afterschool community setting. Methods: Participants were 47 boys and girls (age = 10.8 ± 0.7…

Methods of treating complex space vehicle geometry for charged particle radiation transport

NASA Technical Reports Server (NTRS)

Hill, C. W.

1973-01-01

Current methods of treating complex geometry models for space radiation transport calculations are reviewed. The geometric techniques used in three computer codes are outlined. Evaluations of geometric capability and speed are provided for these codes. Although no code development work is included several suggestions for significantly improving complex geometry codes are offered.

Low-Cost CdTe/Silicon Tandem Solar Cells

DOE PAGES

Tamboli, Adele C.; Bobela, David C.; Kanevce, Ana; ...

2017-09-06

Achieving higher photovoltaic efficiency in single-junction devices is becoming increasingly difficult, but tandem modules offer the possibility of significant efficiency improvements. By device modeling we show that four-terminal CdTe/Si tandem solar modules offer the prospect of 25%-30% module efficiency, and technoeconomic analysis predicts that these efficiency gains can be realized at costs per Watt that are competitive with CdTe and Si single junction alternatives. The cost per Watt of the modeled tandems is lower than crystalline silicon, but slightly higher than CdTe alone. But, these higher power modules reduce area-related balance of system costs, providing increased value especially in area-constrainedmore » applications. This avenue for high-efficiency photovoltaics enables improved performance on a near-term timeframe, as well as a path to further reduced levelized cost of electricity as module and cell processes continue to advance.« less

Low-Cost CdTe/Silicon Tandem Solar Cells

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

Tamboli, Adele C.; Bobela, David C.; Kanevce, Ana

Achieving higher photovoltaic efficiency in single-junction devices is becoming increasingly difficult, but tandem modules offer the possibility of significant efficiency improvements. By device modeling we show that four-terminal CdTe/Si tandem solar modules offer the prospect of 25%-30% module efficiency, and technoeconomic analysis predicts that these efficiency gains can be realized at costs per Watt that are competitive with CdTe and Si single junction alternatives. The cost per Watt of the modeled tandems is lower than crystalline silicon, but slightly higher than CdTe alone. But, these higher power modules reduce area-related balance of system costs, providing increased value especially in area-constrainedmore » applications. This avenue for high-efficiency photovoltaics enables improved performance on a near-term timeframe, as well as a path to further reduced levelized cost of electricity as module and cell processes continue to advance.« less

Out-of-Autoclave Cure Composites

NASA Technical Reports Server (NTRS)

Hayes, Brian S.

2015-01-01

As the size of aerospace composite parts exceeds that of even the largest autoclaves, the development of new out-of-autoclave processes and materials is necessary to ensure quality and performance. Many out-of-autoclave prepreg systems can produce high-quality composites initially; however, due to long layup times, the resin advancement commonly causes high void content and variations in fiber volume. Applied Poleramic, Inc. (API), developed an aerospace-grade benzoxazine matrix composite prepreg material that offers more than a year out-time at ambient conditions and provides exceptionally low void content when out-of-autoclave cured. When compared with aerospace epoxy prepreg systems, API's innovation offers significant improvements in terms of out-time at ambient temperature and the corresponding tack retention. The carbon fiber composites developed with the optimized matrix technology have significantly better mechanical performance in terms of hot-wet retention and compression when compared with aerospace epoxy matrices. These composites also offer an excellent overall balance of properties. This matrix system imparts very low cure shrinkage, low coefficient of thermal expansion, and low density when compared with most aerospace epoxy prepreg materials.

Overcoming Present-Day Powerplant Limitations Via Unconventional Engine Configurations

NASA Technical Reports Server (NTRS)

Meitner, Peter L.

2006-01-01

The Army Research Laboratory s Vehicle Technology Directorate is sponsoring the prototype development of three unconventional engine concepts - two intermittent combustion (IC) engines and one turbine engine (via SBIR (Small Business Innovative Research) contracts). The IC concepts are the Nutating Engine and the Bonner Engine, and the turbine concept is the POWER Engine. Each of the three engines offers unique and greatly improved capabilities (which cannot be achieved by present-day powerplants), while offering significant reductions in size and weight. This paper presents brief descriptions of the physical characteristics of the three engines, and discusses their performance potentials, as well as their development status.

Associations among school characteristics and foodservice practices in a nationally representative sample of United States schools.

PubMed

Thomson, Jessica L; Tussing-Humphreys, Lisa M; Martin, Corby K; LeBlanc, Monique M; Onufrak, Stephen J

2012-01-01

Determine school characteristics associated with healthy/unhealthy food service offerings or healthy food preparation practices. Secondary analysis of cross-sectional data. Nationally representative sample of public and private elementary, middle, and high schools. Data from the 2006 School Health Policies and Practices Study Food Service School Questionnaire, n = 526 for Healthy and Unhealthy Offerings analysis; n = 520 for Healthy Preparation analysis. Scores for healthy/unhealthy foodservice offerings and healthy food preparation practices. Multivariable regression to determine significant associations among school characteristics and offerings/preparation practices. Public schools and schools participating in the United States Department of Agriculture (USDA) Team Nutrition reported more healthy offerings and preparation than private or nonparticipating schools, respectively. Elementary schools reported fewer unhealthy offerings than middle or high schools; middle schools reported fewer unhealthy offerings than high schools. Schools requiring foodservice managers to have a college education reported more healthy preparation, whereas those requiring completion of a foodservice training program reported fewer unhealthy offerings and more healthy preparation than schools without these requirements. Results suggest the school nutrition environment may be improved by requiring foodservice managers to hold a nutrition-related college degree and/or successfully pass a foodservice training program, and by participating in a school-based nutrition program, such as USDA Team Nutrition. Copyright © 2012 Society for Nutrition Education and Behavior. All rights reserved.

Transtheoretical Model Based Exercise Counseling Combined with Music Skipping Rope Exercise on Childhood Obesity.

PubMed

Ham, Ok Kyung; Sung, Kyung Mi; Lee, Bo Gyeong; Choi, Hee Won; Im, Eun-Ok

2016-06-01

The purpose was to evaluate the effects of a transtheoretical model (TTM) based exercise counseling offered with music skipping rope exercise on components of the TTM (stages of change, decisional balance, and self-efficacy), body mass index, glucose, and lipid profile of overweight/obese children in Korea. This study used a nonequivalent pretest and posttest experimental study design. A total of 75 overweight/obese children participated in the study. Eight sessions of exercise counseling combined with music skipping rope exercise for 12 weeks were offered for children in the experimental group, while one session of exercise counseling with music skipping rope exercise for 12 weeks was offered for children in the control group. Outcomes were measured at baseline, and 6 months after the intervention. After the intervention, self-efficacy significantly improved among children in the experimental group (p = .049), while these children maintained their baseline BMI at 6-month follow-up (p > .05). Among children in the control group, BMI significantly increased (p < .05). Fasting blood sugar significantly increased for both groups after the intervention (p < .05). However, a greater increase was observed for the control group. Our study partially supports the hypothesis that a TTM-based exercise intervention is effective in maintaining BMI and improving self-efficacy of overweight/obese children. The TTM-based counseling combined with exercise classes has potential to control weight among overweight/obese children, while involvement of parents and children in the development of the theory-based intervention may generate further benefits regarding health and well-being of overweight/obese children. Copyright © 2016. Published by Elsevier B.V.

Faculty development to improve teaching at a health sciences center: a needs assessment.

PubMed

Scarbecz, Mark; Russell, Cynthia K; Shreve, Robert G; Robinson, Melissa M; Scheid, Cheryl R

2011-02-01

There has been increasing interest at health science centers in improving the education of health professionals by offering faculty development activities. In 2007-08, as part of an effort to expand education-related faculty development offerings on campus, the University of Tennessee Health Science Center surveyed faculty members in an effort to identify faculty development activities that would be of interest. Factor analysis of survey data indicated that faculty interests in the areas of teaching and learning can be grouped into six dimensions: development of educational goals and objectives, the use of innovative teaching techniques, clinical teaching, improving traditional teaching skills, addressing teaching challenges, and facilitating participation. There were significant differences in the level of interest in education-related faculty development activities by academic rank and by the college of appointment. Full professors expressed somewhat less interest in faculty development activities than faculty members of lower ranks. Faculty members in the Colleges of Medicine and Dentistry expressed somewhat greater interest in faculty development to improve traditional teaching skills. The policy implications of the survey results are discussed, including the need for faculty development activities that target the needs of specific faculty groups.

Improvement of feed pellet characteristics by dietary pre-gelatinized starch and their subsequent effects on growth and physiology in tilapia.

PubMed

Kanmani, Naga; Romano, Nicholas; Ebrahimi, Mahdi; Nurul Amin, S M; Kamarudin, Mohd Salleh; Karami, Ali; Kumar, Vikas

2018-01-15

A 9-week study was conducted to compare dietary corn starch (CS) or tapioca starch (TS), with or without being pre-gelatinized (PG), on the growth, feeding efficiencies, plasma and muscle biochemistry, intestinal short chain fatty acids (SCFA), and liver glycogen of triplicate groups of 20 red hybrid tilapia (Orecohromis sp.). Various pellet characteristics were evaluated, along with their surface and cross sectional microstructure. The PG diets had significantly higher water stability, bulk density, and protein solubility, along with a smoother surface. Tilapia fed the TS diet had lower growth than had all other tilapia, but were significantly improved when diet was pre-gelatinized. In the PG treatments, intestinal SCFA significantly decreased while plasma glucose, cholesterol and triglycerides, as well as liver glycogen, significantly increased. Fish fed the CS diet had significantly more long chain polyunsaturated fatty acid than had those fed by other treatments. Pre-gelatinization may improve fish productivity and offer greater flexibility during aquafeed production. Copyright © 2017 Elsevier Ltd. All rights reserved.

Preventing Child Maltreatment and Crime with Prenatal and Infancy Support of Parents: The Nurse-Family Partnership

PubMed Central

OLDS, DAVID L.

2010-01-01

Pregnancy and the early years of the child’s life offer an opportune time to prevent a host of adverse maternal and child outcomes that are important in their own right, but that also have significant implications for the development of criminal behaviour. This paper summarizes a 30-year programme of research that has attempted to improve the health and development of mothers and infants and their future life prospects with prenatal and infancy home visiting by nurses. The programme, known today as the Nurse-Family Partnership, is designed for low-income mothers who have had no previous live births. The home visiting nurses have three major goals: to improve the outcomes of pregnancy by helping women improve their prenatal health; to improve the child’s health and development by helping parents provide more sensitive and competent care of the child; and to improve parental life-course by helping parents plan future pregnancies, complete their educations, and find work. Given consistent effects on prenatal health behaviours, parental care of the child, child abuse and neglect, child health and development, maternal life-course, and criminal involvement of the mothers and children, the programme is now being offered for public investment throughout the United States, where careful attention is being given to ensuring that the programme is being conducted in accordance with the programme model tested in the randomized trials. The programme also is being adapted, developed, and tested in five countries outside of the US: the Netherlands, Germany, England, Australia, and Canada, where programmatic adjustments are being made to accommodate different populations served and health and human service contexts. We believe it is important to test this programme in randomized controlled trials in these new settings before it is offered for public investment. PMID:20885797

New agents in the treatment of premature ejaculation.

PubMed

McMahon, Chris G; McMahon, Chelsea N; Leow, Liang Joo

2006-12-01

Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggest that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have "definite" PE, while men with IELTs between 1 and 1.5 minutes have "probable" PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors (SSRIs) offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains and is well tolerated. Investigational drugs such as the ejaculo-selective serotonin transport inhibitors (ESSTIs) such as dapoxetine and UK-390,957 represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control, and sexual satisfaction with minimal adverse effects.

New agents in the treatment of premature ejaculation

PubMed Central

McMahon, Chris G; McMahon, Chelsea N; Leow, Liang Joo

2006-01-01

Premature ejaculation (PE) is a common male sexual disorder. Recent normative data suggest that men with an intravaginal ejaculatory latency time (IELT) of less than 1 minute have “definite” PE, while men with IELTs between 1 and 1.5 minutes have “probable” PE. Although there is insufficient empirical evidence to identify the etiology of PE, there is limited correlational evidence to suggest that men with PE have high levels of sexual anxiety and inherited altered sensitivity of central 5-HT (serotonin) receptors. Pharmacological modulation of the ejaculatory threshold using off-label daily or on-demand selective serotonin re-uptake inhibitors (SSRIs) offers patients a high likelihood of achieving improved ejaculatory control within a few days of initiating treatment, consequential improvements in sexual desire and other sexual domains and is well tolerated. Investigational drugs such as the ejaculo-selective serotonin transport inhibitors (ESSTIs) such as dapoxetine and UK-390,957 represent a major development in sexual medicine. These drugs offer patients the convenience of on-demand dosing, significant improvements in IELT, ejaculatory control, and sexual satisfaction with minimal adverse effects. PMID:19412497

Electrochemical, H2O2-Boosted Catalytic Oxidation System

NASA Technical Reports Server (NTRS)

Akse, James R.; Thompson, John O.; Schussel, Leonard J.

2004-01-01

An improved water-sterilizing aqueous-phase catalytic oxidation system (APCOS) is based partly on the electrochemical generation of hydrogen peroxide (H2O2). This H2O2-boosted system offers significant improvements over prior dissolved-oxygen water-sterilizing systems in the way in which it increases oxidation capabilities, supplies H2O2 when needed, reduces the total organic carbon (TOC) content of treated water to a low level, consumes less energy than prior systems do, reduces the risk of contamination, and costs less to operate. This system was developed as a variant of part of an improved waste-management subsystem of the life-support system of a spacecraft. Going beyond its original intended purpose, it offers the advantage of being able to produce H2O2 on demand for surface sterilization and/or decontamination: this is a major advantage inasmuch as the benign byproducts of this H2O2 system, unlike those of systems that utilize other chemical sterilants, place no additional burden of containment control on other spacecraft air- or water-reclamation systems.

Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings

PubMed Central

Robitaille, Yvonne; Laforest, Sophie; Fournier, Michel; Gauvin, Lise; Parisien, Manon; Corriveau, Hélène; Trickey, Francine; Damestoy, Nicole

2005-01-01

Objectives. We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. Methods. The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. Results. Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. Conclusion. Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls. PMID:16195514

Summary of: Regenerative endodontics.

PubMed

Clark, Stephen J

2014-03-01

Significant advances in our understanding of the biological processes involved in tooth development and repair at the cellular and molecular levels have underpinned the newly emerging area of regenerative endodontics. Development of treatment protocols based on exploiting the natural wound healing properties of the dental pulp and applying tissue engineering principles has allowed reporting of case series showing preservation of tissue vitality and apexogenesis. To review current case series reporting regenerative endodontics. Current treatment approaches tend to stimulate more reparative than regenerative responses in respect of the new tissue generated, which often does not closely resemble the physiological structure of dentine-pulp. However, despite these biological limitations, such techniques appear to offer significant promise for improved treatment outcomes. Improved biological outcomes will likely emerge from the many experimental studies being reported and will further contribute to improvements in clinical treatment protocols.

Cellular logic array for computation of squares

NASA Technical Reports Server (NTRS)

Shamanna, M.; Whitaker, S.; Canaris, J.

1991-01-01

A cellular logic array is described for squaring binary numbers. This array offers a significant increase in speed, with a relatively small hardware overhead. This improvement is a result of novel implementation of the formula (x + y)exp 2 = x(exp 2) + y(exp 2) + 2(x)(y). These results can also be incorporated in the existing arrays achieving considerable hardware reduction.

Metabolically Healthy Obesity: Personalised and Public Health Implications.

PubMed

Phillips, Catherine M

2016-04-01

Obesity is a heterogeneous condition; thus, metabolic abnormalities and cardiometabolic risk vary among obese individuals, with a significant proportion considered to be metabolically healthy. However, whether these individuals are truly healthy remains controversial and, therefore, a better understanding of such phenotypes may offer opportunities to improve current obesity diagnosis, intervention, and treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

Changing the Introductory IS Course to Improve Future Enrollments: An Irish Perspective

ERIC Educational Resources Information Center

Whelan, Eoin; Firth, David

2012-01-01

A significant challenge facing the IS discipline worldwide is the reversal of the low numbers of students currently enrolling in IS courses. While there is a growing body of literature which offers various insights into the IS enrollment crisis, almost all of this work is either from U.S. scholars or based on findings from U.S. universities. This…

A National Comparative Study Regarding Rural Special Education Delivery Systems Before and After Passage of PL 94-142.

ERIC Educational Resources Information Center

Helge, Doris; And Others

Despite problems, extraordinary progress has been made to provide a free and appropriate public education for handicapped students in rural America. A study of 75 school districts and cooperatives in 17 states revealed significant improvements in programs and services offered and types and ages of exceptional students served. Achievements included…

Training employees as a management attribute of successful companies.

PubMed

Khumalo, R

2001-12-01

This paper discusses training as an important attribute of successful companies and identified as characteristic of excellent Zimbabwean companies. Although confident this attribute contributes to successful performance by companies in which it is applied, it is possible that contributions could be more effective were all characteristics implemented collectively. However, the research suggests that training alone can offer significant improvement in employees' performance.

Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology.

PubMed

Robbins, Reuben N; Mellins, Claude A; Leu, Cheng-Shiun; Rowe, Jessica; Warne, Patricia; Abrams, Elaine J; Witte, Susan; Stein, Dan J; Remien, Robert H

2015-06-01

Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni-is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients, on antiretroviral therapy (ART) for at least 6 months, who were randomized to receive either Masivukeni or standard of care (SOC) counseling for ART non-adherence. At baseline, there were no significant differences between the SOC and Masivukeni groups on any outcome variables. At post-intervention (approximately 5-6 weeks after baseline), -clinic-based pill count adherence data available for 20 participants (10 per intervention arm) showed a 10 % improvement for-participants and a decrease of 8 % for SOC participants. Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants. Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia, computer-based technology can help lay counselors offer better adherence counseling than standard approaches.

Enhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology

PubMed Central

Robbins, Reuben N.; Mellins, Claude A.; Leu, Cheng-Shiun; Rowe, Jessica; Warne, Patricia; Abrams, Elaine J.; Witte, Susan; Stein, Dan J.; Remien, Robert H.

2015-01-01

Multimedia technologies offer powerful tools to increase capacity of health workers to deliver standardized, effective, and engaging antiretroviral medication adherence counseling. Masivukeni is an innovative multimedia-based, computer-driven, lay counselor-delivered intervention designed to help people living with HIV in resource-limited settings achieve optimal adherence. This pilot study examined medication adherence and key psychosocial outcomes among 55 non-adherent South African HIV+ patients, on ART for at least 6 months, who were randomized to receive either Masivukeni or standard of care (SOC) counseling for ART non-adherence. At baseline, there were no significant differences between the SOC and Masivukeni groups on any outcome variables. At post-intervention (approximately 5–6 weeks after baseline), clinic-based pill count adherence data available for 20 participants (10 per intervention arm) showed a 10% improvement for Masivukeni participants and a decrease of 8% for SOC participants. Masivukeni participants reported significantly more positive attitudes towards disclosure and medication social support, less social rejection, and better clinic-patient relationships than did SOC participants. Masivukeni shows promise to promote optimal adherence and provides preliminary evidence that multimedia, computer-based technology can help lay counselors offer better adherence counseling than standard approaches. PMID:25566763

Discrimination of natural and cultivated vegetation using Thematic Mapper spectral data

NASA Technical Reports Server (NTRS)

Degloria, Stephen D.; Bernstein, Ralph; Dizenzo, Silvano

1986-01-01

The availability of high quality spectral data from the current suite of earth observation satellite systems offers significant improvements in the ability to survey and monitor food and fiber production on both a local and global basis. Current research results indicate that Landsat TM data when used in either digital or analog formats achieve higher land-cover classification accuracies than MSS data using either comparable or improved spectral bands and spatial resolution. A review of these quantitative results is presented for both natural and cultivated vegetation.

Membrane-based torque magnetometer: Enhanced sensitivity by optical readout of the membrane displacement

NASA Astrophysics Data System (ADS)

Blankenhorn, M.; Heintze, E.; Slota, M.; van Slageren, J.; Moores, B. A.; Degen, C. L.; Bogani, L.; Dressel, M.

2017-09-01

The design and realization of a torque magnetometer is reported that reads the deflection of a membrane by optical interferometry. The compact instrument allows for low-temperature measurements of tiny crystals less than a microgram with a significant improvement in sensitivity, signal-to-noise ratio as well as data acquisition time compared with conventional magnetometry and offers an enormous potential for further improvements and future applications in different fields. Magnetic measurements on single-molecule magnets demonstrate the applicability of the membrane-based torque magnetometer.

Membrane-based torque magnetometer: Enhanced sensitivity by optical readout of the membrane displacement.

PubMed

Blankenhorn, M; Heintze, E; Slota, M; van Slageren, J; Moores, B A; Degen, C L; Bogani, L; Dressel, M

2017-09-01

The design and realization of a torque magnetometer is reported that reads the deflection of a membrane by optical interferometry. The compact instrument allows for low-temperature measurements of tiny crystals less than a microgram with a significant improvement in sensitivity, signal-to-noise ratio as well as data acquisition time compared with conventional magnetometry and offers an enormous potential for further improvements and future applications in different fields. Magnetic measurements on single-molecule magnets demonstrate the applicability of the membrane-based torque magnetometer.

Food supply and actions to improve dietary behaviour of students - a comparison between secondary schools participating or not participating in the 'Healthy School Canteen Program'.

PubMed

Milder, Ivon E J; Mikolajczak, Jochen; van den Berg, Saskia W; van de Veen-van Hofwegen, Madelon; Bemelmans, Wanda J E

2015-02-01

(i) To identify determinants of participation in the 'Healthy School Canteen Program', a programme that encourages schools to set up their canteen in a way that promotes healthy dietary behaviour. (ii) To compare food supply and actions between participating and non-participating schools. (iii) To investigate what reasons schools have to increase attention for nutrition in the curriculum. A cross-sectional study based on information from questionnaires performed in 2010/2011. All secondary schools (age group 12-18 years) in the Netherlands (n 1145). Response was 33 % (n 375). Analyses included all schools with a canteen in which food is offered (28 %, n 325). None of the investigated determinants was associated with participation. Participating schools offered significantly (P < 0·001) more of eleven inventoried healthy foods (e.g. sandwiches, (butter)milk, fruit, light soft drinks, yoghurt and salad) than non-participating schools. However, there was no difference in the number of less healthy products offered (e.g. candy bars, cakes and regular soft drinks). Participating schools reported more often that they took actions to improve dietary behaviour and more often had a policy on nutrition. Participating schools more often increased attention for nutrition in the curriculum in recent years than non-participating schools (57 % v. 43 %, P = 0·01). Reported reasons were similar and included media attention, eating behaviour of students and 'overweight'. Schools that participate in the programme seemed to offer more healthy products in their canteens and took more actions to improve dietary behaviour than non-participating schools. However, at all schools less healthy foods were also available.

Wii-based movement therapy to promote improved upper extremity function post-stroke: a pilot study.

PubMed

Mouawad, Marie R; Doust, Catherine G; Max, Madeleine D; McNulty, Penelope A

2011-05-01

Virtual-reality is increasingly used to improve rehabilitation outcomes. The Nintendo Wii offers an in-expensive alternative to more complex systems. To investigate the efficacy of Wii-based therapy for post-stroke rehabilitation. Seven patients (5 men, 2 women, aged 42-83 years; 1-38 months post-stroke, mean 15.3 months) and 5 healthy controls (3 men, 2 women, aged 41-71 years) undertook 1 h of therapy on 10 consecutive weekdays. Patients progressively increased home practice to 3 h per day. Functional ability improved for every patient. The mean performance time significantly decreased per Wolf Motor Function Test task, from 3.2 to 2.8 s, and Fugl-Meyer Assessment scores increased from 42.3 to 47.3. Upper extremity range-of-motion increased by 20.1º and 14.33º for passive and active movements, respectively. Mean Motor Activity Log (Quality of Movement scale) scores increased from 63.2 to 87.5, reflecting a transfer of functional recovery to everyday activities. Balance and dexterity did not improve significantly. No significant change was seen in any of these measures for healthy controls, despite improved skill levels for Wii games. An intensive 2-week protocol resulted in significant and clinically relevant improvements in functional motor ability post-stroke. These gains translated to improvement in activities of daily living.

Improving Consumer Satisfaction with Addiction Treatment: An Analysis of Alumni Preferences.

PubMed

Sanghani, Ruchi M; Moler, Alexander K

2015-01-01

Objective. The primary objective of this investigation is to determine which individual and aggregate factors of residential addiction treatment centers are most significant influencers of alumni satisfaction. Design. Survey targeted alumni of residential addiction treatment facilities. Alumni were queried through a survey, which utilized Likert-scale matrices and binary response options: 379 respondents met the completion threshold. Alumni rated amenities and individual and group counseling factors; additionally, respondents provided feedback on two satisfaction proxies: cost worthiness and future recommendations. Descriptive and relational analyses were conducted, with the latter utilizing logistic regression models. Results. Individual factors' scores of group counseling, and overall aggregate group counseling score, are most enthusiastically positive. Group counseling is also the most significant influencer of satisfaction. Other significant influencers of satisfaction are met expectations for individual counseling and psychiatric care offerings. Conclusions. While individual counseling and facility amenities should not be ignored, group counseling may be the most significant influencer of alumni satisfaction. Long-term outcomes are not single-faceted; however, treatment providers should be encouraged to invest in high-quality group counseling offerings in order to best satisfy, and thereby empower, clients.

Improving Consumer Satisfaction with Addiction Treatment: An Analysis of Alumni Preferences

PubMed Central

Sanghani, Ruchi M.; Moler, Alexander K.

2015-01-01

Objective. The primary objective of this investigation is to determine which individual and aggregate factors of residential addiction treatment centers are most significant influencers of alumni satisfaction. Design. Survey targeted alumni of residential addiction treatment facilities. Alumni were queried through a survey, which utilized Likert-scale matrices and binary response options: 379 respondents met the completion threshold. Alumni rated amenities and individual and group counseling factors; additionally, respondents provided feedback on two satisfaction proxies: cost worthiness and future recommendations. Descriptive and relational analyses were conducted, with the latter utilizing logistic regression models. Results. Individual factors' scores of group counseling, and overall aggregate group counseling score, are most enthusiastically positive. Group counseling is also the most significant influencer of satisfaction. Other significant influencers of satisfaction are met expectations for individual counseling and psychiatric care offerings. Conclusions. While individual counseling and facility amenities should not be ignored, group counseling may be the most significant influencer of alumni satisfaction. Long-term outcomes are not single-faceted; however, treatment providers should be encouraged to invest in high-quality group counseling offerings in order to best satisfy, and thereby empower, clients. PMID:26483986

Responsibility for quality improvement and patient safety: hospital board and medical staff leadership challenges.

PubMed

Goeschel, Christine A; Wachter, Robert M; Pronovost, Peter J

2010-07-01

Concern about the quality and safety of health care persists, 10 years after the 1999 Institute of Medicine report To Err is Human. Despite growing awareness of quality and safety risks, and significant efforts to improve, progress is difficult to measure. Hospital leaders, including boards and medical staffs, are accountable to improve care, yet they often address this duty independently. Shared responsibility for quality and patient safety improvement presents unique challenges and unprecedented opportunities for boards and medical staffs. To capitalize on the pressure to improve, both groups may benefit from a better understanding of their synergistic potential. Boards should be educated about the quality of care provided in their institutions and about the challenges of valid measurement and accurate reporting. Boards strengthen their quality oversight capacity by recruiting physicians for vacant board seats. Medical staff members strengthen their role as hospital leaders when they understand the unique duties of the governing board. A quality improvement strategy rooted in synergistic efforts by the board and the medical staff may offer the greatest potential for safer care. Such a mutually advantageous approach requires a clear appreciation of roles and responsibilities and respect for differences. In this article, we review these responsibilities, describe opportunities for boards and medical staffs to collaborate as leaders, and offer recommendations for how boards and medical staff members can address the challenges of shared responsibility for quality of care.

Recent advances in multiple myeloma.

PubMed

Sjak-Shie, N N; Vescio, R A; Berenson, J R

2000-07-01

Multiple myeloma is the second most common hematologic malignancy, with approximately 15,000 new cases each year in the United States. Our understanding of the pathophysiology underlying myeloma continues to expand, but the cause of this plasma cell dyscrasia remains unclear. Though controversy remains regarding a possible viral cause of myeloma, evidence suggesting a role for the human herpesvirus-8 is mounting. The roles of cytogenetic abnormalities as well as aberrant angiogenesis and cytokine expression in the etiology of myeloma continue to be explored and may lead to future therapeutic strategies. Transplantation in myeloma is rarely curative but offers clinical benefit not only for young but possibly for older myeloma patients as well. Newer bisphosphonates may offer greater ease of administration, improved efficacy, and possibly even enhanced antitumor effect. Finally, thalidomide offers significant clinical benefit to patients with myeloma previously refractory to multiple agents, and its role in early stages of the disease is under investigation.

Systemic Therapy in Men With Metastatic Castration-Resistant Prostate Cancer: American Society of Clinical Oncology and Cancer Care Ontario Clinical Practice Guideline

PubMed Central

Basch, Ethan; Loblaw, D. Andrew; Oliver, Thomas K.; Carducci, Michael; Chen, Ronald C.; Frame, James N.; Garrels, Kristina; Hotte, Sebastien; Kattan, Michael W.; Raghavan, Derek; Saad, Fred; Taplin, Mary-Ellen; Walker-Dilks, Cindy; Williams, James; Winquist, Eric; Bennett, Charles L.; Wootton, Ted; Rumble, R. Bryan; Dusetzina, Stacie B.; Virgo, Katherine S.

2014-01-01

Purpose To provide treatment recommendations for men with metastatic castration-resistant prostate cancer (CRPC). Methods The American Society of Clinical Oncology and Cancer Care Ontario convened an expert panel to develop evidence-based recommendations informed by a systematic review of the literature. Results When added to androgen deprivation, therapies demonstrating improved survival, improved quality of life (QOL), and favorable benefit-harm balance include abiraterone acetate/prednisone, enzalutamide, and radium-223 (223Ra; for men with predominantly bone metastases). Improved survival and QOL with moderate toxicity risk are associated with docetaxel/prednisone. For asymptomatic/minimally symptomatic men, improved survival with unclear QOL impact and low toxicity are associated with sipuleucel-T. For men who previously received docetaxel, improved survival, unclear QOL impact, and moderate to high toxicity risk are associated with cabazitaxel/prednisone. Modest QOL benefit (without survival benefit) and high toxicity risk are associated with mitoxantrone/prednisone after docetaxel. No benefit and excess toxicity are observed with bevacizumab, estramustine, and sunitinib. Recommendations Continue androgen deprivation (pharmaceutical or surgical) indefinitely. Abiraterone acetate/prednisone, enzalutamide, or 223Ra should be offered; docetaxel/prednisone should also be offered, accompanied by discussion of toxicity risk. Sipuleucel-T may be offered to asymptomatic/minimally symptomatic men. For men who have experienced progression with docetaxel, cabazitaxel may be offered, accompanied by discussion of toxicity risk. Mitoxantrone may be offered, accompanied by discussion of limited clinical benefit and toxicity risk. Ketoconazole or antiandrogens (eg, bicalutamide, flutamide, nilutamide) may be offered, accompanied by discussion of limited known clinical benefit. Bevacizumab, estramustine, and sunitinib should not be offered. There is insufficient evidence to evaluate optimal sequences or combinations of therapies. Palliative care should be offered to all patients. PMID:25199761

Training directionally selective motion pathways can significantly improve reading efficiency

NASA Astrophysics Data System (ADS)

Lawton, Teri

2004-06-01

This study examined whether perceptual learning at early levels of visual processing would facilitate learning at higher levels of processing. This was examined by determining whether training the motion pathways by practicing leftright movement discrimination, as found previously, would improve the reading skills of inefficient readers significantly more than another computer game, a word discrimination game, or the reading program offered by the school. This controlled validation study found that practicing left-right movement discrimination 5-10 minutes twice a week (rapidly) for 15 weeks doubled reading fluency, and significantly improved all reading skills by more than one grade level, whereas inefficient readers in the control groups barely improved on these reading skills. In contrast to previous studies of perceptual learning, these experiments show that perceptual learning of direction discrimination significantly improved reading skills determined at higher levels of cognitive processing, thereby being generalized to a new task. The deficits in reading performance and attentional focus experienced by the person who struggles when reading are suggested to result from an information overload, resulting from timing deficits in the direction-selectivity network proposed by Russell De Valois et al. (2000), that following practice on direction discrimination goes away. This study found that practicing direction discrimination rapidly transitions the inefficient 7-year-old reader to an efficient reader.

The Visualization Toolkit (VTK): Rewriting the rendering code for modern graphics cards

NASA Astrophysics Data System (ADS)

Hanwell, Marcus D.; Martin, Kenneth M.; Chaudhary, Aashish; Avila, Lisa S.

2015-09-01

The Visualization Toolkit (VTK) is an open source, permissively licensed, cross-platform toolkit for scientific data processing, visualization, and data analysis. It is over two decades old, originally developed for a very different graphics card architecture. Modern graphics cards feature fully programmable, highly parallelized architectures with large core counts. VTK's rendering code was rewritten to take advantage of modern graphics cards, maintaining most of the toolkit's programming interfaces. This offers the opportunity to compare the performance of old and new rendering code on the same systems/cards. Significant improvements in rendering speeds and memory footprints mean that scientific data can be visualized in greater detail than ever before. The widespread use of VTK means that these improvements will reap significant benefits.

Training for Template Creation: A Performance Improvement Method

ERIC Educational Resources Information Center

Lyons, Paul

2008-01-01

Purpose: There are three purposes to this article: first, to offer a training approach to employee learning and performance improvement that makes use of a step-by-step process of skill/knowledge creation. The process offers follow-up opportunities for skill maintenance and improvement; second, to explain the conceptual bases of the approach; and…

Rapid and simple method of photobleaching to reduce background autofluorescence in lung tissue sections.

PubMed

Kumar, B Santhosh; Sandhyamani, S; Nazeer, Shaiju S; Jayasree, R S

2015-02-01

Autofluorescence exhibited by tissues often interferes with immunofluorescence. Using imaging and spectral analysis, we observed remarkable reduction of autofluorescence of formalin fixed paraffin embedded tissues irradiated with light prior to incubation with immunofluorescent dyes. The technique of photobleaching offers significant improvement in the quality and specificity of immunofluorescence. This has the potential for better techniques for disease diagnosis.

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

M. Hoeschele, M. Seitzler

Heat pump water heaters offer a significant opportunity to improve water heating performance for the over 40% of U.S. households that heat domestic hot water using electric resistance storage water heaters. Numerous field studies have also been completed documenting performance in a variety of climates and applications. More recent evaluation efforts have focused attention on the performance of May through September 2014, with ongoing winter monitoring being sponsored by California utility partners.

Increasing Impact of Coursework Through Deep Analytics

NASA Astrophysics Data System (ADS)

Horodyskyj, L.; Schonstein, D.; Buxner, S.; Semken, S. C.; Anbar, A. D.

2014-12-01

Over the past few years, ASU has developed the online astrobiology lab course Habitable Worlds, which has been offered to over 1,500 students over seven semesters. The course is offered through Smart Sparrow's intelligent tutoring system, which records student answers, time on question, simulation setups, and additional data that we refer to as "analytics". As the development of the course has stabilized, we have been able to devote more time to analyzing these data, extracting patterns of student behavior and how they have changed as the course has developed. During the most recent two semesters, pre- and post-tests of content knowledge related to the greenhouse effect were administered to assess changes in students' knowledge. The results of the Fall 2013 content assessment and an analysis of each step of every activity using the course platform analytics were used to identify problematic concepts and lesson elements, which were redesigned for the following semester. We observed a statistically significant improvement from pre to post instruction in Spring 2014. Preliminary results seem to indicate that several interactive activities, which replaced written/spoken content, contributed to this positive outcome. Our study demonstrates the benefit of deep analytics for thorough analysis of student results and quick iteration, allowing for significantly improved exercises to be redeployed quickly. The misconceptions that students have and retain depend on the individual student, although certain patterns do emerge in the class as a whole. These patterns can be seen in student discussion board behavior, the types of answers they submit, and the patterns of mistakes they make. By interrogating this wealth of data, we seek to identify the patterns that outstanding, struggling, and failing students display and how early in the class these patterns can be detected. If these patterns can be identified and detected early in the semester, instructors can intervene earlier, prodding unmotivated students while devoting significant attention to students who struggle yet remain interested in the subject matter. This offers a marked improvement over the more common practice of waiting (often futilely) for students to seek help.

Mind-Body Skills Training for Resident Wellness: A Pilot Study of a Brief Mindfulness Intervention.

PubMed

Romcevich, Laura E; Reed, Suzanne; Flowers, Stacy R; Kemper, Kathi J; Mahan, John D

2018-01-01

Interventions to address burnout include mind-body skills training (MBST), but few studies have evaluated the feasibility of MBST for busy pediatric residents. In this pilot study, we tested the feasibility of a brief MBST intervention, using in-person peer-led training supported by online modules, to decrease stress and burnout in pediatric resident physicians. Of 99 (10%) residents, 10 residents at Nationwide Children's Hospital in Ohio participated in up to four 90-minute MBST sessions more than 1 month, led by a co-resident with 5 years of informal training in mind-body skills. Participants were offered 8 assigned online modules through OSU Center for Integrative Health and Wellness. Measures including Maslach Burnout Inventory (MBI), Cohen's Perceived Stress, Smith's Brief Resilience, Cognitive and Affective Mindfulness Scale-Revised, and Neff's Self-Compassion Scale (NSS) were administered before (T1) and after (T2) the course. Participants were offered optional monthly "maintenance" sessions for 6 months and completed a third set of measures at this follow-up (T3). The residents completed an average of 4.3/8 online modules and attended an average of 2.8/4 in-person sessions. There was significant improvement in positive attitude, perceived stress, and resilience post intervention (T2). Follow-up evaluation (T3) also demonstrated significant improvement in burnout (depersonalization) and mindfulness. More than 75% of participants found the course worthwhile. A short mixed-method mindfulness-based skills course may be a practical way to offer resilience and stress management training to busy resident physicians.

Effects of flexibility and aspect ratio on the aerodynamic performance of flapping wings.

PubMed

Fu, Junjiang; Liu, Xiaohui; Shyy, Wei; Qiu, Huihe

2018-03-14

In the current study, we experimentally investigated the flexibility effects on the aerodynamic performance of flapping wings and the correlation with aspect ratio at angle of attack α  =  45°. The Reynolds number based on the chord length and the wing tip velocity is maintained at Re  =  5.3  ×  10 3 . Our result for compliant wings with an aspect ratio of 4 shows that wing flexibility can offer improved aerodynamic performance compared to that of a rigid wing. Flexible wings are found to offer higher lift-to-drag ratios; in particular, there is significant reduction in drag with little compromise in lift. The mechanism of the flexibility effects on the aerodynamic performance is addressed by quantifying the aerodynamic lift and drag forces, the transverse displacement on the wings and the flow field around the wings. The regime of the effective stiffness that offers improved aerodynamic performance is quantified in a range of about 0.5-10 and it matches the stiffness of insect wings with similar aspect ratios. Furthermore, we find that the aspect ratio of the wing is the predominant parameter determining the flexibility effects of compliant wings. Compliant wings with an aspect ratio of two do not demonstrate improved performance compared to their rigid counterparts throughout the entire stiffness regime investigated. The correlation between wing flexibility effects and the aspect ratio is supported by the stiffness of real insect wings.

Daughters and mothers exercising together (DAMET): a 12-week pilot project designed to improve physical self-perception and increase recreational physical activity.

PubMed

Ransdell, L B; Dratt, J; Kennedy, C; O'Neill, S; DeVoe, D

2001-01-01

This paper presents the results of a 12-week single-sex, family-based physical activity intervention grounded in Social Cognitive Theory. Mother/daughter pairs and triads (n = 20) attended physical activity and classroom sessions twice weekly. Physiological data (VO2peak, height, and weight), psychological data (physical self-perception profile subscale scores), information about physical activity participation (PAP, d x wk(-1)) and qualitative impressions (QI) of the program were collected pre- and post-intervention. PAP and QI were also collected 6-months after completing the intervention. Although no significant increases in physical activity were reported, significant improvements in perceived sport competence, physical condition, and strength and muscularity were reported over time. The social cognitive theory, as used to plan this physical activity intervention, offered a promising theoretical perspective for facilitating improved physical self-perception in adolescent girls and their mothers.

Improving efficiency, reducing infection, and enhancing experience.

PubMed

Massa, Judith

For health professionals to make an informed choice and tailor each bed bath to the individual needs of the patient, they must firstly understand the different bed bath options available, their impact on skin integrity, and any associated risks they may pose to the patient in terms of cross-infection. Only with this knowledge can health professionals determine the appropriate form and frequency of the bed bath. Specialist wipes offer significant improvements in skin care and a reduced risk of cross-infection, compared with the traditional soap and water bed bath. Use of these wipes also improves the efficiency of the process, which links to the Productive Ward Initiative and results in clinical staff (i.e. nursing staff, healthcare assistants) having more time available to undertake additional patient care activities. This product focus highlights the benefits of moving to a wipe-based bed bath method, and the significant efficiency savings that can be realized as a result.

Treating sexual offenders with learning disabilities in the community: a critical review.

PubMed

Craig, Leam A; Stringer, Ian; Moss, Tania

2006-08-01

This study offers a critical review of a treatment group for sexual offenders with learning disabilities. The participants were diverted from criminal proceedings due to their level of cognitive functioning and attended a 7-month treatment program comprising of four main components: sex education, cognitive distortions, offending cycle, and relapse prevention. A number of psychometric assessments were administered immediately before and after intervention. Although no significant differences were found in attitudes toward sexual offending following treatment, the trend was for improvements in sex knowledge and honesty of sexual interest. Improvements in socialization skills (leisure time and interpersonal skills) were significant. No further incidents of sexual offending have been reported during a 12-month follow-up. A number of explanations for the nonsignificant improvement in attitudes are considered and recommendations for future treatment evaluation studies are made. The development of specific questionnaires and treatment programs for sexual offenders with learning disabilities is discussed.

Effects on presenteeism and absenteeism from a 1-year workplace randomized controlled trial among health care workers.

PubMed

Christensen, Jeanette Reffstrup; Overgaard, Kristian; Hansen, Klaus; Søgaard, Karen; Holtermann, Andreas

2013-10-01

It is unknown whether workplace interventions successfully improving health outcomes can also provide concurrent improvements in presenteeism and absenteeism. A 1-year cluster randomized controlled trial was conducted on 144 employees at a care unit in Denmark. The intervention consisted of calorie-limited diet, physical exercise, and cognitive behavioral training during working hours 1 hour per week. The reference group was offered presentations about healthy lifestyle. Absenteeism and presenteeism (productivity, workability, and sickness absence) were recorded at baseline and after 3 and 12 months of intervention. In intention-to-treat analysis, a significant effect of the intervention was found for productivity after 3 months. Nevertheless, after 12 months no significant effects on absenteeism or presenteeism were found. This study suggests that a worksite intervention, despite successfully reducing overweight, does not induce lasting improvements on absenteeism or presenteeism.

Effect of calcium with and without probiotic, lactose, or both on organ and body weights, immune response and caecal microbiota in moulted laying hens.

PubMed

Dastar, B; Khosravi, A; Boldajie, F; Ghoorchi, T

2016-04-01

A total of 72 laying hens were used to investigate the effect of probiotic and lactose on body weight loss, tibia ash, antibody production against sheep red blood cell (SRBC), heterophile-to-lymphocyte (H/L) ratio and gut microbiota in a common moulting method for 14 d. Hens were randomly allocated to 6 experimental groups consisting of (i) full feed (FF), (ii) feed withdrawal (FW), (iii) FW with calcium (Ca), (iv) FW with Ca and offering 7 g/lit lactose in drinking water (CaL), (v) FW with Ca and offering 1 g/lit probiotic in drinking water (CaP), and (vi) FW with Ca and offering a mixture of lactose and probiotic in drinking water (CaLP). The results showed body weight loss in all FW groups were more than 25% that was significantly higher than FF group (p < 0.05). The relative organ weights of hens in FW groups were lower than FF group; especially, it was significant for liver and ovary (p < 0.05). No significant difference was observed between all groups for tibia ash. The highest H/L ratio was related to FW group and offering Ca and lactose numerically and probiotic alone significantly resulted in decrease of this ratio (p < 0.05). The results also showed no significant difference for antibody production against SRBC among experimental groups. The highest coliform bacteria numeration observed in FW group and lactose could significantly reduce this population (p < 0.05). Lactic acid bacteria (LAB) numeration demonstrated a significant difference among treatments, so that FF hens had higher LAB than others (p < 0.05). In addition, FW moulted hens had significantly lower LAB compared to other moulted hens (p < 0.05), except for Ca group. In conclusion, probiotic and lactose was effective in maintaining caecal microbiota balance and improving immunity in hens exposed to moulting. Journal of Animal Physiology and Animal Nutrition © 2015 Blackwell Verlag GmbH.

Does communication help people coordinate?

PubMed Central

2017-01-01

Theoretical and experimental investigations have consistently demonstrated that collective performance in a variety of tasks can be significantly improved by allowing communication. We present the results of the first experiment systematically investigating the value of communication in networked consensus. The goal of all tasks in our experiments is for subjects to reach global consensus, even though nodes can only observe choices of their immediate neighbors. Unlike previous networked consensus tasks, our experiments allow subjects to communicate either with their immediate neighbors (locally) or with the entire network (globally). Moreover, we consider treatments in which essentially arbitrary messages can be sent, as well as those in which only one type of message is allowed, informing others about a node’s local state. We find that local communication adds minimal value: fraction of games solved is essentially identical to treatments with no communication. Ability to communicate globally, in contrast, offers a significant performance improvement. In addition, we find that constraining people to only exchange messages about local state is significantly better than unconstrained communication. We observe that individual behavior is qualitatively consistent across settings: people clearly react to messages they receive in all communication settings. However, we find that messages received in local communication treatments are relatively uninformative, whereas global communication offers substantial information advantage. Exploring mixed communication settings, in which only a subset of agents are global communicators, we find that a significant number of global communicators is needed for performance to approach success when everyone communicates globally. However, global communicators have a significant advantage: a small tightly connected minority of globally communicating nodes can successfully steer outcomes towards their preferences, although this can be significantly mitigated when all other nodes have the ability to communicate locally with their neighbors. PMID:28178295

Characterisation and Modification of Thermally Stable High Explosives for Laser Flyer Applications

NASA Astrophysics Data System (ADS)

Parker, A.; Claridge, R. P.; Proud, W. G.; Johnson, N. A.

2007-12-01

Laser initiation offers improved weapon survivability, versatility and greater Insensitive Munitions (IM) compliance. Detonators based on laser-driven flyers are less vulnerable to electrical initiation and can be based on insensitive secondary explosives. Additionally, this technology will offer advantages in terms of improved flexibility and reliability. Hexanitrostilbene (HNS) and nonanitro-m-terphenyl (NONA) were selected for investigation at QinetiQ as their increased thermal stability over conventional explosives makes them ideal candidates for use in insensitive munition compliant applications. The response of these materials to short duration high-amplitude shock impulses provided by exploding foil initiators (EFI), the electrical equivalent of a laser-driven flyer system, was investigated. Preparation techniques including sonication and the incorporation of additives were used to sensitize the materials to flyer impact, yet maintain their insensitivity to external hazards. Sonication significantly reduced the particle size of both HNS and NONA. The reduced-size explosives exhibited increased sensitivity to EFI impact than the starting materials.

Use of ultrasounds in the food industry-Methods and effects on quality, safety, and organoleptic characteristics of foods: A review.

PubMed

Arvanitoyannis, Ioannis S; Kotsanopoulos, Konstantinos V; Savva, Amalia G

2017-01-02

The use of ultrasounds has recently gained significant interest in the food industry mainly due to the new trends of consumers toward functional foods. Offering several advantages, this form of energy can be applied for the improvement of qualitative characteristics of high-quality foods as well as for assuring safety of a vast variety of foodstuffs, and at the same time minimizing any negative effects of the sensory characteristics of foods. Furthermore, the non-destructive nature of this technology offers several opportunities for the compositional analysis of foods. However, further research is required for the improvement of related techniques and the reduction of application costs in order to render this technology efficient for industrial use. This review paper covers the main applications of ultrasounds as well as several advantages of the use of the technology in combination with conventional techniques. The effects of ultrasounds on the characteristics, microbial safety, and quality of several foods are also detailed.

Predicting subscriber dissatisfaction and improving retention in the wireless telecommunications industry.

PubMed

Mozer, M C; Wolniewicz, R; Grimes, D B; Johnson, E; Kaushansky, H

2000-01-01

Competition in the wireless telecommunications industry is fierce. To maintain profitability, wireless carriers must control churn, which is the loss of subscribers who switch from one carrier to another.We explore techniques from statistical machine learning to predict churn and, based on these predictions, to determine what incentives should be offered to subscribers to improve retention and maximize profitability to the carrier. The techniques include logit regression, decision trees, neural networks, and boosting. Our experiments are based on a database of nearly 47,000 U.S. domestic subscribers and includes information about their usage, billing, credit, application, and complaint history. Our experiments show that under a wide variety of assumptions concerning the cost of intervention and the retention rate resulting from intervention, using predictive techniques to identify potential churners and offering incentives can yield significant savings to a carrier. We also show the importance of a data representation crafted by domain experts. Finally, we report on a real-world test of the techniques that validate our simulation experiments.

A Communication Training Program to Encourage Speaking-Up Behavior in Surgical Oncology.

PubMed

D'Agostino, Thomas A; Bialer, Philip A; Walters, Chasity B; Killen, Aileen R; Sigurdsson, Hrafn O; Parker, Patricia A

2017-10-01

Patient safety in the OR depends on effective communication. We developed and tested a communication training program for surgical oncology staff members to increase communication about patient safety concerns. In phase one, 34 staff members participated in focus groups to identify and rank factors that affect speaking-up behavior. We compiled ranked items into thematic categories that included role relations and hierarchy, staff rapport, perceived competence, perceived efficacy of speaking up, staff personality, fear of retaliation, institutional regulations, and time pressure. We then developed a communication training program that 42 participants completed during phase two. Participants offered favorable ratings of the usefulness and perceived effect of the training. Participants reported significant improvement in communicating patient safety concerns (t 40  = -2.76, P = .009, d = 0.48). Findings offer insight into communication challenges experienced by surgical oncology staff members and suggest that our training demonstrates the potential to improve team communication. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Cleaning the air and improving health with hydrogen fuel-cell vehicles.

PubMed

Jacobson, M Z; Colella, W G; Golden, D M

2005-06-24

Converting all U.S. onroad vehicles to hydrogen fuel-cell vehicles (HFCVs) may improve air quality, health, and climate significantly, whether the hydrogen is produced by steam reforming of natural gas, wind electrolysis, or coal gasification. Most benefits would result from eliminating current vehicle exhaust. Wind and natural gas HFCVs offer the greatest potential health benefits and could save 3700 to 6400 U.S. lives annually. Wind HFCVs should benefit climate most. An all-HFCV fleet would hardly affect tropospheric water vapor concentrations. Conversion to coal HFCVs may improve health but would damage climate more than fossil/electric hybrids. The real cost of hydrogen from wind electrolysis may be below that of U.S. gasoline.

Cleaning the Air and Improving Health with Hydrogen Fuel-Cell Vehicles

NASA Astrophysics Data System (ADS)

Jacobson, M. Z.; Colella, W. G.; Golden, D. M.

2005-06-01

Converting all U.S. onroad vehicles to hydrogen fuel-cell vehicles (HFCVs) may improve air quality, health, and climate significantly, whether the hydrogen is produced by steam reforming of natural gas, wind electrolysis, or coal gasification. Most benefits would result from eliminating current vehicle exhaust. Wind and natural gas HFCVs offer the greatest potential health benefits and could save 3700 to 6400 U.S. lives annually. Wind HFCVs should benefit climate most. An all-HFCV fleet would hardly affect tropospheric water vapor concentrations. Conversion to coal HFCVs may improve health but would damage climate more than fossil/electric hybrids. The real cost of hydrogen from wind electrolysis may be below that of U.S. gasoline.

Six Sigma in healthcare delivery.

PubMed

Liberatore, Matthew J

2013-01-01

The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

A novel pen-based Bluetooth-enabled insulin delivery system with insulin dose tracking and advice.

PubMed

Bailey, Timothy S; Stone, Jenine Y

2017-05-01

Diabetes is growing in prevalence internationally. As more individuals require insulin as part of their treatment, technology evolves to optimize delivery, improve adherence, and reduce dosing errors. Insulin pens outperform vial and syringe in simplicity, dosing accuracy, and user preference. Bolus advisors improve dosing confidence and treatment adherence. The InPen System offers a novel approach to treatment via a wireless pen that syncs to a mobile application featuring a bolus advisor, enabling convenient insulin dose tracking and more accurate bolus advice among other features. Areas covered: Existing technology for insulin delivery and bolus advice are reviewed. The mechanics and functionality of the InPen device are delineated. Findings from formative testing and usability studies of the InPen system are reported. Future directions for the InPen system in the treatment of diabetes are discussed. Expert opinion: Diabetes management is complex and largely data-driven. The InPen System offers a promising new opportunity to avail insulin pen-users of features known to improve treatment efficacy, which have otherwise primarily been available to those using pumps. Given that the majority of insulin users do not use insulin pumps, the InPen System is poised to improve glucose control in a significant portion of the diabetes population.

Religion's Effect on Mental Health in Schizophrenia: Examining the Roles of Meaning-Making and Seeking Social Support

PubMed Central

Tabak, Naomi T.; Weisman de Mamani, Amy

2015-01-01

While a growing body of research suggests that religion offers mental health benefits for individuals with schizophrenia, few studies have examined the mechanisms underlying this effect. The present study investigated two potential mediators (seeking social support and meaning-making coping) that may elucidate the nature of this relationship. The sample included 112 individuals with schizophrenia or schizoaffective disorder. Structural equation modeling was used to test whether religion was related to symptom severity and quality of life (QoL), and whether seeking social support and meaning-making coping mediated these effects. As expected, meaning-making coping significantly mediated the effect of intrinsic religion (use of religion as a framework to understand life) on QoL. While extrinsic religion (use of religion as a social convention) was associated with seeking social support, it did not relate to either outcome variable. Findings offer insight into the ways in which religion may improve the mental health of patients with schizophrenia. Results suggest that the adaptive elements of intrinsic religion seen in prior research may be explained by the meaning that religion offers. Clinical interventions that encourage patients to find meaning amidst adversity may improve QoL in this population. Future research would benefit from further investigation of the meaning-making process in individuals with schizophrenia. PMID:23428788

Initial Results With Image-guided Cochlear Implant Programming in Children.

PubMed

Noble, Jack H; Hedley-Williams, Andrea J; Sunderhaus, Linsey; Dawant, Benoit M; Labadie, Robert F; Camarata, Stephen M; Gifford, René H

2016-02-01

Image-guided cochlear implant (CI) programming can improve hearing outcomes for pediatric CI recipients. CIs have been highly successful for children with severe-to-profound hearing loss, offering potential for mainstreamed education and auditory-oral communication. Despite this, a significant number of recipients still experience poor speech understanding, language delay, and, even among the best performers, restoration to normal auditory fidelity is rare. Although significant research efforts have been devoted to improving stimulation strategies, few developments have led to significant hearing improvement over the past two decades. Recently introduced techniques for image-guided CI programming (IGCIP) permit creating patient-customized CI programs by making it possible, for the first time, to estimate the position of implanted CI electrodes relative to the nerves they stimulate using CT images. This approach permits identification of electrodes with high levels of stimulation overlap and to deactivate them from a patient's map. Previous studies have shown that IGCIP can significantly improve hearing outcomes for adults with CIs. The IGCIP technique was tested for 21 ears of 18 pediatric CI recipients. Participants had long-term experience with their CI (5 mo to 13 yr) and ranged in age from 5 to 17 years old. Speech understanding was assessed after approximately 4 weeks of experience with the IGCIP map. Using a two-tailed Wilcoxon signed-rank test, statistically significant improvement (p < 0.05) was observed for word and sentence recognition in quiet and noise, as well as pediatric self-reported quality-of-life (QOL) measures. Our results indicate that image guidance significantly improves hearing and QOL outcomes for pediatric CI recipients.

The Implementation of Advanced Solar Array Technology in Future NASA Missions

NASA Technical Reports Server (NTRS)

Piszczor, Michael F.; Kerslake, Thomas W.; Hoffman, David J.; White, Steve; Douglas, Mark; Spence, Brian; Jones, P. Alan

2003-01-01

Advanced solar array technology is expected to be critical in achieving the mission goals on many future NASA space flight programs. Current PV cell development programs offer significant potential and performance improvements. However, in order to achieve the performance improvements promised by these devices, new solar array structures must be designed and developed to accommodate these new PV cell technologies. This paper will address the use of advanced solar array technology in future NASA space missions and specifically look at how newer solar cell technologies impact solar array designs and overall power system performance.

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

A.S. Larin; V.V. Demenko; V.L. Voitanik

In recent Giprokoks designs for the reconstruction of coke-sorting systems, high-productivity vibrational-inertial screens have been employed. This permits single-stage screening and reduction in capital and especially operating expenditures, without loss of coke quality. In two-stage screening, >80 mm coke (for foundry needs) is additionally separated, with significant improvement in quality of the metallurgical coke (25-80 mm). New designs for the reconstruction of coke-sorting systems employ mechanical treatment of the coke outside the furnace, which offers new scope for stabilization of coke quality and permits considerable improvement in mechanical strength and granulometric composition of the coke by mechanical crushing.

Leveraging strategic planning for improved financial performance.

PubMed

Zuckerman, A

2000-12-01

Healthcare providers increasingly are relying on strategic planning to guide the allocation of capital and other resources. Strategic planning helps identify and prioritize opportunities for financial improvement, particularly revenue-generating initiatives, which offer the greatest opportunity for significant long-term benefits. New revenue usually can be generated in one of five ways: increase market share, expand service area, fill gaps in the continuum of services, develop niche services where needed in the service area, and repackage existing services to address specific market segments. Once a strategic plan is implemented, it should be reviewed periodically and modified as necessary.

[Improving experimental teaching facilities and opening up of laboratories in order to raise experimental teaching quality of genetics].

PubMed

Xiao, Jian-Fu; Wu, Jian-Guo; Shi, Chun-Hai

2011-12-01

Advanced teaching facilities and the policy of opening laboratories to students play an important role in raising the quality in the experimental teaching of Genetics. This article introduces the superiority of some advanced instruments and equipment (such as digital microscope mutual laboratory system, flow cytometry, and NIRSystems) in the experimental teaching of genetics, and illustrates with examples the significance of exposing students to experiments in developing their creative consciousness and creative ability. This article also offers some new concepts on the further improvement upon teaching in the laboratory.

Advanced supersonic technology and its implications for the future

NASA Technical Reports Server (NTRS)

Driver, C.

1979-01-01

A brief overview of the NASA Supersonic Cruise Research (SCR) program is presented. The SCR program has identified significant improvements in the areas of aerodynamics, structures, propulsion, noise reduction, takeoff and landing procedures, and advanced configuration concepts. These improvements tend to overcome most of the problems which led to the cancellation of the National SST program. They offer the promise of an advanced SST family of aircraft which are environmentally acceptable, have flexible range-payload capability, and are economically viable. The areas of technology addressed by the SCR program have direct application to advanced military aircraft and to supersonic executive aircraft.

Foods and beverages offered in US public secondary schools through the National School Lunch Program from 2011-2013: Early evidence of improved nutrition and reduced disparities.

PubMed

Terry-McElrath, Yvonne M; O'Malley, Patrick M; Johnston, Lloyd D

2015-09-01

To present data on trends in foods and beverages offered through the National School Lunch Program (NSLP) in public middle and high schools in the years immediately preceding and following implementation of new NSLP standards. From 2011 to 2013, primary data collection through the annual Youth, Education, and Society study involved use of mailed questionnaires to obtain data on NSLP meals from schools attended by nationally representative samples of US 8(th), 10(th), and 12(th) grade students (N=792 middle schools and 751 high schools). Each school was weighted to represent the percentage of target grade students enrolled, thus allowing analyses examining changes over time in the percentage of students enrolled in (attending) schools with specified NSLP measure outcomes, as well as disparities in NSLP measures based on school characteristics. Significantly more US secondary students attended schools with specified NSLP measures in 2013 than in 2011; increases were observed at both middle and high school levels. Increase rates for some NSLP measures were moderated by school characteristics; where this was the case, moderating associations decreased prior NSLP nutrition environment disparities that were especially evident in smaller schools and schools with higher percentages of minority students. Meaningful improvements have been made in the nutritional content of NSLP meals offered to US secondary students; these improvements have reduced prior NSLP meal disparities associated with school characteristics. Schools will need continued help with implementation and compliance monitoring in order to have the best opportunity to improve the nutrition environments for US students. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving influenza vaccination rates in the workplace: a randomized trial.

PubMed

Nowalk, Mary Patricia; Lin, Chyongchiou J; Toback, Seth L; Rousculp, Matthew D; Eby, Charles; Raymund, Mahlon; Zimmerman, Richard K

2010-03-01

To minimize absenteeism resulting from influenza, employers frequently offer on-site influenza vaccination to employees. Yet the level of uptake of vaccine is low among working adults. This study was designed to increase workplace influenza vaccination rates by offering both a choice of intranasal (LAIV) and injectable (TIV) influenza vaccines to eligible employees, and an incentive for being vaccinated, and by increasing awareness of the vaccine clinic. This study used a stratified randomized cluster trial. A total of 12,222 employees in 53 U.S. companies with previous influenza vaccine clinics were examined. Control sites advertised and offered vaccine clinics as previously done. Choice sites offered LAIV or TIV and maintained their previous advertising level but promoted the choice of vaccines. Choice Plus sites increased advertising and promoted and offered a choice of vaccines and a nominal incentive. These included vaccination rates among eligible employees. Hierarchic linear modeling (HLM) was used to determine factors associated with vaccination. The overall vaccination rate increased from 39% in 2007-2008 to 46% in 2008-2009 (p<0.001). The difference in vaccination rates for LAIV was 6.5% for Choice versus Control and 9.9% for Choice Plus versus Control (both p<0.001). Rates of TIV increased by 15.9 percentage points in the Choice Plus arm versus Control for workers aged > or =50 years (p=0.024). Rates of TIV did not change in workers aged 18-49 years in either intervention arm or in workers aged > or =50 years in the Choice arm. In HLM analyses, factors significantly associated with increased vaccination were older age, female gender, previous company vaccination rate, and the Choice Plus intervention. An incentive for vaccination, an intensified advertising campaign, and offering a choice of influenza vaccines improved vaccination rates in the workplace. Copyright (c) 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Treatment of vitiligo with the topical Janus kinase inhibitor ruxolitinib.

PubMed

Rothstein, Brooke; Joshipura, Deep; Saraiya, Ami; Abdat, Rana; Ashkar, Huda; Turkowski, Yana; Sheth, Vaneeta; Huang, Victor; Au, Shiu Chung; Kachuk, Courtney; Dumont, Nicole; Gottlieb, Alice B; Rosmarin, David

2017-06-01

Existing therapies for vitiligo are limited in efficacy and can be associated with undesirable side effects. Topical Janus kinase inhibitors may offer a new therapeutic option for vitiligo. We sought to assess the role of topical ruxolitinib 1.5% cream, a Janus kinase inhibitor, in vitiligo treatment. This 20-week, open-label, proof-of-concept trial of twice-daily topical ruxolitinib 1.5% cream was conducted in 12 patients with a minimum of 1% affected body surface area of vitiligo. The primary outcome was percent improvement in Vitiligo Area Scoring Index from baseline to week 20. Of 12 patients screened, 11 were enrolled and 9 completed the study (54.5% men; mean age, 52 years). Four patients with significant facial involvement at baseline had a 76% improvement in facial Vitiligo Area Scoring Index scores at week 20 (95% confidence interval, 53-99%; P = .001). A 23% improvement in overall Vitiligo Area Scoring Index scores was observed in all enrolled patients at week 20 (95% confidence interval, 4-43%; P = .02). Three of 8 patients responded on body surfaces and 1 of 8 patients responded on acral surfaces. Adverse events were minor, including erythema, hyperpigmentation, and transient acne. Limitations of the study include the small sample size and open-label study design. Topical ruxolitinib 1.5% cream provided significant repigmentation in facial vitiligo and may offer a valuable new treatment for vitiligo. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Blended Learning: The Student Viewpoint.

PubMed

Shantakumari, N; Sajith, P

2015-01-01

Blended learning (BL) is defined as "a way of meeting the challenges of tailoring learning and development to the needs of individuals by integrating the innovative and technological advances offered by online learning with the interaction and participation offered in the best of traditional learning." The Gulf Medical University (GMU), Ajman, UAE, offers a number of courses which incorporate BL with contact classes and online component on an E-learning platform. Insufficient learning satisfaction has been stated as an obstacle to its implementation and efficacy. To determine the students' perceptions toward BL which in turn will determine their satisfaction and the efficacy of the courses offered. This was a cross-sectional study conducted at the GMU, Ajman between January and December 2013. Perceptions of BL process, content, and ease of use were collected from 75 students enrolled in the certificate courses offered by the university using a questionnaire. Student perceptions were assessed using Mann-Whitney U-test and Kruskal-Wallis test on the basis of gender, age, and course enrollment. The median scores of all the questions in the three domains were above three suggesting positive perceptions on BL. The distribution of perceptions was similar between gender and age. However, significant differences were observed in the course enrollment (P = 0.02). Students hold a positive perception of the BL courses being offered in this university. The difference in perceptions among students of different courses suggest that the BL format offered needs modification according to course content to improve its perception.

Hierarchical Micro/Nano-Porous Acupuncture Needles Offering Enhanced Therapeutic Properties

NASA Astrophysics Data System (ADS)

in, Su-Ll; Gwak, Young S.; Kim, Hye Rim; Razzaq, Abdul; Lee, Kyeong-Seok; Kim, Hee Young; Chang, Suchan; Lee, Bong Hyo; Grimes, Craig A.; Yang, Chae Ha

2016-10-01

Acupuncture as a therapeutic intervention has been widely used for treatment of many pathophysiological disorders. For achieving improved therapeutic effects, relatively thick acupuncture needles have been frequently used in clinical practice with, in turn, enhanced stimulation intensity. However due to the discomforting nature of the larger-diameter acupuncture needles there is considerable interest in developing advanced acupuncture therapeutical techniques that provide more comfort with improved efficacy. So motivated, we have developed a new class of acupuncture needles, porous acupuncture needles (PANs) with hierarchical micro/nano-scale conical pores upon the surface, fabricated via a simple and well known electrochemical process, with surface area approximately 20 times greater than conventional acupuncture needles. The performance of these high-surface-area PANs is evaluated by monitoring the electrophysiological and behavioral responses from the in vivo stimulation of Shenmen (HT7) points in Wistar rats, showing PANs to be more effective in controlling electrophysiological and behavioral responses than conventional acupuncture needles. Comparative analysis of cocaine induced locomotor activity using PANs and thick acupuncture needles shows enhanced performance of PANs with significantly less pain sensation. Our work offers a unique pathway for achieving a comfortable and improved acupuncture therapeutic effect.

Hierarchical Micro/Nano-Porous Acupuncture Needles Offering Enhanced Therapeutic Properties

PubMed Central

In, Su-ll; Gwak, Young S.; Kim, Hye Rim; Razzaq, Abdul; Lee, Kyeong-Seok; Kim, Hee Young; Chang, SuChan; Lee, Bong Hyo; Grimes, Craig A.; Yang, Chae Ha

2016-01-01

Acupuncture as a therapeutic intervention has been widely used for treatment of many pathophysiological disorders. For achieving improved therapeutic effects, relatively thick acupuncture needles have been frequently used in clinical practice with, in turn, enhanced stimulation intensity. However due to the discomforting nature of the larger-diameter acupuncture needles there is considerable interest in developing advanced acupuncture therapeutical techniques that provide more comfort with improved efficacy. So motivated, we have developed a new class of acupuncture needles, porous acupuncture needles (PANs) with hierarchical micro/nano-scale conical pores upon the surface, fabricated via a simple and well known electrochemical process, with surface area approximately 20 times greater than conventional acupuncture needles. The performance of these high-surface-area PANs is evaluated by monitoring the electrophysiological and behavioral responses from the in vivo stimulation of Shenmen (HT7) points in Wistar rats, showing PANs to be more effective in controlling electrophysiological and behavioral responses than conventional acupuncture needles. Comparative analysis of cocaine induced locomotor activity using PANs and thick acupuncture needles shows enhanced performance of PANs with significantly less pain sensation. Our work offers a unique pathway for achieving a comfortable and improved acupuncture therapeutic effect. PMID:27713547

Tree biomass in the Swiss landscape: nationwide modelling for improved accounting for forest and non-forest trees.

PubMed

Price, B; Gomez, A; Mathys, L; Gardi, O; Schellenberger, A; Ginzler, C; Thürig, E

2017-03-01

Trees outside forest (TOF) can perform a variety of social, economic and ecological functions including carbon sequestration. However, detailed quantification of tree biomass is usually limited to forest areas. Taking advantage of structural information available from stereo aerial imagery and airborne laser scanning (ALS), this research models tree biomass using national forest inventory data and linear least-square regression and applies the model both inside and outside of forest to create a nationwide model for tree biomass (above ground and below ground). Validation of the tree biomass model against TOF data within settlement areas shows relatively low model performance (R 2 of 0.44) but still a considerable improvement on current biomass estimates used for greenhouse gas inventory and carbon accounting. We demonstrate an efficient and easily implementable approach to modelling tree biomass across a large heterogeneous nationwide area. The model offers significant opportunity for improved estimates on land use combination categories (CC) where tree biomass has either not been included or only roughly estimated until now. The ALS biomass model also offers the advantage of providing greater spatial resolution and greater within CC spatial variability compared to the current nationwide estimates.

Nutraceutical approaches to metabolic syndrome.

PubMed

Sirtori, Cesare R; Pavanello, Chiara; Calabresi, Laura; Ruscica, Massimiliano

2017-12-01

Metabolic Syndrome (MetS), affecting at least 30% of adults in the Western World, is characterized by three out of five variables, from high triglycerides, to elevated waist circumference and blood pressure. MetS is not characterized by elevated cholesterolemia, but is rather the consequence of a complex interaction of factors generally leading to increased insulin resistance. Drug treatments are of difficult handling, whereas well-characterized nutraceuticals may offer an effective alternative. Among these, functional foods, e.g. plant proteins, have been shown to improve insulin resistance and reduce triglyceride secretion. Pro- and pre-biotics, that are able to modify intestinal microbiome, reduce absorption of specific nutrients and improve the metabolic handling of energy-rich foods. Finally, specific nutraceuticals have proven to be of benefit, in particular, red-yeast rice, berberine, curcumin as well as vitamin D. All these can improve lipid handling by the liver as well as ameliorate insulin resistance. While lifestyle approaches, such as with the Mediterranean diet, may prove to be too complex for the single patient, better knowledge of selected nutraceuticals and more appropriate formulations leading to improved bioavailability will certainly widen the use of these agents, already in large use for the management of these very frequent patient groups. Key messages Functional foods, e.g. plant proteins, improve insulin resistance. Pro- and pre-biotics improve the metabolic handling of energy-rich foods. Nutraceutical can offer a significant help in handling MetS patients being part of lifestyle recommendations.

Evidential Reasoning in Expert Systems for Image Analysis.

DTIC Science & Technology

1985-02-01

techniques to image analysis (IA). There is growing evidence that these techniques offer significant improvements in image analysis , particularly in the...2) to provide a common framework for analysis, (3) to structure the ER process for major expert-system tasks in image analysis , and (4) to identify...approaches to three important tasks for expert systems in the domain of image analysis . This segment concluded with an assessment of the strengths

Educating Captains For War: Deliberately Designing Professional Military Education

DTIC Science & Technology

2015-05-23

CCC ) Curricula. Many researchers and scholars have written on the subject of education and offered insights on how to improve curricula based on...curricula were developed. Did the SALT deliberately and sufficiently develop current CCC curricula to enable captains to meet the demands of complex...the SALT underwent to design current CCC curricula, this monograph argues that the SALT used a deliberate design process and has significantly

Body Mass Index and Sociodemographic Predictors of School Lunch Purchase Behavior during a Year-Long Environmental Intervention in Middle School.

PubMed

Greece, Jacey A; Kratze, Alyssa; DeJong, William; Cozier, Yvette C; Quatromoni, Paula A

2015-06-10

Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children's diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI), sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students' food choice behaviors.

School-based obesity prevention programs: an evidence-based review.

PubMed

Kropski, Jonathan A; Keckley, Paul H; Jensen, Gordon L

2008-05-01

This review seeks to examine the effectiveness of school-based programs for reducing childhood overweight or obesity. A systematic review of the research literature published since 1990 was conducted to identify experimental or quasi-experimental school-based curricular or environmental preventive interventions, with evaluation>or=6 months after baseline, which reported outcomes in terms of a measure of overweight. Fourteen studies were identified, including one involving a nutrition-only program, two physical activity promotion interventions and eleven studies combining nutrition and physical activity components. Most studies (n=10) offered weak (grade 2) quality evidence. One study offered strong (grade 4) evidence reducing the odds ratio for overweight in girls only, while four grade 2 studies reported significant improvements in BMI or at-risk-for overweight or overweight prevalence in boys, girls, or both. Twelve studies reported significant improvement in at least one measure of dietary intake, physical activity, and/or sedentary behavior. Our ability to draw strong conclusions as to the efficacy of school-based obesity prevention programs is limited by the small number of published studies and by methodological concerns. Qualitative analysis suggests programs grounded in social learning may be more appropriate for girls, while structural and environmental interventions enabling physical activity may be more effective for boys. High-quality evaluation protocols should be considered essential components of future programs.

Body Mass Index and Sociodemographic Predictors of School Lunch Purchase Behavior during a Year-Long Environmental Intervention in Middle School

PubMed Central

Greece, Jacey A.; Kratze, Alyssa; DeJong, William; Cozier, Yvette C.; Quatromoni, Paula A.

2015-01-01

Modifying the school food environment is on the national agenda as one strategy to improve the nutritional quality of children’s diets. Because few environmental-level interventions have been rigorously evaluated, the evidence base to inform programs and policies is limited. Of concern is the impact that changes to cafeteria offerings will have on participation in school meal programs. This study evaluates school lunch participation in the setting of a year-long middle school cafeteria intervention by examining the association between body mass index (BMI), sociodemographics, and the purchases of school lunch meals. IMOVE meals were healthier choices that met stringent nutritional criteria and were offered alongside standard lunch meals. Students who were overweight had a significantly higher purchase rate for both types of meals compared to those with a healthy BMI. Non-white race, younger age, being male, and low-income status were also significantly associated with participation in school lunch. Results indicate that nutritionally vulnerable students participate in school lunch and are equally likely to buy healthy alternatives or standard meals. This behavioral observation has important implications for school foodservice programs and policies. These results are timely given recent federal legislation to improve the school food environment to influence students’ food choice behaviors. PMID:26067683

Iterated Gate Teleportation and Blind Quantum Computation.

PubMed

Pérez-Delgado, Carlos A; Fitzsimons, Joseph F

2015-06-05

Blind quantum computation allows a user to delegate a computation to an untrusted server while keeping the computation hidden. A number of recent works have sought to establish bounds on the communication requirements necessary to implement blind computation, and a bound based on the no-programming theorem of Nielsen and Chuang has emerged as a natural limiting factor. Here we show that this constraint only holds in limited scenarios, and show how to overcome it using a novel method of iterated gate teleportations. This technique enables drastic reductions in the communication required for distributed quantum protocols, extending beyond the blind computation setting. Applied to blind quantum computation, this technique offers significant efficiency improvements, and in some scenarios offers an exponential reduction in communication requirements.

Constructing an adaptive care model for the management of disease-related symptoms throughout the course of multiple sclerosis--performance improvement CME.

PubMed

Miller, Aaron E; Cohen, Bruce A; Krieger, Stephen C; Markowitz, Clyde E; Mattson, David H; Tselentis, Helen N

2014-01-01

Symptom management remains a challenging clinical aspect of MS. To design a performance improvement continuing medical education (PI CME) activity for better clinical management of multiple sclerosis (MS)-related depression, fatigue, mobility impairment/falls, and spasticity. Ten volunteer MS centers participated in a three-stage PI CME model: A) baseline assessment; B) practice improvement CME intervention; C) reassessment. Expert faculty developed performance measures and activity intervention tools. Designated MS center champions reviewed patient charts and entered data into an online database. Stage C data were collected eight weeks after implementation of the intervention and compared with Stage A baseline data to measure change in performance. Aggregate data from the 10 participating MS centers (405 patient charts) revealed performance improvements in the assessment of all four MS-related symptoms. Statistically significant improvements were found in the documented assessment of mobility impairment/falls (p=0.003) and spasticity (p<0.001). For documentation of care plans, statistically significant improvements were reported for fatigue (p=0.007) and mobility impairment/falls (p=0.040); non-significant changes were noted for depression and spasticity. Our PI CME interventions demonstrated performance improvement in the management of MS-related symptoms. This PI CME model (available at www.achlpicme.org/ms/toolkit) offers a new perspective on enhancing symptom management in patients with MS.

The Association between Insurance Status and Acceptance of Chlamydia Screening By Teenagers Who Present for Preventive Care Visits.

PubMed

Playforth, Krupa B; Coughlan, Alexandria; Upadhya, Krishna K

2016-02-01

The purpose of this study was to evaluate whether providers offer chlamydia screening to teenagers and/or whether screening is accepted at different rates depending on insurance type. Retrospective chart review. Academic center serving urban and suburban patients between April 2009 and October 2011. Nine hundred eighty-three health maintenance visits for asymptomatic, insured female adolescents aged 15-19 years. None. Dichotomous dependent variables of interest indicated whether chlamydia screening was: (1) offered; and (2) accepted. The key independent variable insurance type was coded as 'public' if Medicaid or Medicaid Managed Care and 'private' if a commercial plan. χ(2) and logistic regression analyses were used to assess the significance of differences in screening rates according to insurance type. Of asymptomatic health-maintenance visits 933 (95%) had a documented sexual history and 339 (34%) had a documented history of sexual activity. After excluding those who had a documented chlamydia screen in the 12 months before the visit (n = 79; 23%), 260 visits met eligibility for chlamydia screening. Only 169 (65%) of eligible visits had chlamydia screening offered and there was no difference in offer of screening according to insurance type. Significantly more visits covered by public insurance had chlamydia screening accepted (98%) than those covered by private insurance (82%). Controlling for demographic factors, the odds of accepted chlamydia screening was 8 times higher in visits covered by public insurance than those with private insurance. Although publically and privately insured teens were equally likely to be offered chlamydia screening, publically insured teens were significantly more likely to accept screening. Future research should investigate reasons for this difference in screening acceptance. These findings have implications for interventions to improve chlamydia screening because more adolescents are covered by parental insurance under the Affordable Care Act. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Black Art Posters, an Incentive to Increase Study Enrollment among Blacks in a Large Cohort Study

PubMed Central

Yancey, Antronette K.; Herring, R. Patti; Fraser, Gary E.; Yan, Ru; Baker, Phyllip; Lampkin, Andrew; Kyle, James

2009-01-01

Objective Black art posters were offered to replace or augment the established $10 incentive for questionnaire completion in a longitudinal cohort study. Method 81 churches located in the US southern region were divided between two intervention groups, with a control group of 24 churches from the same region. Primary outcome measures were study enrollment rates and questionnaire return rates between December 2003 and July 2004 as a proportion of church goal. Results 9.3% of participants returning questionnaires selected a poster in preference to $10. Half of participants offered both monetary and art incentives indicated a poster selection. Crude questionnaire return rates were 57.4% for the pooled intervention churches and 38.2% for the control churches. Enrollment rates among those offered both incentives were significantly higher (p<0.01) than when monetary incentives alone were offered after adjustment for church size, promotional dates, and average income of church members. Survey return rates were also higher in the churches offered both incentives (p=0.04). Conclusion These data suggest that the black art posters improved study enrollment and survey return rates. The relatively low rate of poster selection suggests that the art primarily influenced participation indirectly, by creating a more culturally inclusive image of the study. PMID:18234325

Potential Improvements to Remote Primary Productivity Estimation in the Southern California Current System

NASA Astrophysics Data System (ADS)

Jacox, M.; Edwards, C. A.; Kahru, M.; Rudnick, D. L.; Kudela, R. M.

2012-12-01

A 26-year record of depth integrated primary productivity (PP) in the Southern California Current System (SCCS) is analyzed with the goal of improving satellite net primary productivity (PP) estimates. The ratio of integrated primary productivity to surface chlorophyll correlates strongly to surface chlorophyll concentration (chl0). However, chl0 does not correlate to chlorophyll-specific productivity, and appears to be a proxy for vertical phytoplankton distribution rather than phytoplankton physiology. Modest improvements in PP model performance are achieved by tuning existing algorithms for the SCCS, particularly by empirical parameterization of photosynthetic efficiency in the Vertically Generalized Production Model. Much larger improvements are enabled by improving accuracy of subsurface chlorophyll and light profiles. In a simple vertically resolved production model, substitution of in situ surface data for remote sensing estimates offers only marginal improvements in model r2 and total log10 root mean squared difference, while inclusion of in situ chlorophyll and light profiles improves these metrics significantly. Autonomous underwater gliders, capable of measuring subsurface fluorescence on long-term, long-range deployments, significantly improve PP model fidelity in the SCCS. We suggest their use (and that of other autonomous profilers such as Argo floats) in conjunction with satellites as a way forward for improved PP estimation in coastal upwelling systems.

Exploring the potential uses of value-added metrics in the context of postgraduate medical education.

PubMed

Gregory, Simon; Patterson, Fiona; Baron, Helen; Knight, Alec; Walsh, Kieran; Irish, Bill; Thomas, Sally

2016-10-01

Increasing pressure is being placed on external accountability and cost efficiency in medical education and training internationally. We present an illustrative data analysis of the value-added of postgraduate medical education. We analysed historical selection (entry) and licensure (exit) examination results for trainees sitting the UK Membership of the Royal College of General Practitioners (MRCGP) licensing examination (N = 2291). Selection data comprised: a clinical problem solving test (CPST); a situational judgement test (SJT); and a selection centre (SC). Exit data was an applied knowledge test (AKT) from MRCGP. Ordinary least squares (OLS) regression analyses were used to model differences in attainment in the AKT based on performance at selection (the value-added score). Results were aggregated to the regional level for comparisons. We discovered significant differences in the value-added score between regional training providers. Whilst three training providers confer significant value-added, one training provider was significantly lower than would be predicted based on the attainment of trainees at selection. Value-added analysis in postgraduate medical education potentially offers useful information, although the methodology is complex, controversial, and has significant limitations. Developing models further could offer important insights to support continuous improvement in medical education in future.

Cognitive-behavioural suicide prevention for male prisoners: a pilot randomized controlled trial.

PubMed

Pratt, D; Tarrier, N; Dunn, G; Awenat, Y; Shaw, J; Ulph, F; Gooding, P

2015-12-01

Prisoners have an exceptional risk of suicide. Cognitive-behavioural therapy for suicidal behaviour has been shown to offer considerable potential, but has yet to be formally evaluated within prisons. This study investigated the feasibility of delivering and evaluating a novel, manualized cognitive-behavioural suicide prevention (CBSP) therapy for suicidal male prisoners. A pilot randomized controlled trial of CBSP in addition to treatment as usual (CBSP; n = 31) compared with treatment as usual (TAU; n = 31) alone was conducted in a male prison in England. The primary outcome was self-injurious behaviour occurring within the past 6 months. Secondary outcomes were dimensions of suicidal ideation, psychiatric symptomatology, personality dysfunction and psychological determinants of suicide, including depression and hopelessness. The trial was prospectively registered (number ISRCTN59909209). Relative to TAU, participants receiving CBSP therapy achieved a significantly greater reduction in suicidal behaviours with a moderate treatment effect [Cohen's d = -0.72, 95% confidence interval -1.71 to 0.09; baseline mean TAU: 1.39 (S.D. = 3.28) v. CBSP: 1.06 (S.D. = 2.10), 6 months mean TAU: 1.48 (S.D. = 3.23) v. CBSP: 0.58 (S.D. = 1.52)]. Significant improvements were achieved on measures of psychiatric symptomatology and personality dysfunction. Improvements on psychological determinants of suicide were non-significant. More than half of the participants in the CBSP group achieved a clinically significant recovery by the end of therapy, compared with a quarter of the TAU group. The delivery and evaluation of CBSP therapy within a prison is feasible. CBSP therapy offers significant promise in the prevention of prison suicide and an adequately powered randomized controlled trial is warranted.

The effectiveness of Pilates exercise in people with chronic low back pain: a systematic review.

PubMed

Wells, Cherie; Kolt, Gregory S; Marshall, Paul; Hill, Bridget; Bialocerkowski, Andrea

2014-01-01

To evaluate the effectiveness of Pilates exercise in people with chronic low back pain (CLBP) through a systematic review of randomised controlled trials (RCTs). A search for RCTs was undertaken using Medical Search Terms and synonyms for "Pilates" and "low back pain" within the maximal date range of 10 databases. Databases included the Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Medline; Physiotherapy Evidence Database; ProQuest: Health and Medical Complete, Nursing and Allied Health Source, Dissertation and Theses; Scopus; Sport Discus; Web of Science. Two independent reviewers were involved in the selection of evidence. To be included, relevant RCTs needed to be published in the English language. From 152 studies, 14 RCTs were included. Two independent reviewers appraised the methodological quality of RCTs using the McMaster Critical Review Form for Quantitative Studies. The author(s), year of publication, and details regarding participants, Pilates exercise, comparison treatments, and outcome measures, and findings, were then extracted. The methodological quality of RCTs ranged from "poor" to "excellent". A meta-analysis of RCTs was not undertaken due to the heterogeneity of RCTs. Pilates exercise provided statistically significant improvements in pain and functional ability compared to usual care and physical activity between 4 and 15 weeks, but not at 24 weeks. There were no consistent statistically significant differences in improvements in pain and functional ability with Pilates exercise, massage therapy, or other forms of exercise at any time period. Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise. Future research should explore optimal Pilates exercise designs, and whether some people with CLBP may benefit from Pilates exercise more than others.

Pharmacist-led, primary care-based disease management improves hemoglobin A1c in high-risk patients with diabetes.

PubMed

Rothman, Russell; Malone, Robb; Bryant, Betsy; Horlen, Cheryl; Pignone, Michael

2003-01-01

We developed and evaluated a comprehensive pharmacist-led, primary care-based diabetes disease management program for patients with Type 2 diabetes and poor glucose control at our academic general internal medicine practice. The primary goal of this program was to improve glucose control, as measured by hemoglobin A1c (HbA1c). Clinic-based pharmacists offered support to patients with diabetes through direct teaching about diabetes, frequent phone follow-up, medication algorithms, and use of a database that tracked patient outcomes and actively identified opportunities to improve care. From September 1999, to May 2000, 159 subjects were enrolled, and complete follow-up data were available for 138 (87%) patients. Baseline HbA1c averaged 10.8%, and after an average of 6 months of intervention, the mean reduction in HbA1c was 1.9 percentage points (95% confidence interval, 1.5-2.3). In predictive regression modeling, baseline HbA1c and new onset diabetes were associated with significant improvements in HbA1c. Age, race, gender, educational level, and provider status were not significant predictors of improvement. In conclusion, a pharmacist-based diabetes care program integrated into primary care practice significantly reduced HbA1c among patients with diabetes and poor glucose control.

Improving LC-MS sensitivity through increases in chromatographic performance: comparisons of UPLC-ES/MS/MS to HPLC-ES/MS/MS.

PubMed

Churchwell, Mona I; Twaddle, Nathan C; Meeker, Larry R; Doerge, Daniel R

2005-10-25

Recent technological advances have made available reverse phase chromatographic media with a 1.7 microm particle size along with a liquid handling system that can operate such columns at much higher pressures. This technology, termed ultra performance liquid chromatography (UPLC), offers significant theoretical advantages in resolution, speed, and sensitivity for analytical determinations, particularly when coupled with mass spectrometers capable of high-speed acquisitions. This paper explores the differences in LC-MS performance by conducting a side-by-side comparison of UPLC for several methods previously optimized for HPLC-based separation and quantification of multiple analytes with maximum throughput. In general, UPLC produced significant improvements in method sensitivity, speed, and resolution. Sensitivity increases with UPLC, which were found to be analyte-dependent, were as large as 10-fold and improvements in method speed were as large as 5-fold under conditions of comparable peak separations. Improvements in chromatographic resolution with UPLC were apparent from generally narrower peak widths and from a separation of diastereomers not possible using HPLC. Overall, the improvements in LC-MS method sensitivity, speed, and resolution provided by UPLC show that further advances can be made in analytical methodology to add significant value to hypothesis-driven research.

Impact of a Telehealth and Care Management Program on All-Cause Mortality and Healthcare Utilization in Patients with Heart Failure.

PubMed

Kao, David P; Lindenfeld, JoAnn; Macaulay, Dendy; Birnbaum, Howard G; Jarvis, John L; Desai, Urvi S; Page, Robert L

2016-01-01

Telehealth has the potential to improve chronic disease management and outcomes, but data regarding direct benefit of telehealth in patients with heart failure (HF) have been mixed. The objective of this study was to determine whether the Health Buddy Program (HBP) (Bosch Healthcare, Palo Alto, CA), a content-driven telehealth system coupled with care management, is associated with improved outcomes in Medicare beneficiaries with HF. This was a retrospective cohort study of 623 Medicare beneficiaries with HF offered HBP enrollment compared with a propensity score-matched control group of Medicare beneficiaries with HF from the Medicare 5% sample. Associations between availability of the HBP and all-cause mortality, hospitalization, hospital days, and emergency department visits were evaluated. Beneficiaries offered enrollment in the HBP had 24.9% lower risk-adjusted all-cause mortality over 3 years of follow-up (hazard ratio [HR] = 0.75; 95% confidence interval [CI], 0.63-0.89; p = 0.001). Patients who used the HBP at least once (36.9%) had 57.2% lower mortality compared with matched controls (HR = 0.43; 95% CI, 0.31-0.60; p < 0.001), whereas patients who did not use the HBP had no significant difference in survival (HR = 0.96; 95% CI, 0.78-1.19; p = 0.69). Patients offered the HBP also had fewer hospital admissions following enrollment (Δ = -0.05 admissions/quarter; p = 0.011), which was primarily observed in patients who used the HBP at least once (Δ = -0.10 admissions/quarter; p < 0.001). The HBP, a content-driven telehealth system coupled with care management, was associated with significantly better survival and reduced hospitalization in Medicare beneficiaries with HF. Prospective study is warranted to determine the mechanism of this association and opportunities for optimization.

Mind-Body Skills Training for Resident Wellness: A Pilot Study of a Brief Mindfulness Intervention

PubMed Central

Romcevich, Laura E; Reed, Suzanne; Flowers, Stacy R; Kemper, Kathi J; Mahan, John D

2018-01-01

Background: Interventions to address burnout include mind-body skills training (MBST), but few studies have evaluated the feasibility of MBST for busy pediatric residents. Objective: In this pilot study, we tested the feasibility of a brief MBST intervention, using in-person peer-led training supported by online modules, to decrease stress and burnout in pediatric resident physicians. Methods: Of 99 (10%) residents, 10 residents at Nationwide Children’s Hospital in Ohio participated in up to four 90-minute MBST sessions more than 1 month, led by a co-resident with 5 years of informal training in mind-body skills. Participants were offered 8 assigned online modules through OSU Center for Integrative Health and Wellness. Measures including Maslach Burnout Inventory (MBI), Cohen’s Perceived Stress, Smith’s Brief Resilience, Cognitive and Affective Mindfulness Scale-Revised, and Neff’s Self-Compassion Scale (NSS) were administered before (T1) and after (T2) the course. Participants were offered optional monthly “maintenance” sessions for 6 months and completed a third set of measures at this follow-up (T3). Results: The residents completed an average of 4.3/8 online modules and attended an average of 2.8/4 in-person sessions. There was significant improvement in positive attitude, perceived stress, and resilience post intervention (T2). Follow-up evaluation (T3) also demonstrated significant improvement in burnout (depersonalization) and mindfulness. More than 75% of participants found the course worthwhile. Conclusions: A short mixed-method mindfulness-based skills course may be a practical way to offer resilience and stress management training to busy resident physicians. PMID:29780891

Optimizing the electronic health record to standardize administration and documentation of nutritional supplements

PubMed Central

Citty, Sandra W.; Kamel, Amir; Garvan, Cynthia; Marlowe, Lee; Westhoff, Lynn

2017-01-01

Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription. This paper reports on a process improvement project that redesigned the ordering, administration and documentation process of oral nutritional supplements in the electronic health record. By adding nutritional products to the medication order sets and adding an electronic nutrition administration record (ENAR) tab, the multidisciplinary team sought to standardize nutritional supplement ordering, documentation and administration at prescribed intervals. This process improvement project used a triangulated approach to evaluating pre- and post-process change including: medical record reviews, patient interviews, and nutrition formula room log reports. Staff education and training was carried out prior to initiation of the system changes. This process change resulted in an average decrease in the return of unused nutritional formula from 76% returned at baseline to 54% post-process change. The process change resulted in 100% of nutritional supplement orders having documentation about nutritional medication administration and/or reason for non-administration. Documentation in the ENAR showed that 41% of ONS orders were given and 59% were not given. Significantly more patients reported being offered the ONS product (p=0.0001) after process redesign and more patients (5% before ENAR and 86% after ENAR reported being offered the correct type, amount and frequency of nutritional products (p=0.0001). ENAR represented an effective strategy to improve administration and documentation of nutritional supplements for hospitalized patients. PMID:28243439

Optimizing the electronic health record to standardize administration and documentation of nutritional supplements.

PubMed

Citty, Sandra W; Kamel, Amir; Garvan, Cynthia; Marlowe, Lee; Westhoff, Lynn

2017-01-01

Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription. This paper reports on a process improvement project that redesigned the ordering, administration and documentation process of oral nutritional supplements in the electronic health record. By adding nutritional products to the medication order sets and adding an electronic nutrition administration record (ENAR) tab, the multidisciplinary team sought to standardize nutritional supplement ordering, documentation and administration at prescribed intervals. This process improvement project used a triangulated approach to evaluating pre- and post-process change including: medical record reviews, patient interviews, and nutrition formula room log reports. Staff education and training was carried out prior to initiation of the system changes. This process change resulted in an average decrease in the return of unused nutritional formula from 76% returned at baseline to 54% post-process change. The process change resulted in 100% of nutritional supplement orders having documentation about nutritional medication administration and/or reason for non-administration. Documentation in the ENAR showed that 41% of ONS orders were given and 59% were not given. Significantly more patients reported being offered the ONS product (p=0.0001) after process redesign and more patients (5% before ENAR and 86% after ENAR reported being offered the correct type, amount and frequency of nutritional products (p=0.0001). ENAR represented an effective strategy to improve administration and documentation of nutritional supplements for hospitalized patients.

The psychosocial benefits of secondary hydroxyapatite orbital implant insertion and prosthesis wearing for patients with anophthalmia.

PubMed

Wang, Junming; Zhang, Hong; Chen, Wei; Li, Guigang

2012-01-01

Anophthalmia is associated with a range of psychosocial difficulties and hydroxyapatite orbital implant insertion and prosthesis wearing is the predominant rehabilitation therapy for anophthalmia. However, few articles have compared preoperative and postoperative psychosocial outcomes using standardized questionnaires. This study aimed to investigate the psychosocial benefits of hydroxyapatite orbital implant insertion and prosthesis wearing in this patient population. In all, 36 participants were tested preoperatively and 6-months postoperatively using standardized measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety and social avoidance (Derriford Appearance Scale-Short Form), and quality of life (World Health Organization Quality of Life Scale-Short Form). Before treatment, levels of depression were comparable with population norms; however, levels of general anxiety were slightly raised, levels of social anxiety, social avoidance, and quality of life were significantly poorer than population norms. Treatment resulted in significant improvement in psychosocial adjustment with improvements in all study variables for the participant group as a whole. Hydroxyapatite orbital implant insertion and prosthesis wearing offers significant improvements in psychological and physical functioning for patients with anophthalmia.

Addressing Compassion Fatigue and Stress of Special Education Teachers and Professional Staff Using Mindfulness and Prayer.

PubMed

Sharp Donahoo, Lori M; Siegrist, Beverly; Garrett-Wright, Dawn

2017-01-01

Alternative therapies are promising nursing interventions for improvement of compassion fatigue in educators working in special education. A convenience sample of 27 teachers and professional staff working in special education participated in a quasi-experimental pilot study and completed a pre/posttest of demographic questions, the Perceived Stress Scale (PSS) (10-item) and Professional Quality of Life (ProQOL). All attended a presentation on stress, compassion satisfaction (CS), mindfulness, prayer, and social support. Nearly, one half received weekly electronic text message reminders encouraging use of mindfulness and prayer. All were offered support groups. Use of alternative therapies was self-selected and self-reported. Significant improvement occurred in posttest PSS scores ( p = .0485) of participants with the highest reported levels of use of mindfulness. ProQOL CS scores ( p = .0289) and PSS scores ( p = .0244) significantly improved when evaluating difference in means between groups with the highest levels and lowest levels of prayer and mindfulness. ProQOL burnout scores ( p = <.0001) increased from pretest to posttest. Findings were not significant in regard to reminders and social support.

A novel tele-medical environment appropriate for use in tele-advisory and tele-surgery cases.

PubMed

Chatzipapadopoulos, F; Georgantas, N; Kotaras, A; Mamais, G; Tombros, S; Tselikis, G

1996-08-01

Tele-medical systems have been recently introduced in the field of networking as promising applications that can significantly improve the offering of medical treatment by providing services such as tele-advising, tele-surgery and remote monitoring in places where the presence of doctors or any medical specialists is difficult or time consuming. Some already existent networking models can be used for the establishment of a connection between the communicating sides. The offered network's security is also a significant factor. The present paper describes a software environment implementing a particular aspect of a tele-medical system. The developed system includes features such as direct communication between doctors and medical assistants, medical information acquisition and storing and high band information transfer in real-time. TCP/IP point-to-point protocol has been used for the implementation of the non bandwidth-critical connections. The application introduces novel features with the use of ATM connection for supporting the time-critical service of video transfer to and from the medical database.

The Knowledge Base for Achieving the Sustainable Development Goal Targets on Water Supply, Sanitation and Hygiene.

PubMed

Hutton, Guy; Chase, Claire

2016-05-27

Safe drinking water, sanitation, and hygiene (WASH) are fundamental to an improved standard of living. Globally, 91% of households used improved drinking water sources in 2015, while for improved sanitation it is 68%. Wealth disparities are stark, with rural populations, slum dwellers and marginalized groups lagging significantly behind. Service coverage is significantly lower when considering the new water and sanitation targets under the sustainable development goals (SDGs) which aspire to a higher standard of 'safely managed' water and sanitation. Lack of access to WASH can have an economic impact as much as 7% of Gross Domestic Product, not including the social and environmental consequences. Research points to significant health and socio-economic consequences of poor nutritional status, child growth and school performance caused by inadequate WASH. Groundwater over-extraction and pollution of surface water bodies have serious impacts on water resource availability and biodiversity, while climate change exacerbates the health risks of water insecurity. A significant literature documents the beneficial impacts of WASH interventions, and a growing number of impact evaluation studies assess how interventions are optimally financed, implemented and sustained. Many innovations in behavior change and service delivery offer potential for scaling up services to meet the SDGs.

Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation.

PubMed

Detweiler-Bedell, Jerusha B; Friedman, Michael A; Leventhal, Howard; Miller, Ivan W; Leventhal, Elaine A

2008-12-01

Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.

Integrating Co-Morbid Depression and Chronic Physical Disease Management: Identifying and Resolving Failures in Self-Regulation

PubMed Central

Detweiler-Bedell, Jerusha B.; Friedman, Michael A.; Leventhal, Howard; Miller, Ivan W.; Leventhal, Elaine A.

2008-01-01

Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes. PMID:18848740

Improving the recommender algorithms with the detected communities in bipartite networks

NASA Astrophysics Data System (ADS)

Zhang, Peng; Wang, Duo; Xiao, Jinghua

2017-04-01

Recommender system offers a powerful tool to make information overload problem well solved and thus gains wide concerns of scholars and engineers. A key challenge is how to make recommendations more accurate and personalized. We notice that community structures widely exist in many real networks, which could significantly affect the recommendation results. By incorporating the information of detected communities in the recommendation algorithms, an improved recommendation approach for the networks with communities is proposed. The approach is examined in both artificial and real networks, the results show that the improvement on accuracy and diversity can be 20% and 7%, respectively. This reveals that it is beneficial to classify the nodes based on the inherent properties in recommender systems.

Business Models for Training and Performance Improvement Departments

ERIC Educational Resources Information Center

Carliner, Saul

2004-01-01

Although typically applied to entire enterprises, the concept of business models applies to training and performance improvement groups. Business models are "the method by which firm[s] build and use [their] resources to offer.. value." Business models affect the types of projects, services offered, skills required, business processes, and type of…

Simplified Methods for Improving the Blast Resistance of Cold-Formed Steel Walls

DTIC Science & Technology

2011-01-01

sheathing products such as oriented strand board ( OSB ) offer a level of blast resistance that may be effective in mitigating lower-level blast...considered in order to keep designs to a minimum cost. Standard sheathing materials such as OSB , gypsum and plywood— as well as specially selected sheathing...commercially available clip connectors. Sheathing materials such as gypsum and OSB are brittle and have significantly lower capacity than sheet steel

More Fight-Less Fuel: Reducing Fuel Burn through Ground Process Improvement

DTIC Science & Technology

2013-06-01

These joint government and commercial air operations management suites are fast, accurate, and offer many of 33 same tools as SPADE. However, the U.S...passing hour of the day. Simulating the operations at an airfield is similar to a host of related operations management problems including restaurant...flight line may yield significant fuel and cost reductions. Focusing on the efficient use of ground resources through air operations management in a

Teaching ergonomics to nursing facility managers using computer-based instruction.

PubMed

Harrington, Susan S; Walker, Bonnie L

2006-01-01

This study offers evidence that computer-based training is an effective tool for teaching nursing facility managers about ergonomics and increasing their awareness of potential problems. Study participants (N = 45) were randomly assigned into a treatment or control group. The treatment group completed the ergonomics training and a pre- and posttest. The control group completed the pre- and posttests without training. Treatment group participants improved significantly from 67% on the pretest to 91% on the posttest, a gain of 24%. Differences between mean scores for the control group were not significant for the total score or for any of the subtests.

Comparative Evaluation of Recombinant Protein Production in Different Biofactories: The Green Perspective

PubMed Central

Capaldi, Stefano

2014-01-01

In recent years, the production of recombinant pharmaceutical proteins in heterologous systems has increased significantly. Most applications involve complex proteins and glycoproteins that are difficult to produce, thus promoting the development and improvement of a wide range of production platforms. No individual system is optimal for the production of all recombinant proteins, so the diversity of platforms based on plants offers a significant advantage. Here, we discuss the production of four recombinant pharmaceutical proteins using different platforms, highlighting from these examples the unique advantages of plant-based systems over traditional fermenter-based expression platforms. PMID:24745008

Barriers to Household Risk Management: Evidence from India.

PubMed

Cole, Shawn; Giné, Xavier; Tobacman, Jeremy; Townsend, Robert; Topalova, Petia; Vickery, James

2013-01-01

Why do many households remain exposed to large exogenous sources of non-systematic income risk? We use a series of randomized field experiments in rural India to test the importance of price and non-price factors in the adoption of an innovative rainfall insurance product. Demand is significantly price sensitive, but widespread take-up would not be achieved even if the product offered a payout ratio comparable to U.S. insurance contracts. We present evidence suggesting that lack of trust, liquidity constraints and limited salience are significant non-price frictions that constrain demand. We suggest contract design improvements to mitigate these frictions.

The treatment of female pattern hair loss and other applications of surgical hair restoration in women.

PubMed

Epstein, Jeffrey S

2004-05-01

In the specialty of surgical hair restoration, men comprise more than 90% of the patients treated; however, in the last few years the number of women undergoing the procedure has increased significantly. The reasons for this growth are many and include the increase in public awareness of the efficacy of hair transplantation from such sources as the media,the Internet, advertising and word of mouth. More importantly, advances in technique have significantly improved results, increasing the confidence level in women to undergo the procedure and in hair transplant specialists to offer it.

Impact and Costs of Incentives to Reduce Attrition in Online Trials: Two Randomized Controlled Trials

PubMed Central

Murray, Elizabeth; Kalaitzaki, Eleftheria; White, Ian R; McCambridge, Jim; Thompson, Simon G; Wallace, Paul; Godfrey, Christine

2011-01-01

Background Attrition from follow-up is a major methodological challenge in randomized trials. Incentives are known to improve response rates in cross-sectional postal and online surveys, yet few studies have investigated whether they can reduce attrition from follow-up in online trials, which are particularly vulnerable to low follow-up rates. Objectives Our objective was to determine the impact of incentives on follow-up rates in an online trial. Methods Two randomized controlled trials were embedded in a large online trial of a Web-based intervention to reduce alcohol consumption (the Down Your Drink randomized controlled trial, DYD-RCT). Participants were those in the DYD pilot trial eligible for 3-month follow-up (study 1) and those eligible for 12-month follow-up in the DYD main trial (study 2). Participants in both studies were randomly allocated to receive an offer of an incentive or to receive no offer of an incentive. In study 1, participants in the incentive arm were randomly offered a £5 Amazon.co.uk gift voucher, a £5 charity donation to Cancer Research UK, or entry in a prize draw for £250. In study 2, participants in the incentive arm were offered a £10 Amazon.co.uk gift voucher. The primary outcome was the proportion of participants who completed follow-up questionnaires in the incentive arm(s) compared with the no incentive arm. Results In study 1 (n = 1226), there was no significant difference in response rates between those participants offered an incentive (175/615, 29%) and those with no offer (162/611, 27%) (difference = 2%, 95% confidence interval [CI] –3% to 7%). There was no significant difference in response rates among the three different incentives offered. In study 2 (n = 2591), response rates were 9% higher in the group offered an incentive (476/1296, 37%) than in the group not offered an incentive (364/1295, 28%) (difference = 9%, 95% CI 5% to 12%, P < .001). The incremental cost per extra successful follow-up in the incentive arm was £110 in study 1 and £52 in study 2. Conclusion Whereas an offer of a £10 Amazon.co.uk gift voucher can increase follow-up rates in online trials, an offer of a lower incentive may not. The marginal costs involved require careful consideration. Trial registration ISRCTN31070347; http://www.controlled-trials.com/ISRCTN31070347 (Archived by WebCite at http://www.webcitation.org/5wgr5pl3s) PMID:21371988

Improving performance on core processes of care.

PubMed

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

Better quality of life in patients offered financial incentives for taking anti-psychotic medication: Linked to improved adherence or more money?

PubMed

Moran, Katherine; Priebe, Stefan

2016-08-01

In a randomised controlled trial, patients were offered financial incentives to improve their adherence to anti-psychotic maintenance medication. Compared to a control group without the incentives, they had an improved adherence and also better subjective quality of life (SQOL) after 1 year. This paper explores the question as to whether this improvement in SQOL was associated with the amount of money received or with the improved adherence itself. A secondary analysis was performed using data of the experimental group in the trial. Adherence was assessed as the percentage of all prescribed long-acting anti-psychotic injections that were taken by the patient. In regression models, we tested whether changes in medication adherence and/or the amount of incentives received over the 12-month period was associated with SQOL, as rated on the DIALOG scale. Adherence changed from 68.49 % at baseline to 88.23 % (mean difference in adherence = 19.59 %, SD = 17.52 %). The total amount of incentives received within the 1-year study period varied between £75 and £735, depending on the treatment cycle and the number of long-acting injections taken. Improvement in adherence was found to be a significant predictor of better subjective quality of life (β = 0.014, 95 % CI 0.003-0.025, p = 0.014), whilst the amount of incentives received was not (β = 0.0002, 95 % CI -0.002 to 0.002, p = 0.818). Improved medication adherence is associated with a more favourable SQOL. This underlines the clinical relevance of improved adherence in response to financial incentives in this patient group.

The Stretched Lens Array (SLA): A Low-Risk, Cost-Effective Array Offering Wing-Level Performance of 180 W/KG and 300 W/M2 at 300 VDC

NASA Technical Reports Server (NTRS)

ONeill, Mark; Piszczor, Michael F.; Eskenazi, Michael I.; McDanal, A. J.; George, Patrick J.; Botke, Matthew M.; Brandhorst, Henry W.; Edwards, David L.; Jaster, Paul A.; Lyons, Valerie J. (Technical Monitor)

2002-01-01

At IECEC 2001, our team presented a paper on the new stretched lens array (SLA), including its evolution from the successful SCARLET array on the NASA/JPL Deep Space 1 spacecraft. Since that conference, the SLA team has made significant advances in the SLA technology, including component-level improvements, array-level optimization, space environment exposure testing, and prototype hardware fabrication and evaluation. This paper describes the evolved version of the SLA, highlighting recent improvements in the lens, solar cell, photovoltaic receiver, rigid panel structure, and complete solar array wing.

Improving Performance of the System Safety Function at Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Kiessling, Ed; Tippett, Donald D.; Shivers, Herb

2004-01-01

The Columbia Accident Investigation Board (CAIB) determined that organizational and management issues were significant contributors to the loss of Space Shuttle Columbia. In addition, the CAIB observed similarities between the organizational and management climate that preceded the Challenger accident and the climate that preceded the Columbia accident. To prevent recurrence of adverse organizational and management climates, effective implementation of the system safety function is suggested. Attributes of an effective system safety program are presented. The Marshall Space Flight Center (MSFC) system safety program is analyzed using the attributes. Conclusions and recommendations for improving the MSFC system safety program are offered in this case study.

Composite material application for liquid rocket engines

NASA Technical Reports Server (NTRS)

Heubner, S. W.

1982-01-01

With increasing emphasis on improving engine thrust-to-weight ratios to provide improved payload capabilities, weight reductions achievable by the use of composites have become attractive. Of primary significance is the weight reduction offered by composites, although high temperature properties and cost reduction were also considered. The potential for application of composites to components of Earth-to-orbit hydrocarbon engines and orbit-to-orbit LOX/H2 engines was assessed. The components most likely to benefit from the application of composites were identified, as were the critical technology areas where developed would be required. Recommendations were made and a program outlined for the design, fabrication, and demonstration of specific engine components.

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

Ezzati, M.; Mbinda, B.M.; Kammen, D.M.

Suspended particulate matter and carbon emissions from the combustion of biomass, in addition to their environmental consequences, have been causally associated with the incidence of respiratory and eye infections. Improved stoves offer the potential for emissions reduction. The authors compare the emissions of suspended particulate matter and carbon monoxide from traditional and improved biofuel stoves in Kenya under the actual conditions of household use. Data for analysis is from 137 14-h days of continuous real-time emission concentration monitoring in a total of 38 households. Their analysis shows that improved (ceramic) wood-burning stoves reduce daily average suspended particulate matter concentration bymore » 48% during the active burning period and by 77% during the smoldering phase. Ceramic stoves also reduce the median and the 75th and 95th percentiles of daily emission concentration during the burning period and the 95th percentile during the smoldering phase, and therefore shift the overall emission profile downward. Improved charcoal-burning stoves also offer reductions in indoor air pollution compared to the traditional metal stove, but these are not statistically significant. The greatest reduction in emission concentration is achieved as a result of transition from wood to charcoal where mean emission concentrations drop by 87% during the burning period and by 92% when smoldering as well as large reductions in the median and 75th and 95th percentiles. These results indicate that transition to charcoal, followed by the use of improved wood stoves, are viable options for reduction of human exposure to indoor air pollution in many developing nations.« less

Blended Learning: The Student Viewpoint

PubMed Central

Shantakumari, N; Sajith, P

2015-01-01

Background: Blended learning (BL) is defined as “a way of meeting the challenges of tailoring learning and development to the needs of individuals by integrating the innovative and technological advances offered by online learning with the interaction and participation offered in the best of traditional learning.” The Gulf Medical University (GMU), Ajman, UAE, offers a number of courses which incorporate BL with contact classes and online component on an E-learning platform. Insufficient learning satisfaction has been stated as an obstacle to its implementation and efficacy. Aim: To determine the students’ perceptions toward BL which in turn will determine their satisfaction and the efficacy of the courses offered. Subjects and Methods: This was a cross-sectional study conducted at the GMU, Ajman between January and December 2013. Perceptions of BL process, content, and ease of use were collected from 75 students enrolled in the certificate courses offered by the university using a questionnaire. Student perceptions were assessed using Mann–Whitney U-test and Kruskal–Wallis test on the basis of gender, age, and course enrollment. Results: The median scores of all the questions in the three domains were above three suggesting positive perceptions on BL. The distribution of perceptions was similar between gender and age. However, significant differences were observed in the course enrollment (P = 0.02). Conclusion Students hold a positive perception of the BL courses being offered in this university. The difference in perceptions among students of different courses suggest that the BL format offered needs modification according to course content to improve its perception. PMID:26500788

Adjunctive antipsychotic in the treatment of body dysmorphic disorder - A retrospective naturalistic case note study.

PubMed

Rashid, Haroon; Khan, Akif A; Fineberg, Naomi A

2015-06-01

A retrospective naturalistic case note study to determine the frequency, co-morbidity and treatment-response of body dysmorphic disorder (BDD). Records from 280 patients attending a highly specialised obsessive-compulsive disorder (OCD)/BDD service were analysed. The clinical outcome was measured either through scoring of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for OCD/BDD, or textual analysis of case notes for evidence of symptomatic improvement, treatment tolerability, and premature disengagement. A total of 32 patients (11.43%) were diagnosed with BDD. Of these, 28 (87.5%) had at least one co-morbidity. All patients were offered cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitor (SSRI). Adjunctive low-dose antipsychotic was prescribed for 21 (66%) patients. Overall, 18/32 (56%) responded, and 7/32 (22%) disengaged prematurely. Patients offered antipsychotic, SSRI and CBT (n = 21) were compared with those offered SSRI and CBT only (n = 11). The treatment was well-tolerated. Whereas there was no significant inter-group difference in the clinical response rate, premature disengagement occurred less frequently in the antipsychotic-treated patients (9.5% versus 45%; Fisher's Exact Test P = 0.0318). BDD frequently presents with co-morbidity, treatment-resistance and premature disengagement. Adjunctive antipsychotic was associated with significantly better treatment adherence, but responder rates did not differ significantly, possibly related to the small sample-size. A well-powered randomised controlled study is warranted, to determine clinical outcomes with adjunctive antipsychotic in BDD.

Enrollment Management in Medical School Admissions: A Novel Evidence-Based Approach at One Institution.

PubMed

Burkhardt, John C; DesJardins, Stephen L; Teener, Carol A; Gay, Steven E; Santen, Sally A

2016-11-01

In higher education, enrollment management has been developed to accurately predict the likelihood of enrollment of admitted students. This allows evidence to dictate numbers of interviews scheduled, offers of admission, and financial aid package distribution. The applicability of enrollment management techniques for use in medical education was tested through creation of a predictive enrollment model at the University of Michigan Medical School (U-M). U-M and American Medical College Application Service data (2006-2014) were combined to create a database including applicant demographics, academic application scores, institutional financial aid offer, and choice of school attended. Binomial logistic regression and multinomial logistic regression models were estimated in order to study factors related to enrollment at the local institution versus elsewhere and to groupings of competing peer institutions. A predictive analytic "dashboard" was created for practical use. Both models were significant at P < .001 and had similar predictive performance. In the binomial model female, underrepresented minority students, grade point average, Medical College Admission Test score, admissions committee desirability score, and most individual financial aid offers were significant (P < .05). The significant covariates were similar in the multinomial model (excluding female) and provided separate likelihoods of students enrolling at different institutional types. An enrollment-management-based approach would allow medical schools to better manage the number of students they admit and target recruitment efforts to improve their likelihood of success. It also performs a key institutional research function for understanding failed recruitment of highly desirable candidates.

Organizational-level correlates of the provision of detoxification services and medication-based treatments for substance abuse in correctional institutions.

PubMed

Oser, Carrie B; Knudsen, Hannah K; Staton-Tindall, Michele; Taxman, Faye; Leukefeld, Carl

2009-08-01

In recent years, there has been an increased examination of organizational-level innovation adoption in substance abuse treatment organizations. However, the majority of these studies have focused on community-based treatment centers. One understudied area of the substance abuse treatment system is correctional institutions. This study uses the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative's National Criminal Justice Treatment Practices (NCJTP) survey to examine the adoption of detoxification services and pharmacotherapies for the treatment of substance abuse across a nationally representative sample of correctional institutions (n=198). There were significant differences between jails and prisons in the percentage of organizations offering detoxification services and medications. Specifically, detoxification services were offered by 5% of prisons and 34% of jails; and, medications were offered by 6% of prisons and 32% of jails. Binary logistic regression models were used to examine the associations between these services and organizational characteristics, including context, resources, previously introduced practices, culture, and systems integration. Variables measuring organizational context and previously introduced practices were significant correlates of the provision of both detoxification services and medications. Multivariate results indicated that the differences between jails and prisons remained significant after controlling for other organizational factors. Although the adoption of detoxification services and pharmacotherapies may be a controversial topic for correctional institutions, these services have the potential to improve offender well-being and reduce public health risks associated with substance abuse.

Organizational-Level Correlates of the Provision of Detoxification Services and Medication-Based Treatments for Substance Abuse in Correctional Institutions

PubMed Central

Knudsen, Hannah K.; Staton-Tindall, Michele; Taxman, Faye; Leukefeld, Carl

2009-01-01

In recent years, there has been an increased examination of organizational-level innovation adoption in substance abuse treatment organizations. However, the majority of these studies have focused on community-based treatment centers. One understudied area of the substance abuse treatment system is correctional institutions. This study uses the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative’s National Criminal Justice Treatment Practices survey (NCJTP) to examine the adoption of detoxification services and pharmacotherapies for the treatment of substance abuse across a nationally representative sample of correctional institutions (n=198). There were significant differences between jails and prisons in the percentage of organizations offering detoxification services and medications. Specifically, detoxification services were offered by 5% of prisons and 34% of jails; and, medications were offered by 6% of prisons and 32% of jails. Binary logistic regression models were used to examine the associations between these services and organizational characteristics, including context, resources, previously introduced practices, culture, and systems integration. Variables measuring organizational context and previously introduced practices were significant correlates of the provision of both detoxification services and medications. Multivariate results indicated that the differences between jails and prisons remained significant after controlling for other organizational factors. Although the adoption of detoxification services and pharmacotherapies may be a controversial topic for correctional institutions, these services have the potential to improve offender well-being and reduce public health risks associated with substance abuse. PMID:19108957

Investigating the use of CD-Rom CBT for bulimia nervosa and binge eating disorder in an NHS adult outpatient eating disorders service.

PubMed

Graham, Lisa; Walton, Mark

2011-07-01

Many patients who experience bulimia nervosa (BN) and binge eating disorder (BED) find it hard to access evidence-based treatments. Rates of failure to enter outpatient services following initial assessment are high, as are dropout rates from specialist outpatient eating disorders services. To offer CD-Rom CBT, a cognitive-behavioural multi-media supported self-help treatment, in a locality-based outpatient NHS Eating Disorders Service to patients who have binge eating disorder and bulimia nervosa. Patients referred to a catchment-based NHS outpatient eating disorders service who were assessed and had an eating disorder with a binge-eating component were offered CD-Rom based CBT (Overcoming Bulimia) whilst on the waiting list for individual CBT. Forty patients completed the 8 sessions and attended the evaluation appointment (13 had BN, 27 had BED). For both groups, there were significant improvements in well-being and functioning, as well as significant reductions in problems and risk. There was also a significant reduction on the "Bulimic Subscale" of the EDI. These results were comparable with the original study findings (Schmidt, Treasure and Williams, 2001). Dropouts from the CD-Rom reflected rates common to other EDS treatments suggesting that CD-Rom did not directly impact upon service dropout rates. Computer assisted CBT for Eating Disorders offers a promising, feasible and acceptable first step for patients who have bulimia nervosa or binge eating disorder and access treatment from specialist eating disorders services.

Aircraft Photovoltaic Power-Generating System.

NASA Astrophysics Data System (ADS)

Doellner, Oscar Leonard

Photovoltaic cells, appropriately cooled and operating in the combustion-created high radiant-intensity environment of gas-turbine and jet engines, may replace the conventional (gearbox-driven) electrical power generators aboard jet aircraft. This study projects significant improvements not only in aircraft electrical power-generating-system performance, but also in overall aircraft performance. Jet -engine design modifications incorporating this concept not only save weight (and thus fuel), but are--in themselves --favorable to jet-engine performance. The dissertation concentrates on operational, constructional, structural, thermal, optical, radiometrical, thin-film, and solid-state theoretical aspects of the overall project. This new electrical power-generating system offers solid-state reliability with electrical power-output capability comparable to that of existing aircraft electromechanical power-generating systems (alternators and generators). In addition to improvements in aircraft performance, significant aircraft fuel- and weight-saving advantages are projected.

Enzymatic mitigation of 5-O-chlorogenic acid for an improved digestibility of coffee.

PubMed

Siebert, Mareike; Berger, Ralf G; Nieter, Annabel

2018-08-30

A p-coumaroyl esterase from Rhizoctonia solani was used to decrease 5-O-chlorogenic acid (5-CQA) content in coffee powder. HPLC-UV showed a decline of up to 98% of 5-CQA after the enzyme treatment. Effects on aroma were determined by means of aroma extract dilution analysis. Flavour dilution factors of treated and control extract differed in four volatile compounds only. Effect on aroma and taste was evaluated by sensory tests. No significant differences were perceived, and no off-flavour nor off-taste was noted. As chlorogenic acids are suspected to cause stomach irritating effects in sensitive people, the enzyme treatment offers a technically feasible approach to improve the quality of coffee beverages by reducing 5-CQA concentration without significantly affecting the aroma and taste profile. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effectiveness of a School-based Academic Asthma Health Education and Counseling Program on Fostering Acceptance of Asthma in Older School-age Students with Asthma

PubMed Central

Kintner, Eileen K.; Cook, Gwendolyn; Marti, C. Nathan; Gomes, Melissa; Meeder, Linda; Van Egeren, Laurie A.

2014-01-01

Purpose The purpose was to evaluate the effectiveness of the academic asthma education and counseling SHARP program on fostering psychosocial acceptance of asthma. Design and Methods This was a phase III, two-group, cluster randomized, single-blinded, longitudinal study. Students from grades 4 and 5 (N = 205) with asthma and their caregivers completed surveys at pre-intervention and at 1, 12, and 24 months post-intervention. Analysis involved multilevel modeling. Results All students demonstrated significant improvement in aspects of acceptance; students in SHARP demonstrated significant improvement in openness to sharing and connectedness with teachers over students in the control condition. Practice Implications The SHARP program offers a well-tested, effective program for psychosocial acceptance of asthma, which is welcomed by schools. PMID:25443593

167th Airlift Wing > Home

Science.gov Websites

encouraged to call 304-616-5127, to offer suggestions on how to improve the wing. The number goes directly to Spotlight Life saver training offered at wing proves invaluable to Airman Life saver training offered at wing proves invaluable to Airman Life saver training offered at wing proves invaluable to Airman WVANG

A review of nanostructured lithium ion battery materials via low temperature synthesis.

PubMed

Chen, Jiajun

2013-01-01

Nanostructured materials afford us new opportunities to improve the current technology for synthesizing Li ion batteries. Generating nanomaterials with new properties via an inexpensive approach offers a tremendous potential for realizing high performance Li-ion batteries. In this review, I mainly summarize some of the recent progress made, and describe the patents awarded on synthesizing nanostructured cathode materials for these batteries via low temperature wet- chemistry methods. From an economical view, such syntheses, especially hydrothermal synthesis, may offer the opportunities for significantly lowering the cost of manufacturing battery materials, while conferring distinct environmental advantages. Recent advances in in-situ (real time) X-ray diffraction for studying hydrothermal synthesis have great potential for bettering the rational design of advanced lithium-electrode materials. The development of this technique also will be discussed.

Incentives, Program Configuration, and Employee Uptake of Workplace Wellness Programs.

PubMed

Huang, Haijing; Mattke, Soeren; Batorsky, Benajmin; Miles, Jeremy; Liu, Hangsheng; Taylor, Erin

2016-01-01

The aim of this study was to determine the effect of wellness program configurations and financial incentives on employee participation rate. We analyze a nationally representative survey on workplace wellness programs from 407 employers using cluster analysis and multivariable regression analysis. Employers who offer incentives and provide a comprehensive set of program offerings have higher participation rates. The effect of incentives differs by program configuration, with the strongest effect found for comprehensive and prevention-focused programs. Among intervention-focused programs, incentives are not associated with higher participation. Wellness programs can be grouped into distinct configurations, which have different workplace health focuses. Although monetary incentives can be effective in improving employee participation, the magnitude and significance of the effect is greater for some program configurations than others.

The efficacy of unsupervised home-based exercise regimens in comparison to supervised laboratory-based exercise training upon cardio-respiratory health facets.

PubMed

Blackwell, James; Atherton, Philip J; Smith, Kenneth; Doleman, Brett; Williams, John P; Lund, Jonathan N; Phillips, Bethan E

2017-09-01

Supervised high-intensity interval training (HIIT) can rapidly improve cardiorespiratory fitness (CRF). However, the effectiveness of time-efficient unsupervised home-based interventions is unknown. Eighteen volunteers completed either: laboratory-HIIT (L-HIIT); home-HIIT (H-HIIT) or home-isometric hand-grip training (H-IHGT). CRF improved significantly in L-HIIT and H-HIIT groups, with blood pressure improvements in the H-IHGT group only. H-HIIT offers a practical, time-efficient exercise mode to improve CRF, away from the laboratory environment. H-IHGT potentially provides a viable alternative to modify blood pressure in those unable to participate in whole-body exercise. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

Microbial Resources and Enological Significance: Opportunities and Benefits

PubMed Central

Petruzzi, Leonardo; Capozzi, Vittorio; Berbegal, Carmen; Corbo, Maria R.; Bevilacqua, Antonio; Spano, Giuseppe; Sinigaglia, Milena

2017-01-01

Among the innovative trends in the wine sector, the continuous exploration of enological properties associated with wine microbial resources represents a cornerstone driver of quality improvement. Since the advent of starter cultures technology, the attention has been focused on intraspecific biodiversity within the primary species responsible for alcoholic fermentation (Saccharomyces cerevisiae) and, subsequently, for the so-called ‘malolactic fermentation’ (Oenococcus oeni). However, in the last decade, a relevant number of studies proposed the enological exploitation of an increasing number of species (e.g., non-Saccharomyces yeasts) associated with spontaneous fermentation in wine. These new species/strains may provide technological solutions to specific problems and/or improve sensory characteristics, such as complexity, mouth-feel and flavors. This review offers an overview of the available information on the enological/protechnological significance of microbial resources associated with winemaking, summarizing the opportunities and the benefits associated with the enological exploitation of this microbial potential. We discuss proposed solutions to improve quality and safety of wines (e.g., alternative starter cultures, multistrains starter cultures) and future perspectives. PMID:28642742

Pathway Linking Patient-Centered Communication to Emotional Well-Being: Taking into Account Patient Satisfaction and Emotion Management.

PubMed

Jiang, Shaohai

2017-03-01

In the United States, levels of emotional well-being remain low, with 40% of American adults reporting the experience of daily stress and excessive anxiety. The doctor-patient communication during medical encounters may play a significant role in improving people's emotional well-being. Based on Street and his colleagues' (2009) pathway mediation model linking communication to health outcomes, this paper illustrates a mechanism that underlies how patient-centered communication improves emotional well-being. The results showed that patient-centered communication had direct effects on emotional well-being. In addition to the direct effects, patient-centered communication also indirectly influenced emotional well-being, mediated by patient satisfaction and emotion management, supporting the partial mediation. The findings provide additional empirical evidence to the pathways from communication to health outcomes, one of the least developed areas of communication research, and also offer significant implications for the design of interventions to improve patients' emotional well-being.

Introducing routine HIV screening for patients on an internal medicine residency inpatient service: a quality improvement project.

PubMed

Padrnos, Leslie J; Barr, Patrick J; Klassen, Christine L; Fields, Heather E; Azadeh, Natalya; Mendoza, Neil; Saadiq, Rayya A; Pauwels, Emanuel M; King, Christopher S; Chung, Andrew A; Sakata, Kenneth K; Blair, Janis E

2016-01-01

The US Centers for Disease Control and Prevention (CDC) recommend human immunodeficiency virus (HIV) screening for all persons aged 13 to 64 years who present to a health care provider. We sought to improve adherence to the CDC guidelines on the Internal Medicine Resident Hospital Service. We surveyed residents about the CDC guidelines, sent email reminders, provided education, and engaged them in friendly competition. Credit for guideline adherence was awarded if an offer of HIV screening was documented at admission, if a screening test was performed, or if a notation in the resident sign out sheet indicated why screening was not performed. We examined HIV screening of a postintervention group of patients admitted between August 8, 2012, and June 30, 2013, and compared them to a preintervention group admitted between August 1, 2011, and June 30, 2012. Postintervention offers of HIV screening increased significantly (7.9% [44/559] vs 55.5% [300/541]; P<.001), as did documentation of residents' contemplation of screening (8.9% [50/559] vs 67.5% [365/541]; P<.001). A significantly higher proportion of HIV screening tests was ordered postintervention (7.7% [43/559] vs 44.4% [240/541]; P<.001). Monthly HIV screening documentation ranged from 0% (0/53) to 17% (9/53) preintervention, whereas it ranged from 30.6% (11/36) to 100% (62/62) postintervention. HIV screening adherence can be improved through resident education, friendly competition, and system reminders. Barriers to achieving sustained adherence to the CDC guidelines include a heterogeneous patient population and provider discomfort with the subject.

Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): design and methods.

PubMed

Mazzeo, Suzanne E; Kelly, Nichole R; Stern, Marilyn; Gow, Rachel W; Serdar, Kasey; Evans, Ronald K; Jones, Resa M; Bulik, Cynthia M

2012-05-01

Pediatric overweight is associated with numerous physical and psychological health risks, and overweight children are at significant risk for obesity in adulthood. African-American children are at particularly high risk for obesity and related health complications. However, this racial group has traditionally had limited access to obesity treatment and relatively few studies have included sufficient numbers of lower-SES, African American participants. Further, although parental involvement in treatment for pediatric overweight has been found to be beneficial, few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost-effective approach which could benefit the entire family. This pilot project will evaluate the efficacy of an intensive parenting intervention, (NOURISH; Nourishing Our Understanding of Role modeling to Improve Support and Health), targeting racially diverse parents of overweight children (ages 6-11). NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. Parents meeting study criteria (having a child between the ages of 6 and 11 with a BMI ≥ the 85th percentile) will be offered participation in the randomized trial comparing NOURISH with a control group. We hypothesize that children whose parents participate in NOURISH will manifest greater decreases in BMI, and greater improvements in dietary intake, and quality of life compared to children whose parents do not participate. This study is designed explicitly to gather preliminary feasibility, acceptability, and effectiveness data to inform a subsequent larger randomized controlled trial. Copyright © 2012 Elsevier Inc. All rights reserved.

Nanomedicine, an emerging therapeutic strategy for oral cancer therapy.

PubMed

Marcazzan, Sabrina; Varoni, Elena Maria; Blanco, Elvin; Lodi, Giovanni; Ferrari, Mauro

2018-01-01

Oral cavity and oropharyngeal carcinomas (oral cancer) represents a significant cause of morbidity and mortality. Despite efforts in improving early diagnosis and treatment, the 5-year survival rate of advanced stage of the disease is less than 63%. The field of nanomedicine has offered promising diagnostic and therapeutic advances in cancer. Indeed, several platforms have been clinically approved for cancer therapy, while other promising systems are undergoing exploration in clinical trials. With its ability to deliver drugs, nucleic acids, and MRI contrast agents with high efficiency, nanomedicine platforms offer the potential to improve drug efficacy and tolerability. The aim of the present mini-review is to summarize the current preclinical status of nanotechnology systems for oral cancer therapy. The nanoplatforms for delivery of chemopreventive agents presented herein resulted in significantly higher anti-tumor activity than free forms of the drug, even against a chemo-resistant cell line. Impressive results have also been obtained using nanoparticles to deliver chemotherapeutics, resulting in reduced toxicity both in vitro and in vivo. Nanoparticles have also led to improvements in efficacy of photodynamic therapies through the development of targeted magnetic nanoparticles. Finally, gene therapy using nanoparticles demonstrated promising results specifically with regards to inhibition of gene expression. Of the few in vivo studies that have been reported, many of these used animal models with several limitations, which will be discussed herein. Lastly, we will discuss several future perspectives in oral cancer nanoparticle-based therapy and the development of appropriate animal models, distinguishing between oral cavity and oropharyngeal carcinoma. Copyright © 2017 Elsevier Ltd. All rights reserved.

Practice-based learning and improvement in family medicine student clerkships: a CERA study.

PubMed

Willis, Deanna R; Bennett, Ian; Jones, Betsy G; Renshaw, Scott E; Holley, Matthew; Dankoski, Mary E

2014-06-01

Practice-based learning and improvement (PBLI) has been promoted as a key component of competency-based training in medical student education, but little is known about its implementation. This project is part of a larger CERA omnibus survey of family medicine medical student clerkship directors carried out from July to September 2012. Analyses were conducted to assess clerkship infrastructure, learner assessment and feedback, and clerkship director perceptions of PBLI curricula. The majority (69.0%, 58/82) of family medicine clerkship directors reported that PBLI is not included in their clerkship. Significant predictors of PBLI in the curriculum include: regularly scheduled centralized teaching (weekly or more versus less than weekly, OR=1.14, 95% CI=1.01--1.29) and clerkship director belief that students should achieve PBLI competency (agree in competency versus disagree in competency, OR=1.19, 95% CI=1.08--1.30). Few (20.5%, 16/78) family medicine clerkship directors reported that the amount of PBLI in their curriculum is likely to increase in the next 12 months. The duration of the clerkship was a significant predictor of reported likelihood of increasing PBLI over the next 12 months (3 weeks versus 8 weeks, OR=1.23, 95% CI=1.00--1.51). Despite increased emphasis on quality improvement activities in practice, most family medicine clerkships do not currently offer PBLI curricula. Additionally, less than one in four family medicine clerkships plan on increasing the amount of PBLI curricula in the next 12 months. Continued research in this area is needed to identify successful models for PBLI curricular offerings.

Lessons learned from the Apple stores.

PubMed

Pinkney, Henry; Baum, Neil

2012-01-01

Medical practices have an opportunity to improve the services that they offer their patients. Practices can look at other businesses and industries for examples of outstanding customer service. This article will discuss the services provided by Apple, Inc., and how medical practices can learn from this industry giant and improve the services that they offer patients.

Making Departments Distinctive: The Continuous Quality Improvement (CQI) Mindset.

ERIC Educational Resources Information Center

Chambliss, Catherine

The Continuous Quality Improvement (CQI) approach has provided many corporations with a tool for adapting to ongoing shifts in demands and resources, and it can offer academic settings similar assistance. CQI offers a mechanism for building a collaborative process that can help departments define their unique strengths and cultivate a distinctive…

EEG-based recognition of video-induced emotions: selecting subject-independent feature set.

PubMed

Kortelainen, Jukka; Seppänen, Tapio

2013-01-01

Emotions are fundamental for everyday life affecting our communication, learning, perception, and decision making. Including emotions into the human-computer interaction (HCI) could be seen as a significant step forward offering a great potential for developing advanced future technologies. While the electrical activity of the brain is affected by emotions, offers electroencephalogram (EEG) an interesting channel to improve the HCI. In this paper, the selection of subject-independent feature set for EEG-based emotion recognition is studied. We investigate the effect of different feature sets in classifying person's arousal and valence while watching videos with emotional content. The classification performance is optimized by applying a sequential forward floating search algorithm for feature selection. The best classification rate (65.1% for arousal and 63.0% for valence) is obtained with a feature set containing power spectral features from the frequency band of 1-32 Hz. The proposed approach substantially improves the classification rate reported in the literature. In future, further analysis of the video-induced EEG changes including the topographical differences in the spectral features is needed.

Expanding the Availability of Lightweight Aluminum Alloy Armor Plate Procured from Detailed Military Specifications

NASA Astrophysics Data System (ADS)

Doherty, Kevin; Squillacioti, Richard; Cheeseman, Bryan; Placzankis, Brian; Gallardy, Denver

For many years, the range of aluminum alloys for armor plate applications obtainable in accordance with detailed military specifications was very limited. However, the development of improved aluminum alloys for aerospace and other applications has provided an opportunity to modernize the Army portfolio for ground vehicle armor applications. While the benefits of offering additional alloy choices to vehicle designers is obvious, the process of creating detailed military specifications for armor plate applications is not trivial. A significant amount of material and testing is required to develop the details required by an armor plate specification. Due to the vast number of material programs that require standardization and with a limited amount of manpower and funds as a result of Standardization Reform in 1995, one typically requires a need statement from a vehicle program office to justify and sponsor the work. This presentation will focus on recent aluminum alloy armor plate specifications that have added capability to vehicle designers' selection of armor materials that offer possible benefits such as lower cost, higher strength, better ballistic and corrosion resistance, improved weldability, etc.

Integrating psychopharmacology and cognitive remediation to treat cognitive dysfunction in the psychotic disorders.

PubMed

Medalia, Alice; Opler, Lewis A; Saperstein, Alice M

2014-04-01

Cognitive deficits are a prominent and enduring aspect of schizophrenia, which pose a significant barrier to achieving functional goals. The most promising intervention for treating cognitive impairment is cognitive remediation (CR), a behaviorally based therapy associated with medium effect sizes for cognitive and functional outcomes. However, there is a sizeable group of nonresponders whose CR outcomes become limited when the therapeutic approach fails to address individual differences in baseline cognition, motivation variables, and the extent to which CR offers opportunities for generalization. This speaks to a need to develop cognitive interventions that are both personalized and scalable. Emerging data suggest that specific pharmacological agents have the potential to enhance and accelerate behaviorally based CR effects. This article will review the rationale and preliminary evidence to support combining CR and pharmacotherapy. We will review crucial aspects of cognitive interventions that offer the most promise for improving not only cognitive outcomes, but also for enhancing improvement in real-world functioning. Finally, we will address methodological issues to be considered for future research on combined pharmacological and CR interventions.

16 CFR 436.5 - Disclosure items.

Code of Federal Regulations, 2010 CFR

2010-01-01

... offered j. Warranty and customer service requirements k. Territorial development and sales quotas l... the franchisee will offer to its customers. (ii) Hiring and training employees. (iii) Improving and.... (iv) The general market for the product or service the franchisee will offer. In describing the...

Exploring the ameliorative potential of probiotic Dahi containing Lactobacillus acidophilus and Bifidobacterium bifidum on dextran sodium sulphate induced colitis in mice.

PubMed

Jadhav, Sagar R; Shandilya, Umesh Kr; Kansal, Vinod K

2013-02-01

Conventional medical therapies for ulcerative colitis (UC) are still limited due to the adverse side effects like dose-dependent diarrhoea and insufficient potency to keep in remission for long-term periods. So, new alternatives that provide more effective and safe therapies for ulcerative colitis are constantly being sought. In the present study, probiotic LaBb Dahi was selected for investigation of its therapeutic effect on DSS-induced colitis model in mice. LaBb Dahi was prepared by co-culturing Dahi culture of Lactococci along with selected strain of Lactobacillus acidophilus LaVK2 and Bifidobacterium bifidum BbVK3 in buffalo milk. Four groups of mice (12 each) were fed for 17 d with buffalo milk (normal control), buffalo milk plus DSS (Colitis control), Dahi plus DSS, and LaBb Dahi plus DSS, respectively, with basal diet. The disease activity scores, weight loss, organ weight, colon length, myeloperoxidase (MPO) and β-glucoronidase activity was assessed, and the histopathological picture of the colon of mice was studied. All colitis control mice evidenced significant increase in MPO, β-glucoronidase activity and showed high disease activity scores along with histological damage to colonic tissue. Feeding with LaBb Dahi offered significant reduction in MPO activity, β-glucoronidase activity and improved disease activity scores. We found significant decline in length of colon, organ weight and body weight in colitis induced controls which were improved significantly by feeding LaBb Dahi. The present study suggests that LaBb Dahi can be used as a potential nutraceutical intervention to combat UC related changes and may offer effective adjunctive treatment for management of UC.

Effect of food service nutrition improvements on elementary school cafeteria lunch purchase patterns.

PubMed

Cluss, Patricia A; Fee, Luann; Culyba, Rebecca J; Bhat, Kiran B; Owen, Kay

2014-06-01

Schools can play a major role in prevention and intervention for childhood obesity. We describe changes in elementary school cafeteria lunch sales patterns resulting from nutritional improvements in menu offerings that were part of a community-wide focus on health. Elementary school lunch sales data were collected for 1 week in each of 7 years in a district serving a predominantly poor, rural, and Caucasian student population, with high rates of obesity. Post hoc data analyses described lunch sales patterns and related food service costs over the project years. The percentage of high calorie/low nutrition foods sold decreased from 22% of all sales in 2005 to 0% in 2011. High-calorie snack purchases decreased from 535 items to 0 items. The sale of fresh fruits increased by 12%. There was only a slight decline in the percentage of children who purchased cafeteria lunches over the years and a 15.2% cost increase for purchasing healthier food supplies. Elementary school children purchased healthier lunches when healthier menu items were offered and when less healthy foods were eliminated from the menu. There was no significant decline in the number of students who purchased lunches as nutritional improvements were made. © 2014, American School Health Association.

ESA's Planetary Science Archive: Preserve and present reliable scientific data sets

NASA Astrophysics Data System (ADS)

Besse, S.; Vallat, C.; Barthelemy, M.; Coia, D.; Costa, M.; De Marchi, G.; Fraga, D.; Grotheer, E.; Heather, D.; Lim, T.; Martinez, S.; Arviset, C.; Barbarisi, I.; Docasal, R.; Macfarlane, A.; Rios, C.; Saiz, J.; Vallejo, F.

2018-01-01

The European Space Agency (ESA) Planetary Science Archive (PSA) is undergoing a significant refactoring of all its components to improve the services provided to the scientific community and the public. The PSA supports ESA's missions exploring the Solar System by archiving scientific peer-reviewed observations as well as engineering data sets. This includes the Giotto, SMART-1, Huygens, Venus Express, Mars Express, Rosetta, Exomars 2016, Exomars RSP, BepiColombo, and JUICE missions. The PSA is offering a newly designed graphical user interface which is simultaneously meant to maximize the interaction with scientific observations and also minimise the efforts needed to download these scientific observations. The PSA still offers the same services as before (i.e., FTP, documentation, helpdesk, etc.). In addition, it will support the two formats of the Planetary Data System (i.e., PDS3 and PDS4), as well as providing new ways for searching the data products with specific metadata and geometrical parameters. As well as enhanced services, the PSA will also provide new services to improve the visualisation of data products and scientific content (e.g., spectra, etc.). Together with improved access to the spacecraft engineering data sets, the PSA will provide easier access to scientific data products that will help to maximize the science return of ESA's space missions.

One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey.

PubMed

Gorman, Mark; Coelho, James; Gujral, Sameer; McKay, Alastair

2015-01-01

Introduction. "See and treat" one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service.

One-Stop Clinic Utilization in Plastic Surgery: Our Local Experience and the Results of a UK-Wide National Survey

PubMed Central

Gorman, Mark; Coelho, James; Gujral, Sameer; McKay, Alastair

2015-01-01

Introduction. “See and treat” one-stop clinics (OSCs) are an advocated NHS initiative to modernise care, reducing cancer treatment waiting times. Little studied in plastic surgery, the existing evidence suggests that though they improve care, they are rarely implemented. We present our experience setting up a plastic surgery OSC for minor skin surgery and survey their use across the UK. Methods. The OSC was evaluated by 18-week wait target compliance, measures of departmental capacity, and patient satisfaction. Data was obtained from 32 of the 47 UK plastic surgery departments to investigate the prevalence of OSCs for minor skin cancer surgery. Results. The OSC improved 18-week waiting times, from a noncompliant mean of 80% to a compliant 95% average. Department capacity increased 15%. 95% of patients were highly satisfied with and preferred the OSC to a conventional service. Only 25% of UK plastic surgery units run OSCs, offering varying reasons for not doing so, 42% having not considered their use. Conclusions. OSCs are underutilised within UK plastic surgery, where a significant proportion of units have not even considered their benefit. This is despite associated improvements in waiting times, department capacity, and levels of high patient satisfaction. We offer our considerations and local experience instituting an OSC service. PMID:26236502

Improved methodologies for the preparation of highly substituted pyridines.

PubMed

Fernández Sainz, Yolanda; Raw, Steven A; Taylor, Richard J K

2005-11-25

[reaction: see text] Two separate strategies have been developed for the preparation of highly substituted pyridines from 1,2,4-triazines via the inverse-electron-demand Diels-Alder reaction: a microwave-promoted, solvent-free procedure and a tethered imine-enamine (TIE) approach. Both routes avoid the need for a discrete aromatization step and offer significant advantages over the classical methods, giving a wide variety of tri-, tetra-, and penta-substituted pyridines in high, optimized yields.

A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women.

PubMed

Toohill, Jocelyn; Fenwick, Jennifer; Gamble, Jenny; Creedy, Debra K; Buist, Anne; Turkstra, Erika; Ryding, Elsa-Lena

2014-12-01

Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women's childbirth fear. Women (n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention (n = 170) or control (n = 169) groups. All women received a decision-aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear (WDEQ-A) from second trimester to 36 weeks' gestation. Secondary outcomes were improved childbirth self-efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy. There were significant differences between groups on postintervention scores for fear of birth (p < 0.001) and childbirth self-efficacy (p = 0.002). Decisional conflict and depressive symptoms reduced but were not significant. Psycho-education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women. Improving antenatal emotional well-being may have wider positive social and maternity care implications for optimal childbirth experiences. © 2014 The Authors. Birth Published by Wiley Periodicals, Inc.

Pilot study of a brief intervention based on the theory of planned behaviour and self-identity to increase chlamydia testing among young people living in deprived areas.

PubMed

Booth, Amy R; Norman, Paul; Goyder, Elizabeth; Harris, Peter R; Campbell, Michael J

2014-09-01

This study sought to estimate the effects of a novel intervention, compared with usual chlamydia testing promotion, on chlamydia test uptake and intentions among young people living in deprived areas. The intervention was based on the theory of planned behaviour, augmented with self-identity, and targeted the significant predictors of chlamydia testing intentions identified in the previous research. Cluster randomization was used to allocate college tutor groups (intervention n = 10; control n = 11) to the intervention or control group. The sample comprised 253 participants (intervention n = 145, control n = 108). The primary outcome was test offer uptake at the end of the session. Other outcomes measured at immediate follow-up were intention, attitude, subjective norm, perceived behavioural control, and self-identity. Generalized estimating equations, controlling for cluster effects and sexual activity, found a small but non-significant effect of condition on test offer uptake, OR = 1.65 (95% CI 0.70, 3.88) p = .25, with 57.5% of intervention participants accepting the offer of a test compared with 40.2% of control participants. Using the same analysis procedure, small-to-medium intervention effects were found on other outcome variables, including a significant effect on attitudes towards chlamydia testing, OR = 1.37 (95% CI 1.00, 1.87), p = .05. The results provide encouraging initial evidence that this theory-based intervention, targeting the key determinants of chlamydia testing, may help to improve chlamydia testing uptake in a high-risk group. They support the conduct of a larger trial to evaluate the effectiveness of the intervention. What is already known on this subject? Young people living in areas of increased socio-economic deprivation have been identified as a high-risk group for chlamydia. Previous research within an extended model of the theory of planned behaviour (TPB) found that attitude, subjective norm, perceived behavioural control, and self-identity all significantly predicted chlamydia testing intentions in this high-risk group. What does this study add? Development and testing of a novel, TPB-based intervention targeting predictors of chlamydia testing intentions. The intervention led to significantly more positive attitudes towards chlamydia testing. Preliminary indication that a TPB-based intervention may help to improve chlamydia testing in a high-risk group. © 2013 The British Psychological Society.

Improvement in Self-reported Quality of Life with Cognitive Therapy for Recurrent Major Depressive Disorder

PubMed Central

Jha, Manish Kumar; Minhajuddin, Abu; Thase, Michael E.; Jarrett, Robin B.

2014-01-01

Background Major Depressive Disorder is common, often recurrent and/or chronic. Theoretically, assessing quality of life (QoL) in addition to the current practice of assessing depressive symptoms has the potential to offer a more comprehensive evaluation of the effects of treatment interventions and course of illness. Methods Before and after acute-phase cognitive therapy (CT), 492 patients from Continuation Phase Cognitive Therapy Relapse Prevention trial (Jarrett et al., 2013, Jarrett and Thase, 2010) completed the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Inventory of Depressive Symptomatology Self-report (IDS-SR) & Beck Depression Inventory (BDI); clinicians completed Hamilton Rating Scale for Depression-17-items. Repeated measures analysis of variance evaluated the improvement in QoL before/after CT and measured the effect sizes. Change analyses to assess clinical significance (Hageman and Arrindell, 1999) were conducted. Results At the end of acute-phase CT, a repeated measure analysis of variance produced a statistically significant increase in Q-LES-Q scores with effect sizes of 0.48 - 1.3; 76.9 - 91.4% patients reported clinically significant improvement. Yet, only 11 - 38.2% QoL scores normalized. An analysis of covariance showed that change in depression severity (covariates=IDS-SR, BDI) completely accounted for the improvement in Q-LES-Q scores. Limitations There were only two time points of observation; clinically significant change analyses lacked matched normal controls; and generalizability is constrained by sampling characteristics. Conclusions: Quality of life improves significantly in patients with recurrent MDD after CT; however, this improvement is completely accounted for by change in depression severity. Normalization of QoL in all patients may require targeted, additional, and/or longer treatment. PMID:25082112

Improvement in self-reported quality of life with cognitive therapy for recurrent major depressive disorder.

PubMed

Jha, Manish Kumar; Minhajuddin, Abu; Thase, Michael E; Jarrett, Robin B

2014-01-01

Major depressive disorder (MDD) is common, often recurrent and/or chronic. Theoretically, assessing quality of life (QoL) in addition to the current practice of assessing depressive symptoms has the potential to offer a more comprehensive evaluation of the effects of treatment interventions and course of illness. Before and after acute-phase cognitive therapy (CT), 492 patients from Continuation Phase Cognitive Therapy Relapse Prevention trial (Jarrett et al., 2013; Jarrett and Thase, 2010) completed the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Inventory of Depressive Symptomatology Self-report (IDS-SR) and Beck Depression Inventory (BDI); clinicians completed Hamilton Rating Scale for Depression-17-items. Repeated measures analysis of variance evaluated the improvement in QoL before/after CT and measured the effect sizes. Change analyses to assess clinical significance (Hageman and Arrindell, 1999) were conducted. At the end of acute-phase CT, a repeated measure analysis of variance produced a statistically significant increase in Q-LES-Q scores with effect sizes of 0.48-1.3%; 76.9-91.4% patients reported clinically significant improvement. Yet, only 11-38.2% QoL scores normalized. An analysis of covariance showed that change in depression severity (covariates=IDS-SR, BDI) completely accounted for the improvement in Q-LES-Q scores. There were only two time points of observation; clinically significant change analyses lacked matched normal controls; and generalizability is constrained by sampling characteristics. Quality of life improves significantly in patients with recurrent MDD after CT; however, this improvement is completely accounted for by change in depression severity. Normalization of QoL in all patients may require targeted, additional, and/or longer treatment. Copyright © 2014 Elsevier B.V. All rights reserved.

Applying the Theory of Constraints (TOC) to the Component Section of Naval Aviation Depot (NADEP), North Island

DTIC Science & Technology

1992-12-01

current repair policies and procedures within this shop. We offer some ideas and suggestions for changing and improving existing operations and the...implementing and focusing continual improvements in Shop 93302 and ultimately in the depot as a whole. 20. DISTRIBUTION/AVAILABILITY OF ABSTRACT 21...used to evaluate current repair policies and procedures within this shop. We also offer some ideas and suggestions for changing and improving existing

E4orf1: a novel ligand that improves glucose disposal in cell culture.

PubMed

Dhurandhar, Emily J; Dubuisson, Olga; Mashtalir, Nazar; Krishnapuram, Rashmi; Hegde, Vijay; Dhurandhar, Nikhil V

2011-01-01

Reducing dietary fat intake and excess adiposity, the cornerstones of behavioral treatment of insulin resistance (IR), are marginally successful over the long term. Ad36, a human adenovirus, offers a template to improve IR, independent of dietary fat intake or adiposity. Ad36 increases cellular glucose uptake via a Ras-mediated activation of phosphatidyl inositol 3-kinase(PI3K), and improves hyperglycemia in mice, despite a high-fat diet and without reducing adiposity. Ex-vivo studies suggest that Ad36 improves hyperglycemia in mice by increasing glucose uptake by adipose tissue and skeletal muscle, and by reducing hepatic glucose output. It is impractical to use Ad36 for therapeutic action. Instead, we investigated if the E4orf1 protein of Ad36, mediates its anti-hyperglycemic action. Such a candidate protein may offer an attractive template for therapeutic development. Experiment-1 determined that Ad36 'requires' E4orf1 protein to up-regulate cellular glucose uptake. Ad36 significantly increased glucose uptake in 3T3-L1 preadipocytes, which was abrogated by knocking down E4orf1 with siRNA. Experiment-2 identified E4orf1 as 'sufficient' to up-regulate glucose uptake. 3T3-L1 cells that inducibly express E4orf1, increased glucose uptake in an induction-dependent manner, compared to null vector control cells. E4orf1 up-regulated PI3K pathway and increased abundance of Ras--the obligatory molecule in Ad36-induced glucose uptake. Experiment-3: Signaling studies of cells transiently transfected with E4orf1 or a null vector, revealed that E4orf1 may activate Ras/PI3K pathway by binding to Drosophila discs-large (Dlg1) protein. E4orf1 activated total Ras and, particularly the H-Ras isoform. By mutating the PDZ domain binding motif (PBM) of E4orf1, Experiment-4 showed that E4orf1 requires its PBM to increase Ras activation or glucose uptake. Experiment-5: In-vitro, a transient transfection by E4orf1 significantly increased glucose uptake in preadipocytes, adipocytes, or myoblasts, and reduced glucose output by hepatocytes. Thus, the highly attractive anti-hyperglycemic effect of Ad36 is mirrored by E4orf1 protein, which may offer a novel ligand to develop anti-hyperglycemic drugs.

E4orf1: A Novel Ligand That Improves Glucose Disposal in Cell Culture

PubMed Central

Dhurandhar, Emily J.; Dubuisson, Olga; Mashtalir, Nazar; Krishnapuram, Rashmi; Hegde, Vijay; Dhurandhar, Nikhil V.

2011-01-01

Reducing dietary fat intake and excess adiposity, the cornerstones of behavioral treatment of insulin resistance(IR), are marginally successful over the long term. Ad36, a human adenovirus, offers a template to improve IR, independent of dietary fat intake or adiposity. Ad36 increases cellular glucose uptake via a Ras-mediated activation of phosphatidyl inositol 3-kinase(PI3K), and improves hyperglycemia in mice, despite a high-fat diet and without reducing adiposity. Ex-vivo studies suggest that Ad36 improves hyperglycemia in mice by increasing glucose uptake by adipose tissue and skeletal muscle, and by reducing hepatic glucose output. It is impractical to use Ad36 for therapeutic action. Instead, we investigated if the E4orf1 protein of Ad36, mediates its anti-hyperglycemic action. Such a candidate protein may offer an attractive template for therapeutic development. Experiment-1 determined that Ad36 ‘requires’ E4orf1 protein to up-regulate cellular glucose uptake. Ad36 significantly increased glucose uptake in 3T3-L1 preadipocytes, which was abrogated by knocking down E4orf1 with siRNA. Experiment-2 identified E4orf1 as ‘sufficient’ to up-regulate glucose uptake. 3T3-L1 cells that inducibly express E4orf1, increased glucose uptake in an induction-dependent manner, compared to null vector control cells. E4orf1 up-regulated PI3K pathway and increased abundance of Ras–the obligatory molecule in Ad36-induced glucose uptake. Experiment-3: Signaling studies of cells transiently transfected with E4orf1 or a null vector, revealed that E4orf1 may activate Ras/PI3K pathway by binding to Drosophila discs-large(Dlg1) protein. E4orf1 activated total Ras and, particularly the H-Ras isoform. By mutating the PDZ domain binding motif(PBM) of E4orf1, Experiment-4 showed that E4orf1 requires its PBM to increase Ras activation or glucose uptake. Experiment-5: In-vitro, a transient transfection by E4orf1 significantly increased glucose uptake in preadipocytes, adipocytes, or myoblasts, and reduced glucose output by hepatocytes. Thus, the highly attractive anti-hyperglycemic effect of Ad36 is mirrored by E4orf1 protein, which may offer a novel ligand to develop anti-hyperglycemic drugs. PMID:21886789

Improving performance in thermodynamics: Integrating learning by teaching pedagogy

NASA Astrophysics Data System (ADS)

Campagni, Jamie Anthony

Historically, Thermo is perceived to be the most challenging course in the MET Curriculum at UNC Charlotte. The complexity and difficulties of this course have contributed to the some of the highest DFW rates compared to any other courses offered within the MET program. One hypothesis contributing to high DFW rates is the pedagogy in which Thermo is taught, which is the foundation of this study. Implementation of LBT in the spring 2014 offering of Thermo was deemed a success. The DFW rate in spring 2014 was reduced by 19 percentage points compared to the DFW rate in spring 2013, which exceeded the target of 10 percentage points. However, only cumulative GPA was a significant predictor of whether a student passed or failed the course. The semester in which students took Thermo was not a significant predictor. Students in the spring 2014 semester also exhibited statistically significant higher final exam averages compared to the 2012 and 2013 semesters. In general, students felt that LBT activities enhanced their learning and application of Thermodynamic concepts. Students had a very positive perception of LBT compared to traditional lecture in that 100% of students would recommend this teaching style to other students.

Feasibility of a pilot intervention to reduce pain and syncope during adolescent vaccination.

PubMed

Henninger, Michelle L; Kuntz, Jennifer L; Firemark, Alison J; Varga, Alexandra M; Bok, Karin; Naleway, Allison L

2018-05-24

Vaccines recommended for adolescents are considered safe and effective, however administration may occasionally result in acute pain at the injection site or syncope (fainting). These adverse effects pose a risk to patient safety and are potential barriers to adherence to future vaccinations. We assessed a novel intervention designed to help prevent acute pain and syncope associated with adolescent vaccinations. We conducted a 3-month pilot study to assess the feasibility and acceptability of a vaccination comfort menu within two Kaiser Permanente Northwest pediatric clinics. The menu offered a variety of comfort items (e.g., cold packs, squeeze balls) that children could select prior to their vaccination. We surveyed parents of recently vaccinated adolescents and interviewed providers to assess the implementation and effectiveness of the intervention. Response rate for the parent survey was 33% (378/1136). Only 20% of the parents reported that their provider offered the comfort menu during the vaccination visit. Approximately 50% of the adolescents who were offered the menu selected a comfort item and most of these participants reported that the item was very (35%) or somewhat (38%) helpful in improving their vaccination experience. Per provider interviews, common barriers to implementing the intervention included lack of time and convenience, and the brevity of the pilot period. The comfort menu may improve the vaccination experience of youth and increase the likelihood of adherence with future vaccinations. However, only 20% of the parents reported that their provider offered the menu during the vaccination visit. Additional research is needed to determine the feasibility of implementing this intervention on a larger scale, as well as assessing whether the intervention has a significant impact on reducing adverse events. Copyright © 2018. Published by Elsevier Ltd.

Evidence-Based Design Features Improve Sleep Quality Among Psychiatric Inpatients.

PubMed

Pyrke, Ryan J L; McKinnon, Margaret C; McNeely, Heather E; Ahern, Catherine; Langstaff, Karen L; Bieling, Peter J

2017-10-01

The primary aim of the present study was to compare sleep characteristics pre- and post-move into a state-of-the-art mental health facility, which offered private sleeping quarters. Significant evidence points toward sleep disruption among psychiatric inpatients. It is unclear, however, how environmental factors (e.g., dorm-style rooms) impact sleep quality in this population. To assess sleep quality, a novel objective technology, actigraphy, was used before and after a facility move. Subjective daily interviews were also administered, along with the Horne-Ostberg Morningness-Eveningness Questionnaire and the Pittsburgh Sleep Quality Index. Actigraphy revealed significant improvements in objective sleep quality following the facility move. Interestingly, subjective report of sleep quality did not correlate with the objective measures. Circadian sleep type appeared to play a role in influencing subjective attitudes toward sleep quality. Built environment has a significant effect on the sleep quality of psychiatric inpatients. Given well-documented disruptions in sleep quality present among psychiatric patients undergoing hospitalization, design elements like single patient bedrooms are highly desirable.

FaStore - a space-saving solution for raw sequencing data.

PubMed

Roguski, Lukasz; Ochoa, Idoia; Hernaez, Mikel; Deorowicz, Sebastian

2018-03-29

The affordability of DNA sequencing has led to the generation of unprecedented volumes of raw sequencing data. These data must be stored, processed, and transmitted, which poses significant challenges. To facilitate this effort, we introduce FaStore, a specialized compressor for FASTQ files. FaStore does not use any reference sequences for compression, and permits the user to choose from several lossy modes to improve the overall compression ratio, depending on the specific needs. FaStore in the lossless mode achieves a significant improvement in compression ratio with respect to previously proposed algorithms. We perform an analysis on the effect that the different lossy modes have on variant calling, the most widely used application for clinical decision making, especially important in the era of precision medicine. We show that lossy compression can offer significant compression gains, while preserving the essential genomic information and without affecting the variant calling performance. FaStore can be downloaded from https://github.com/refresh-bio/FaStore. sebastian.deorowicz@polsl.pl. Supplementary data are available at Bioinformatics online.

Treatment of Macular Degeneration with Sildenafil: Results of a Two-Year Trial.

PubMed

Coleman, D Jackson; Lee, Winston; Chang, Stanley; Silverman, Ronald H; Lloyd, Harriet O; Daly, Suzanne; Tsang, Stephen H

2018-04-25

To evaluate PDE5/6 inhibition with sildenafil to reduce choroidal ischemia and treat age-related macular degeneration. Sildenafil was prescribed to treat participants with macular degenerations or macular dystrophies measured by spectral-domain optical coherence tomography, color fundus photography, enhanced depth imaging, and best-corrected visual acuity. No change in calcified drusen was noted. Vitelliform-type soft drusen were not substantially changed. A participant with Best vitelliform macular dystrophy had a significant improvement in vision as well as in photoreceptor and ellipsoid layers. Our research supports sildenafil as a safe treatment for age-related and vitelliform macular degenerations. Thickened Bruch's membrane reduces the beneficial effect of perfusion increase, but all eyes appear to benefit from PDE6. Notably, maintenance or improvement in the photoreceptor layer may be the most significant result of sildenafil and is consistent with PDE6 inhibition. Thus, sil-denafil treatment of macular degeneration offers significant potential for vision retention and recovery. © 2018 S. Karger AG, Basel.

Needles and Haystacks: Finding Funding for Medical Education Research.

PubMed

Gruppen, Larry D; Durning, Steven J

2016-04-01

Medical education research suffers from a significant and persistent lack of funding. Although adequate funding has been shown to improve the quality of research, there are a number of factors that continue to limit it. The competitive environment for medical education research funding makes it essential to understand strategies for improving the search for funding sources and the preparation of proposals. This article offers a number of resources, strategies, and suggestions for finding funding. Investigators must be able to frame their research in the context of significant issues and principles in education. They must set their proposed work in the context of prior work and demonstrate its potential for significant new contributions. Because there are few funding sources earmarked for medical education research, researchers much also be creative, flexible, and adaptive as they seek to present their ideas in ways that are appealing and relevant to the goals of funders. Above all, the search for funding requires persistence and perseverance.

A clinical nutrition course to improve pharmacy students' skills and confidence in counseling patients.

PubMed

Chang, Linda; Popovich, Nicholas G; Iramaneerat, Cherdsak; Smith, Everett V; Lutfiyya, M Nawal

2008-06-15

To create, implement, and evaluate a PharmD course on primary care nutrition. A 2-credit hour elective course was offered to second- and third-year pharmacy students. It was informed by the Socratic method using a minimum number of formal lecture presentations and featured problem-based learning exercises, case-based scenarios, and scientific literature to fuel informed debate. A single group posttest design with a retrospective pretest was used to assess students' self-efficacy. There was a significant overall improvement in students' self-efficacy in their ability to practice primary care nutrition. Completion of a nutrition course improved students' confidence in providing primary care nutrition and empowered them to speak more comfortably about the role of nutrition in the prevention of chronic diseases.

Prevention concept in industry: improvement in occupational safety and health protection--an empirical study.

PubMed

Ramsauer, F

2001-12-01

This prevention concept offers a contribution to the expansion of the set of instruments for occupational safety and health protection within workplace prevention. The concept involves the multilateral analysis of work conditions. The utilized instruments include a strategy group, a survey, a health issue round table, and an analysis of work demands, and lead to synergy effects at the results level. Employees are drawn into the analysis of work conditions and workplace design solutions for the improvement of the work situation. The prevention concept was tested in a large company and its application established in practice. It was accepted by all participants, and the comparison with the previous situation (defined only through the analysis of work demands) demonstrated a significant improvement in health protection.

Properties of Polymer-Infiltrated Carbon Foams

NASA Astrophysics Data System (ADS)

Adams, W. A.; Bunning, T. J.; Farmer, B. L.; Kearns, K. M.; Anderson, D. A.; Roy, A. K.; Banerjee, T.; Jeon, H. G.

2001-03-01

There is considerable interest in extending the use-temperatures of both commodity and high performance polymers. There is also interest in improving the mechanical strength of carbon foams. Composites prepared by infiltrating carbon foam with polymers may offer significant improvements in both, the polymer helping to rigidize the foam and the foam providing thermal protection by virtue of its high thermal conductivity. The mechanical properties and thermal stability of carbon foams of various densities infiltrated with polyurethane have been studied. When used with a heat sink, the composite is able to maintain a substantial thermal gradient which provides stability of the polymer nominally above its decomposition temperature. The composite also has much improved strength properties without sacrificing tensile modulus. The composites may be very well suited for thermal management applications.

Spontaneous Resolution of Long-Standing Macular Detachment due to Optic Disc Pit with Significant Visual Improvement.

PubMed

Parikakis, Efstratios A; Chatziralli, Irini P; Peponis, Vasileios G; Karagiannis, Dimitrios; Stratos, Aimilianos; Tsiotra, Vasileia A; Mitropoulos, Panagiotis G

2014-01-01

To report a case of spontaneous resolution of a long-standing serous macular detachment associated with an optic disc pit, leading to significant visual improvement. A 63-year-old female presented with a 6-month history of blurred vision and micropsia in her left eye. Her best-corrected visual acuity was 6/24 in the left eye, and fundoscopy revealed serous macular detachment associated with optic disc pit, which was confirmed by optical coherence tomography (OCT). The patient was offered vitrectomy as a treatment alternative, but she preferred to be reviewed conservatively. Three years after initial presentation, neither macular detachment nor subretinal fluid was evident in OCT, while the inner segment/outer segment (IS/OS) junction line was intact. Her visual acuity was improved from 6/24 to 6/12 in her left eye, remaining stable at the 6-month follow-up after resolution. We present a case of spontaneous resolution of a long-standing macular detachment associated with an optic disc pit with significant visual improvement, postulating that the integrity of the IS/OS junction line may be a prognostic factor for final visual acuity and suggesting OCT as an indicator of visual prognosis and the probable necessity of a surgical management.

[Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

PubMed

Bergholz, W

2008-11-01

In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

Rowing performance, body composition, and bone mineral density outcomes in college-level rowers after a season of concurrent training.

PubMed

Young, Kaelin C; Kendall, Kristina L; Patterson, Kaitlyn M; Pandya, Priyanka D; Fairman, Ciaran M; Smith, Samuel W

2014-11-01

To assess changes in body composition, lumbar-spine bone mineral density (BMD), and rowing performance in college-level rowers over a competition season. Eleven Division I college rowers (mean ± SD 21.4 ± 3.7 y) completed 6 testing sessions throughout the course of their competition season. Testing included measurements of fat mass, bone-free lean mass (BFLM), body fat (%BF), lumbar-spine BMD, and 2000-m time-trial performance. After preseason testing, rowers participated in a periodized training program, with the addition of resistance training to the traditional aerobic-training program. Significant (P < .05) improvements in %BF, total mass, and BFLM were observed at midseason and postseason compared with preseason. Neither lumbar-spine BMD nor BMC significantly changed over the competitive season (P > .05). Finally, rowing performance (as measured by 2000-m time and average watts achieved) significantly improved at midseason and postseason compared with preseason. Our results highlight the efficacy of a seasonal concurrent training program serving to improve body composition and rowing performance, as measured by 2000-m times and average watts, among college-level rowers. Our findings offer practical applications for coaches and athletes looking to design a concurrent strength and aerobic training program to improve rowing performance across a season.

Advanced Multi-Axis Spine Testing: Clinical Relevance and Research Recommendations

PubMed Central

Holsgrove, Timothy P.; Nayak, Nikhil R.; Welch, William C.

2015-01-01

Back pain and spinal degeneration affect a large proportion of the general population. The economic burden of spinal degeneration is significant, and the treatment of spinal degeneration represents a large proportion of healthcare costs. However, spinal surgery does not always provide improved clinical outcomes compared to non-surgical alternatives, and modern interventions, such as total disc replacement, may not offer clinically relevant improvements over more established procedures. Although psychological and socioeconomic factors play an important role in the development and response to back pain, the variation in clinical success is also related to the complexity of the spine, and the multi-faceted manner by which spinal degeneration often occurs. The successful surgical treatment of degenerative spinal conditions requires collaboration between surgeons, engineers, and scientists in order to provide a multi-disciplinary approach to managing the complete condition. In this review, we provide relevant background from both the clinical and the basic research perspectives, which is synthesized into several examples and recommendations for consideration in increasing translational research between communities with the goal of providing improved knowledge and care. Current clinical imaging, and multi-axis testing machines, offer great promise for future research by combining invivo kinematics and loading with in-vitro testing in six degrees of freedom to offer more accurate predictions of the performance of new spinal instrumentation. Upon synthesis of the literature, it is recommended that in-vitro tests strive to recreate as many aspects of the in-vivo environment as possible, and that a physiological preload is a critical factor in assessing spinal biomechanics in the laboratory. A greater link between surgical procedures, and the outcomes in all three anatomical planes should be considered in both the in-vivo and in-vitro settings, to provide data relevant to quality of motion, and stability. PMID:26273552

PeakRanger: A cloud-enabled peak caller for ChIP-seq data

PubMed Central

2011-01-01

Background Chromatin immunoprecipitation (ChIP), coupled with massively parallel short-read sequencing (seq) is used to probe chromatin dynamics. Although there are many algorithms to call peaks from ChIP-seq datasets, most are tuned either to handle punctate sites, such as transcriptional factor binding sites, or broad regions, such as histone modification marks; few can do both. Other algorithms are limited in their configurability, performance on large data sets, and ability to distinguish closely-spaced peaks. Results In this paper, we introduce PeakRanger, a peak caller software package that works equally well on punctate and broad sites, can resolve closely-spaced peaks, has excellent performance, and is easily customized. In addition, PeakRanger can be run in a parallel cloud computing environment to obtain extremely high performance on very large data sets. We present a series of benchmarks to evaluate PeakRanger against 10 other peak callers, and demonstrate the performance of PeakRanger on both real and synthetic data sets. We also present real world usages of PeakRanger, including peak-calling in the modENCODE project. Conclusions Compared to other peak callers tested, PeakRanger offers improved resolution in distinguishing extremely closely-spaced peaks. PeakRanger has above-average spatial accuracy in terms of identifying the precise location of binding events. PeakRanger also has excellent sensitivity and specificity in all benchmarks evaluated. In addition, PeakRanger offers significant improvements in run time when running on a single processor system, and very marked improvements when allowed to take advantage of the MapReduce parallel environment offered by a cloud computing resource. PeakRanger can be downloaded at the official site of modENCODE project: http://www.modencode.org/software/ranger/ PMID:21554709

Predicting outcome on admission and post-admission for acetaminophen-induced acute liver failure using classification and regression tree models.

PubMed

Speiser, Jaime Lynn; Lee, William M; Karvellas, Constantine J

2015-01-01

Assessing prognosis for acetaminophen-induced acute liver failure (APAP-ALF) patients often presents significant challenges. King's College (KCC) has been validated on hospital admission, but little has been published on later phases of illness. We aimed to improve determinations of prognosis both at the time of and following admission for APAP-ALF using Classification and Regression Tree (CART) models. CART models were applied to US ALFSG registry data to predict 21-day death or liver transplant early (on admission) and post-admission (days 3-7) for 803 APAP-ALF patients enrolled 01/1998-09/2013. Accuracy in prediction of outcome (AC), sensitivity (SN), specificity (SP), and area under receiver-operating curve (AUROC) were compared between 3 models: KCC (INR, creatinine, coma grade, pH), CART analysis using only KCC variables (KCC-CART) and a CART model using new variables (NEW-CART). Traditional KCC yielded 69% AC, 90% SP, 27% SN, and 0.58 AUROC on admission, with similar performance post-admission. KCC-CART at admission offered predictive 66% AC, 65% SP, 67% SN, and 0.74 AUROC. Post-admission, KCC-CART had predictive 82% AC, 86% SP, 46% SN and 0.81 AUROC. NEW-CART models using MELD (Model for end stage liver disease), lactate and mechanical ventilation on admission yielded predictive 72% AC, 71% SP, 77% SN and AUROC 0.79. For later stages, NEW-CART (MELD, lactate, coma grade) offered predictive AC 86%, SP 91%, SN 46%, AUROC 0.73. CARTs offer simple prognostic models for APAP-ALF patients, which have higher AUROC and SN than KCC, with similar AC and negligibly worse SP. Admission and post-admission predictions were developed. • Prognostication in acetaminophen-induced acute liver failure (APAP-ALF) is challenging beyond admission • Little has been published regarding the use of King's College Criteria (KCC) beyond admission and KCC has shown limited sensitivity in subsequent studies • Classification and Regression Tree (CART) methodology allows the development of predictive models using binary splits and offers an intuitive method for predicting outcome, using processes familiar to clinicians • Data from the ALFSG registry suggested that CART prognosis models for the APAP population offer improved sensitivity and model performance over traditional regression-based KCC, while maintaining similar accuracy and negligibly worse specificity • KCC-CART models offered modest improvement over traditional KCC, with NEW-CART models performing better than KCC-CART particularly at late time points.

A comparison of four typical green exercise environments and prediction of psychological health outcomes.

PubMed

Rogerson, Mike; Brown, Daniel K; Sandercock, Gavin; Wooller, John-James; Barton, Jo

2016-05-01

'Green exercise' (GE) is physical activity while simultaneously being exposed to nature. GE comprises three physical components: the individual, the exercise and the environment, and one processes component encompassing a range of psychological and physiological processes. Previous research has consistently shown affective benefits of GE compared to equivalent non-GE. Investigating the possibility of optimum GE environments may help maximise health benefits. The aim of this study was to compare affective outcomes of GE participation between four different typical GE environments (beach, grasslands, riverside, heritage), and further examine influences of several physical component-related variables and one processes component-related variable, on these outcomes. Participants (N = 331) completed questionnaires before and after a 5km run, at one of four parkrun event locations. Self-esteem (Δ = 1.61, 95% confidence interval (CI) = (1.30, 1.93)), stress (Δ = -2.36, 95% CI = (-3.01, -1.71)) and mood (Δ = -5.25, 95% CI = (-7.45, -3.05)) all significantly improved from pre- to post-run (p < .05). Improvements in these measures were not significantly different between environments. Several component-related variables significantly predicted these improvements, accounting for 9% of self-esteem improvement, 1.6% of perceived stress improvement, and 9.5% of mood improvement. GE offers accessible provision for improving acute psychological wellbeing. Although nature-based exercise environments can facilitate affective outcomes, the overall type of nature may be less critical. Other characteristics of the individual, exercise and environment can significantly influence attainment of psychological GE benefits. However, the results support a greater importance of the processes component in attaining previously reported affective outcomes. © Royal Society for Public Health 2015.

Profiting and providing less care: comprehensive services at for-profit, nonprofit, and public opioid treatment programs in the United States.

PubMed

Bachhuber, Marcus A; Southern, William N; Cunningham, Chinazo O

2014-05-01

Opioid use disorders are frequently associated with medical and psychiatric comorbidities (eg, HIV infection and depression), as well as social problems (eg, lack of health insurance). Comprehensive services addressing these conditions improve outcomes. To compare the proportion of for-profit, nonprofit, and public opioid treatment programs offering comprehensive services, which are not mandated by government regulations. Cross-sectional analysis of opioid treatment programs offering outpatient care in the United States (n=1036). Self-reported offering of communicable disease (HIV, sexually transmitted infections, and viral hepatitis) testing, psychiatric services (screening, assessment and diagnostic evaluation, and pharmacotherapy), and social services support (assistance in applying for programs such as Medicaid). Mixed-effects logistic regression models were developed to adjust for several county-level factors. Of opioid treatment programs, 58.0% were for profit, 33.5% were nonprofit, and 8.5% were public. Nonprofit programs were more likely than for-profit programs to offer testing for all communicable diseases [adjusted odds ratios (AOR), 1.7; 95% confidence interval (CI), 1.2, 2.5], all psychiatric services (AOR, 8.0; 95% CI, 4.9, 13.1), and social services support (AOR, 3.3; 95% CI, 2.3, 4.8). Public programs were also more likely than for-profit programs to offer communicable disease testing (AOR, 6.4; 95% CI, 3.5, 11.7), all psychiatric services (AOR, 25.8; 95% CI, 12.6, 52.5), and social services support (AOR, 2.4; 95% CI, 1.4, 4.3). For-profit programs were significantly less likely than nonprofit and public programs to offer comprehensive services. Interventions to increase the offering of comprehensive services are needed, particularly among for-profit programs.

The effectiveness of psychotherapy with refugees and asylum seekers: preliminary results from an Austrian study.

PubMed

Renner, Walter

2009-02-01

An Austrian Non-Governmental Organization (NGO) offered psychotherapy to 37 asylum seekers and refugees (21 of them female) with a mean age of 36.1 years (s = 7.5), with the majority of them from Chechnya or Afghanistan. Comparative data between the start of therapy and the time of evaluation revealed a highly significant positive effect (d = 0.77), while most therapies were still going on. By a retrospective measure of perceived change, 85% of the participants reported significant improvements. The results show that even under difficult conditions, when working with asylum seekers and refugees, psychotherapy can be effective.

Barriers to Household Risk Management: Evidence from India

PubMed Central

Cole, Shawn; Giné, Xavier; Tobacman, Jeremy; Townsend, Robert; Topalova, Petia; Vickery, James

2012-01-01

Why do many households remain exposed to large exogenous sources of non-systematic income risk? We use a series of randomized field experiments in rural India to test the importance of price and non-price factors in the adoption of an innovative rainfall insurance product. Demand is significantly price sensitive, but widespread take-up would not be achieved even if the product offered a payout ratio comparable to U.S. insurance contracts. We present evidence suggesting that lack of trust, liquidity constraints and limited salience are significant non-price frictions that constrain demand. We suggest contract design improvements to mitigate these frictions. PMID:24765234

Improving older people's life satisfaction via social networking site use: Evidence from China.

PubMed

Zhou, Junjie

2018-03-01

This study aimed to examine the pathways by which social networking sites (SNSs) can improve older people's life satisfaction. We conducted an online survey in China that lasted eight weeks. Respondents were required to report their demographic characteristics and feelings regarding SNS use. Data were analysed using SPSS 20 and Amos 21. We collected 596 valid samples. The empirical results show that SNS use improves older people's life satisfaction by reducing their loneliness and improving their self-efficacy. Social support alleviates the negative effect of loneliness and enhances the positive effect of self-efficacy on life satisfaction. Sex differences and education differences were significant. Men and less educated people had higher levels of life satisfaction. Policymakers should offer support to SNSs targeting older people and encourage them to provide more useful services. SNS operators should encourage social support among older users and pay attention to sex differences and education differences. © 2018 AJA Inc.

A retrospective evaluation of the Perfecting Patient Care University training program for health care organizations.

PubMed

Morganti, Kristy Gonzalez; Lovejoy, Susan; Beckjord, Ellen Burke; Haviland, Amelia M; Haas, Ann C; Farley, Donna O

2014-01-01

This study evaluated how the Perfecting Patient Care (PPC) University, a quality improvement (QI) training program for health care leaders and clinicians, affected the ability of organizations to improve the health care they provide. This training program teaches improvement methods based on Lean concepts and principles of the Toyota Production System and is offered in several formats. A retrospective evaluation was performed that gathered data on training, other process factors, and outcomes after staff completed the PPC training. A majority of respondents reported gaining QI competencies and cultural achievements from the training. Organizations had high average scores for the success measures of "outcomes improved" and "sustainable monitoring" but lower scores for diffusion of QI efforts. Total training dosage was significantly associated with the measures of QI success. This evaluation provides evidence that organizations gained the PPC competencies and cultural achievements and that training dosage is a driver of QI success.

A novel technique based on in vitro oocyte injection to improve CRISPR/Cas9 gene editing in zebrafish

PubMed Central

Xie, Shao-Lin; Bian, Wan-Ping; Wang, Chao; Junaid, Muhammad; Zou, Ji-Xing; Pei, De-Sheng

2016-01-01

Contemporary improvements in the type II clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9) system offer a convenient way for genome editing in zebrafish. However, the low efficiencies of genome editing and germline transmission require a time-intensive and laborious screening work. Here, we reported a method based on in vitro oocyte storage by injecting oocytes in advance and incubating them in oocyte storage medium to significantly improve the efficiencies of genome editing and germline transmission by in vitro fertilization (IVF) in zebrafish. Compared to conventional methods, the prior micro-injection of zebrafish oocytes improved the efficiency of genome editing, especially for the sgRNAs with low targeting efficiency. Due to high throughputs, simplicity and flexible design, this novel strategy will provide an efficient alternative to increase the speed of generating heritable mutants in zebrafish by using CRISPR/Cas9 system. PMID:27680290

Performance of structured lipids incorporating selected phenolic and ascorbic acids.

PubMed

Gruczynska, Eliza; Przybylski, Roman; Aladedunye, Felix

2015-04-15

Conditions applied during frying require antioxidant which is stable at these conditions and provides protection for frying oil and fried food. Novel structured lipids containing nutraceuticals and antioxidants were formed by enzymatic transesterification, exploring canola oil and naturally occurring antioxidants such as ascorbic and selected phenolic acids as substrates. Lipozyme RM IM lipase from Rhizomucor miehei was used as biocatalyst. Frying performance and oxidative stability of the final transesterification products were evaluated. The novel lipids showed significantly improved frying performance compared to canola oil. Oxidative stability assessment of the structured lipids showed significant improvement in resistance to oxidative deterioration compared to original canola oil. Interestingly, the presence of ascorbic acid in an acylglycerol structure protected α-tocopherol against thermal degradation, which was not observed for the phenolic acids. Developed structured lipids containing nutraceuticals and antioxidants may directly affect nutritional properties of lipids also offering nutraceutical ingredients for food formulation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Present status of metrology of electro-optical surveillance systems

NASA Astrophysics Data System (ADS)

Chrzanowski, K.

2017-10-01

There has been a significant progress in equipment for testing electro-optical surveillance systems over the last decade. Modern test systems are increasingly computerized, employ advanced image processing and offer software support in measurement process. However, one great challenge, in form of relative low accuracy, still remains not solved. It is quite common that different test stations, when testing the same device, produce different results. It can even happen that two testing teams, while working on the same test station, with the same tested device, produce different results. Rapid growth of electro-optical technology, poor standardization, limited metrology infrastructure, subjective nature of some measurements, fundamental limitations from laws of physics, tendering rules and advances in artificial intelligence are major factors responsible for such situation. Regardless, next decade should bring significant improvements, since improvement in measurement accuracy is needed to sustain fast growth of electro-optical surveillance technology.

Keep it clean: a visual approach to reinforce hand hygiene compliance in the emergency department.

PubMed

Wiles, Lynn L; Roberts, Chris; Schmidt, Kim

2015-03-01

Although hand hygiene strategies significantly reduce health care-associated infections, multiple studies have documented that hand hygiene is the most overlooked and poorly performed infection control intervention. Emergency nurses and technicians (n = 95) in a 41-bed emergency department in eastern Virginia completed pretests and posttests, an education module, and two experiential learning activities reinforcing hand hygiene and infection control protocols. Posttest scores were significantly higher than pretest scores (t (108) = -6.928, P = .048). Hand hygiene compliance rates improved at the conclusion of the project and 3 months after the study (F (2, 15) = 9.89, P = .002). Interfaces with staff as they completed the interactive exercise, as well as anecdotal notes collected during the study, identified key times when compliance suffered and offered opportunities to further improve hand hygiene and, ultimately, patient safety. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Wii-based interactive video games as a supplement to conventional therapy for rehabilitation of children with cerebral palsy: A pilot, randomized controlled trial.

PubMed

Sajan, Jane Elizabeth; John, Judy Ann; Grace, Pearlin; Sabu, Sneha Sara; Tharion, George

2017-08-01

To assess the effect of interactive video gaming (IVG) with Nintendo Wii (Wii) supplemented to conventional therapy in rehabilitation of children with cerebral palsy (CP). Randomized, controlled, assessor-blinded study. Children with CP; 10 children each in the control and intervention groups. IVG using Wii, given as a supplement to conventional therapy, for 45 min per day, 6 days a week for 3 weeks. The children in the control group received conventional therapy alone. Posture control and balance, upper limb function, visual-perceptual skills, and functional mobility. Significant improvement in upper limb functions was seen in the intervention group but not in the control group. Improvements in balance, visual perception, and functional mobility were not significantly different between control and intervention groups. Wii-based IVG may be offered as an effective supplement to conventional therapy in the rehabilitation of children with CP.

The Knowledge Base for Achieving the Sustainable Development Goal Targets on Water Supply, Sanitation and Hygiene

PubMed Central

Hutton, Guy; Chase, Claire

2016-01-01

Safe drinking water, sanitation, and hygiene (WASH) are fundamental to an improved standard of living. Globally, 91% of households used improved drinking water sources in 2015, while for improved sanitation it is 68%. Wealth disparities are stark, with rural populations, slum dwellers and marginalized groups lagging significantly behind. Service coverage is significantly lower when considering the new water and sanitation targets under the sustainable development goals (SDGs) which aspire to a higher standard of ‘safely managed’ water and sanitation. Lack of access to WASH can have an economic impact as much as 7% of Gross Domestic Product, not including the social and environmental consequences. Research points to significant health and socio-economic consequences of poor nutritional status, child growth and school performance caused by inadequate WASH. Groundwater over-extraction and pollution of surface water bodies have serious impacts on water resource availability and biodiversity, while climate change exacerbates the health risks of water insecurity. A significant literature documents the beneficial impacts of WASH interventions, and a growing number of impact evaluation studies assess how interventions are optimally financed, implemented and sustained. Many innovations in behavior change and service delivery offer potential for scaling up services to meet the SDGs. PMID:27240389

The international forum of ophthalmic simulation: developing a virtual reality training curriculum for ophthalmology.

PubMed

Saleh, George M; Lamparter, Julia; Sullivan, Paul M; O'Sullivan, Fiona; Hussain, Badrul; Athanasiadis, Ioannis; Litwin, Andre S; Gillan, Stewart N

2013-06-01

To investigate the effect of a structured, supervised, cataract simulation programme on ophthalmic surgeons in their first year of training, and to evaluate the level of skill transfer. Trainees with minimal intraocular and simulator experience in their first year of ophthalmology undertook a structured, sequential, customised, virtual reality (VR) cataract training programme developed through the International Forum of Ophthalmic Simulation. A set of one-handed, bimanual, static and dynamic tasks were evaluated before and after the course and scores obtained. Statistical significance was evaluated with the Wilcoxon sign-rank test. The median precourse score of 101.50/400 (IQR 58.75-145.75) was significantly improved after completing the training programme ((postcourse score: 302/400, range: 266.25-343), p<0.001). While improvement was evident and found to be statistically significant in all parameters, greatest improvements were found for capsulorhexis and antitremor training ((Capsulorhexis: precourse score=0/100, range 0-4.5; postcourse score=81/100, range 13-87.75; p=0.002), (antitremor training: precourse score=0/100, range 0-0; postcourse score=80/100, range 60.25-91.50; p=0.001)). Structured and supervised VR training can offer a significant level of skills transfer to novice ophthalmic surgeons. VR training at the earliest stage of ophthalmic surgical training may, therefore, be of benefit.

Using a wrap skirt to improve the pelvic examination experience.

PubMed

Neuhaus, Lilian R; Memeti, Elza; Schäffer, Marie-Kristin; Zimmermann, Roland; Schäffer, Leonhard

2016-05-01

The study aims were to analyze the experience of women and their physicians of nakedness when moving between changing room and examination chair and during pelvic examination itself, and to assess the protective benefit of a wrap skirt in alleviating the associated discomfort and vulnerability. We offered 1000 women a wrap skirt for pelvic examination and asked them to complete a post-procedure questionnaire. Physicians were invited to complete a similar but separate questionnaire. Data were analyzed using chi-squared contingency tables. A total of 425 women (43%, age 15-78 years) completed the questionnaire; 51% felt uncomfortable and embarrassed during the examination, Muslim women significantly more so (p < 0.001). Most women (n = 255; 58%) rated the wrap skirt a significant improvement; 69% requested it for future examinations, significantly more so if the physician was male rather than female (66% vs. 54%, p = 0.003). Even the one-third of women experiencing no discomfort reported improvement. Most examiners (n = 45; 56%) found the wrap skirt beneficial; 31 (38%) were unconvinced. Pelvic examination as practiced in many countries, on women naked from the waist down throughout, causes unnecessary embarrassment. A simple protective measure, such as a wrap skirt, significantly alleviates the discomfort and sense of vulnerability associated with nakedness. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

A stage of change approach to reducing occupational ill health.

PubMed

Whysall, Z; Haslam, C; Haslam, R

2006-11-01

Interventions targeted by stage of change have been shown to improve the efficacy of public health promotion initiatives in areas such as smoking cessation, alcohol reduction, and mammography screening. Targeted interventions are designed to tackle the key attitudes, beliefs, and intentions that underpin an individual's health-related behavior. Work-related ill health is an increasingly serious issue, the most common cause of which in both the UK and the US is musculoskeletal disorders. This study examined whether the stage approach could be applied to workplace interventions aimed at improving occupational health. A total of 24 multi-component occupational interventions aimed at reducing musculoskeletal disorders were monitored over a period of 4-6 months. In half of these cases, approaches were targeted according to workers' stage of change. Targeted interventions were found to be significantly more effective in promoting risk awareness and desired behavior change among workers. Significant reductions were also found in self-reported musculoskeletal discomfort among workers having received targeted interventions. No significant differences were found in self-reported musculoskeletal discomfort among workers following standard interventions. Stage-matched approaches may offer scope for substantially improving the efficacy of occupational health and safety interventions by increasing the uptake, implementation, and maintenance of risk-reducing measures.

Improving Chemistry Education by Offering Salient Technology Training to Preservice Teachers: A Graduate-Level Course on Using Software to Teach Chemistry

ERIC Educational Resources Information Center

Tofan, Daniel C.

2009-01-01

This paper describes an upper-level undergraduate and graduate-level course on computers in chemical education that was developed and offered for the first time in Fall 2007. The course provides future chemistry teachers with exposure to current software tools that can improve productivity in teaching, curriculum development, and education…

Acoustically enhanced microfluidic mixer to synthesize highly uniform nanodrugs without the addition of stabilizers.

PubMed

Le, Nguyen Hoai An; Van Phan, Hoang; Yu, Jiaqi; Chan, Hak-Kim; Neild, Adrian; Alan, Tuncay

2018-01-01

This article presents an acoustically enhanced microfluidic mixer to generate highly uniform and ultra-fine nanoparticles, offering significant advantages over conventional liquid antisolvent techniques. The method employed a 3D microfluidic geometry whereby two different phases - solvent and antisolvent - were introduced at either side of a 1 μm thick resonating membrane, which contained a through-hole. The vibration of the membrane rapidly and efficiently mixed the two phases, at the location of the hole, leading to the formation of nanoparticles. The versatility of the device was demonstrated by synthesizing budesonide (a common asthma drug) with a mean diameter of 135.7 nm and a polydispersity index of 0.044. The method offers a 40-fold reduction in the size of synthesized particles combined with a substantial improvement in uniformity, achieved without the need of stabilizers.

Single atom visibility in STEM optical depth sectioning

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

Ishikawa, Ryo; Pennycook, Stephen J.; Lupini, Andrew R.

The continuing development of aberration correctors for the scanning transmission electron microscope (STEM) offers the possibility of locating single atoms in crystals in 3D via optical depth sectioning. The main factors that determine the feasibility of such an approach are visibility and dose requirements. In this paper, we show how Poisson's statistics can be quantitatively incorporated into STEM image simulations and demonstrate that the 3D location of single cerium atoms in wurtzite-type aluminum nitride is indeed feasible under large-angle illumination conditions with a relatively low dose. We also show that chromatic aberration does not presently represent a limitation provided amore » cold field emission source is used. Finally, these results suggest efforts into improved aberration corrector designs for larger illumination angles that offer significant potential for 3D structure determination of materials.« less

Oral mucositis: etiology, and clinical and pharmaceutical management.

PubMed

Zur, Eyal

2012-01-01

Oral mucosal damage is one of the common and worst side effects of radiotherapy and chemotherapy treatment for cancer. With prevalence between 10% and 100%, depending on the cytotoxic and/or radiotherapy regimen and patient-associated variables, this morbid condition represents a significant problem in oncology. This article addresses oral mucositis and discusses its prevalence, risk factors, clinical and economical impacts, etiology, and clinical management in view of the most recent evidence. Despite clear progress and the development of clinical guidelines on this topic, what we currently have to offer to patients to manage mucositis and oropharyngeal pain is still inadequate. This article offers two compounded preparations supported by evidence-based data to treat oral mucositis. Expansion of the knowledge of the pathogenesis of mucositis as well as a better insight into individual risk factors will provide opportunities to improve management strategies.

Single atom visibility in STEM optical depth sectioning

DOE PAGES

Ishikawa, Ryo; Pennycook, Stephen J.; Lupini, Andrew R.; ...

2016-10-19

The continuing development of aberration correctors for the scanning transmission electron microscope (STEM) offers the possibility of locating single atoms in crystals in 3D via optical depth sectioning. The main factors that determine the feasibility of such an approach are visibility and dose requirements. In this paper, we show how Poisson's statistics can be quantitatively incorporated into STEM image simulations and demonstrate that the 3D location of single cerium atoms in wurtzite-type aluminum nitride is indeed feasible under large-angle illumination conditions with a relatively low dose. We also show that chromatic aberration does not presently represent a limitation provided amore » cold field emission source is used. Finally, these results suggest efforts into improved aberration corrector designs for larger illumination angles that offer significant potential for 3D structure determination of materials.« less

Evaluation of the impact response of textile composites

NASA Technical Reports Server (NTRS)

Portanova, M. A.

1995-01-01

An evaluation of the impact damage resistance and impact damage tolerance of stitched and unstitched uniweaves, 2-D braids, and 3-D weaves was conducted. Uniweave laminates were tested at four thicknesses to determine the sensitivity of the tests to this parameter. Several braid and weave parameters were also varied to establish their velocity (large mass) impacts and then loaded in tension or compression to measure residual strength. Experimental results indicate that stitching significantly improves the uniweaves' damage resistance. The 2-D braids and 3-D weaves offered less damage resistance than the stitched materials. Stitching also improved the compression after impact (CAI) and tension after impact (TAI) strengths of the uniweave materials.

Combination therapy for solar lentigines.

PubMed

Farris, Patricia K

2004-01-01

Solar lentigines are benign, hyperpigmented lesions that present a significant cosmetic nuisance for many middle-aged and elderly patients with chronic accumulated sun exposure. While previous monotherapies designed to lighten these lesions offer relatively modest improvement, there are several new treatment options. Combination topical therapy using 2% mequinol/0.01% tretinoin [Solagé Topical Solution] has been shown to markedly reduce lesion darkness with few side effects. Chemical peels can give good results either alone or in combination with topical therapy. Cryotherapy is an effective and inexpensive way of treating solar lentigines while IPL and lasers are more costly treatment options. For patients desiring treatment, optimal cosmetic improvement can be achieved using a combination of topical and procedural therapies.

Loading amorphous Asarone in mesoporous silica SBA-15 through supercritical carbon dioxide technology to enhance dissolution and bioavailability.

PubMed

Zhang, Zhengzan; Quan, Guilan; Wu, Qiaoli; Zhou, Chan; Li, Feng; Bai, Xuequn; Li, Ge; Pan, Xin; Wu, Chuanbin

2015-05-01

The aim of this study was to load amorphous hydrophobic drug into ordered mesoporous silica (SBA-15) by supercritical carbon dioxide technology in order to improve the dissolution and bioavailability of the drug. Asarone was selected as a model drug due to its lipophilic character and poor bioavailability. In vitro dissolution and in vivo bioavailability of the obtained Asarone-SBA-15 were significantly improved as compared to the micronized crystalline drug. This study offers an effective, safe, and environmentally benign means of solving the problems relating to the solubility and bioavailability of hydrophobic molecules. Copyright © 2015 Elsevier B.V. All rights reserved.

Development of new EVA formulations for improved performance at NREL

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

Pern, F.J.

1997-02-01

We review in chronological order the research stages and fundamental concepts involved in developing modified and new EVA formulations for improved performance against photo-induced degradation and discoloration. The new NREL EVA formulations use additives totally different from the present commercial formulations (EVA A9918 and EVA 15295). Validation of their long-term photostability and thermostability is presently under way. Together with UV-absorbing glass superstrates, they may offer better success in achieving a more reliable module performance and longer service life without significant EVA discoloration problems, which are commonly experienced with EVA A9918 and, at a lesser rate, EVA 15295. {copyright} {ital 1997more » American Institute of Physics.}« less

Shelf Life of PMR Polyimide Monomer Solutions and Prepregs Extended

NASA Technical Reports Server (NTRS)

Alston, William B.; Scheiman, Daniel A.

2000-01-01

PMR (Polymerization of Monomeric Reactants) technology was developed in the mid-1970's at the NASA Glenn Research Center at Lewis Field for fabricating high-temperature stable polyimide composites. This technology allowed a solution of polyimide monomers or prepreg (a fiber, such as glass or graphite, impregnated with PMR polyimide monomers) to be thermally cured without the release of volatiles that cause the formation of voids unlike the non-PMR technology used for polyimide condensation type resins. The initial PMR resin introduced as PMR 15 is still commercially available and is used worldwide by aerospace industries as the state-of-the-art resin for high-temperature polyimide composite applications. PMR 15 offers easy composite processing, excellent composite mechanical property retention, a long lifetime at use temperatures of 500 to 550 F, and relatively low cost. Later, second-generation PMR resin versions, such as PMR II 50 and VCAP 75, offer improvements in the upper-use temperature (to 700 F) and in the useful life at temperature without major compromises in processing and property retention but with significant increases in resin cost. Newer versions of nontoxic (non-methylene dianiline) PMR resins, such as BAX PMR 15, offer similar advantages as originally found for PMR 15 but also with significant increases in resin cost. Thus, the current scope of the entire PMR technology available meets a wide range of aeronautical requirements for polymer composite applications.

Direct and comprehensive analysis of dyes based on integrated molecular and structural information via laser desorption laser postionization mass spectrometry.

PubMed

Liu, Rong; Yin, Zhibin; Leng, Yixin; Hang, Wei; Huang, Benli

2018-01-01

Laser desorption laser postionization time-of-flight mass spectrometry (LDPI-TOFMS) was employed for direct analysis and determination of typical basic dyes. It was also used for the analysis and comprehensive understanding of complex materials such as blue ballpoint pen inks. Simultaneous emergences of fragmental and molecular information largely simplify and facilitate unambiguous identification of dyes via variable energy of 266nm postionization laser. More specifically, by optimizing postionization laser energy with the same energy of desorption laser, the structurally significant results show definite differences in the fragmentation patterns, which offer opportunities for discrimination of isomeric species with identical molecular weight. Moreover, relatively high spectra resolution can be acquired without the expense of sensitivity. In contrast to laser desorption/ionization mass spectrometry (LDI-MS), LDPI-MS simultaneously offers valuable molecular information about dyes in traces, solvents and additives about inks, thereby offering direct determination and comprehensive understanding of blue ballpoint inks and giving a high level of confidence to discriminate the complicated evidentiary samples. In addition, direct analysis of the inks not only allows the avoidance of the tedious sample preparation processes, significantly shortening the overall analysis time and improving throughput, but allows minimized sample consumption which is important for rare and precious samples. Copyright © 2017 Elsevier B.V. All rights reserved.

Relationship between Systems-Level Factors and Hand Hygiene Adherence

PubMed Central

Dunn-Navarra, Ann-Margaret; Cohen, Bevin; Stone, Patricia W.; Pogorzelska, Monika; Jordan, Sarah; Larson, Elaine

2010-01-01

This study was a cross sectional descriptive survey of acute care hospitals in California to describe staff hand hygiene compliance and related predictors, and explore the relationship between hand hygiene adherence to health care-associated infections. Although there was a relatively small sample size, institutions with morning huddles reported a significantly higher proportion of ≥95% hand hygiene compliance. Huddles are an organizational tool to improve teamwork and communication and may offer promise to influence hand hygiene adherence. PMID:20489659

Assessment of Alternate Thermal Protection Systems for the Space Shuttle Orbiter

NASA Technical Reports Server (NTRS)

Kelly, H. N.; Webb, G. L.

1982-01-01

Candidate concepts are identified. The impact on the Shuttle Orbiter performance life cycle cost, and risk was assessed and technology advances required to bring the selected TPS to operational readiness are defined. The best system is shown to be a hybrid blend of metallic and carbon-carbon TPS concepts. These alternate concepts offer significant improvements in reusability and are mass competitive with the current ceramic tile reusable surface insulation. Programmatic analysis indicates approximately five years are required to bring the concepts to operational readiness.

Not lost in translation: how study of diseases in our pets can benefit them and us.

PubMed

Henry, Carolyn J; Bryan, Jeffrey N

2013-01-01

Practice-changing medical discovery requires preclinical and clinical assessment be carried out using appropriate disease models. There is growing awareness of companion animals with naturally-occurring disease as such models. They offer significant advantages over more traditional in vivo models of induced disease. This review describes current efforts to promote translation of discoveries between human and veterinary medicine in order to more rapidly and efficiently make progress in improving the health of all human and animal patients.

Microchannel plate streak camera

DOEpatents

Wang, Ching L.

1989-01-01

An improved streak camera in which a microchannel plate electron multiplier is used in place of or in combination with the photocathode used in prior streak cameras. The improved streak camera is far more sensitive to photons (UV to gamma-rays) than the conventional x-ray streak camera which uses a photocathode. The improved streak camera offers gamma-ray detection with high temporal resolution. It also offers low-energy x-ray detection without attenuation inside the cathode. Using the microchannel plate in the improved camera has resulted in a time resolution of about 150 ps, and has provided a sensitivity sufficient for 1000 KeV x-rays.

Effect of a dual-task net-step exercise on cognitive and gait function in older adults.

PubMed

Kitazawa, Kazutoshi; Showa, Satoko; Hiraoka, Akira; Fushiki, Yasuhiro; Sakauchi, Humio; Mori, Mitsuru

2015-01-01

Participation in generally recommended aerobics or strength exercises may be challenging for older adults. Therefore, it is necessary to consider the types and levels of physical activities suited for them to improve their cognitive and gait function and adherence to exercise programs. This has prompted efforts to identify exercises that require less physical strength and frequency of performance, while still offering cognitive and health benefits. Here, we aimed to assess the effect of a novel dual-task net-step exercise (NSE) performed once a week for 8 consecutive weeks on improvements in cognitive performance and gait function in an older population. In this pretest/posttest experimental case control study, 60 healthy older adults (mean age 76.4 years) were recruited from community-dwelling people and separated randomly into 2 groups: a dual-task NSE group and a control group. The NSE group was asked to walk across a net without stepping on the ropes or being caught in the net. Two computer panel-type cognitive functional assessments, the Touch-M and Touch Panel-Type Dementia Assessment Scale, were administered at baseline and after 8 weeks of intervention to determine the effects of NSE. Improvements in gait function were also evaluated using Timed Up and Go test scores. Mixed-effect models with repeated measures (group × time) (analysis of variance, F test) were used to test the effects of NSE. Adjustments were made for covariates including age and sex (analysis of covariance). The NSE group showed significant improvement in cognitive performance (6.8% change; total Touch-M score 5.4 points; P = .04) and gait performance (11.5% change; Timed Up and Go time -0.98 second; P < .001) over the 8-week period. In the control group, there was no significant improvement. This study shows that dual-task NSE is capable of improving cognitive and gait performance in healthy older adults. Our results indicate that NSE offers an option for a large segment of the older population who need an easier way to maintain their cognitive health and gait function.

Psychosocial Interventions in Reducing Cannabis Use in Early Phase Psychosis: A Canadian Survey of Treatments Offered.

PubMed

Aydin, Cristina; Tibbo, Philip G; Ursuliak, Zenovia

2016-06-01

Cannabis use in people with early phase psychosis (EPP) can have a significant impact on long-term outcomes. The purpose of this investigation was to describe current cannabis use treatment practices in English-speaking early intervention services (EISs) in Canada and determine if their services are informed by available evidence. Thirty-five Canadian English-speaking EISs for psychosis were approached to complete a survey through email, facsimile, or online in order to collect information regarding their current cannabis use treatment practices. Data were acquired from 27 of the 35 (78%) programs approached. Only 12% of EISs offered formal services that targeted cannabis use, whereas the majority (63%) of EISs offered informal services for all substance use, not specifically cannabis. In programs with informal services, individual patient psychoeducation (86%) was slightly more common than individual motivational interviewing (MI) (76%) followed by group patient psychoeducation (52%) and information handouts (52%). Thirty-seven percent of EISs offered formal services for substance use, and compared to programs with informal services, more MI, cognitive-behavioural therapy, and family services were offered, with individual treatment modalities more common than groups. No EISs used contingency management, even though it has some preliminary evidence in chronic populations. Evidence-based service implementation barriers included appropriate training and administrative support. While most English-speaking Canadian EIS programs offer individual MI and psychoeducation, which is in line with the available literature, there is room for improvement in cannabis treatment services based on current evidence for both people with EPP and their families. © The Author(s) 2016.

Pharmacoeconomic Education in Egyptian Schools of Pharmacy

PubMed Central

Soliman, Ahmed M.; Hussein, Mustafa; Abdulhalim, Abdulla M.

2013-01-01

Objective. To investigate the status of pharmacoeconomics education in Egyptian schools of pharmacy and compile and construct recommendations on how Egypt and similar countries could improve their educational infrastructure in pharmacoeconomics. Methods. A modified version of a published survey instrument was sent to all schools of pharmacy in Egypt (n= 24). The data were assessed to identify associations between offering pharmacoeconomics education and school characteristics. Results. Usable responses were obtained from 20 schools (response rate: 83%). Only 7 schools offered pharmacoeconomics education, with a median of 20 teaching hours per semester. Among respondents, 4 schools had instructors with some training in pharmacoeconomics and only 1 school had a faculty member with PhD-level training. Only 4 schools offered graduate-level courses in pharmacoeconomics. Eight additional schools expressed interest in teaching pharmacoeconomics in the near future. Having 1 or more faculty members with training in pharmacoeconomics was significantly associated with offering pharmacoeconomics education (p = 0.03). Conclusions. Pharmacoeconomics education in Egypt is still in its infancy and there exists a unique opportunity for well-trained instructors and researchers to fill this gap. Providing structured pharmacoeconomics education to student pharmacists, researchers, and stakeholders can help countries establish an integrated scientific community that can start applying pharmacoeconomic evidence to healthcare decision-making. PMID:23610475

A Comparison Between Phone-Based Psychotherapy With and Without Text Messaging Support In Between Sessions for Crisis Patients

PubMed Central

2014-01-01

Background Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation. Objective The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises. Methods Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only. Results A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3). Conclusions Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects. PMID:25295667

A comparison between phone-based psychotherapy with and without text messaging support in between sessions for crisis patients.

PubMed

Furber, Gareth; Jones, Gabrielle Margaret; Healey, David; Bidargaddi, Niranjan

2014-10-08

Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation. The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises. Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only. A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3). Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects.

Trajectories of women's homelessness in Canada's 3 northern territories

PubMed Central

Schmidt, Rose; Hrenchuk, Charlotte; Bopp, Judie; Poole, Nancy

2015-01-01

Background Repairing the Holes in the Net was a 2-year, multilevel action research project designed to inform the development of culturally appropriate and gender-specific services for northern women who are homeless or marginally housed and who face mental health and substance use concerns. The study was designed to learn about the barriers and supports experienced by homeless women in the North when accessing mental health care, shelter, housing and other services; and to inform the work of northern service providers and policy advocates in a position to implement adjustments in their praxis. Methods This article describes the trajectories of women's service access and their ideas for service improvement from 61 qualitative, semi-structured interviews conducted with homeless women in Whitehorse, Yukon (YT), Yellowknife, Northwest Territories (NT), and Iqualit, Nunavut (NU). Results Unresolved trauma, poverty and social exclusion, inability to find and maintain housing and ineffective services emerged as interconnected and multifaceted challenges related to women's service engagement. In the face of these challenges, women displayed significant resilience and resistance, and offered important ideas for service improvement. Conclusions The 4 interconnected systemic challenges identified in the research, coupled with specific ideas for change cited by the resilient homeless women interviewed, offer points of entry to improve service policy and delivery. Implementing trauma-informed approaches emerged as a key example of how access to, and quality of, services could be improved for homeless women in the North. PMID:26700413

Effects of different discount levels on healthy products coupled with a healthy choice label, special offer label or both: results from a web-based supermarket experiment.

PubMed

Waterlander, Wilma E; Steenhuis, Ingrid H M; de Boer, Michiel R; Schuit, Albertine J; Seidell, Jacob C

2013-05-16

Two strategies commonly recommended to improve population diets include food labels and food taxes/subsidies. The aim of this study was to examine the effects of both strategies separately and in combination. An experiment with a 3x3 factorial design was conducted, including: three levels of price reduction (10%; 25%; and 50%) x three labels ('special offer', 'healthy choice' and 'special offer & healthy choice') on healthy foods defined following the Choices front-of-pack nutrition label. N=109 participants completed the experiment by conducting a typical weekly shop for their household at a three-dimensional web-based supermarket. Data were analysed using analysis of covariance. Participants receiving a 50% price discount purchased significantly more healthy foods for their household in a typical weekly shop than the 10% discount (+8.7 items; 95%CI=3.8-13.6) and the 25% discount group (+7.7 items; 95%CI=2.74 - 12.6). However, the proportion of healthy foods was not significantly higher and the discounts lead to an increased amount of energy purchased. No significant effects of the labels were found. This study brings some relevant insights into the effects of price discounts on healthier foods coupled with different labels and shows that price effects over shadowed food labels. However, price discounts seem to have ambiguous effects; they do encourage the purchase of healthy products, but also lead to increased energy purchases. More research is needed to examine how pricing strategies can work in directing consumers towards interchanging unhealthier options for healthier alternatives.

Towards ambient temperature-stable vaccines: the identification of thermally stabilizing liquid formulations for measles virus using an innovative high-throughput infectivity assay.

PubMed

Schlehuber, Lisa D; McFadyen, Iain J; Shu, Yu; Carignan, James; Duprex, W Paul; Forsyth, William R; Ho, Jason H; Kitsos, Christine M; Lee, George Y; Levinson, Douglas A; Lucier, Sarah C; Moore, Christopher B; Nguyen, Niem T; Ramos, Josephine; Weinstock, B André; Zhang, Junhong; Monagle, Julie A; Gardner, Colin R; Alvarez, Juan C

2011-07-12

As a result of thermal instability, some live attenuated viral (LAV) vaccines lose substantial potency from the time of manufacture to the point of administration. Developing regions lacking extensive, reliable refrigeration ("cold-chain") infrastructure are particularly vulnerable to vaccine failure, which in turn increases the burden of disease. Development of a robust, infectivity-based high throughput screening process for identifying thermostable vaccine formulations offers significant promise for vaccine development across a wide variety of LAV products. Here we describe a system that incorporates thermal stability screening into formulation design using heat labile measles virus as a prototype. The screening of >11,000 unique formulations resulted in the identification of liquid formulations with marked improvement over those used in commercial monovalent measles vaccines, with <1.0 log loss of activity after incubation for 8h at 40°C. The approach was shown to be transferable to a second unrelated virus, and therefore offers significant promise towards the optimization of formulation for LAV vaccine products. Copyright © 2011 Elsevier Ltd. All rights reserved.

Techno-economic requirements for composite aircraft components

NASA Technical Reports Server (NTRS)

Palmer, Ray

1993-01-01

The primary reason for use of composites is to save structural weight. A well designed composite aircraft structure will usually save 25-30 percent of a well designed metal structure. The weight savings then translates into improved performance of the aircraft in measures of greater payload, increased flying range or improved efficiency - less use of fuel. Composite materials offer technical advantages. Key technical advantages that composites offer are high stiffness, tailored strength capability, fatigue resistance, and corrosion resistance. Low thermal expansion properties produce dimensionally stable structures over a wide range of temperature. Specialty resin 'char' forming characteristics in a fire environment offer potential fire barrier application and safer aircraft. The materials and processes of composite fabrication offer the potential for lower cost structures in the near future. The application of composite materials to aircraft are discussed.

Cognitive remediation for adolescents with 22q11 deletion syndrome (22q11DS): a preliminary study examining effectiveness, feasibility, and fidelity of a hybrid strategy, remote and computer-based intervention.

PubMed

Mariano, Margaret A; Tang, Kerri; Kurtz, Matthew; Kates, Wendy R

2015-08-01

22q11DS is a multiple anomaly syndrome involving intellectual and behavioral deficits, and increased risk for schizophrenia. As cognitive remediation (CR) has recently been found to improve cognition in younger patients with schizophrenia, we investigated the efficacy, feasibility, and fidelity of a remote, hybrid strategy, computerized CR program in youth with 22q11DS. A longitudinal design was implemented in which 21 participants served as their own controls. Following an eight month baseline period in which no interventions were provided, cognitive coaches met with participants remotely for CR via video conferencing three times a week over a targeted 8month timeframe and facilitated their progress through the intervention, offering task-specific strategies. A subset of strategies were examined for fidelity. Outcomes were evaluated using a neurocognitive test battery at baseline, pre-treatment and post-treatment. All participants adhered to the intervention. The mean length of the treatment phase was 7.96months. A moderately high correlation (intraclass correlation coefficient, 0.73) was found for amount and type of strategies offered by coaches. Participants exhibited significant improvements (ES=.36-.55, p≤.009) in working memory, shifting attention and cognitive flexibility. All significant models were driven by improvements in pre to post-treatment scores. Based on our preliminary investigation, a remote, hybrid strategy, computerized CR program can be implemented with 22q11DS youth despite geographic location, health, and cognitive deficits. It appears effective in enhancing cognitive skills during the developmental period of adolescence, making this type of CR delivery useful for youth with 22q11DS transitioning into post-school environments. Copyright © 2015 Elsevier B.V. All rights reserved.

Where has all the chocolate gone? A national survey assesses the effects of recent legislation to improve the nutritional quality of English secondary-school vending.

PubMed

Matthews, Anne; Nelson, Michael; Kaur, Asha; Rayner, Mike; Kelly, Paul; Cowburn, Gill

2011-08-01

Obesity levels are rising in almost all parts of the world, including the UK. School food offers children in Great Britain between 25 % and 33 % of their total daily energy, with vending typically offering products high in fat, salt or sugar. Government legislation of 2007 to improve the quality of school food now restricts what English schools can vend. In assessing the effect of this legislation on the quality of English secondary-school vending provision, the response of schools to these effects is explored through qualitative data. A longitudinal postal and visit-based inventory survey of schools collected vending data during the academic year 2006-2007 (pre-legislation), 2007-2008 and 2008-2009 (both post-legislation). Interviews with school staff explored issues of compliance. Product categorisation and analysis were carried out by product type, nutrient profiling and by categories of foods allowed or prohibited by the legislation. English secondary schools. A representative sample of 279 schools including sixty-two researcher-visited inventory schools participated in the research. School vending seems to have moved towards compliance with the new standards - now drinks vending predominates and is largely compliant, whereas food vending is significantly reduced and is mostly non-compliant. Sixth form vending takes a disproportionate share of non-compliance. Vending has declined overall, as some schools now perceive food vending as uneconomic. Schools adopting a 'whole-school' approach appeared the most successful in implementing the new standards. Government legislation has achieved significant change towards improving the quality of English school vending, with the unintended consequence of reducing provision.

A new design concept for knitted external vein-graft support mesh.

PubMed

Singh, Charanpreet; Wang, Xungai

2015-08-01

Autologous vein-graft failure significantly limits the long-term efficacy of coronary artery bypass procedures. The major cause behind this complication is biomechanical mismatch between the vein and coronary artery. The implanted vein experiences a sudden increase (10-12 fold) in luminal pressures. The resulting vein over-distension or 'ballooning' initiates wall thickening phenomenon and ultimate occlusion. Therefore, a primary goal in improving the longevity of a coronary bypass procedure is to inhibit vein over-distension using mechanical constriction. The idea of using an external vein-graft support mesh has demonstrated sustained benefits and wide acceptance in experimental studies. Nitinol based knitted structures have offered more promising mechanical features than other mesh designs owing to their unique loosely looped construction. However, the conventional plain knit construction still exhibits limitations (radial compliance, deployment ease, flexibility, and bending stresses) which limit this design from proving its real clinical advantage. The new knitted mesh design presented in this study is based on the concept of composite knitting utilising high modulus (nitinol and polyester) and low modulus (polyurethane) material components. The experimental comparison of the new design with a plain knit design demonstrated significant improvement in biomechanical (compliance, flexibility, extensibility, viscoelasticity) and procedural (deployment limit) parameters. The results are indicative of the promising role of new mesh in restoring the lost compliance and pulsatility of vein-graft at high arterial pressures. This way it can assist in controlled vein-graft remodelling and stepwise restoration of vein mechanical homoeostasis. Also, improvement in deployment limit parameter offers more flexibility for a surgeon to use a wide range of vein diameters, which may otherwise be rendered unusable for a plain knit mesh. Copyright © 2015 Elsevier Ltd. All rights reserved.

Materials

NASA Technical Reports Server (NTRS)

Glaessgen, Edward H.; Schoeppner, Gregory A.

2006-01-01

NASA Langley Research Center has successfully developed an electron beam freeform fabrication (EBF3) process, a rapid metal deposition process that works efficiently with a variety of weldable alloys. The EBF3 process can be used to build a complex, unitized part in a layer-additive fashion, although the more immediate payoff is for use as a manufacturing process for adding details to components fabricated from simplified castings and forgings or plate products. The EBF3 process produces structural metallic parts with strengths comparable to that of wrought product forms and has been demonstrated on aluminum, titanium, and nickel-based alloys to date. The EBF3 process introduces metal wire feedstock into a molten pool that is created and sustained using a focused electron beam in a vacuum environment. Operation in a vacuum ensures a clean process environment and eliminates the need for a consumable shield gas. Advanced metal manufacturing methods such as EBF3 are being explored for fabrication and repair of aerospace structures, offering potential for improvements in cost, weight, and performance to enhance mission success for aircraft, launch vehicles, and spacecraft. Near-term applications of the EBF3 process are most likely to be implemented for cost reduction and lead time reduction through addition of details onto simplified preforms (casting or forging). This is particularly attractive for components with protruding details that would require a significantly large volume of material to be machined away from an oversized forging, offering significant reductions to the buy-to-fly ratio. Future far-term applications promise improved structural efficiency through reduced weight and improved performance by exploiting the layer-additive nature of the EBF3 process to fabricate tailored unitized structures with functionally graded microstructures and compositions.

An Application of Multi-band Forced Photometry to One Square Degree of SERVS: Accurate Photometric Redshifts and Implications for Future Science

NASA Astrophysics Data System (ADS)

Nyland, Kristina; Lacy, Mark; Sajina, Anna; Pforr, Janine; Farrah, Duncan; Wilson, Gillian; Surace, Jason; Häußler, Boris; Vaccari, Mattia; Jarvis, Matt

2017-05-01

We apply The Tractor image modeling code to improve upon existing multi-band photometry for the Spitzer Extragalactic Representative Volume Survey (SERVS). SERVS consists of post-cryogenic Spitzer observations at 3.6 and 4.5 μm over five well-studied deep fields spanning 18 deg2. In concert with data from ground-based near-infrared (NIR) and optical surveys, SERVS aims to provide a census of the properties of massive galaxies out to z ≈ 5. To accomplish this, we are using The Tractor to perform “forced photometry.” This technique employs prior measurements of source positions and surface brightness profiles from a high-resolution fiducial band from the VISTA Deep Extragalactic Observations survey to model and fit the fluxes at lower-resolution bands. We discuss our implementation of The Tractor over a square-degree test region within the XMM Large Scale Structure field with deep imaging in 12 NIR/optical bands. Our new multi-band source catalogs offer a number of advantages over traditional position-matched catalogs, including (1) consistent source cross-identification between bands, (2) de-blending of sources that are clearly resolved in the fiducial band but blended in the lower resolution SERVS data, (3) a higher source detection fraction in each band, (4) a larger number of candidate galaxies in the redshift range 5 < z < 6, and (5) a statistically significant improvement in the photometric redshift accuracy as evidenced by the significant decrease in the fraction of outliers compared to spectroscopic redshifts. Thus, forced photometry using The Tractor offers a means of improving the accuracy of multi-band extragalactic surveys designed for galaxy evolution studies. We will extend our application of this technique to the full SERVS footprint in the future.

Aerobic, resistance or combined training: A systematic review and meta-analysis of exercise to reduce cardiovascular risk in adults with metabolic syndrome.

PubMed

Wewege, Michael A; Thom, Jeanette M; Rye, Kerry-Anne; Parmenter, Belinda J

2018-05-03

Exercise is beneficial to individuals with metabolic syndrome (MetS). An understudied group, who represent the majority of the MetS population, are individuals who have not developed diabetes. This review examined aerobic, resistance and combined (aerobic + resistance) exercise for cardiovascular risk factors in MetS without diabetes. Eight electronic databases were searched up to September 2017 for randomised controlled trials >4 weeks in duration that compared an exercise intervention to the non-exercise control in MetS without diabetes. MetS criteria, cardiorespiratory fitness and cardiovascular risk factors were meta-analysed in a random effects model. Eleven studies with 16 interventions were included (12 aerobic, 4 resistance). Aerobic exercise significantly improved waist circumference -3.4 cm (p < 0.01), fasting glucose -0.15 mmol/L (p = 0.03), high-density cholesterol 0.05 mmol/L (p = 0.02), triglycerides -0.29 mmol/L (p < 0.01), diastolic blood pressure -1.6 mmHg (p = 0.01), and cardiorespiratory fitness 4.2 ml/kg/min (p < 0.01), among other outcomes. No significant effects were determined following resistance exercise possibly due to limited data. Sub-analyses suggested that aerobic exercise progressed to vigorous intensity, and conducted 3 days/week for ≥12 weeks offered larger and more widespread improvements. Aerobic exercise following current guidelines offers widespread benefits to individuals with MetS without diabetes. More studies on resistance/combined exercise programs in MetS are required to improve the quality of evidence. Copyright © 2018 Elsevier B.V. All rights reserved.

Mapping of H.264 decoding on a multiprocessor architecture

NASA Astrophysics Data System (ADS)

van der Tol, Erik B.; Jaspers, Egbert G.; Gelderblom, Rob H.

2003-05-01

Due to the increasing significance of development costs in the competitive domain of high-volume consumer electronics, generic solutions are required to enable reuse of the design effort and to increase the potential market volume. As a result from this, Systems-on-Chip (SoCs) contain a growing amount of fully programmable media processing devices as opposed to application-specific systems, which offered the most attractive solutions due to a high performance density. The following motivates this trend. First, SoCs are increasingly dominated by their communication infrastructure and embedded memory, thereby making the cost of the functional units less significant. Moreover, the continuously growing design costs require generic solutions that can be applied over a broad product range. Hence, powerful programmable SoCs are becoming increasingly attractive. However, to enable power-efficient designs, that are also scalable over the advancing VLSI technology, parallelism should be fully exploited. Both task-level and instruction-level parallelism can be provided by means of e.g. a VLIW multiprocessor architecture. To provide the above-mentioned scalability, we propose to partition the data over the processors, instead of traditional functional partitioning. An advantage of this approach is the inherent locality of data, which is extremely important for communication-efficient software implementations. Consequently, a software implementation is discussed, enabling e.g. SD resolution H.264 decoding with a two-processor architecture, whereas High-Definition (HD) decoding can be achieved with an eight-processor system, executing the same software. Experimental results show that the data communication considerably reduces up to 65% directly improving the overall performance. Apart from considerable improvement in memory bandwidth, this novel concept of partitioning offers a natural approach for optimally balancing the load of all processors, thereby further improving the overall speedup.

Improved Oceanographic Measurements from SAR Altimetry: Results and Scientific Roadmap from the ESA Cryosat Plus for Oceans Project

NASA Astrophysics Data System (ADS)

Benveniste, J.; Cotton, D.; Andersen, O. B.; Boy, F.; Cancet, M.; Dinardo, S.; Gommenginger, C.; Egido, A.; Fernandes, J.; Garcia, P. N.; Lucas, B.; Moreau, T.; Naeije, M.; Scharroo, R.; Stenseng, L.

2014-12-01

The ESA CryoSat mission is the first space mission to carry a radar altimeter that can operate in Synthetic Aperture Radar (SAR) mode. It thus provides the first opportunity to test and evaluate, using real data, the significant potential benefits of SAR altimetry for ocean applications. The objective of the CryoSat Plus for Oceans (CP4O) project is to develop and evaluate new ocean products from CryoSat data and so maximize the scientific return of CryoSat over oceans. The main focus of CP4O has been on the additional measurement capabilities that are offered by the SAR mode of the SIRAL altimeter, with further work in developing improved geophysical corrections. CP4O has developed SAR based ocean products for application in four themes: Open Oceans, Coastal Oceans, Polar Oceans and Sea Floor Topography. The team has developed a number of new processing schemes and compared and evaluated the resultant data products. This work has clearly demonstrated the improved ocean measuring capability offered by SAR mode altimetry and has also added significantly to our understanding of the issues around the processing and interpretation of SAR altimeter echoes. The project finishes in the summer of 2014, so this paper presents an overview of the major results and outlines a proposed roadmap for the further development and exploitation of these results in operational and scientific applications. The results are of course also highly relevant to support the planning for future missions, including Sentinel-3 and Jason-CS. The "CryoSat Plus for Oceans" (CP4O) project has been supported by ESA (Support To Science Element) and CNES.

Comparison of nonpolar III-nitride vertical-cavity surface-emitting lasers with tunnel junction and ITO intracavity contacts

NASA Astrophysics Data System (ADS)

Leonard, J. T.; Young, E. C.; Yonkee, B. P.; Cohen, D. A.; Shen, C.; Margalith, T.; Ng, T. K.; DenBaars, S. P.; Ooi, B. S.; Speck, J. S.; Nakamura, S.

2016-02-01

We report on the lasing of III-nitride nonpolar, violet, vertical-cavity surface-emitting lasers (VCSELs) with IIInitride tunnel-junction (TJ) intracavity contacts and ion implanted apertures (IIAs). The TJ VCSELs are compared to similar VCSELs with tin-doped indium oxide (ITO) intracavity contacts. Prior to analyzing device results, we consider the relative advantages of III-nitride TJs for blue and green emitting VCSELs. The TJs are shown to be most advantageous for violet and UV VCSELs, operating near or above the absorption edge for ITO, as they significantly reduce the total internal loss in the cavity. However, for longer wavelength III-nitride VCSELs, TJs primarily offer the advantage of improved cavity design flexibility, allowing one to make the p-side thicker using a thick n-type III-nitride TJ intracavity contact. This offers improved lateral current spreading and lower loss, compare to using ITO and p-GaN, respectively. These aspects are particularly important for achieving high-power CW VCSELs, making TJs the ideal intracavity contact for any III-nitride VCSEL. A brief overview of III-nitride TJ growth methods is also given, highlighting the molecular-beam epitaxy (MBE) technique used here. Following this overview, we compare 12 μm aperture diameter, violet emitting, TJ and ITO VCSEL experimental results, which demonstrate the significant improvement in differential efficiency and peak power resulting from the reduced loss in the TJ design. Specifically, the TJ VCSEL shows a peak power of ~550 μW with a threshold current density of ~3.5 kA/cm2, while the ITO VCSELs show peak powers of ~80 μW and threshold current densities of ~7 kA/cm2.

The UK Healthy Universities Self-Review Tool: Whole System Impact.

PubMed

Dooris, Mark; Farrier, Alan; Doherty, Sharon; Holt, Maxine; Monk, Robert; Powell, Susan

2018-06-01

Over recent years, there has been growing interest in Healthy Universities, evidenced by an increased number of national networks and the participation of 375 participants from over 30 countries in the 2015 International Conference on Health Promoting Universities and Colleges, which also saw the launch of the Okanagan Charter. This paper reports on research exploring the use and impact of the UK Healthy Universities Network's self review tool, specifically examining whether this has supported universities to understand and embed a whole system approach. The research study comprised two stages, the first using an online questionnaire and the second using focus groups. The findings revealed a wide range of perspectives under five overarching themes: motivations; process; outcomes/benefits; challenges/suggested improvements; and future use. In summary, the self review tool was extremely valuable and, when engaged with fully, offered significant benefits to universities seeking to improve the health and wellbeing of their communities. These benefits were felt by institutions at different stages in the journey and spanned outcome and process dimensions: not only did the tool offer an engaging and user-friendly means of undertaking internal benchmarking, generating an easy-to-understand report summarizing strengths and weaknesses; it also proved useful in building understanding of the whole system Healthy Universities approach and served as a catalyst to effective cross-university and cross-sectoral partnership working. Additionally, areas for potential enhancement were identified, offering opportunities to increase the tool's utility further whilst engaging actively in the development of a global movement for Healthy Universities.

Improving children's nutrition environments: A survey of adoption and implementation of nutrition guidelines in recreational facilities

PubMed Central

2011-01-01

Background Although the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release. Methods A cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study. Results One half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability. Conclusions If fully adopted and implemented, the ANGCY have the potential to make a significant and sustained contribution to improving the recreational facility food environment, however one year following their release, awareness, adoption and implementation of the ANGCY remained low. A mandated policy approach could offer an efficacious, cost-effective means of improving the food environment within recreational facilities. PMID:21631946

Health benefits achieved through the Seventh-Day Adventist Wellness Challenge program.

PubMed

Kamieneski, R; Brown, C M; Mitchell, C; Perrin, K M; Dindial, K

2000-11-01

The Wellness Challenge program introduces the philosophy of the healing power of God and stresses the importance of developing a sense of spirituality in conjunction with the promotion of good health. To employ scientific rigor to the outcome measures of the Seventh-Day Adventist Wellness Challenge program. A 2-tailed, paired sample t test. East Pasco Medical Center in Zephyrhills, Fla. 165 participants. Presurvey, 21-day outpatient wellness intervention; postsurvey, 6 weeks after completion of the program. Changes in behaviors related to cigarette smoking, alcohol use, eating patterns, exercise, water consumption, rest, relaxation, and time spent outdoors, as well as demographic data. Statistically significant differences were found between the pre- and postprogram clinical and laboratory test results for the participants' blood pressure, weight, glucose levels, and cholesterol at .05 alpha. Furthermore, self-health improvements measured by a pre- and postsurvey response confirmed statistically significant improvement in participants' willingness to improve their lifestyle behaviors for a potentially greater quality of life. The Wellness Challenge program offers ways to reduce risk factors related to chronic disease while improving the quality of life within an adult population by allowing people to slowly incorporate newly acquired tools into their everyday life.

Sildenafil citrate (Viagra) enhances vasodilatation in fetal growth restriction.

PubMed

Wareing, Mark; Myers, Jenny E; O'Hara, Maureen; Baker, Philip N

2005-05-01

Fetal growth restriction (FGR) affects up to 8% of all pregnancies and has massive short-term (increased fetal morbidity and mortality) and long-term (increased incidence of cardiovascular disease in adulthood) health implications. Doppler waveform analysis of pregnancies complicated by FGR suggests compromised uteroplacental circulation and placental hypoperfusion. Our aim was to determine whether myometrial small artery function was aberrant in FGR and to assess whether sildenafil citrate could improve vasodilatation in FGR pregnancies. Small arteries dissected from myometrial biopsies obtained at cesarean section from normal pregnant women (n = 27) or women whose pregnancies were complicated by FGR (n = 12) were mounted on wire myographs. Vessels were constricted (with arginine vasopressin or U46619) and relaxed (with bradykinin) before and after incubation with a phosphodiesterase-5 inhibitor, sildenafil citrate. We demonstrated increased myometrial small artery vasoconstriction and decreased endothelium-dependent vasodilatation in vessels from women whose pregnancies were complicated by FGR. Sildenafil citrate significantly reduced vasoconstriction and significantly improved relaxation of FGR small arteries. We conclude that sildenafil citrate improves endothelial function of myometrial vessels from women whose pregnancies are complicated by intrauterine growth restriction. Sildenafil citrate may offer a potential therapeutic strategy to improve uteroplacental blood flow in FGR pregnancies.

Effects of allergen and trigger factor avoidance advice in primary care on asthma control: a randomized-controlled trial.

PubMed

Bobb, C; Ritz, T; Rowlands, G; Griffiths, C

2010-01-01

Allergy contributes significantly to asthma exacerbation, yet avoidance of triggers, in particular allergens, is rarely addressed in detail in regular asthma review in primary care. To determine whether structured, individually tailored allergen and trigger avoidance advice, given as part of a primary care asthma review, improves lung function and asthma control. In a randomized-controlled trial 214 adults with asthma in six general practices were either offered usual care during a primary care asthma review or usual care with additional allergen and trigger identification (by skin prick testing and structured allergy assessment) and avoidance advice according to a standardized protocol by trained practice nurses. Main outcome measures were lung function, asthma control, asthma self-efficacy. Both intervention groups were equivalent in demographic and asthma-related variables at baseline. At 3-6-month follow-up, patients receiving the allergen and trigger avoidance review showed significant improvements in lung function (assessed by blinded research nurses) compared with those receiving usual care. Significantly more patients in the intervention group than in the control group showed improvements in forced expiratory volume in 1 s > or =15%. No significant differences were found in self-report measures of asthma control. Asthma-specific self-efficacy improved in both groups but did not differ between groups. Allergen and trigger identification and avoidance advice, given as part of a structured asthma review delivered in primary care by nurses results in clinically important improvements in lung function but not self-report of asthma control. ISRCTN45684820.

Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care.

PubMed

Aeyels, Daan; Seys, Deborah; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Bruyneel, Luk; Vanhaecht, Kris

2018-02-01

A focus on specific priorities increases the success rate of quality improvement efforts for broad and complex-care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes ST-elevation myocardial infarction care relevant to consider for importance-performance analysis. The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care. Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The significance of between-hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting. Seven key interventions were each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals. Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.

A Clinical Nutrition Course to Improve Pharmacy Students' Skills and Confidence in Counseling Patients

PubMed Central

Popovich, Nicholas G.; Iramaneerat, Cherdsak; Smith, Everett V.; Lutfiyya, M. Nawal

2008-01-01

Objective To create, implement, and evaluate a PharmD course on primary care nutrition. Design A 2-credit hour elective course was offered to second- and third-year pharmacy students. It was informed by the Socratic method using a minimum number of formal lecture presentations and featured problem-based learning exercises, case-based scenarios, and scientific literature to fuel informed debate. A single group posttest design with a retrospective pretest was used to assess students' self-efficacy. Assessment There was a significant overall improvement in students' self-efficacy in their ability to practice primary care nutrition. Conclusion Completion of a nutrition course improved students' confidence in providing primary care nutrition and empowered them to speak more comfortably about the role of nutrition in the prevention of chronic diseases. PMID:18698396

Rewarding healthy behaviors--pay patients for performance.

PubMed

Wu, Joanne

2012-01-01

Despite a considerable investment of resources into pay for performance, preliminary studies have found that it may not be significantly more effective in improving health outcome measures when compared with voluntary quality improvement programs. Because patient behaviors ultimately affect health outcomes, I would propose a novel pay-for-performance program that rewards patients directly for achieving evidence-based health goals. These rewards would be in the form of discounts towards co-payments for doctor's visits, procedures, and medications, thereby potentially reducing cost and compliance issues. A pilot study recruiting patients with diabetes or hypertension, diseases with clear and objective outcome measures, would be useful to examine true costs, savings, and health outcomes of such a reward program. Offering incentives to patients for reaching health goals has the potential to foster a stronger partnership between doctors and patients and improve health outcomes.

Improving Attitudes and Perceived Competence in Caring for Dying Patients: An End-of-Life Simulation.

PubMed

Lippe, Megan Pfitzinger; Becker, Heather

2015-01-01

The aim of this study was to assess learning outcomes from a simulation on providing care to a critically ill patient from whom care is ultimately withdrawn. Nursing students have anxiety and low perceived competence for caring for dying patients. Effective strategies for teaching communication, assessment, and basic nursing skills are needed. A pretest-posttest design compared perceived competence and attitudes in caring for dying patients with three separate cohorts of undergraduate nursing students performing the simulation. The cohorts had significantly improved scores on the perceived competence (p < .001) and attitude (p < .01) measures following the simulation. Reliability for a new instrument to assess perceived competence in caring for dying patients was also established. This study's simulation offers a robust teaching strategy for improving nursing students' attitudes and perceived competence in caring for dying patients.

The Effectiveness of Pilates Exercise in People with Chronic Low Back Pain: A Systematic Review

PubMed Central

Wells, Cherie; Kolt, Gregory S.; Marshall, Paul; Hill, Bridget; Bialocerkowski, Andrea

2014-01-01

Objective To evaluate the effectiveness of Pilates exercise in people with chronic low back pain (CLBP) through a systematic review of randomised controlled trials (RCTs). Data Sources A search for RCTs was undertaken using Medical Search Terms and synonyms for “Pilates” and “low back pain” within the maximal date range of 10 databases. Databases included the Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Medline; Physiotherapy Evidence Database; ProQuest: Health and Medical Complete, Nursing and Allied Health Source, Dissertation and Theses; Scopus; Sport Discus; Web of Science. Study Selection Two independent reviewers were involved in the selection of evidence. To be included, relevant RCTs needed to be published in the English language. From 152 studies, 14 RCTs were included. Data Extraction Two independent reviewers appraised the methodological quality of RCTs using the McMaster Critical Review Form for Quantitative Studies. The author(s), year of publication, and details regarding participants, Pilates exercise, comparison treatments, and outcome measures, and findings, were then extracted. Data Synthesis The methodological quality of RCTs ranged from “poor” to “excellent”. A meta-analysis of RCTs was not undertaken due to the heterogeneity of RCTs. Pilates exercise provided statistically significant improvements in pain and functional ability compared to usual care and physical activity between 4 and 15 weeks, but not at 24 weeks. There were no consistent statistically significant differences in improvements in pain and functional ability with Pilates exercise, massage therapy, or other forms of exercise at any time period. Conclusions Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise. Future research should explore optimal Pilates exercise designs, and whether some people with CLBP may benefit from Pilates exercise more than others. PMID:24984069

Does one workshop on respecting cultural differences increase health professionals' confidence to improve the care of Australian Aboriginal patients with cancer? An evaluation.

PubMed

Durey, Angela; Halkett, Georgia; Berg, Melissa; Lester, Leanne; Kickett, Marion

2017-09-15

Aboriginal Australians have worse cancer survival rates than other Australians. Reasons include fear of a cancer diagnosis, reluctance to attend mainstream health services and discrimination from health professionals. Offering health professionals education in care focusing on Aboriginal patients' needs is important. The aim of this paper was to evaluate whether participating in a workshop improved the confidence of radiation oncology health professionals in their knowledge, communication and ability to offer culturally safe healthcare to Aboriginal Australians with cancer. Mixed methods using pre and post workshop online surveys, and one delivered 2 months later, were evaluated. Statistical analysis determined the relative proportion of participants who changed from not at all/a little confident at baseline to fairly/extremely confident immediately and 2 months after the workshop. Factor analysis identified underlying dimensions in the items and nonparametric tests recorded changes in mean dimension scores over and between times. Qualitative data was analysed for emerging themes. Fifty-nine participants attended the workshops, 39 (66% response rate) completed pre-workshop surveys, 32 (82% of study participants) completed post-workshop surveys and 25 (64% of study participants) completed surveys 2 months later. A significant increase in the proportion of attendees who reported fair/extreme confidence within 2 days of the workshop was found in nine of 14 items, which was sustained for all but one item 2 months later. Two additional items had a significant increase in the proportion of fair/extremely confident attendees 2 months post workshop compared to baseline. An exploratory factor analysis identified three dimensions: communication; relationships; and awareness. All dimensions' mean scores significantly improved within 2 days (p < 0.005) and persisted to 2 months. The workshop raised awareness about barriers and enablers to delivering services respectful of cultural differences, led to a willingness to reflect on pre-existing beliefs and assumptions about Aboriginal Australians that in some cases resulted in improved care. Single workshops co-delivered by an Aboriginal and non-Aboriginal presenter can be effective in building health professionals' confidence and translating into practice knowledge of respectful care of Aboriginal patients with cancer. Sustaining improvements may require integrating this approach into ongoing professional development.

Changes in Nutrition Policies and Dietary Intake in Child Care Homes Participating in Healthy Eating and Active Living Initiative.

PubMed

Woodward-Lopez, Gail; Kao, Janice; Kuo, Elena S; James, Paula; Lenhart, Kitty; Becker, Christina; Boyle, Kathryn; Williamson, Dana; Rauzon, Suzanne

2018-05-01

From 2012 to 2014, a total of 17 family child care homes participated in a multisector, community-wide initiative to prevent obesity. Strategies included staff workshops, materials, site visits, and technical assistance regarding development and implementation of nutrition policies. The purpose of the evaluation was to examine the impact of the initiative on family child care home nutrition-related policies and practices and child dietary intake. Pre- and post-intervention without control group. Measures taken at baseline and follow-up included structured observations and questionnaires regarding nutrition policies, practices, and environments; documentation of lunch foods served on 5 days; and lunch plate waste observations on 2 days. Paired t-tests were used to determine the significance of change over time. Seventeen family child care homes in a low-income diverse community in Northern California; children aged 2-5 years who attended the family child care homes. Change in nutrition-related policies and practices, lunch foods served and consumed. Data was collected at 17 sites for an average of 5.2 children aged 2-5 years per site per day at baseline and 4.6 at follow-up for a total of 333 plate waste observations. There were significant increases in staff training, parental involvement, and several of the targeted nutrition-related practices; prevalence of most other practices either improved or was maintained over time. There were significant increases in the number of sites meeting Child and Adult Care Food Program meal guidelines, variety of fruit and frequency of vegetables offered, and reductions in frequency of juice and high-fat processed meats offered. Adequate portions of all food groups were consumed at both time points with no significant change over time. A simple, policy-focused intervention by a child care resource and referral agency was successful at reinforcing and improving upon nutrition-related practices at family child care homes. Children consumed adequate, but not excessive, portions of the balanced meals served to them, suggesting there is no reason to offer unhealthy options. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

A pilot study of modified cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG).

PubMed

Cohen, Judith A; Mannarino, Anthony P; Staron, Virginia R

2006-12-01

This pilot study evaluated outcomes for a modified 12-session protocol of cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG) conducted between March 2004 and October 2005. CTG is an emerging condition characterized by a combination of posttraumatic stress and unresolved grief symptoms. This two-module treatment model consisting of sequential trauma- and grief-focused components was shortened from a previously presented 16-session protocol. Thirty-nine children ages 6 to 17 years old with CTG and their parents received the modified 12-session protocol of CBT-CTG. CTG and posttraumatic stress disorder (PTSD) symptoms were assessed at pretreatment, after the trauma-focused module, and after the grief-focused module (at posttreatment). Child depression, anxiety, and behavioral symptoms, as well as parental depression and PTSD symptoms, were assessed at pre- and posttreatment. Children reported significant improvement in CTG, PTSD, depression, and anxiety, and parents reported significant improvement in children's PTSD, internalizing and total behavior problems, and their personal PTSD symptoms. Although PTSD significantly improved only during the trauma-focused module of treatment, CTG improved significantly during both trauma- and grief-focused modules of treatment. Child satisfaction and parent satisfaction for this treatment protocol were also high. These findings suggest that the shortened CBT-CTG protocol, which is similar in the number of sessions to what many community child bereavement programs offer, may be acceptable and efficacious for this population. The CBT-CTG model requires further evaluation in randomized, controlled treatment trials.

Improving mechanical properties of maxillary complete dentures through a bioinspired engineering design.

PubMed

White, James A P; Bond, Ian P; Jagger, Daryll C

2011-01-01

This study investigated how ribbed design features, including palatal rugae, may be used to significantly improve the structural performance of a maxillary denture under load. A computer-aided design model of a generic maxillary denture, incorporating various rib features, was created and imported into a finite element analysis program. The denture and ribbed features were assigned the material properties of standard denture acrylic resin, and load was applied in two different ways: the first simulating a three-point flexural bend of the posterior section and the second simulating loading of the entire palatal region. To investigate the combined use of ribbing and reinforcement, the same simulations were repeated with the ribbed features having a Young modulus two orders of magnitude greater than denture acrylic resin. For a prescribed load, total displacements of tracking nodes were compared to those of a control denture (without ribbing) to assess relative denture rigidity. When subjected to flexural loading, an increase in rib depth was seen to result in a reduction of both the transverse displacement of the last molar and vertical displacement at the centerline. However, ribbed features assigned the material properties of denture acrylic resin require a depth that may impose on speech and bolus propulsion before significant improvements are observed. The use of ribbed features, when made from a significantly stiffer material (eg, fiber-reinforced polymer) and designed to mimic palatal rugae, offer an acceptable method of providing significant improvements in rigidity to a maxillary denture under flexural load.

Effectiveness of different interventions in public nurseries based on food and nutrition education: promoting breast-feeding and healthy complementary feeding.

PubMed

Cândido, Naiara Abrantes; de Sousa, Taciana Maia; Dos Santos, Luana Caroline

2018-05-10

Food practices in the early years of life are important to form healthy eating habits; therefore, it is essential for the caregivers of infants to receive appropriate guidance. The present study aimed to investigate the effectiveness of different nutritional interventions on complementary feeding practices in municipal nurseries. Non-randomized controlled intervention study with education professionals and parents of infants (<2 years). Participants were divided into: control group (CG), standard food and nutrition education in writing; and intervention group (IG), the same information as the CG and face-to-face meetings (professionals, 8 h; parents, 5 h). Changes in professionals' knowledge on the subject and alterations in parents' beliefs, attitudes and intentions were assessed using questionnaires before and after the educational activities. Ten public nurseries in Nova Lima, Belo Horizonte, Minas Gerais, Brazil, 2015. Ninety professionals (fifty in CG; forty in IG) and 169 parents (ninety-seven in CG; seventy-two in IG). After the intervention, there was a significant increase in the mean number of correct responses given by professionals in the IG (12·2 v. 10·7; P=0·001). In addition, there were improvements among the parents of the IG in relation to beliefs (soups and broths do not nourish my child: P=0·012), attitudes (offer meat from the sixth month: P=0·032) and intentions (do not offer soups and broths: P=0·003; offer vegetables: P=0·018; offer meat: P<0·001). Face-to-face nutritional intervention had a significantly greater effect on the parameters evaluated, indicating the importance of adequate guidance in childcare services to support the introduction of complementary feeding.

pH-responsive and enzymatically-responsive hydrogel microparticles for the oral delivery of therapeutic proteins: Effects of protein size, crosslinking density, and hydrogel degradation on protein delivery.

PubMed

Koetting, Michael Clinton; Guido, Joseph Frank; Gupta, Malvika; Zhang, Annie; Peppas, Nicholas A

2016-01-10

Two potential platform technologies for the oral delivery of protein therapeutics were synthesized and tested. pH-responsive poly(itaconic acid-co-N-vinyl-2-pyrrolidone) (P(IA-co-NVP)) hydrogel microparticles were tested in vitro with model proteins salmon calcitonin, urokinase, and rituximab to determine the effects of particle size, protein size, and crosslinking density on oral delivery capability. Particle size showed no significant effect on overall delivery potential but did improve percent release of encapsulated protein over the micro-scale particle size range studied. Protein size was shown to have a significant impact on the delivery capability of the P(IA-co-NVP) hydrogel. We show that when using P(IA-co-NVP) hydrogel microparticles with 3 mol% tetra(ethylene glycol) dimethacrylate crosslinker, a small polypeptide (salmon calcitonin) loads and releases up to 45 μg/mg hydrogel while the mid-sized protein urokinase and large monoclonal antibody rituximab load and release only 19 and 24 μg/mg hydrogel, respectively. We further demonstrate that crosslinking density offers a simple method for tuning hydrogel properties to variously sized proteins. Using 5 mol% TEGDMA crosslinker offers optimal performance for the small peptide, salmon calcitonin, whereas lower crosslinking density of 1 mol% offers optimal performance for the much larger protein rituximab. Finally, an enzymatically-degradable hydrogels of P(MAA-co-NVP) crosslinked with the peptide sequence MMRRRKK were synthesized and tested in simulated gastric and intestinal conditions. These hydrogels offer ideal loading and release behavior, showing no degradative release of encapsulated salmon calcitonin in gastric conditions while yielding rapid and complete release of encapsulated protein within 1h in intestinal conditions. Copyright © 2015 Elsevier B.V. All rights reserved.

Allocating Logging Rights in Peruvian Amazonia—Does It Matter to Be Local?

PubMed Central

Salo, Matti; Helle, Samuli; Toivonen, Tuuli

2011-01-01

Background The fate of tropical forests is a global concern, yet many far-reaching decisions affecting forest resources are made locally. We explore allocation of logging rights using a case study from Loreto, Peruvian Amazonia, where millions of hectares of tropical rainforest were offered for concession in a competitive tendering process that addressed issues related to locality. Methodology/Principal Findings After briefly presenting the study area and the tendering process, we identify and define local and non-local actors taking part in the concession process. We then analyse their tenders, results of the tendering, and attributes of the concession areas. Our results show that there was more offer than demand for concession land in the tendering. The number of tenders the concession areas received was related to their size and geographic location in relation to the major cities, but not to their estimated timber volumes or median distances from transport routes. Small and Loreto-based actors offered lower yearly area-based fees compared to larger ones, but the offers did not significantly affect the results of the tenders. Local experience in the form of logging history or residence near the solicited concession areas, as well as being registered in the region of Loreto, improved the success of the tenders. Conclusions/Significance The allocation process left a considerable number of forest areas under the management of small and local actors, and if Peru is to reach its goal of zero deforestation rate by safeguarding 75 per cent of its forests by 2020, the small and the local actors need to be integrated to the forest regime as important constituents of its legitimacy. PMID:21589922

An alternate pathophysiologic paradigm of sepsis and septic shock

PubMed Central

Kumar, Anand

2014-01-01

The advent of modern antimicrobial therapy following the discovery of penicillin during the 1940s yielded remarkable improvements in case fatality rate of serious infections including septic shock. Since then, pathogens have continuously evolved under selective antimicrobial pressure resulting in a lack of significant improvement in clinical effectiveness in the antimicrobial therapy of septic shock despite ever more broad-spectrum and potent drugs. In addition, although substantial effort and money has been expended on the development novel non-antimicrobial therapies of sepsis in the past 30 years, clinical progress in this regard has been limited. This review explores the possibility that the current pathophysiologic paradigm of septic shock fails to appropriately consider the primacy of the microbial burden of infection as the primary driver of septic organ dysfunction. An alternate paradigm is offered that suggests that has substantial implications for optimizing antimicrobial therapy in septic shock. This model of disease progression suggests the key to significant improvement in the outcome of septic shock may lie, in great part, with improvements in delivery of existing antimicrobials and other anti-infectious strategies. Recognition of the role of delays in administration of antimicrobial therapy in the poor outcomes of septic shock is central to this effort. However, therapeutic strategies that improve the degree of antimicrobial cidality likely also have a crucial role. PMID:24184742

Improved electrolyte for zinc-bromine flow batteries

NASA Astrophysics Data System (ADS)

Wu, M. C.; Zhao, T. S.; Wei, L.; Jiang, H. R.; Zhang, R. H.

2018-04-01

Conventional zinc bromide electrolytes offer low ionic conductivity and often trigger severe zinc dendrite growth in zinc-bromine flow batteries. Here we report an improved electrolyte modified with methanesulfonic acid, which not only improves the electrolyte conductivity but also ameliorates zinc dendrite. Experimental results also reveal that the kinetics and reversibility of Zn2+/Zn and Br2/Br- are improved in this modified electrolyte. Moreover, the battery's internal resistance is significantly reduced from 4.9 to 2.0 Ω cm2 after adding 1 M methanesulfonic acid, thus leading to an improved energy efficiency from 64% to 75% at a current density of 40 mA cm-2. More impressively, the battery is capable of delivering an energy efficiency of about 78% at a current density of as high as 80 mA cm-2 when the electrode is replaced by a thermally treated one. Additionally, zinc dendrite growth is found to be effectively suppressed in methanesulfonic acid supported media, which, as a result, enables the battery to be operated for 50 cycles without degradation, whereas the one without methanesulfonic acid suffers from significant decay after only 40 cycles, primarily due to severe zinc dendrite growth. These superior results indicate methanesulfonic acid is a promising supporting electrolyte for zinc-bromine flow batteries.

The integration of studio cycling into a worksite stress management programme.

PubMed

Clark, Matthew M; Soyring, Jason E; Jenkins, Sarah M; Daniels, Denise C; Berkland, Bridget E; Werneburg, Brooke L; Hagen, Philip T; Lopez-Jimenez, Francisco; Warren, Beth A; Olsen, Kerry D

2014-04-01

High stress is a prevalent problem in the worksite. To reduce stress, improve productivity, reduce absenteeism, and lower healthcare costs, many companies offer exercise classes or stress management programmes. Although physical activity is an important component of stress management, few worksites have integrated physical activity into their comprehensive stress reduction programmes. The purpose of this single-arm pilot project was to examine the potential effectiveness of an integrated exercise (studio cycling) and cognitive-behavioural stress management programme. Eighty-four adults, 75% female, mostly aged 40+ years, participated in an integrated 12-week cycling studio and cognitive-behavioural stress management programme. Participants experienced a significant and clinically meaningful reduction on the Perceived Stress Scale (p < 0.01), rating of current stress level and confidence to manage stress at the programme's end and at a 1-month follow-up. Participants also reported having significantly improved overall health, improved nutritional habits, higher physical activity level, greater confidence in their ability to follow a healthy diet, higher spiritual well-being, improved sleep, receiving more support for maintaining healthy living and improved quality of life at the completion of the 12-week programme and 1-month follow-up. These findings provide further support for an integrated exercise and stress management programme. © 2013 John Wiley & Sons, Ltd.

Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

PubMed Central

López-Liria, Remedios; Padilla-Góngora, David; Catalan-Matamoros, Daniel; Rocamora-Pérez, Patricia; Pérez-de la Cruz, Sagrario; Fernández-Sánchez, Manuel

2015-01-01

Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients' functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. The groups did not significantly differ in the leg side (right/left) or clinical characteristics (P > 0.05). After the intervention, both groups showed significant improvements (P < 0.001) from the baseline values in the level of pain (visual analogue scale), the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective. PMID:25961017

Comparison of answer-until-correct and full-credit assessments in a team-based learning course.

PubMed

Farland, Michelle Z; Barlow, Patrick B; Levi Lancaster, T; Franks, Andrea S

2015-03-25

To assess the impact of awarding partial credit to team assessments on team performance and on quality of team interactions using an answer-until-correct method compared to traditional methods of grading (multiple-choice, full-credit). Subjects were students from 3 different offerings of an ambulatory care elective course, taught using team-based learning. The control group (full-credit) consisted of those enrolled in the course when traditional methods of assessment were used (2 course offerings). The intervention group consisted of those enrolled in the course when answer-until-correct method was used for team assessments (1 course offering). Study outcomes included student performance on individual and team readiness assurance tests (iRATs and tRATs), individual and team final examinations, and student assessment of quality of team interactions using the Team Performance Scale. Eighty-four students enrolled in the courses were included in the analysis (full-credit, n=54; answer-until-correct, n=30). Students who used traditional methods of assessment performed better on iRATs (full-credit mean 88.7 (5.9), answer-until-correct mean 82.8 (10.7), p<0.001). Students who used answer-until-correct method of assessment performed better on the team final examination (full-credit mean 45.8 (1.5), answer-until-correct 47.8 (1.4), p<0.001). There was no significant difference in performance on tRATs and the individual final examination. Students who used the answer-until-correct method had higher quality of team interaction ratings (full-credit 97.1 (9.1), answer-until-correct 103.0 (7.8), p=0.004). Answer-until-correct assessment method compared to traditional, full-credit methods resulted in significantly lower scores for iRATs, similar scores on tRATs and individual final examinations, improved scores on team final examinations, and improved perceptions of the quality of team interactions.

Wilderness adventure therapy effects on the mental health of youth participants.

PubMed

Bowen, Daniel J; Neill, James T; Crisp, Simon J R

2016-10-01

Adventure therapy offers a prevention, early intervention, and treatment modality for people with behavioural, psychological, and psychosocial issues. It can appeal to youth-at-risk who are often less responsive to traditional psychotherapeutic interventions. This study evaluated Wilderness Adventure Therapy (WAT) outcomes based on participants' pre-program, post-program, and follow-up responses to self-report questionnaires. The sample consisted of 36 adolescent out-patients with mixed mental health issues who completed a 10-week, manualised WAT intervention. The overall short-term standardised mean effect size was small, positive, and statistically significant (0.26), with moderate, statistically significant improvements in psychological resilience and social self-esteem. Total short-term effects were within age-based adventure therapy meta-analytic benchmark 90% confidence intervals, except for the change in suicidality which was lower than the comparable benchmark. The short-term changes were retained at the three-month follow-up, except for family functioning (significant reduction) and suicidality (significant improvement). For participants in clinical ranges pre-program, there was a large, statistically significant reduction in depressive symptomology, and large to very large, statistically significant improvements in behavioural and emotional functioning. These changes were retained at the three-month follow-up. These findings indicate that WAT is as effective as traditional psychotherapy techniques for clinically symptomatic people. Future research utilising a comparison or wait-list control group, multiple sources of data, and a larger sample, could help to qualify and extend these findings. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Flash NanoPrecipitation (FNP) for bioengineering nanoparticles to enhance the bioavailability

NASA Astrophysics Data System (ADS)

Feng, Jie; Zhang, Yingyue; McManus, Simone; Prud'Homme, Robert

2017-11-01

Nanoparticles for the delivery of therapeutics have been one of the successful areas in biomedical nanotechnology. Nanoparticles improve bioavailability by 1) the higher surface-to-volume ratios, enhancing dissolution rates, and 2) trapping drug molecules in higher energy, amorphous states for a higher solubility. However, conventional direct precipitation to prepare nanoparticles has the issues of low loading and encapsulation efficiency. Here we demonstrate a kinetically controlled and rapid-precipitation process called Flash NanoPrecipitation (FNP), to offer a multi-phase mixing platform for bioengineering nanoparticles. With the designed geometry in the micro-mixer, we can generate nanoparticles with a narrow size distribution, while maintaining high loading and encapsulation efficiency. By controlling the time scales in FNP, we can tune the nanoparticle size and the robustness of the process. Remarkably, the dissolution rates of the nanoparticles are significantly improved compared with crystalline drug powders. Furthermore, we investigate how to recover the drug-loaded nanoparticles from the aqueous dispersions. Regarding the maintenance of the bioavailability, we discuss the advantages and disadvantages of each drying process. These results suggest that FNP offers a versatile and scalable nano-fabrication platform for biomedical engineering.

Safinamide in the treatment of Parkinson's disease.

PubMed

Schapira, Anthony H V

2010-09-01

Current therapy for Parkinson's disease (PD) is primarily directed at reversing the motor symptoms that are the consequence of dopamine deficiency and includes levodopa, dopamine agonists and monoamine oxidase (MAO) B inhibitors. New drugs offering both dopaminergic and non-dopaminergic actions could offer a significant advantage. This review surveys the current treatment strategies for PD. Defining unmet needs and how a new compound - safinamide, which has both dopaminergic and non-dopaminergic actions - might address these. The reader will gain an understanding of safinamide and its mechanisms of action, including reversible MAOB inhibition and reduced dopamine reuptake with antiglutamatergic effects, and how it may potentially provide improvement of PD motor symptoms with an antidyskinetic effect through its effect on glutamate release. The clinical trial profile of safinamide is reviewed. Early results are promising in terms of improved motor function and reduced 'OFF' time. Additional Phase III trials are now in progress for this adjunctive indication. Finally, the reader will understand the potential role for safinamide in the selection and sequencing of drugs for PD. safinamide combines both dopaminergic and non-dopaminergic actions that may add a new dimension to PD treatment options as an adjunct to current drugs. Its efficacy is under active evaluation in Phase III clinical trials.

Mobile User Connectivity in Relay-Assisted Visible Light Communications.

PubMed

Pešek, Petr; Zvanovec, Stanislav; Chvojka, Petr; Bhatnagar, Manav R; Ghassemlooy, Zabih; Saxena, Prakriti

2018-04-07

In this paper, we investigate relay-assisted visible light communications (VLC) where a mobile user acts as a relay and forwards data from a transmitter to the end mobile user. We analyse the utilization of the amplify-and-forward (AF) and decode-and-forward (DF) relaying schemes. The focus of the paper is on analysis of the behavior of the mobile user acting as a relay while considering a realistic locations of the receivers and transmitters on a standard mobile phone, more specifically with two photodetectors on both sides of a mobile phone and a transmitting LED array located upright. We also investigate dependency of the bit error rate (BER) performance on the azimuth and elevation angles of the mobile relay device within a typical office environment. We provide a new analytical description of BER for AF and DF-based relays in VLC. In addition we compare AF and DF-based systems and show that DF offers a marginal improvement in the coverage area with a BER < 10 -3 and a data rate of 100 Mb/s. Numerical results also illustrate that relay-based systems offer a significant improvement in terms of the coverage compared to direct non-line of sight VLC links.

Mobile User Connectivity in Relay-Assisted Visible Light Communications

PubMed Central

Pešek, Petr; Zvanovec, Stanislav; Chvojka, Petr; Bhatnagar, Manav R.; Ghassemlooy, Zabih; Saxena, Prakriti

2018-01-01

In this paper, we investigate relay-assisted visible light communications (VLC) where a mobile user acts as a relay and forwards data from a transmitter to the end mobile user. We analyse the utilization of the amplify-and-forward (AF) and decode-and-forward (DF) relaying schemes. The focus of the paper is on analysis of the behavior of the mobile user acting as a relay while considering a realistic locations of the receivers and transmitters on a standard mobile phone, more specifically with two photodetectors on both sides of a mobile phone and a transmitting LED array located upright. We also investigate dependency of the bit error rate (BER) performance on the azimuth and elevation angles of the mobile relay device within a typical office environment. We provide a new analytical description of BER for AF and DF-based relays in VLC. In addition we compare AF and DF-based systems and show that DF offers a marginal improvement in the coverage area with a BER < 10–3 and a data rate of 100 Mb/s. Numerical results also illustrate that relay-based systems offer a significant improvement in terms of the coverage compared to direct non-line of sight VLC links. PMID:29642432

Use of a consumer market activity monitoring and feedback device improves exercise capacity and activity levels in COPD.

PubMed

Caulfield, Brian; Kaljo, Indira; Donnelly, Seamas

2014-01-01

COPD is associated with a gradual decline in physical activity, which itself contributes to a worsening of the underlying condition. Strategies that improve physical activity levels are critical to halt this cycle. Wearable sensor based activity monitoring and persuasive feedback might offer a potential solution. However it is not clear just how much intervention might be needed in this regard - i.e. whether programmes need to be tailored specifically for the target clinical population or whether more simple activity monitoring and feedback solutions, such as that offered in consumer market devices, might be sufficient. This research was carried out to investigate the impact of 4 weeks of using an off the shelf consumer market activity monitoring and feedback application on measures of physical activity, exercise capacity, and health related quality of life in a population of 10 Stage I and II COPD patients. Results demonstrate a significant and positive effect on exercise capacity (measured using a 6-minute walk test) and activity levels (measured in terms of average number of steps per hour) yet no impact on health related quality of life (St Georges Respiratory Disease Questionnaire).

[Evaluating the effectiveness of a disease management program diabetes in the German Statutory Health Insurance: first results and methodological considerations].

PubMed

Drabik, Anna; Graf, Christian; Büscher, Guido; Stock, Stephanie

2012-01-01

Disease management programs (DMPs) were implemented in the German Statutory Health Insurance (SHI) in a nationwide rollout in 2002. The explicit goal of the programs is to improve coordination and quality of care for the chronically ill (Sect. 137f, SGB V). To reach this goal extensive quality assurance measures in the programs are mandatory, enrolment and coordination of care rests with the primary care or DMP physician, treatment is based on evidence-based care guidelines, and patients are offered diabetes education classes to support self-management. The present study evaluates the DMP diabetes mellitus type II, a nationwide program offered by the BARMER, a German health insurance company. To minimize selection bias we formed a control group of administrative data using a propensity score matching approach. In comparison to the control group DMP participants have a significantly lower mortality rate, and their average drug and hospital costs are reduced. Enrolled patients also had a lower mean number of hospital stays and shorter hospital stays. These results indicate that the programs meet the initial goal of improving the quality of care for the chronically ill. Copyright © 2011. Published by Elsevier GmbH.

Seismic Forecasting of Solar Activity

NASA Technical Reports Server (NTRS)

Braun, Douglas; Lindsey, Charles

2001-01-01

We have developed and improved helioseismic imaging techniques of the far-side of the Sun as part of a synoptic monitor of solar activity. In collaboration with the MIDI team at Stanford University we are routinely applying our analysis to images within 24 hours of their acquisition by SOHO. For the first time, real-time seismic maps of large active regions on the Sun's far surface are publicly available. The synoptic images show examples of active regions persisting for one or more solar rotations, as well as those initially detected forming on the solar far side. Until recently, imaging the far surface of the Sun has been essentially blind to active regions more than about 50 degrees from the antipode of disk center. In a paper recently accepted for publication, we have demonstrated how acoustic travel-time perturbations may be mapped over the entire hemisphere of the Sun facing away from the Earth, including the polar regions. In addition to offering significant improvements to ongoing space weather forecasting efforts, the procedure offers the possibility of local seismic monitoring of both the temporal and spatial variations in the acoustic properties of the Sun over the entire far surface.

From Inpatient to Ambulatory Care: The Introduction of a Rapid Access Transient Ischaemic Attack Service.

PubMed

Maddula, Mohana; Adams, Laura; Donnelly, Jonathan

2018-06-01

Background : Transient Ischaemic Attacks (TIA) should be treated as a medical emergency. While high-risk TIAs have higher stroke risks than low-risk patients, there is an inherent limitation to this risk stratification, as some low-risk patients may have undiagnosed high-risk conditions. Inequity of care for TIA patients was observed, such that high-risk patients received urgent assessment through acute admission, while low-risk patients faced long waits for clinical consultation. A redesign of the TIA service was planned to offer timely assessment for all patients and avoid acute admission for high-risk patients. Methods : Service reconfiguration was undertaken to set up a daily weekday rapid access TIA clinic where patients would be assessed, investigated, and treated. Results : A re-audit of clinic performance showed a significant increase in the number of patients seen in the ages of 18 to 52. The median time from referral to clinical consultation improved from 10 days to 1. There were similar significant improvements seen in median time to brain imaging (from 10.5 days to 1), and carotid ultrasound (from 10 days to all scans being performed on the same day). Conclusions : The redesigned service achieved the objective of offering urgent assessment and investigations for all TIA patients, including low-risk patients, while avoiding the acute admission for high-risk patients. We share our experience of establishing a successful rapid access ambulatory service without any additional resources.

A Randomized Controlled Trial of a Psycho-Education Intervention by Midwives in Reducing Childbirth Fear in Pregnant Women

PubMed Central

Toohill, Jocelyn; Fenwick, Jennifer; Gamble, Jenny; Creedy, Debra K; Buist, Anne; Turkstra, Erika; Ryding, Elsa-Lena

2014-01-01

Background Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women's childbirth fear. Methods Women (n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention (n = 170) or control (n = 169) groups. All women received a decision-aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear (WDEQ-A) from second trimester to 36 weeks’ gestation. Secondary outcomes were improved childbirth self-efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy. Results There were significant differences between groups on postintervention scores for fear of birth (p < 0.001) and childbirth self-efficacy (p = 0.002). Decisional conflict and depressive symptoms reduced but were not significant. Conclusion Psycho-education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women. Improving antenatal emotional well-being may have wider positive social and maternity care implications for optimal childbirth experiences. PMID:25303111

NASA F-16XL supersonic laminar flow control program overview

NASA Technical Reports Server (NTRS)

Fischer, Michael C.

1992-01-01

The viewgraphs and discussion of the NASA supersonic laminar flow control program are provided. Successful application of laminar flow control to a High Speed Civil Transport (HSCT) offers significant benefits in reductions of take-off gross weight, mission fuel burn, cruise drag, structural temperatures, engine size, emissions, and sonic boom. The ultimate economic success of the proposed HSCT may depend on the successful adaption of laminar flow control, which offers the single most significant potential improvements in lift drag ratio (L/D) of all the aerodynamic technologies under consideration. The F-16XL Supersonic Laminar Flow Control (SLFC) Experiment was conceived based on the encouraging results of in-house and NASA supported industry studies to determine if laminar flow control is feasible for the HSCT. The primary objective is to achieve extensive laminar flow (50-60 percent chord) on a highly swept supersonic wing. Data obtained from the flight test will be used to validate existing Euler and Navier Stokes aerodynamic codes and transition prediction boundary layer stability codes. These validated codes and developed design methodology will be delivered to industry for their use in designing supersonic laminar flow control wings. Results from this experiment will establish preliminary suction system design criteria enabling industry to better size the suction system and develop improved estimates of system weight, fuel volume loss due to wing ducting, turbocompressor power requirements, etc. so that benefits and penalties can be more accurately assessed.

Perinatal pathology: practice suggestions for limited-resource settings.

PubMed

Roberts, Drucilla J

2013-06-01

The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health-related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements ("ramping up") over time.

Educational Intervention on Undergraduate Cancer Awareness and Self-Directed Learning.

PubMed

Hwang, Lih-Lian

2018-06-01

Traditional lecture-based learning (LBL) can increase cancer awareness in undergraduates. However, because of the rapidly changing knowledge base in medicine, undergraduates must develop skills required for lifelong self-directed learning (SDL). Problem-based learning (PBL) has been suggested as an SDL approach. This study used a nonequivalent control group with a pretest-posttest design for comparing PBL and LBL for their effectiveness in increasing cancer awareness and SDL among nonmedicine or nonnursing major undergraduates in a health-related general education course. Experimental groups 1 and 2 were instructed using PBL while the control group was instructed using LBL. Cancer educational programs were offered to experimental group 1 and the control group but not to experimental group 2. Among the 325 undergraduates who completed a questionnaire regarding cancer awareness and SDL in the pretest, 223 completed the 12-week follow-up survey of the posttest. Cancer awareness significantly improved between the pretest and posttest in the control group (P < 0.001). No significant difference in cancer awareness improvement was observed between experimental group 1 and the control group (P = 0.934). Cancer awareness improvement in experimental group 2 was significantly less than in the control group (P = 0.010). No statistically significant change in SDL was observed in the control group during the study (P = 0.897). However, the SDL of experimental groups 1 and 2 improved more significantly than that of the control group (P = 0.049 and 0.023, respectively). Therefore, PBL is an effective method of increasing cancer awareness and SDL in undergraduates.

Noise filtering of composite pulses for singlet-triplet qubits

PubMed Central

Yang, Xu-Chen; Wang, Xin

2016-01-01

Semiconductor quantum dot spin qubits are promising candidates for quantum computing. In these systems, the dynamically corrected gates offer considerable reduction of gate errors and are therefore of great interest both theoretically and experimentally. They are, however, designed under the static-noise model and may be considered as low-frequency filters. In this work, we perform a comprehensive theoretical study of the response of a type of dynamically corrected gates, namely the supcode for singlet-triplet qubits, to realistic 1/f noises with frequency spectra 1/ωα. Through randomized benchmarking, we have found that supcode offers improvement of the gate fidelity for α  1 and the improvement becomes exponentially more pronounced with the increase of the noise exponent in the range 1  α ≤ 3 studied. On the other hand, for small α, supcode will not offer any improvement. The δJ-supcode, specifically designed for systems where the nuclear noise is absent, is found to offer additional error reduction than the full supcode for charge noises. The computed filter transfer functions of the supcode gates are also presented. PMID:27383129

Connecting the Space between Design and Research: Explorations in Participatory Research Supervision

ERIC Educational Resources Information Center

Caldwell, Glenda Amayo; Osborne, Lindy; Mewburn, Inger; Nottingham, Anitra

2016-01-01

In this article we offer a single case study using an action research method for gathering and analysing data offering insights valuable to both design and research supervision practice. We do not attempt to generalise from this single case, but offer it as an instance that can improve our understanding of research supervision practice. We…

Implementing a collaborative coaching intervention for professionals providing care to children and their families: An exploratory study.

PubMed

Tatla, Sandy K; Howard, Dori; Antunes Silvestre, Alda; Burnes, Stacey; Husson, Meghan; Jarus, Tal

2017-09-01

The growing complexity of healthcare requires family and interprofessional partnerships to deliver effective care. Interprofessional coaching can enhance family-centred practice and collaboration. The purpose of this study was to explore the acceptability and feasibility of collaborative coaching training to improve family centredness within acute paediatric rehabilitation. Using a participatory action design, service providers (SPs; n = 36) underwent a 6-month coaching programme involving coaching workshops, learning triads, and tailored sessions with a licensed coach. The feasibility and acceptability of coaching on SPs' family interactions and care was explored. Measure of Processes of Care (MPOC) and MPOC-SP, a coaching skills questionnaire, and focus groups were used to evaluate the acceptability of coaching training. We found that structured coaching training was feasible and SPs reported significant improvements in their coaching skills; however, MPOC and MPOC-SP scores did not reveal significant differences. Qualitative themes indicated that clinicians are developing coaching competencies and applying these skills in clinical practice. Participants perceived that the coaching approach strengthened relationships amongst colleagues, and they valued the opportunity for interprofessional learning. Findings suggest that coaching offers promise as an approach to facilitate successful patient outcomes and improve processes of care. Preliminary findings indicate that interprofessional coaching training is acceptable, feasible, and can significantly improve SP coaching skills and improve team cohesion. Further research to study the effects of coaching on interprofessional care using validated outcome measures and to assess the impact on service delivery is recommended.

Improving Smallholder Farmer Biosecurity in the Mekong Region Through Change Management.

PubMed

Young, J R; Evans-Kocinski, S; Bush, R D; Windsor, P A

2015-10-01

Transboundary animal diseases including foot-and-mouth disease and haemorrhagic septicaemia remain a major constraint for improving smallholder large ruminant productivity in the Mekong region, producing negative impacts on rural livelihoods and compromising efforts to reduce poverty and food insecurity. The traditional husbandry practices of smallholders largely exclude preventive health measures, increasing risks of disease transmission. Although significant efforts have been made to understand the social aspects of change development in agricultural production, attention to improving the adoption of biosecurity has been limited. This study reviews smallholder biosecurity risk factors identified in the peer-reviewed literature and from field research observations conducted in Cambodia and Laos during 2006-2013, considering these in the context of a change management perspective aimed at improving adoption of biosecurity measures. Motivation for change, resistance to change, knowledge management, cultural dimensions, systems theory and leadership are discussed. Due to geographical, physical and resource variability, the implementation of biosecurity interventions suitable for smallholders is not a 'one size fits all'. Smallholders should be educated in biosecurity principles and empowered to make personal decisions rather than adopt prescribed pre-defined interventions. Biosecurity interventions should be aligned with smallholder farmer motivations, preferably offering clear short-term risk management benefits that elicit interest from smallholders. Linking biosecurity and disease control with improved livestock productivity provides opportunities for sustainable improvements in livelihoods. Participatory research and extension that improves farmer knowledge and practices offers a pathway to elicit sustainable broad-scale social change. However, examples of successes need to be communicated both at the 'evidence-based level' to influence regional policy development and at the village or commune level, with 'champion farmers' and 'cross-visits' used to lead local change. The adoption of applied change management principles to improving regional biosecurity may assist current efforts to control and eradicate transboundary diseases in the Mekong region. © 2013 Blackwell Verlag GmbH.

Housing and sexual health among street-involved youth.

PubMed

Kumar, Maya M; Nisenbaum, Rosane; Barozzino, Tony; Sgro, Michael; Bonifacio, Herbert J; Maguire, Jonathon L

2015-10-01

Street-involved youth (SIY) carry a disproportionate burden of sexually transmitted diseases (STD). Studies among adults suggest that improving housing stability may be an effective primary prevention strategy for improving sexual health. Housing options available to SIY offer varying degrees of stability and adult supervision. This study investigated whether housing options offering more stability and adult supervision are associated with fewer STD and related risk behaviors among SIY. A cross-sectional study was performed using public health survey and laboratory data collected from Toronto SIY in 2010. Three exposure categories were defined a priori based on housing situation: (1) stable and supervised housing, (2) stable and unsupervised housing, and (3) unstable and unsupervised housing. Multivariate logistic regression was used to test the association between housing category and current or recent STD. Secondary analyses were performed using the following secondary outcomes: blood-borne infection, recent binge-drinking, and recent high-risk sexual behavior. The final analysis included 184 SIY. Of these, 28.8 % had a current or recent STD. Housing situation was stable and supervised for 12.5 %, stable and unsupervised for 46.2 %, and unstable and unsupervised for 41.3 %. Compared to stable and supervised housing, there was no significant association between current or recent STD among stable and unsupervised housing or unstable and unsupervised housing. There was no significant association between housing category and risk of blood-borne infection, binge-drinking, or high-risk sexual behavior. Although we did not demonstrate a significant association between stable and supervised housing and lower STD risk, our incorporation of both housing stability and adult supervision into a priori defined exposure groups may inform future studies of housing-related prevention strategies among SIY. Multi-modal interventions beyond housing alone may also be required to prevent sexual morbidity among these vulnerable youth.

Experience of Primary Care among Homeless Individuals with Mental Health Conditions

PubMed Central

Chrystal, Joya G.; Glover, Dawn L.; Young, Alexander S.; Whelan, Fiona; Austin, Erika L.; Johnson, Nancy K.; Pollio, David E.; Holt, Cheryl L.; Stringfellow, Erin; Gordon, Adam J.; Kim, Theresa A.; Daigle, Shanette G.; Steward, Jocelyn L.; Kertesz, Stefan G

2015-01-01

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons’ needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers. PMID:25659142

Customer loyalty among daily disposable contact lens wearers.

PubMed

Patel, Neelam I; Naroo, Shehzad A; Eperjesi, Frank; Rumney, Nicholas J

2015-02-01

Optometric practices offer contact lenses as cash sale items or as part of monthly payment plans. With the contact lens market becoming increasingly competitive, patients are opting to purchase lenses from supermarkets and Internet suppliers. Monthly payment plans are often implemented to improve loyalty. This study aimed to compare behavioural loyalty between monthly payment plan members and non-members. BBR Optometry Ltd offers a monthly payment plan (Eyelife™) to their contact lens wearers. A retrospective audit of 38 Eyelife™ members (mean±SD: 42.7±15.0 years) and 30 non-members (mean±SD: 40.8±16.7 years) was conducted. Revenue and profits generated, service uptake and product sales between the two groups were compared over a fixed period of 18 months. Eyelife™ members generated significantly higher professional fee revenue (P<0.001), £153.96 compared to £83.50, and profits (P<0.001). Eyelife™ members had a higher uptake of eye examinations (P<0.001). The 2 groups demonstrated no significant difference in spectacle sales by volume (P=0.790) or value (P=0.369). There were also no significant differences in contact lens revenue (P=0.337), although Eyelife™ members did receive a discount. The Eyelife™ group incurred higher contact lens costs (P=0.037), due to a greater volume of contact lens purchases, 986 units compared to 582. Monthly payment plans improve loyalty among contact lens wearers, particularly service uptake and volume of lens purchases. Additionally the greater professional fees generated, render monthly payment plans an attractive business model and practice builder. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Experience of primary care among homeless individuals with mental health conditions.

PubMed

Chrystal, Joya G; Glover, Dawn L; Young, Alexander S; Whelan, Fiona; Austin, Erika L; Johnson, Nancy K; Pollio, David E; Holt, Cheryl L; Stringfellow, Erin; Gordon, Adam J; Kim, Theresa A; Daigle, Shanette G; Steward, Jocelyn L; Kertesz, Stefan G

2015-01-01

The delivery of primary care to homeless individuals with mental health conditions presents unique challenges. To inform healthcare improvement, we studied predictors of favorable primary care experience among homeless persons with mental health conditions treated at sites that varied in degree of homeless-specific service tailoring. This was a multi-site, survey-based comparison of primary care experiences at three mainstream primary care clinics of the Veterans Administration (VA), one homeless-tailored VA clinic, and one tailored non-VA healthcare program. Persons who accessed primary care service two or more times from July 2008 through June 2010 (N = 366) were randomly sampled. Predictor variables included patient and organization characteristics suggested by the patient perception model developed by Sofaer and Firminger (2005), with an emphasis on mental health. The primary care experience was assessed with the Primary Care Quality-Homeless (PCQ-H) questionnaire, a validated survey instrument. Multiple regression identified predictors of positive experiences (i.e. higher PCQ-H total score). Significant predictors of a positive experience included a site offering tailored service design, perceived choice among providers, and currently domiciled status. There was an interaction effect between site and severe psychiatric symptoms. For persons with severe psychiatric symptoms, a homeless-tailored service design was significantly associated with a more favorable primary care experience. For persons without severe psychiatric symptoms, this difference was not significant. This study supports the importance of tailored healthcare delivery designed for homeless persons' needs, with such services potentially holding special relevance for persons with mental health conditions. To improve patient experience among the homeless, organizations may want to deliver services that are tailored to homelessness and offer a choice of providers.

Reducing the Disruptive Effects of Interruptions With Noninvasive Brain Stimulation.

PubMed

Blumberg, Eric J; Foroughi, Cyrus K; Scheldrup, Melissa R; Peterson, Matthew S; Boehm-Davis, Debbie A; Parasuraman, Raja

2015-09-01

The authors determine whether transcranial direct current stimulation (tDCS) can reduce resumption time when an ongoing task is interrupted. Interruptions are common and disruptive. Working memory capacity has been shown to predict resumption lag (i.e., time to successfully resume a task after interruption). Given that tDCS applied to brain areas associated with working memory can enhance performance, tDCS has the potential to improve resumption lag when a task is interrupted. Participants were randomly assigned to one of four groups that received anodal (active) stimulation of 2 mA tDCS to one of two target brain regions, left and right dorsolateral prefrontal cortex (DLPFC), or to one of two control areas, active stimulation of the left primary motor cortex or sham stimulation of the right DLPFC, while completing a financial management task that was intermittently interrupted with math problem solving. Anodal stimulation to the right and left DLPFC significantly reduced resumption lags compared to the control conditions (sham and left motor cortex stimulation). Additionally, there was no speed-accuracy tradeoff (i.e., the improvement in resumption time was not accompanied by an increased error rate). Noninvasive brain stimulation can significantly decrease resumption lag (improve performance) after a task is interrupted. Noninvasive brain stimulation offers an easy-to-apply tool that can significantly improve interrupted task performance. © 2014, Human Factors and Ergonomics Society.

Computerised CBT for depressed adolescents: Randomised controlled trial.

PubMed

Smith, Patrick; Scott, Rebecca; Eshkevari, Ertimiss; Jatta, Fatoumata; Leigh, Eleanor; Harris, Victoria; Robinson, Alex; Abeles, Paul; Proudfoot, Judy; Verduyn, Chrissie; Yule, William

2015-10-01

Depression in adolescents is a common and impairing problem. Effective psychological therapies for depression are not accessed by most adolescents. Computerised therapy offers huge potential for improving access to treatment. To test the efficacy of Stressbusters, a Computerised-CBT (C-CBT) programme for depression in young people. Multi-site, schools-based, RCT of C-CBT compared to Waiting List, for young people (N = 112; aged 12-16) with significant symptoms of depression, using multiple-informants (adolescents, parents, teachers), with follow-up at 3 and 6 months. Relative to being on a Waiting List, C-CBT was associated with statistically significant and clinically meaningful improvements in symptoms of depression and anxiety according to adolescent self-report; and with a trend towards improvements in depression and anxiety according to parent-report. Improvements were maintained at follow-up. Treatment gains were similar for boys and girls across the participating age range. Treatment effect was partially mediated by changes in ruminative thinking. Teachers rated adolescents as having few emotional or behavioural problems, both before and after intervention. C-CBT had no detectable effect on academic attainment. In the month after intervention, young people who received C-CBT had significantly fewer absences from school than those on the Waiting List. C-CBT shows considerable promise for the treatment of mild-moderate depression in adolescents. Copyright © 2015 Elsevier Ltd. All rights reserved.

Introducing a feedback training system for guided home rehabilitation.

PubMed

Kohler, Fabian; Schmitz-Rode, Thomas; Disselhorst-Klug, Catherine

2010-01-15

As the number of people requiring orthopaedic intervention is growing, individualized physiotherapeutic rehabilitation and adequate postoperative care becomes increasingly relevant. The chances of improvement in the patients condition is directly related to the performance and consistency of the physiotherapeutic exercises.In this paper a smart, cost-effective and easy to use Feedback Training System for home rehabilitation based on standard resistive elements is introduced. This ensures high accuracy of the exercises performed and offers guidance and control to the patient by offering direct feedback about the performance of the movements.46 patients were recruited and performed standard physiotherapeutic training to evaluate the system. The results show a significant increase in the patient's ability to reproduce even simple physiotherapeutic exercises when being supported by the Feedback Training System. Thus physiotherapeutic training can be extended into the home environment whilst ensuring a high quality of training.

Reconfigurable Computing As an Enabling Technology for Single-Photon-Counting Laser Altimetry

NASA Technical Reports Server (NTRS)

Powell, Wesley; Hicks, Edward; Pinchinat, Maxime; Dabney, Philip; McGarry, Jan; Murray, Paul

2003-01-01

Single-photon-counting laser altimetry is a new measurement technique offering significant advantages in vertical resolution, reducing instrument size, mass, and power, and reducing laser complexity as compared to analog or threshold detection laser altimetry techniques. However, these improvements come at the cost of a dramatically increased requirement for onboard real-time data processing. Reconfigurable computing has been shown to offer considerable performance advantages in performing this processing. These advantages have been demonstrated on the Multi-KiloHertz Micro-Laser Altimeter (MMLA), an aircraft based single-photon-counting laser altimeter developed by NASA Goddard Space Flight Center with several potential spaceflight applications. This paper describes how reconfigurable computing technology was employed to perform MMLA data processing in real-time under realistic operating constraints, along with the results observed. This paper also expands on these prior results to identify concepts for using reconfigurable computing to enable spaceflight single-photon-counting laser altimeter instruments.

Domestic wastewater treatment as a net energy producer--can this be achieved?

PubMed

McCarty, Perry L; Bae, Jaeho; Kim, Jeonghwan

2011-09-01

In seeking greater sustainability in water resources management, wastewater is now being considered more as a resource than as a waste-a resource for water, for plant nutrients, and for energy. Energy, the primary focus of this article, can be obtained from wastewater's organic as well as from its thermal content. Also, using wastewater's nitrogen and P nutrients for plant fertilization, rather than wasting them, helps offset the high energy cost of producing synthetic fertilizers. Microbial fuel cells offer potential for direct biological conversion of wastewater's organic materials into electricity, although significant improvements are needed for this process to be competitive with anaerobic biological conversion of wastewater organics into biogas, a renewable fuel used in electricity generation. Newer membrane processes coupled with complete anaerobic treatment of wastewater offer the potential for wastewater treatment to become a net generator of energy, rather than the large energy consumer that it is today.

Platinum Nickel Nanowires as Methanol Oxidation Electrocatalysts

DOE PAGES

Alia, Shaun M.; Pylypenko, Svitlana; Neyerlin, Kenneth C.; ...

2015-08-27

We investigated platinum(Pt) nickel (Ni) nanowires (PtNiNWs) as methanol oxidation reaction (MOR) catalysts in rotating disk electrode (RDE) half-cells under acidic conditions. Pt-ruthenium (Ru) nanoparticles have long been the state of the art MOR catalyst for direct methanol fuel cells (DMFCs) where Ru provides oxophilic sites, lowering the potential for carbon monoxide oxidation and the MOR onset. Ru, however, is a precious metal that has long term durability concerns. Ni/Ni oxide species offer a potential to replace Ru in MOR electrocatalysis. PtNiNWs were investigated for MOR and oxygen annealing was investigated as a route to improve catalyst performance (mass activitymore » 65% greater) and stability to potential cycling. Our results presented show that PtNiNWs offer significant promise in the area, but also result in Ni ion leaching that is a concern requiring further evaluation in fuel cells.« less

Pharmaceutical cocrystals: the coming wave of new drug substances.

PubMed

Brittain, Harry G

2013-02-01

Solid crystalline phases containing two cocrystallized components offer a new development pathway whereby one can potentially improve the physical characteristics (i.e., equilibrium solubility, dissolution rate, solid-state stability, etc.) of a drug substance that exhibits a profile that is less than desirable. In this commentary, the topic of pharmaceutical cocrystals will be briefly explored, and a short exposition of the solubility and dissolution rate advantages that have been realized in various systems will be provided. The Guidance for Industry document recently proposed by United States Food and Drug Administration will be outlined, and its requirements explained. Finally, the subset of pharmaceutical cocrystals that consist of a drug substance and a salt of that substance (termed a salt cocrystal) will be examined to illustrate this additional class of pharmaceutical cocrystals that may offer significant scientific and regulatory advantages. Copyright © 2012 Wiley Periodicals, Inc.

LOW-ENGINE-FRICTION TECHNOLOGY FOR ADVANCED NATURAL-GAS RECIPROCATING ENGINES

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

Victor Wong; Tian Tian; Luke Moughon

This program aims at improving the efficiency of advanced natural-gas reciprocating engines (ANGRE) by reducing piston and piston ring assembly friction without major adverse effects on engine performance, such as increased oil consumption and wear. An iterative process of simulation, experimentation and analysis is being followed towards achieving the goal of demonstrating a complete optimized low-friction engine system. To date, a detailed set of piston and piston-ring dynamic and friction models have been developed and applied that illustrate the fundamental relationships among mechanical, surface/material and lubricant design parameters and friction losses. Demonstration of low-friction ring-pack designs in the Waukesha VGFmore » 18GL engine confirmed total engine FEMP (friction mean effective pressure) reduction of 7-10% from the baseline configuration without significantly increasing oil consumption or blow-by flow. This represents a substantial (30-40%) reduction of the ringpack friction alone. The measured FMEP reductions were in good agreement with the model predictions. Further improvements via piston, lubricant, and surface designs offer additional opportunities. Tests of low-friction lubricants are in progress and preliminary results are very promising. The combined analysis of lubricant and surface design indicates that low-viscosity lubricants can be very effective in reducing friction, subject to component wear for extremely thin oils, which can be mitigated with further lubricant formulation and/or engineered surfaces. Hence a combined approach of lubricant design and appropriate wear reduction offers improved potential for minimum engine friction loss. Piston friction studies indicate that a flatter piston with a more flexible skirt, together with optimizing the waviness and film thickness on the piston skirt offer significant friction reduction. Combined with low-friction ring-pack, material and lubricant parameters, a total power cylinder friction reduction of 30-50% is expected, translating to an engine efficiency increase of two percentage points from its current baseline towards the goal of 50% ARES engine efficiency. The design strategies developed in this study have promising potential for application in all modern reciprocating engines as they represent simple, low-cost methods to extract significant fuel savings. The current program has possible spinoffs and applications in other industries as well, including transportation, CHP, and diesel power generation. The progress made in this program has wide engine efficiency implications, and potential deployment of low-friction engine components or lubricants in the near term is possible as current investigations continue.« less

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Quality improvement organization activities. 423... and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers, practitioners, and...

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Quality improvement organization activities. 423... Cost Control and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers...

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Quality improvement organization activities. 423... Cost Control and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers...

42 CFR 423.162 - Quality improvement organization activities.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Quality improvement organization activities. 423... Cost Control and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers...

Gas storage carbon with enhanced thermal conductivity

DOEpatents

Burchell, Timothy D.; Rogers, Michael Ray; Judkins, Roddie R.

2000-01-01

A carbon fiber carbon matrix hybrid adsorbent monolith with enhanced thermal conductivity for storing and releasing gas through adsorption and desorption is disclosed. The heat of adsorption of the gas species being adsorbed is sufficiently large to cause hybrid monolith heating during adsorption and hybrid monolith cooling during desorption which significantly reduces the storage capacity of the hybrid monolith, or efficiency and economics of a gas separation process. The extent of this phenomenon depends, to a large extent, on the thermal conductivity of the adsorbent hybrid monolith. This invention is a hybrid version of a carbon fiber monolith, which offers significant enhancements to thermal conductivity and potential for improved gas separation and storage systems.

The efficacy of problem-solving treatments after deliberate self-harm: meta-analysis of randomized controlled trials with respect to depression, hopelessness and improvement in problems.

PubMed

Townsend, E; Hawton, K; Altman, D G; Arensman, E; Gunnell, D; Hazell, P; House, A; Van Heeringen, K

2001-08-01

Brief problem-solving therapy is regarded as a pragmatic treatment for deliberate self-harm (DSH) patients. A recent meta-analysis of randomized controlled trials (RCTs) evaluating this approach indicated a trend towards reduced repetition of DSH but the pooled odds ratio was not statistically significant. We have now examined other important outcomes using this procedure, namely depression, hopelessness and improvement in problems. Six trials in which problem-solving therapy was compared with control treatment were identified from an extensive literature review of RCTs of treatments for DSH patients. Data concerning depression, hopelessness and improvement in problems were extracted. Where relevant statistical data (e.g. standard deviations) were missing these were imputed using various statistical methods. Results were pooled using meta-analytical procedures. At follow-up, patients who were offered problem-solving therapy had significantly greater improvement in scores for depression (standardized mean difference = -0.36; 95% CI -0.61 to -0.11) and hopelessness (weighted mean difference =-3.2; 95% CI -4.0 to -2.41), and significantly more reported improvement in their problems (odds ratio = 2.31; 95% CI 1.29 to 4.13), than patients who were in the control treatment groups. Problem-solving therapy for DSH patients appears to produce better results than control treatment with regard to improvement in depression, hopelessness and problems. It is desirable that this finding is confirmed in a large trial, which will also allow adequate testing of the impact of this treatment on repetition of DSH.

Effectiveness of Interventions Within the Scope of Occupational Therapy Practice to Improve Motor Function of People With Traumatic Brain Injury: A Systematic Review.

PubMed

Chang, Pei-Fen J; Baxter, Mary Frances; Rissky, Jenna

2016-01-01

After traumatic brain injury (TBI), many people experience significant motor function impairments. To help occupational therapy practitioners make informed decisions in choosing treatment strategies to improve clients' motor function, we undertook a systematic review and synthesized applicable findings of intervention studies. Of 2,306 articles identified in the literature search, we reviewed 47 full-text articles, of which 16 met approved criteria. We found moderate evidence that various exercise programs increase motor function and limited evidence that people with TBI can benefit from rehabilitation and computer-based programs. We offer implications for practice, education, and research. Copyright © 2016 by the American Occupational Therapy Association, Inc.

Effectiveness of the United Steel Workers of America Coke Oven Intervention Program.

PubMed

Parkinson, D K; Bromet, E J; Dew, M A; Dunn, L O; Barkman, M; Wright, M

1989-05-01

This paper describes the implementation and evaluation of the Coke Oven Intervention Program developed jointly by the United Steel Workers of America and the University of Pittsburgh. The program was offered on four occasions at each of seven coke oven plants over a 2-year period. Participants were compared with nonparticipating co-workers and controls from matched plants on knowledge of the Coke Oven Standard and workplace behaviors. Few baseline differences were found among participants, nonparticipants, and controls. Participants improved significantly as a result of the program, with those attending multiple programs accruing the greatest benefits. Panel controls interviewed on six occasions throughout the 2-year period showed little improvement. Reasons for and implications of the effectiveness of the program are discussed.

Magnetic bearings for inertial energy storage

NASA Technical Reports Server (NTRS)

Rodriguez, G. Ernest; Eakin, Vickie

1987-01-01

Advanced flywheels utilizing high strength fibers must operate at high rotational speeds and as such must operate in vacuum to reduce windage losses. The utilization of magnetic bearings in the flywheels overcome lubrication and seal problems, resulting in an energy storage system offering potential improvements over conventional electrochemical energy storage. Magnetic bearings evolved in the 1950s from the simple application of permanent magnets positioned to exert repulsive forces to the present where permanent magnets and electromagnets have been combined to provide axial and radial suspension. Further development of magnetic suspension has led to the design of a shaftless flywheel system for aerospace application. Despite the lack of proof of concept, integrated magnetic suspension in inertial storage systems can provide significant performance improvements to warrant development and tests.

[Establishing ward-independent, intensive treatment concept in a psychiatric hospital : A model project within the new German remuneration system].

PubMed

Noeker, M; Juckel, G

2017-03-01

Model projects according to § 64b of the Social Code V in the context of the new remuneration system in psychiatry and psychosomatics, offer great possibilities to improve the treatment of people with mental illnesses. This article presents the model project of the University Hospital Bochum, which is essentially characterized by improved transition through the internal hospital sections so that patients can be quickly transferred from inpatient and daycare sections to high frequency outpatient sections with ward-independent therapies (SUL), including outreach home treatment. The SUL is also intended to facilitate preadmission crises, to significantly reduce duration of inpatient treatment and to maximize post-inpatient continuity of treatment.

Advances in rechargeable lithium molybdenum disulfide batteries

NASA Technical Reports Server (NTRS)

Brandt, K.; Stiles, J. A. R.

1985-01-01

The lithium molybdenum disulfide system as demonstrated in a C size cell, offers performance characteristics for applications where light weight and low volume are important. A gravimetric energy density of 90 watt hours per kilogram can be achieved in a C size cell package. The combination of charge retention capabilities, high energy density and a state of charge indicator in a rechargeable cell provides power package for a wide range of devices. The system overcomes the memory effect in Nicads where the full capacity of the battery cannot be utilized unless it was utilized on previous cycles. The development of cells with an advanced electrolyte formulation led to an improved rate capability especially at low temperatures and to a significantly improved life cycle.

Factors affecting electronic health record adoption in long-term care facilities.

PubMed

Cherry, Barbara; Carter, Michael; Owen, Donna; Lockhart, Carol

2008-01-01

Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers.

Multi-Fresnel lenses pumping approach for improving high-power Nd:YAG solar laser beam quality.

PubMed

Liang, Dawei; Almeida, Joana

2013-07-20

To significantly improve the present-day high-power solar laser beam quality, a three-stage multi-Fresnel lenses approach is proposed for side-pumping either a Nd:YAG single-crystal or a core-doped Sm(3+)Nd:YAG ceramic rod. Optimum pumping and laser beam parameters are found through ZEMAX and LASCAD numerical analysis. The proposed scheme offers a uniform absorption profile along the rod. 167 W laser power can be achieved, corresponding to 29.3 W/m(2) collection efficiency. High brightness figure of merit of 8.34 W is expected for the core-doped rod within a convex-concave resonator, which is 1300 times higher than that of the most-recent high-power solar laser.

Progress in the utilization of an oxide-dispersion-strengthened alloy for small engine turbine blades

NASA Technical Reports Server (NTRS)

Beatty, T. G.; Millan, P. P.

1984-01-01

The conventional means of improving gas turbine engine performance typically involves increasing the turbine inlet temperature; however, at these higher operational temperatures the high pressure turbine blades require air-cooling to maintain durability. Air-cooling imposes design, material, and economic constraints not only on the turbine blades but also on engine performance. The use of uncooled turbine blades at increased operating temperatures can offer significantly improved performance in small gas turbine engines. A program to demonstrate uncooled MA6000 high pressure turbine blades in a GTEC TFE731 turbofan engine is being conducted. The project goals include demonstration of the advantages of using uncooled MA6000 turbine blades as compared with cast directionally solidified MAR-M 247 blades.

A review of failure models for unidirectional ceramic matrix composites under monotonic loads

NASA Technical Reports Server (NTRS)

Tripp, David E.; Hemann, John H.; Gyekenyesi, John P.

1989-01-01

Ceramic matrix composites offer significant potential for improving the performance of turbine engines. In order to achieve their potential, however, improvements in design methodology are needed. In the past most components using structural ceramic matrix composites were designed by trial and error since the emphasis of feasibility demonstration minimized the development of mathematical models. To understand the key parameters controlling response and the mechanics of failure, the development of structural failure models is required. A review of short term failure models with potential for ceramic matrix composite laminates under monotonic loads is presented. Phenomenological, semi-empirical, shear-lag, fracture mechanics, damage mechanics, and statistical models for the fast fracture analysis of continuous fiber unidirectional ceramic matrix composites under monotonic loads are surveyed.

Parallax barrier engineering for image quality improvement in an autostereoscopic 3D display.

PubMed

Kim, Sung-Kyu; Yoon, Ki-Hyuk; Yoon, Seon Kyu; Ju, Heongkyu

2015-05-18

We present a image quality improvement in a parallax barrier (PB)-based multiview autostereoscopic 3D display system under a real-time tracking of positions of a viewer's eyes. The system presented exploits a parallax barrier engineered to offer significantly improved quality of three-dimensional images for a moving viewer without an eyewear under the dynamic eye tracking. The improved image quality includes enhanced uniformity of image brightness, reduced point crosstalk, and no pseudoscopic effects. We control the relative ratio between two parameters i.e., a pixel size and the aperture of a parallax barrier slit to improve uniformity of image brightness at a viewing zone. The eye tracking that monitors positions of a viewer's eyes enables pixel data control software to turn on only pixels for view images near the viewer's eyes (the other pixels turned off), thus reducing point crosstalk. The eye tracking combined software provides right images for the respective eyes, therefore producing no pseudoscopic effects at its zone boundaries. The viewing zone can be spanned over area larger than the central viewing zone offered by a conventional PB-based multiview autostereoscopic 3D display (no eye tracking). Our 3D display system also provides multiviews for motion parallax under eye tracking. More importantly, we demonstrate substantial reduction of point crosstalk of images at the viewing zone, its level being comparable to that of a commercialized eyewear-assisted 3D display system. The multiview autostereoscopic 3D display presented can greatly resolve the point crosstalk problem, which is one of the critical factors that make it difficult for previous technologies for a multiview autostereoscopic 3D display to replace an eyewear-assisted counterpart.

Genomic-based-breeding tools for tropical maize improvement.

PubMed

Chakradhar, Thammineni; Hindu, Vemuri; Reddy, Palakolanu Sudhakar

2017-12-01

Maize has traditionally been the main staple diet in the Southern Asia and Sub-Saharan Africa and widely grown by millions of resource poor small scale farmers. Approximately, 35.4 million hectares are sown to tropical maize, constituting around 59% of the developing worlds. Tropical maize encounters tremendous challenges besides poor agro-climatic situations with average yields recorded <3 tones/hectare that is far less than the average of developed countries. On the contrary to poor yields, the demand for maize as food, feed, and fuel is continuously increasing in these regions. Heterosis breeding introduced in early 90 s improved maize yields significantly, but genetic gains is still a mirage, particularly for crop growing under marginal environments. Application of molecular markers has accelerated the pace of maize breeding to some extent. The availability of array of sequencing and genotyping technologies offers unrivalled service to improve precision in maize-breeding programs through modern approaches such as genomic selection, genome-wide association studies, bulk segregant analysis-based sequencing approaches, etc. Superior alleles underlying complex traits can easily be identified and introgressed efficiently using these sequence-based approaches. Integration of genomic tools and techniques with advanced genetic resources such as nested association mapping and backcross nested association mapping could certainly address the genetic issues in maize improvement programs in developing countries. Huge diversity in tropical maize and its inherent capacity for doubled haploid technology offers advantage to apply the next generation genomic tools for accelerating production in marginal environments of tropical and subtropical world. Precision in phenotyping is the key for success of any molecular-breeding approach. This article reviews genomic technologies and their application to improve agronomic traits in tropical maize breeding has been reviewed in detail.

Investigating the effect of nurse-team communication on nurse turnover: relationships among communication processes, identification, and intent to leave.

PubMed

Apker, Julie; Propp, Kathleen M; Ford, Wendy S Zabava

2009-03-01

Enhanced team communication may strengthen nurses' attachment to their organizations and teams and improve nurse retention. This study examines the relationships among nurse-team communication, identification (organizational and team), and intent to leave. Hospital nurses (N = 201) completed surveys measuring 3 nurse-team communication processes: promoting team synergy, ensuring quality decisions, and individualizing communication. Hierarchical regression analyses revealed that promoting team synergy was a significant predictor of intent to leave, whereas ensuring quality decisions and individualizing communication did not account for significant additional variance in intent to leave. Separate analyses showed that the relationship between promoting team synergy and intent to leave was partially mediated by team identification or by organizational identification. Further analyses were conducted on the 7 communication practices for promoting team synergy. Mentoring emerged as the only significant predictor of intent to leave; however, its relationship to intent to leave was fully mediated by organizational identification or partially mediated by team identification. Pragmatic suggestions are offered to improve nurse identification and reduce turnover.

Exceptional oxygen reduction reaction activity and durability of platinum–nickel nanowires through synthesis and post-treatment optimization

DOE PAGES

Alia, Shaun M.; Ngo, Chilan; Shulda, Sarah; ...

2017-04-11

For the first time, extended nanostructured catalysts are demonstrated with both high specific activity (>6000 μA cm Pt –2 at 0.9 V) and high surface areas (>90 m 2 g Pt –1). Platinum–nickel (Pt—Ni) nanowires, synthesized by galvanic displacement, have previously produced surface areas in excess of 90 m 2 g Pt –1, a significant breakthrough in and of itself for extended surface catalysts. Unfortunately, these materials were limited in terms of their specific activity and durability upon exposure to relevant electrochemical test conditions. Through a series of optimized postsynthesis steps, significant improvements were made to the activity (3-fold increasemore » in specific activity), durability (21% mass activity loss reduced to 3%), and Ni leaching (reduced from 7 to 0.3%) of the Pt—Ni nanowires. Finally, these materials show more than a 10-fold improvement in mass activity compared to that of traditional carbon-supported Pt nanoparticle catalysts and offer significant promise as a new class of electrocatalysts in fuel cell applications.« less

Exceptional oxygen reduction reaction activity and durability of platinum–nickel nanowires through synthesis and post-treatment optimization

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

Alia, Shaun M.; Ngo, Chilan; Shulda, Sarah

For the first time, extended nanostructured catalysts are demonstrated with both high specific activity (>6000 μA cm Pt –2 at 0.9 V) and high surface areas (>90 m 2 g Pt –1). Platinum–nickel (Pt—Ni) nanowires, synthesized by galvanic displacement, have previously produced surface areas in excess of 90 m 2 g Pt –1, a significant breakthrough in and of itself for extended surface catalysts. Unfortunately, these materials were limited in terms of their specific activity and durability upon exposure to relevant electrochemical test conditions. Through a series of optimized postsynthesis steps, significant improvements were made to the activity (3-fold increasemore » in specific activity), durability (21% mass activity loss reduced to 3%), and Ni leaching (reduced from 7 to 0.3%) of the Pt—Ni nanowires. Finally, these materials show more than a 10-fold improvement in mass activity compared to that of traditional carbon-supported Pt nanoparticle catalysts and offer significant promise as a new class of electrocatalysts in fuel cell applications.« less

Five years' experience in a (really) rural teleradiology practice. Was it worth it? The successes and the failures

NASA Astrophysics Data System (ADS)

Telepak, Robert J.; Freede, Emily; Jaramillo, Richard E.; Alverson, Dale C.

1998-07-01

During the past 5 years (1992 - 1997) the Department of Radiology of the University of New Mexico Health Sciences Center has developed an active teleradiology program. Contracts are in place to provide both routine and emergency image interpretations 24 hours per day, every day of the year. Several rural hospitals are served as well as the Navajo Indian Health Service. Areas of success: include significantly improved radiologic service to the rural sites, specialty consultations to general radiologists, successful teaching of teleradiology practice to radiology residents and staff, good diagnostic quality images, a small but real profit, improved quality assurance for the rural sites, and no significant medical-legal problems. Failures include: significant telecommunications problems, lack of acceptance and utilization by some of the rural sites, poor QA compliance by some sites, a long period of disappointing technical support by equipment vendors, and slow acceptance of DICOM by equipment manufacturers. The successes outweigh the failures. We would do it again -- but somewhat differently. We offer advice to institutions developing a new rural teleradiology operation.

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

Henry, Michael David; Young, Travis R.; Griffin, Ben

Here, this work reports the utilization of a recently developed film, ScAlN, as a silicon etch mask offering significant improvements in high etch selectivity to silicon. Utilization of ScAlN as a fluorine chemistry based deep reactive ion etch mask demonstrated etch selectivity at 23 550:1, four times better than AlN, 11 times better than Al 2O 3, and 148 times better than silicon dioxide with significantly less resputtering at high bias voltage than either Al 2O 3 or AlN. Ellipsometry film thickness measurements show less than 0.3 nm/min mask erosion rates for ScAlN. Micromasking of resputtered Al for Al 2Omore » 3, AlN, and ScAlN etch masks is also reported here, utilizing cross-sectional scanning electron microscope and confocal microscope roughness measurements. With lower etch bias, the reduced etch rate can be optimized to achieve a trench bottom surface roughness that is comparable to SiO 2 etch masks. Etch mask selectivity enabled by ScAlN is likely to make significant improvements in microelectromechanical systems, wafer level packaging, and plasma dicing of silicon.« less

Optical clearing of skin enhanced with hyaluronic acid for increased contrast of optoacoustic imaging

NASA Astrophysics Data System (ADS)

Liopo, Anton; Su, Richard; Tsyboulski, Dmitri A.; Oraevsky, Alexander A.

2016-08-01

Enhanced delivery of optical clearing agents (OCA) through skin may improve sensitivity of optical and optoacoustic (OA) methods of imaging, sensing, and monitoring. This report describes a two-step method for enhancement of light penetration through skin. Here, we demonstrate that topical application of hyaluronic acid (HA) improves skin penetration of hydrophilic and lipophilic OCA and thus enhances their performance. We examined the OC effect of 100% polyethylene and polypropylene glycols (PPGs) and their mixture after pretreatment by HA, and demonstrated significant increase in efficiency of light penetration through skin. Increased light transmission resulted in a significant increase of OA image contrast in vitro. Topical pretreatment of skin for about 30 min with 0.5% HA in aqueous solution offers effective delivery of low molecular weight OCA such as a mixture of PPG-425 and polyethylene glycol (PEG)-400. The developed approach of pretreatment by HA prior to application of clearing agents (PEG and PPG) resulted in a ˜47-fold increase in transmission of red and near-infrared light and significantly enhanced contrast of OA images.

Pilot study on the effects of a 1-day sleep education program: influence on sleep of stopping alcohol intake at bedtime.

PubMed

Morita, Emi; Miyazaki, Soichiro; Okawa, Masako

2012-08-01

The aim of this pilot study was to evaluate whether sleep was improved by a 1-day sleep education program in an occupational setting and whether stopping alcohol intake at bedtime might influence sleep. Subjects were 40 high school employees. The sleep education program lasted 4.5 hours and consisted of sleep science information, and sleep hygiene education including the risk of sleep related breathing disorder resulting from alcohol intake. Sleep conditions were evaluated by self-administered questionnaires at baseline and approximately 1 month later. The mean the Epworth Sleepiness Scale (ESS) score was significantly decreased by 1.2 points (P = 0.04), while the mean sleep duration was significantly decreased by 10 minutes (P = 0.02). Shortened sleep duration coincided with a decrease in sleepiness. This may indicate an improvement in sleep quality. The percentage of habitual alcohol intake at bedtime was significantly decreased (from 38.5% (15/39) to 20.5% (8/39), P = 0.04). Subjects who stopped alcohol intake at bedtime (n = 8) received the most benefit, with decreased scores of ESS and Insomnia Severity Index (ISI), although the reductions were not significant. This education program offers the possibility of improving sleep conditions among the general population, especially in those who cease habitual alcohol intake at bedtime. Further larger, randomized, controlled studies are warranted.

Profit versus public health: the need to improve the food environment in recreational facilities.

PubMed

Olstad, Dana Lee; Raine, Kim D

2013-01-08

Despite their wellness mandate, many publicly funded recreational facilities offer primarily unhealthy foods. Governments have developed programs and resources to assist facilities to improve their food offerings, however the challenge to incent preferential sale of healthier foods remains substantial. In the Canadian province of Alberta, uptake of government-issued voluntary nutrition guidelines for recreational facilities has been limited, and offers of free assistance to implement them as part of a research study were not embraced. Financial constraints appear to be the most important barrier to offering healthier items in Alberta's recreational facilities, as facility and food service managers perceive that selling healthier foods is unprofitable and might jeopardize sponsorship agreements. Mandatory government regulation may therefore be required to overcome the barriers to offering healthier foods in this setting. The advantages of a regulatory approach appear to outweigh any disadvantages, with benefits for population health, more effective use of public funds, and greater equity for the public and industry. Adverse effects on corporate profitability and freedom of choice are expected to be limited. Regulation may offer an efficient, effective and equitable means of ensuring that recreational facilities support child health and do not undermine it by exposing children to unhealthy food environments.

Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

PubMed

Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

2014-06-01

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p < 0.01) and Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p < 0.001). More substantial improvements were noted when using alternative measures. Clinically meaningful pain relief was achieved by 37% of patients, and the body area affected by pain decreased by 31%. ROM showed significant improvements in straight leg raise and cervical motion, without improvements in lumbar ROM. Daily walking distance increased fourfold and arm exercise repetitions doubled. Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

DART system analysis.

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

Boggs, Paul T.; Althsuler, Alan; Larzelere, Alex R.

2005-08-01

The Design-through-Analysis Realization Team (DART) is chartered with reducing the time Sandia analysts require to complete the engineering analysis process. The DART system analysis team studied the engineering analysis processes employed by analysts in Centers 9100 and 8700 at Sandia to identify opportunities for reducing overall design-through-analysis process time. The team created and implemented a rigorous analysis methodology based on a generic process flow model parameterized by information obtained from analysts. They also collected data from analysis department managers to quantify the problem type and complexity distribution throughout Sandia's analyst community. They then used this information to develop a communitymore » model, which enables a simple characterization of processes that span the analyst community. The results indicate that equal opportunity for reducing analysis process time is available both by reducing the ''once-through'' time required to complete a process step and by reducing the probability of backward iteration. In addition, reducing the rework fraction (i.e., improving the engineering efficiency of subsequent iterations) offers approximately 40% to 80% of the benefit of reducing the ''once-through'' time or iteration probability, depending upon the process step being considered. Further, the results indicate that geometry manipulation and meshing is the largest portion of an analyst's effort, especially for structural problems, and offers significant opportunity for overall time reduction. Iteration loops initiated late in the process are more costly than others because they increase ''inner loop'' iterations. Identifying and correcting problems as early as possible in the process offers significant opportunity for time savings.« less

Active acute leukaemia: should transplant be offered to all patients?

PubMed

Avni, Batia; Shapira, Michael Y; Resnick, Igor B; Stepensky, Polina; Or, Reuven; Grisariu, Sigal

2017-12-01

The probability of achieving long term remission for patients with refractory acute leukaemia is very low. Allogeneic stem cell transplantation (SCT) is offered to these patients in order to improve their dismal outcome. We retrospectively analyzed 361 acute leukaemia patients, who underwent allogeneic SCT in the Hadassah's bone marrow transplantation department between the years 2005 and 2012 and identified 84 patients with active leukaemia at transplantation. Median age was 34 years. Sixty four patients were diagnosed with acute myeloid leukaemia (AML), 18 patients with acute lymphoblastic leukaemia and two with biphenotypic leukaemia. The majority of patients were diagnosed with de-novo AML and transplanted at relapse. In the surviving patients, median follow up was 15 months. One year OS was 20%. At time of last follow up, 13 patients were alive (15.5%): ten patients with AML and two patients with acute lymphoblastic leukaemia. In the univariate analysis, factors associated with significantly better overall survival were as follows: matched unrelated donor (p = 0.006), matched donor (p = 0.014) and occurrence of acute graft-versus-host disease (aGVHD) (p = 0.019). Karnofsky performance score at SCT and occurrence of cGVHD were found to be borderline significant. Only matched unrelated donor and aGVHD were found to affect overall survival significantly in the multivariate analysis. Other than performance score at SCT, none of the pretransplant patients' characteristics were found to influence survival. In conclusion, as none of the pretransplant characteristics were found to influence the ability to select the patients that will benefit from HSC transplantation, this work supports offering HSCT to all active leukaemia eligible patients with reasonable performance status. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Prunus rootstocks

USDA-ARS?s Scientific Manuscript database

New clonal Prunus hybrid rootstocks for apricot and plums offer improved adaptation to site related problems including soil borne diseases, waterlogging, calcareous soils and various species of nematodes. Additionally, they offer varying degrees of vigor control compared to standard seedling and clo...

Relationship of impaired processing speed and flexibility of abstract thought to improvements in work performance over time in schizophrenia.

PubMed

Lysaker, Paul H; Bryson, Gary J; Davis, Louanne W; Bell, Morris D

2005-06-15

Vocational impairments in schizophrenia have been widely linked to deficits in neurocognition. This study examined the possibility that deficits in visuomotor processing speed and flexibility in abstract thought may in combination be an especially potent risk factor for poorer levels of work performance in rehabilitation. Fifty-seven participants with confirmed diagnoses of schizophrenia spectrum disorders were administered the Digit Symbol Subtest and the Wisconsin Card Sorting Test and then offered work placements in a vocational rehabilitation program. Work performance was assessed biweekly over two months using the Work Behavior Inventory. Multivariate and univariate repeated ANOVA revealed that participants classified as having no impairments in either visuomotor processing speed and flexibility in abstract thought (n=14) had superior work performance compared to participants with deficits in either one area (n=20) or both areas (n=23). Additionally, participants with no impairments were the only group to show significant improvement in work performance over 7 weeks of rehabilitation. Participants with only one deficit had significantly better work performance than participants with both deficits but showed no statistically significant improvement in work performance. Results suggest assessments of these domains of neurocognition may provide important information about individual needs for adjunct services.

Epstein-Barr virus lymphoproliferative disease after hematopoietic stem cell transplant.

PubMed

Rouce, Rayne H; Louis, Chrystal U; Heslop, Helen E

2014-11-01

Epstein-Barr virus (EBV) reactivation can cause significant morbidity and mortality after allogeneic hematopoietic stem cell transplant. Delays in reconstitution of EBV-specific T lymphocyte activity can lead to life-threatening EBV lymphoproliferative disease (EBV-PTLD). This review highlights recent advances in the understanding of pathophysiology, risk factors, diagnosis, and management of EBV viremia and PTLD. During the past decade, early detection strategies, such as serial measurement of EBV-DNA load, have helped identify high-risk patients and diagnose early lymphoproliferation. The most significant advances have come in the form of innovative treatment options, including manipulation of the balance between outgrowing EBV-infected B cells and the EBV cytotoxic T lymphocyte response, and targeting infected B cells with monoclonal antibodies, chemotherapy, unmanipulated donor lymphocytes, and donor or more recently third-party EBV cytotoxic T lymphocytes. Defining criteria for preemptive therapy remains a challenge. EBV reactivation is a significant complication after stem cell transplant. Continued improvements in risk stratification and treatment options are required to improve the morbidity and mortality caused by EBV-associated diseases. Current approaches use rituximab to deplete B cells or adoptive transfer of EBV cytotoxic T lymphocyte to reconstitute immunity. The availability of rapid EBV-specific T cell products offers the possibility of improved outcomes.

Dietary outcomes in a Spanish-language randomized controlled diabetes prevention trial with pregnant Latinas.

PubMed

Kieffer, Edith C; Welmerink, Diana B; Sinco, Brandy R; Welch, Kathleen B; Rees Clayton, Erin M; Schumann, Christina Y; Uhley, Virginia E

2014-03-01

We evaluated the effectiveness of a community-based healthy lifestyle intervention in improving dietary behaviors of pregnant Latinas from 2004 to 2006 in Detroit, Michigan. The 11-week, culturally tailored, Spanish-language Healthy Mothers on the Move (MOMs) intervention offered home visits, group classes, related activities, and social support from trained community health workers (CHWs) and peers. Dietary behaviors were measured by food frequency questionnaire. Linear mixed models estimated pre- and post-intervention changes, within and between MOMs intervention and minimal intervention (MI) groups. MOMs (n = 139) and MI (n = 139) participants had similar baseline characteristics and dietary intake. Post-intervention, MOMs participants showed significant improvement in all dietary behaviors, except fruit and fiber consumption. Compared with MI participants, MOMs participants had significantly decreased consumption of added sugar (P = .05), total fat (P < .05), saturated fat (P < .01), percentage of daily calories from saturated fat (P < .001), solid fats and added sugars (P < .001), and had increased vegetable consumption (P < .001). Their increase in fiber consumption (P < .05) was significant relative to MI participants' decrease in fiber intake. We confirmed the hypothesis that a community-planned, CHW-led healthy lifestyle intervention could improve dietary behaviors of low-income Latina women during pregnancy.

Neurology didactic curricula for psychiatry residents: a review of the literature and a survey of program directors.

PubMed

Reardon, Claudia L; Walaszek, Art

2012-03-01

Minimal literature exists on neurology didactic instruction offered to psychiatry residents, and there is no model neurology didactic curriculum offered for psychiatry residency programs. The authors sought to describe the current state of neurology didactic training in psychiatry residencies. The authors electronically surveyed 172 directors of U.S. psychiatric residency training programs to examine the types and extent of neurology didactic instruction offered to their residents. Fifty-seven program directors (33%) responded. The majority of these psychiatry residency programs offer neurology didactic instruction to their residents, as provided by both neurology and psychiatry faculty, in a number of different settings and covering many topics. However, room for improvement likely remains. The authors hope this report will guide psychiatry residencies in optimizing their neurology didactic curricula. Further research should explore tools for assessing resident knowledge in neurology and measure the effectiveness of neurology curricula in increasing knowledge and improving clinical outcomes.

A unified framework for approximation in inverse problems for distributed parameter systems

NASA Technical Reports Server (NTRS)

Banks, H. T.; Ito, K.

1988-01-01

A theoretical framework is presented that can be used to treat approximation techniques for very general classes of parameter estimation problems involving distributed systems that are either first or second order in time. Using the approach developed, one can obtain both convergence and stability (continuous dependence of parameter estimates with respect to the observations) under very weak regularity and compactness assumptions on the set of admissible parameters. This unified theory can be used for many problems found in the recent literature and in many cases offers significant improvements to existing results.

Stereolithographic Surgical Template: A Review

PubMed Central

Dandekeri, Shilpa Sudesh; Sowmya, M.K.; Bhandary, Shruthi

2013-01-01

Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this article.It permits graphic and complex 3D implant placement and fabrication of stereolithographic surgical templates. Also offers many significant benefits over traditional procedures. PMID:24179955

Investigation of fast initialization of spacecraft bubble memory systems

NASA Technical Reports Server (NTRS)

Looney, K. T.; Nichols, C. D.; Hayes, P. J.

1984-01-01

Bubble domain technology offers significant improvement in reliability and functionality for spacecraft onboard memory applications. In considering potential memory systems organizations, minimization of power in high capacity bubble memory systems necessitates the activation of only the desired portions of the memory. In power strobing arbitrary memory segments, a capability of fast turn on is required. Bubble device architectures, which provide redundant loop coding in the bubble devices, limit the initialization speed. Alternate initialization techniques are investigated to overcome this design limitation. An initialization technique using a small amount of external storage is demonstrated.

Structured illumination for wide-field Raman imaging of cell membranes

NASA Astrophysics Data System (ADS)

Chen, Houkai; Wang, Siqi; Zhang, Yuquan; Yang, Yong; Fang, Hui; Zhu, Siwei; Yuan, Xiaocong

2017-11-01

Although the diffraction limit still restricts their lateral resolution, conventional wide-field Raman imaging techniques offer fast imaging speeds compared with scanning schemes. To extend the lateral resolution of wide-field Raman microscopy using filters, standing-wave illumination technique is used, and an improvement of lateral resolution by a factor of more than two is achieved. Specifically, functionalized surface enhanced Raman scattering nanoparticles are employed to strengthen the desired scattering signals to label cell membranes. This wide-field Raman imaging technique affords various significant opportunities in the biological applications.

Supersonic transport grid generation, validation, and optimization

NASA Technical Reports Server (NTRS)

Aaronson, Philip G.

1995-01-01

The ever present demand for reduced flight times has renewed interest in High Speed Civil Transports (HSCT). The need for an HSCT becomes especially apparent when the long distance, over-sea, high growth Pacific rim routes are considered. Crucial to any successful HSCT design are minimal environmental impact and economic viability. Vital is the transport's aerodynamic efficiency, ultimately effecting both the environmental impact and the operating cost. Optimization, including numerical optimization, coupled with the use of computational fluid dynamics (CFD) technology, has and will offer a significant improvement beyond traditional methods.

Implant rehabilitation of partial maxillectomy edentulous patient

PubMed Central

Gowda, Mahesh E.; Mohan, Murali S.; Verma, Kamal; Roy, I. D.

2013-01-01

Edentulous patients with maxillectomy defects present a significant challenge for prosthetic rehabilitation and the adaptive capabilities of the patient as retention is highly compromised. Hence, the option of using endosseous implants to increase obturator retention has been used. A patient of mucormycosis of the left maxilla was treated with surgical excision. After satisfactory healing, definitive implant supported magnet retained prosthesis was fabricated for the patient. Implants with magnetic units offer a practical method of improving the retention of obturators provided acceptable prosthetic protocols are followed for the rehabilitation. PMID:24124314

Early Results from NICER Observations of Accreting Neutron Stars

NASA Astrophysics Data System (ADS)

Chakrabarty, Deepto; Ozel, Feryal; Arzoumanian, Zaven; Gendreau, Keith C.; Bult, Peter; Cackett, Ed; Chenevez, Jerome; Fabian, Andy; Guillot, Sebastien; Guver, Tolga; Homan, Jeroen; Keek, Laurens; Lamb, Frederick; Ludlam, Renee; Mahmoodifar, Simin; Markwardt, Craig B.; Miller, Jon M.; Psaltis, Dimitrios; Strohmayer, Tod E.; Wilson-Hodge, Colleen A.; Wolff, Michael T.

2018-01-01

The Neutron Star Interior Composition Explorer (NICER) offers significant new capabilities for the study of accreting neuton stars relative to previous X-ray missions including large effective area, low background, and greatly improved low-energy response. The NICER Burst and Accretion Working Group has designed a 2 Ms observation program to study a number of phenomena in accreting neutron stars including type-I X-ray bursts, superbursts, accretion-powered pulsations, quasi-periodic oscillations, and accretion disk reflection spectra. We present some early results from the first six months of the NICER mission.

The role of nanotechnology in the development of battery materials for electric vehicles

NASA Astrophysics Data System (ADS)

Lu, Jun; Chen, Zonghai; Ma, Zifeng; Pan, Feng; Curtiss, Larry A.; Amine, Khalil

2016-12-01

A significant amount of battery research and development is underway, both in academia and industry, to meet the demand for electric vehicle applications. When it comes to designing and fabricating electrode materials, nanotechnology-based approaches have demonstrated numerous benefits for improved energy and power density, cyclability and safety. In this Review, we offer an overview of nanostructured materials that are either already commercialized or close to commercialization for hybrid electric vehicle applications, as well as those under development with the potential to meet the requirements for long-range electric vehicles.

Implementation of Wireless Terminals at Farmers’ Markets: Impact on SNAP Redemption and Overall Sales

PubMed Central

Bertmann, Farryl M. W.; Ohri-Vachaspati, Punam; Buman, Matthew P.

2012-01-01

Although farmers’ markets offer healthy foods for purchase, many lack the equipment necessary to process convenient, card-based transactions. We assessed the impact of providing wireless terminals to 5 markets on overall sales and redemption of Supplemental Nutrition Assistance Program (SNAP) benefits. Sales increased significantly at 4 of the 5 markets after implementation of the terminals, and overall sales increased above and beyond SNAP redemption alone. Implementation of wireless terminals may be important for improving the financial stability and accessibility of farmers’ markets. PMID:22594725

JT8D engine performance retention

NASA Technical Reports Server (NTRS)

James, A. D.; Weisel, D. R.

1981-01-01

The attractive performance retention characteristics of the JT8D engine are described. Because of its moderate bypass ratio and turbine temperature, and stiff structural design, the performance retention versus flight cycles of the JT8D engine sets a standard that is difficult for other engines to equal. In addition, the significant benefits of refurbishment of the JT8D engine are presented. Cold section refurbishment offers thrust specific fuel consumption improvements of up to 2 percent and payback in less than a year, making a very attractive investment option for the airlines.

The role of nanotechnology in the development of battery materials for electric vehicles.

PubMed

Lu, Jun; Chen, Zonghai; Ma, Zifeng; Pan, Feng; Curtiss, Larry A; Amine, Khalil

2016-12-06

A significant amount of battery research and development is underway, both in academia and industry, to meet the demand for electric vehicle applications. When it comes to designing and fabricating electrode materials, nanotechnology-based approaches have demonstrated numerous benefits for improved energy and power density, cyclability and safety. In this Review, we offer an overview of nanostructured materials that are either already commercialized or close to commercialization for hybrid electric vehicle applications, as well as those under development with the potential to meet the requirements for long-range electric vehicles.

A Complete Pathological Response to Pembrolizumab following ex vivo Liver Resection in a Patient with Colorectal Liver Metastases.

PubMed

Baimas-George, Maria; Baker, Erin; Kamionek, Michal; Salmon, J Stuart; Sastry, Amit; Levi, David; Vrochides, Dionisios

2018-04-05

Advances in the systemic treatment of stage IV colorectal cancer with liver metastases has offered improved survival rates for patients who otherwise face a dismal prognosis. However, a pathologically complete response (PCR) to chemotherapy for colorectal liver metastases is still rare, and its significance is not fully understood. In this case report, we describe a patient who achieved PCR after neoadjuvant immunotherapy with pembrolizumab and a left hepatectomy using an ex vivo resection technique. © 2018 S. Karger AG, Basel.

Physician input: a critical strategic-planning tool.

PubMed

Rovinsky, Michael

2002-01-01

To establish effective working relationships with medical staff and community physicians, an IDS must adopt a strategic-planning approach that adequately incorporates physicians' needs and expectations. Research shows that most physicians considered the IDS's market position, the degree to which the IDS can offer physicians practice-enhancing capabilities, and physician involvement in IDS governance to be critical factors for the success of an IDS. By establishing a meaningful role for physicians in the organizational strategic-planning process, an IDS can significantly improve its market position and its relationships with physicians.

E-commerce in healthcare: changing the traditional landscape.

PubMed

Aggarwal, A K; Travers, S

2001-01-01

The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.

Improvement of foaming ability of egg white product by irradiation and its application

NASA Astrophysics Data System (ADS)

Song, Hyun-Pa; Kim, Binna; Choe, Jun-Ho; Jung, Samooel; Kim, Kyong-Su; Kim, Dong-Ho; Jo, Cheorun

2009-03-01

To investigate the enhancement of foaming abilities of liquid egg white (LEW) and egg white powder (EWP) by irradiation and its application for bakery product, LEW and EWP were irradiated at 0, 1, 2, and 5 kGy by Co-60 gamma ray. There was no pH change found among treatments in both LEW and EWP. The viscosity of LEW decreased significantly by irradiation ( P<0.05), whereas that of EWP was not affected by irradiation. The foaming ability of LEW and EWP was significantly increased by irradiation as a dose-dependent manner ( P<0.05). The volume and the height of angel cake baked with irradiated LEW were significantly higher than those of unirradiated control ( P<0.05). For EWP, the volume and the height of angel cake were greater at 2 kGy only than those of control. A significant decrease in hardness, chewiness, and gumminess values and an increase in Hunter L* value were observed in the angel cakes prepared from irradiated egg white products ( P<0.05). Results indicated that irradiation of egg white could offer advantages in increasing foaming ability and improving quality of final bakery products.

Role of a Semiotics-Based Curriculum in Empathy Enhancement: A Longitudinal Study in Three Dominican Medical Schools.

PubMed

San-Martín, Montserrat; Delgado-Bolton, Roberto; Vivanco, Luis

2017-01-01

Background: Empathy in the context of patient care is defined as a predominantly cognitive attribute that involves an understanding of the patient's experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help. In medical education, it is recognized that empathy can be improved by interventional approaches. In this sense, a semiotic-based curriculum could be an important didactic tool for improving medical empathy. The main purpose of this study was to determine if in medical schools where a semiotic-based curriculum is offered, the empathetic orientation of medical students improves as a consequence of the acquisition and development of students' communication skills that are required in clinician-patient encounters. Design: This quasi-experimental study was conducted in three medical schools of the Dominican Republic that offer three different medical curricula: (i) a theoretical and practical semiotic-based curriculum; (ii) a theoretical semiotic-based curriculum; and (iii) a curriculum without semiotic courses. The Jefferson scale of empathy was administered in two different moments to students enrolled in pre-clinical cycles of those institutions. Data was subjected to comparative statistical analysis and logistic regression analysis. Results: The study included 165 students (55 male and 110 female). Comparison analysis showed statistically significant differences in the development of empathy among groups ( p < 0.001). Logistic regression confirmed that gender, age, and a semiotic-based curriculum contributed toward the enhancement of empathy. Conclusion: These findings demonstrate the importance of medical semiotics as a didactic teaching method for improving beginners' empathetic orientation in patients' care.

Role of a Semiotics-Based Curriculum in Empathy Enhancement: A Longitudinal Study in Three Dominican Medical Schools

PubMed Central

San-Martín, Montserrat; Delgado-Bolton, Roberto; Vivanco, Luis

2017-01-01

Background: Empathy in the context of patient care is defined as a predominantly cognitive attribute that involves an understanding of the patient’s experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help. In medical education, it is recognized that empathy can be improved by interventional approaches. In this sense, a semiotic-based curriculum could be an important didactic tool for improving medical empathy. The main purpose of this study was to determine if in medical schools where a semiotic-based curriculum is offered, the empathetic orientation of medical students improves as a consequence of the acquisition and development of students’ communication skills that are required in clinician–patient encounters. Design: This quasi-experimental study was conducted in three medical schools of the Dominican Republic that offer three different medical curricula: (i) a theoretical and practical semiotic-based curriculum; (ii) a theoretical semiotic-based curriculum; and (iii) a curriculum without semiotic courses. The Jefferson scale of empathy was administered in two different moments to students enrolled in pre-clinical cycles of those institutions. Data was subjected to comparative statistical analysis and logistic regression analysis. Results: The study included 165 students (55 male and 110 female). Comparison analysis showed statistically significant differences in the development of empathy among groups (p < 0.001). Logistic regression confirmed that gender, age, and a semiotic-based curriculum contributed toward the enhancement of empathy. Conclusion: These findings demonstrate the importance of medical semiotics as a didactic teaching method for improving beginners’ empathetic orientation in patients’ care. PMID:29209252

Implementation of client versus care-provider strategies to improve external cephalic version rates: a cluster randomized controlled trial.

PubMed

Vlemmix, Floortje; Rosman, Ageeth N; Rijnders, Marlies E; Beuckens, Antje; Opmeer, Brent C; Mol, Ben W J; Kok, Marjolein; Fleuren, Margot A H

2015-05-01

To determine the effectiveness of a client or care-provider strategy to improve the implementation of external cephalic version. Cluster randomized controlled trial. Twenty-five clusters; hospitals and their referring midwifery practices randomly selected in the Netherlands. Singleton breech presentation from 32 weeks of gestation onwards. We randomized clusters to a client strategy (written information leaflets and decision aid), a care-provider strategy (1-day counseling course focused on knowledge and counseling skills), a combined client and care-provider strategy and care-as-usual strategy. We performed an intention-to-treat analysis. Rate of external cephalic version in various strategies. Secondary outcomes were the percentage of women counseled and opting for a version attempt. The overall implementation rate of external cephalic version was 72% (1169 of 1613 eligible clients) with a range between clusters of 8-95%. Neither the client strategy (OR 0.8, 95% CI 0.4-1.5) nor the care-provider strategy (OR 1.2, 95% CI 0.6-2.3) showed significant improvements. Results were comparable when we limited the analysis to those women who were actually offered intervention (OR 0.6, 95% CI 0.3-1.4 and OR 2.0, 95% CI 0.7-4.5). Neither a client nor a care-provider strategy improved the external cephalic version implementation rate for breech presentation, neither with regard to the number of version attempts offered nor the number of women accepting the procedure. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Traceable Radiometry Underpinning Terrestrial- and Helio- Studies (TRUTHS)

USGS Publications Warehouse

Fox, N.; Aiken, J.; Barnett, J.J.; Briottet, X.; Carvell, R.; Frohlich, C.; Groom, S.B.; Hagolle, O.; Haigh, J.D.; Kieffer, H.H.; Lean, J.; Pollock, D.B.; Quinn, T.; Sandford, M.C.W.; Schaepman, M.; Shine, K.P.; Schmutz, W.K.; Teillet, P.M.; Thome, K.J.; Verstraete, M.M.; Zalewski, E.; ,

2002-01-01

The Traceable Radiometry Underpinning Terrestrial- and Helio- Studies (TRUTHS) mission offers a novel approach to the provision of key scientific data with unprecedented radiometric accuracy for Earth Observation (EO) and solar studies, which will also establish well-calibrated reference targets/standards to support other EO missions. This paper will present the TRUTHS mission and its objectives. TRUTHS will be the first satellite mission to calibrate its instrumentation directly to SI in orbit, overcoming the usual uncertainties associated with drifts of sensor gain and spectral shape by using an electrical rather than an optical standard as the basis of its calibration. The range of instruments flown as part of the payload will also provide accurate input data to improve atmospheric radiative transfer codes by anchoring boundary conditions, through simultaneous measurements of aerosols, particulates and radiances at various heights. Therefore, TRUTHS will significantly improve the performance and accuracy of Earth observation missions with broad global or operational aims, as well as more dedicated missions. The provision of reference standards will also improve synergy between missions by reducing errors due to different calibration biases and offer cost reductions for future missions by reducing the demands for on-board calibration systems. Such improvements are important for the future success of strategies such as Global Monitoring for Environment and Security (GMES) and the implementation and monitoring of international treaties such as the Kyoto Protocol. TRUTHS will achieve these aims by measuring the geophysical variables of solar and lunar irradiance, together with both polarised and un-polarised spectral radiance of the Moon, and the Earth and its atmosphere.

Traceable Radiometry Underpinning Terrestrial - and Helio- Studies (TRUTHS)

USGS Publications Warehouse

Fox, N.; Aiken, J.; Barnett, J.J.; Briottet, X.; Carvell, R.; Frohlich, C.; Groom, S.B.; Hagolle, O.; Haigh, J.D.; Kieffer, H.H.; Lean, J.; Pollock, D.B.; Quinn, T.; Sandford, M.C.W.; Schaepman, M.; Shine, K.P.; Schmutz, W.K.; Teillet, P.M.; Thome, K.J.; Verstraete, M.M.; Zalewski, E.

2003-01-01

The Traceable Radiometry Underpinning Terrestrial- and Helio- Studies (TRUTHS) mission offers a novel approach to the provision of key scientific data with unprecedented radiometric accuracy for Earth Observation (EO) and solar studies, which will also establish well-calibrated reference targets/standards to support other EO missions. This paper presents the TRUTHS mission and its objectives. TRUTHS will be the first satellite mission to calibrate its EO instrumentation directly to SI in orbit, overcoming the usual uncertainties associated with drifts of sensor gain and spectral shape by using an electrical rather than an optical standard as the basis of its calibration. The range of instruments flown as part of the payload will also provide accurate input data to improve atmospheric radiative transfer codes by anchoring boundary conditions, through simultaneous measurements of aerosols, particulates and radiances at various heights. Therefore, TRUTHS will significantly improve the performance and accuracy of EO missions with broad global or operational aims, as well as more dedicated missions. The provision of reference standards will also improve synergy between missions by reducing errors due to different calibration biases and offer cost reductions for future missions by reducing the demands for on-board calibration systems. Such improvements are important for the future success of strategies such as Global Monitoring for Environment and Security (GMES) and the implementation and monitoring of international treaties such as the Kyoto Protocol. TRUTHS will achieve these aims by measuring the geophysical variables of solar and lunar irradiance, together with both polarised and unpolarised spectral radiance of the Moon, Earth and its atmosphere. Published by Elsevier Ltd of behalf of COSPAR.

Linear relationship between increasing amounts of extruded linseed in dairy cow diet and milk fatty acid composition and butter properties.

PubMed

Hurtaud, C; Faucon, F; Couvreur, S; Peyraud, J-L

2010-04-01

The aim of this experiment was to compare the effects of increasing amounts of extruded linseed in dairy cow diet on milk fat yield, milk fatty acid (FA) composition, milk fat globule size, and butter properties. Thirty-six Prim'Holstein cows at 104 d in milk were sorted into 3 groups by milk production and milk fat globule size. Three diets were assigned: a total mixed ration (control) consisting of corn silage (70%) and concentrate (30%), or a supplemented ration based on the control ration but where part of the concentrate energy was replaced on a dry matter basis by 2.1% (LIN1) or 4.3% (LIN2) extruded linseed. The increased amounts of extruded linseed linearly decreased milk fat content and milk fat globule size and linearly increased the percentage of milk unsaturated FA, specifically alpha-linolenic acid and trans FA. Extruded linseed had no significant effect on butter color or on the sensory properties of butters, with only butter texture in the mouth improved. The LIN2 treatment induced a net improvement of milk nutritional properties but also created problems with transforming the cream into butter. The butters obtained were highly spreadable and melt-in-the-mouth, with no pronounced deficiency in taste. The LIN1 treatment appeared to offer a good tradeoff of improved milk FA profile and little effect on butter-making while still offering butters with improved functional properties. Copyright (c) 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The use of computerized image guidance in lumbar disk arthroplasty.

PubMed

Smith, Harvey E; Vaccaro, Alexander R; Yuan, Philip S; Papadopoulos, Stephen; Sasso, Rick

2006-02-01

Surgical navigation systems have been increasingly studied and applied in the application of spinal instrumentation. Successful disk arthroplasty requires accurate midline and rotational positioning for optimal function and longevity. A surgical simulation study in human cadaver specimens was done to evaluate and compare the accuracy of standard fluoroscopy, computer-assisted fluoroscopic image guidance, and Iso-C3D image guidance in the placement of lumbar intervertebral disk replacements. Lumbar intervertebral disk prostheses were placed using three different image guidance techniques in three human cadaver spine specimens at multiple levels. Postinstrumentation accuracy was assessed with thin-cut computed tomography scans. Intervertebral disk replacements placed using the StealthStation with Iso-C3D were more accurately centered than those placed using the StealthStation with FluoroNav and standard fluoroscopy. Intervertebral disk replacements placed with Iso-C3D and FluoroNav had improved rotational divergence compared with standard fluoroscopy. Iso-C3D and FluoroNav had a smaller interprocedure variance than standard fluoroscopy. These results did not approach statistical significance. Relative to both virtual and standard fluoroscopy, use of the StealthStation with Iso-C3D resulted in improved accuracy in centering the lumbar disk prosthesis in the coronal midline. The StealthStation with FluoroNav appears to be at least equivalent to standard fluoroscopy and may offer improved accuracy with rotational alignment while minimizing radiation exposure to the surgeon. Surgical guidance systems may offer improved accuracy and less interprocedure variation in the placement of intervertebral disk replacements than standard fluoroscopy. Further study regarding surgical navigation systems for intervertebral disk replacement is warranted.

Birth weight differences between those offered financial voucher incentives for verified smoking cessation and control participants enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), employing an intuitive approach and a Complier Average Causal Effects (CACE) analysis.

PubMed

McConnachie, Alex; Haig, Caroline; Sinclair, Lesley; Bauld, Linda; Tappin, David M

2017-07-20

The Cessation in Pregnancy Incentives Trial (CPIT), which offered financial incentives for smoking cessation during pregnancy showed a clinically and statistically significant improvement in cessation. However, infant birth weight was not seen to be affected. This study re-examines birth weight using an intuitive and a complier average causal effects (CACE) method to uncover important information missed by intention-to-treat analysis. CPIT offered financial incentives up to £400 to pregnant smokers to quit. With incentives, 68 women (23.1%) were confirmed non-smokers at primary outcome, compared to 25 (8.7%) without incentives, a difference of 14.3% (Fisher test, p < 0.0001). For this analysis, randomised groups were split into three theoretical sub-groups: independent quitters - quit without incentives, hardened smokers - could not quit even with incentives and potential quitters - required the addition of financial incentives to quit. Viewed in this way, the overall birth weight gain with incentives is attributable only to potential quitters. We compared an intuitive approach to a CACE analysis. Mean birth weight of potential quitters in the incentives intervention group (who therefore quit) was 3338 g compared with potential quitters in the control group (who did not quit) 3193 g. The difference attributable to incentives, was 3338 - 3193 = 145 g (95% CI -617, +803). The mean difference in birth weight between the intervention and control groups was 21 g, and the difference in the proportion who managed to quit was 14.3%. Since the intervention consisted of the offer of incentives to quit smoking, the intervention was received by all women in the intervention group. However, "compliance" was successfully quitting with incentives, and the CACE analysis yielded an identical result, causal birth weight increase 21 g ÷ 0.143 = 145 g. Policy makers have great difficulty giving pregnant women money to stop smoking. This study indicates that a small clinically insignificant improvement in average birth weight is likely to hide an important clinically significant increase in infants born to pregnant smokers who want to stop but cannot achieve smoking cessation without the addition of financial voucher incentives. ISRCTN Registry, ISRCTN87508788 . Registered on 1 September 2011.

A Worksite Occupational Health Clinic-Based Diabetes Mellitus Management Program.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; Erickson, Denise; McCluskey, Maureen; Schultz, Alyssa

2015-12-01

This study is an analysis of a workplace diabetes management program offered to employees of a Fortune 100 financial services corporation located in the United States. The 12-month worksite-based educational program was for employees who were at risk for diabetes, had prediabetes, or were diagnosed with diabetes. This employed population, with health benefits, generally had acceptable control of their diabetes at the start of the program. They statistically improved most self-efficacy measures, but improvement in biometric tests at 6 and 12 months were not significantly different from baseline. Mean hemoglobin A1c at baseline, 6 months, and 12 months was 7.2%, 7.2%, and 7.3%, respectively. At 12 months, about 40% of preprogram survey participants completed all screenings and the post-program questionnaire. Disease management programs at the workplace can be an important component in helping employees enhance their knowledge of diabetes and maintain and improve their health.

Magnetic resonance imaging of the preterm infant brain.

PubMed

Doria, Valentina; Arichi, Tomoki; Edwards, David A

2014-01-01

Despite improvements in neonatal care, survivors of preterm birth are still at a significantly increased risk of developing life-long neurological difficulties including cerebral palsy and cognitive difficulties. Cranial ultrasound is routinely used in neonatal practice, but has a low sensitivity for identifying later neurodevelopmental difficulties. Magnetic Resonance Imaging (MRI) can be used to identify intracranial abnormalities with greater diagnostic accuracy in preterm infants, and theoretically might improve the planning and targeting of long-term neurodevelopmental care; reducing parental stress and unplanned healthcare utilisation; and ultimately may improve healthcare cost effectiveness. Furthermore, MR imaging offers the advantage of allowing the quantitative assessment of the integrity, growth and function of intracranial structures, thereby providing the means to develop sensitive biomarkers which may be predictive of later neurological impairment. However further work is needed to define the accuracy and value of diagnosis by MR and the techniques's precise role in care pathways for preterm infants.

Addressing dysfunctional relations among healthcare teams: improving team cooperation through applied organizational theories.

PubMed

Horwitz, Sujin K; Horwitz, Irwin B; Barshes, Neal R

2011-01-01

Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health-care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health-care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health-care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health-care organizations.

Retention of drug administration skills after intensive teaching.

PubMed

Wheeler, D W; Degnan, B A; Murray, L J; Dunling, C P; Whittlestone, K D; Wood, D F; Smith, H L; Gupta, A K

2008-04-01

We have identified deficiencies in medical students' drug administration skills, and we attempted to address them with interactive online teaching modules and simulated critical incident scenarios. Short-term improvements have been evident with this intensive effort, but medium-term retention of skills has not been measured. A drug administration lecture, an online module and a simulated emergency scenario were offered to final year clinical students. None of the teaching was compulsory but participation was recorded, along with students' simulator performances and marks in an objective structured practical examination 9 months later. A poor simulator score predicted a poor performance in the later examination. Participation in the simulated scenario only significantly improved examination scores when supplemented by online teaching (p = 0.002). Intensive drug administration teaching using an online module and high fidelity simulation improves drug administration skills in the medium term. Students found simulation much more engaging than online teaching.

Motor skill interventions to improve fundamental movement skills of preschoolers with developmental delay.

PubMed

Kirk, Megan A; Rhodes, Ryan E

2011-07-01

Preschoolers with developmental delay (DD) are at risk for poor fundamental movement skills (FMS), but a paucity of early FMS interventions exist. The purpose of this review was to critically appraise the existing interventions to establish direction for future trials targeting preschoolers with DD. A total of 11 studies met the inclusion criteria. Major findings were summarized based on common subtopics of overall intervention effect, locomotor skill outcomes, object-control outcomes, and gender differences. Trials ranged from 8 to 24 weeks and offered 540-1700 min of instruction. The majority of trials (n = 9) significantly improved FMS of preschoolers with DD, with a large intervention effect (η(2) = 0.57-0.85). This review supports the utility of interventions to improve FMS of preschoolers with DD. Future researchers are encouraged to include more robust designs, a theoretical framework, and involvement of parents and teachers in the delivery of the intervention.

Effect of a 9-wk. after-school multiskills club on fundamental movement skill proficiency in 8- to 9-yr.-old children: an exploratory trial.

PubMed

Foweather, Lawrence; McWhannell, Nicola; Henaghan, Jayne; Lees, Adrian; Stratton, Gareth; Batterham, Alan M

2008-06-01

This exploratory study examined the effects of a 9-wk. after-school multiskills club on fundamental movement skill proficiency in 8- to 9-yr.-old children. Two schools were randomly assigned to either a control (n = 15 children) or multiskill club (n = 19 children) condition. The multiskill club received 18 coaching sessions designed to improve fundamental movement skills. The control group followed normal routines. 7 skills were assessed using process-oriented measures with video analysis. Participation in the multiskill club yielded significant improvements in proficiency at posttest only in static balance, while potentially practically important improvements were observed in performance of the catch, throw, and kick skills. The after-school multiskill club offered a viable opportunity for movement skill acquisition, but any such programme would need to run for a longer duration to assess whether this type of activity could benefit all skills.

Multidisciplinary teamwork and communication training.

PubMed

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

2011-04-01

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

High-resolution method for evolving complex interface networks

NASA Astrophysics Data System (ADS)

Pan, Shucheng; Hu, Xiangyu Y.; Adams, Nikolaus A.

2018-04-01

In this paper we describe a high-resolution transport formulation of the regional level-set approach for an improved prediction of the evolution of complex interface networks. The novelty of this method is twofold: (i) construction of local level sets and reconstruction of a global level set, (ii) local transport of the interface network by employing high-order spatial discretization schemes for improved representation of complex topologies. Various numerical test cases of multi-region flow problems, including triple-point advection, single vortex flow, mean curvature flow, normal driven flow, dry foam dynamics and shock-bubble interaction show that the method is accurate and suitable for a wide range of complex interface-network evolutions. Its overall computational cost is comparable to the Semi-Lagrangian regional level-set method while the prediction accuracy is significantly improved. The approach thus offers a viable alternative to previous interface-network level-set method.

Logical Differential Prediction Bayes Net, improving breast cancer diagnosis for older women.

PubMed

Nassif, Houssam; Wu, Yirong; Page, David; Burnside, Elizabeth

2012-01-01

Overdiagnosis is a phenomenon in which screening identities cancer which may not go on to cause symptoms or death. Women over 65 who develop breast cancer bear the heaviest burden of overdiagnosis. This work introduces novel machine learning algorithms to improve diagnostic accuracy of breast cancer in aging populations. At the same time, we aim at minimizing unnecessary invasive procedures (thus decreasing false positives) and concomitantly addressing overdiagnosis. We develop a novel algorithm. Logical Differential Prediction Bayes Net (LDP-BN), that calculates the risk of breast disease based on mammography findings. LDP-BN uses Inductive Logic Programming (ILP) to learn relational rules, selects older-specific differentially predictive rules, and incorporates them into a Bayes Net, significantly improving its performance. In addition, LDP-BN offers valuable insight into the classification process, revealing novel older-specific rules that link mass presence to invasive, and calcification presence and lack of detectable mass to DCIS.

Comparative efficacy of CPAP, MADs, exercise-training, and dietary weight loss for sleep apnea: a network meta-analysis.

PubMed

Iftikhar, Imran H; Bittencourt, Lia; Youngstedt, Shawn D; Ayas, Najib; Cistulli, Peter; Schwab, Richard; Durkin, Martin W; Magalang, Ulysses J

2017-02-01

To synthesize evidence from available studies on the relative efficacies of continuous positive airway pressure (CPAP), mandibular advancement device (MAD), supervised aerobic exercise training, and dietary weight loss in patients with obstructive sleep apnea (OSA). Network meta-analysis of 80 randomized controlled trials (RCTs) short-listed from PubMed, SCOPUS, Web of science, and Cochrane register (inception - September 8, 2015). Individuals with OSA. CPAP, MADs, exercise training, and dietary weight loss. CPAP decreased apnea-hypopnea index (AHI) the most [by 25.27 events/hour (22.03-28.52)] followed by exercise training, MADs, and dietary weight loss. While the difference between exercise training and CPAP was non-significant [-8.04 (-17.00 to 0.92), a significant difference was found between CPAP and MADs on AHI and oxygen desaturation index (ODI) [-10.06 (-14.21 to -5.91) and -7.82 (-13.04 to -2.59), respectively]. Exercise training significantly improved Epworth sleepiness scores (ESS) [by 3.08 (0.68-5.48)], albeit with a non-significant difference compared to MADs and CPAP. CPAP is the most efficacious in complete resolution of sleep apnea and in improving the indices of saturation during sleep. While MADs offer a reasonable alternative to CPAP, exercise training which significantly improved daytime sleepiness (ESS) could be used as adjunctive to the former two. Copyright © 2016 Elsevier B.V. All rights reserved.

The effectiveness of a monetary incentive offer on survey response rates and response completeness in a longitudinal study.

PubMed

Yu, Shengchao; Alper, Howard E; Nguyen, Angela-Maithy; Brackbill, Robert M; Turner, Lennon; Walker, Deborah J; Maslow, Carey B; Zweig, Kimberly C

2017-04-26

Achieving adequate response rates is an ongoing challenge for longitudinal studies. The World Trade Center Health Registry is a longitudinal health study that periodically surveys a cohort of ~71,000 people exposed to the 9/11 terrorist attacks in New York City. Since Wave 1, the Registry has conducted three follow-up surveys (Waves 2-4) every 3-4 years and utilized various strategies to increase survey participation. A promised monetary incentive was offered for the first time to survey non-respondents in the recent Wave 4 survey, conducted 13-14 years after 9/11. We evaluated the effectiveness of a monetary incentive in improving the response rate five months after survey launch, and assessed whether or not response completeness was compromised due to incentive use. The study compared the likelihood of returning a survey for those who received an incentive offer to those who did not, using logistic regression models. Among those who returned surveys, we also examined whether those receiving an incentive notification had higher rate of response completeness than those who did not, using negative binomial regression models and logistic regression models. We found that a $10 monetary incentive offer was effective in increasing Wave 4 response rates. Specifically, the $10 incentive offer was useful in encouraging initially reluctant participants to respond to the survey. The likelihood of returning a survey increased by 30% for those who received an incentive offer (AOR = 1.3, 95% CI: 1.1, 1.4), and the incentive increased the number of returned surveys by 18%. Moreover, our results did not reveal any significant differences on response completeness between those who received an incentive offer and those who did not. In the face of the growing challenge of maintaining a high response rate for the World Trade Center Health Registry follow-up surveys, this study showed the value of offering a monetary incentive as an additional refusal conversion strategy. Our findings also suggest that an incentive offer could be particularly useful near the end of data collection period when an immediate boost in response rate is needed.

The Impact of Specialized Telephonic Guides on Employee Engagement in Corporate Well-Being Programs

PubMed Central

Barleen, Nathan A.; Marzec, Mary L.; Moloney, Daniel P.; Dobro, Jeff

2018-01-01

Abstract Employer-sponsored well-being programs have been growing in popularity as a means to control rising health care costs and increase workplace productivity. Engagement by employees is necessary for these programs to achieve their desired effects. Extrinsic motivators in the form of incentives and surcharges are commonly introduced by employer program sponsors to promote meaningful engagement. Although these may be successful in achieving a degree of engagement, individuals benefit by being intrinsically motivated as they modify behaviors and improve short- and long-term well-being. Telephonic guides equipped with motivational interviewing and other behavioral strategies to improve engagement may bridge the gap between extrinsic and intrinsic motivation. The objectives of this study are to determine characteristics associated with employee utilization of these guides when offered and to compare subsequent program engagement rates between utilizers to a propensity score matched group of employees who were not offered the service. The data were retrieved from a well-being program provider's database. The study examined 166,258 employees across 35 employers. It found utilizers were older, proportionally more female, in the manufacturing industry, incented to use the guide service, offered a larger incentive for program participation, had healthier self-reported behaviors, and had a higher perception of their employer's focus on well-being. The study found that guide utilizers were significantly more likely to engage in telephonic coaching, digital coaching, and activity tracking up to 6 months. The study's findings suggest telephonic guides using a range of behavioral techniques are an effective strategy to drive well-being program engagement. PMID:28586257

NASA Puffin Electric Tailsitter VTOL Concept

NASA Technical Reports Server (NTRS)

Moore, Mark D.

2010-01-01

Electric propulsion offers dramatic new vehicle mission capabilities, not possible with turbine or reciprocating engines; including high reliability and efficiency, low engine weight and maintenance, low cooling drag and volume required, very low noise and vibration, and zero emissions. The only penalizing characteristic of electric propulsion is the current energy storage technology level, which is set to triple over the next 5-10 years through huge new investments in this field. Most importantly, electric propulsion offers incredible new degrees of freedom in aircraft system integration to achieve unprecedented levels of aerodynamic, propulsive, control, and structural synergistic coupling. A unique characteristic of electric propulsion is that the technology is nearly scale-free, permitting small motors to be parallelized for fail-safe redundancy, or distributed across the airframe for tightly coupled interdisciplinary functionality without significant impacts in motor-controller efficiency or specific weight. Maximizing the potential benefit of electric propulsion is dependent on applying this technology to synergistic mission concepts. The vehicle missions with the most benefit include those which constrain environmental impact (or limit noise, exhaust, or emission signatures) are short range, or where large differences exist in the propulsion system sizing between takeoff and cruise conditions. Electric propulsion offers the following unique capabilities that other propulsion systems can t provide for short range Vertical Takeoff and Landing (VTOL) aircraft; elimination of engine noise and emissions, drastic reduction in engine cooling and radiated heat, drastic reduction in vehicle vibration levels, drastic improvement in reliability and operating costs, variable speed output at full power, for improved cruise efficiency at low tip-speed, elimination of high/hot sizing penalty, and reduction of engine-out penalties.

Seventeen years of progress for supportive care services: A resurvey of National Cancer Institute-designated comprehensive cancer centers.

PubMed

Hammer, Sheila L; Clark, Karen; Grant, Marcia; Loscalzo, Matthew J

2015-08-01

We replicated a 1994 study that surveyed the state of supportive care services due to changes in the field and the increased need for such services. We provide an updated assessment, comparing the changes that have occurred and describing the current status of supportive care services in comprehensive cancer settings. We used Coluzzi and colleague's 60-question survey from their 1995 Journal of Clinical Oncology article to frame the 98-question survey employed in the current study. Medical and palliative care directors for the 2011 National Cancer Institute (NCI) comprehensive cancer centers were surveyed regarding their supportive care services and their subjective review of the overall effectiveness of the services provided. We achieved a 76% response rate (n = 31). The data revealed increases in the number of cancer beds in the hospitals, the degree of integration of supportive care services, the availability of complementary services, and the number of pain and palliative care services offered. There was also an overall shift toward centers becoming more patient centered, as 65% reported now having a patient and family advisory council. Our findings revealed a growing trend to offer distress screening for both outpatients and inpatients. Medical and palliative care directors' evaluations of the supportive care services they offered also significantly improved. However, the results revealed an ongoing gap in services for end-of-life care and timely referrals for hospice services. Overall, both the quantity and quality of supportive care services in the surveyed NCI-designated cancer centers has improved.

The Impact of Specialized Telephonic Guides on Employee Engagement in Corporate Well-Being Programs.

PubMed

Boerger, Nicholas L; Barleen, Nathan A; Marzec, Mary L; Moloney, Daniel P; Dobro, Jeff

2018-02-01

Employer-sponsored well-being programs have been growing in popularity as a means to control rising health care costs and increase workplace productivity. Engagement by employees is necessary for these programs to achieve their desired effects. Extrinsic motivators in the form of incentives and surcharges are commonly introduced by employer program sponsors to promote meaningful engagement. Although these may be successful in achieving a degree of engagement, individuals benefit by being intrinsically motivated as they modify behaviors and improve short- and long-term well-being. Telephonic guides equipped with motivational interviewing and other behavioral strategies to improve engagement may bridge the gap between extrinsic and intrinsic motivation. The objectives of this study are to determine characteristics associated with employee utilization of these guides when offered and to compare subsequent program engagement rates between utilizers to a propensity score matched group of employees who were not offered the service. The data were retrieved from a well-being program provider's database. The study examined 166,258 employees across 35 employers. It found utilizers were older, proportionally more female, in the manufacturing industry, incented to use the guide service, offered a larger incentive for program participation, had healthier self-reported behaviors, and had a higher perception of their employer's focus on well-being. The study found that guide utilizers were significantly more likely to engage in telephonic coaching, digital coaching, and activity tracking up to 6 months. The study's findings suggest telephonic guides using a range of behavioral techniques are an effective strategy to drive well-being program engagement.

Efforts to Support Consumer Enrollment Decisions Using Total Cost Estimators: Lessons from the Affordable Care Act’s Marketplaces.

PubMed

Giovannelli, Justin; Curran, Emily

2017-02-01

Issue: Policymakers have sought to improve the shopping experience on the Affordable Care Act’s marketplaces by offering decision support tools that help consumers better understand and compare their health plan options. Cost estimators are one such tool. They are designed to provide consumers a personalized estimate of the total cost--premium, minus subsidy, plus cost-sharing--of their coverage options. Cost estimators were available in most states by the start of the fourth open enrollment period. Goal: To understand the experiences of marketplaces that offer a total cost estimator and the interests and concerns of policymakers from states that are not using them. Methods: Structured interviews with marketplace officials, consumer enrollment assisters, technology vendors, and subject matter experts; analysis of the total cost estimators available on the marketplaces as of October 2016. Key findings and conclusions: Informants strongly supported marketplace adoption of a total cost estimator. Marketplaces that offer an estimator faced a range of design choices and varied significantly in their approaches to resolving them. Interviews suggested a clear need for additional consumer testing and data analysis of tool usage and for sustained outreach to enrollment assisters to encourage greater use of the estimators.

Facet joint injections as a means of reducing the need for vertebroplasty in insufficiency fractures of the spine.

PubMed

Wilson, David J; Owen, Sara; Corkill, Rufus A

2011-08-01

Recent publications compared treatment of vertebral fractures reporting improvement in the majority but with no significant difference between the local anaesthetic and vertebroplasty groups. Potential explanations include placebo response or therapeutic response to the "control procedure". We investigated whether preliminary facet joint injection can identify those patients whose pain arises from paravertebral structures rather than the vertebral insufficiency fracture itself. Patients referred for treatment by vertebroplasty were first offered local anaesthetic and steroid facet joint injection (FJI) at the most painful level. Those who failed to respond were offered a vertebroplasty. Ninety one patients referred, 16 went straight to vertebroplasty. Sixty one of 75 were initially offered FJI. Twenty one were successful; two relapsed, had further FJIs with good results; three declined treatment; 5 had temporary benefit; 1 died from unrelated causes. Of 29 who failed to respond to FJIs, 24 underwent vertebroplasty and 23 had a successful outcome. A third of patients technically suitable for vertebroplasty responded beneficially to FJI. In this group the pain mediator maybe one of instability and overload on the facet joints produced by adjacent wedge fracture. This protocol allows more selective and more successful vertebroplasty.

Characteristics of the group of radiologists that benefits the most using Breast Screen Reader Assessment Strategy (BREAST)

NASA Astrophysics Data System (ADS)

Ganesan, A.; Alakhras, M.; Brennan, P. C.; Lee, W.; Tapia, K.; Mello-Thoms, C.

2018-03-01

Purpose: To determine the impact of Breast Screen Reader Assessment Strategy (BREAST) over time in improving radiologists' breast cancer detection performance, and to identify the group of radiologists that benefit the most by using BREAST as a training tool. Materials and Methods: Thirty-six radiologists who completed three case-sets offered by BREAST were included in this study. The case-sets were arranged in radiologists' chronological order of completion and five performance measures (sensitivity, specificity, location sensitivity, receiver operating characteristics area under the curve (ROC AUC) and jackknife alternative free-response receiver operating characteristic (JAFROC) figure-of-merit (FOM)), available from BREAST, were compared between case-sets to determine the level of improvement achieved. The radiologists were then grouped based on their characteristics and the above performance measures between the case-sets were compared. Paired t-tests or Wilcoxon signed-rank tests with statistical significance set at p < 0.05 were used to compare the performance measures. Results: Significant improvement was demonstrated in radiologists' case-set performance in terms of location sensitivity and JAFROC FOM over the years, and radiologists' location sensitivity and JAFROC FOM showed significant improvement irrespective of their characteristics. In terms of ROC AUC, significant improvement was shown for radiologists who were reading screen mammograms for more than 7 years and spent more than 9 hours per week reading mammograms. Conclusion: Engaging with case-sets appears to enhance radiologists' performance suggesting the important value of initiatives such as BREAST. However, such performance enhancement was not shown for everyone, highlighting the need to tailor the BREAST platform to benefit all radiologists.

The effects of low-volume resistance training with and without advanced techniques in trained subjects.

PubMed

Gieβsing, Jùrgen; Fisher, James; Steele, James; Rothe, Frank; Raubold, Kristin; Eichmann, Björn

2016-03-01

This study examined low-volume resistance training (RT) in trained participants with and without advanced training methods. Trained participants (RT experience 4±3 years) were randomised to groups performing single-set RT: ssRM (N.=21) performing repetitions to self-determined repetition maximum (RM), ssMMF (N.=30) performing repetitions to momentary muscular failure (MMF), and ssRP (N.=28) performing repetitions to self-determined RM using a rest pause (RP) method. Each performed supervised RT twice/week for 10 weeks. Outcomes included maximal isometric strength and body composition using bioelectrical impedance analysis. The ssRM group did not significantly improve in any outcome. The ssMMF and ssRP groups both significantly improved strength (p < 0.05). Magnitude of changes using effect size (ES) was examined between groups. Strength ES's were considered large for ssMMF (0.91 to 1.57) and ranging small to large for ssRP (0.42 to 1.06). Body composition data revealed significant improvements (P<0.05) in muscle and fat mass and percentages for whole body, upper limbs and trunk for ssMMF, but only upper limbs for ssRP. Body composition ES's ranged moderate to large for ssMMF (0.56 to 1.27) and ranged small to moderate for ssRP (0.28 to 0.52). ssMMF also significantly improved (P<0.05) total abdominal fat and increased intracellular water with moderate ES's (-0.62 and 0.56, respectively). Training to self-determined RM is not efficacious for trained participants. Training to MMF produces greatest improvements in strength and body composition, however, RP style training does offer some benefit.

Do recommendations for institutional food service result in better food service? A study of compliance in Danish hospitals and nursing homes from 1995 to 2002-2003.

PubMed

Mikkelsen, B E; Beck, A M; Lassen, A

2007-01-01

Since 1995, significant efforts by authorities and researchers have been directed towards addressing the nutritional problems in Danish hospitals and nursing homes. The purpose of this study was to investigate whether the increased focus on nutritional problems in patients and nursing home residents has resulted in measurable progress. A questionnaire-based study was carried out among foodservice managers in Danish hospitals (n=96) and nursing homes (n=898) in 1995 and 2002/3 (n=90) and (n=682), respectively. The study used compliance with selected issues in the official Danish recommendations for institutional food service as an indicator for progress. The issues included: using nutrient calculated recipes/menus, offering menu choice options, using feedback routines on acceptability of menus, maintaining nutritional steering committees, employing food and nutrition contact persons, employing official recommendations and offering choice between three different menu energy levels. Hospitals had a higher compliance compared to nursing homes. In 1995, this was the case for all questions asked and differences were statistically significant. Also in 2002/3, hospitals had a higher compliance, except in the case of established feedback routines. Differences were statistically significant. The results indicate that nutritional care is higher on the agenda in hospital, than in nursing homes. However, very little progress can be seen in compliance when results are analysed over the 8-year period. The only progress for nursing homes was that more homes had implemented feedback routines on acceptability of food service in 2002/3 than in 1995. The difference was statistically significant. For hospitals, however, no progress was found between 1995 and 2002/3. The attempts to improve the nutritional status of hospital patients and nursing home residents seem to have failed. Still, the initiatives taken to improve the situation seem relevant. Especially the nursing homes might benefit from advantage of these experiences.

Creating a standardized process to offer the standard of care: continuous process improvement methodology is associated with increased rates of sperm cryopreservation among adolescent and young adult males with cancer.

PubMed

Shnorhavorian, Margarett; Kroon, Leah; Jeffries, Howard; Johnson, Rebecca

2012-11-01

There is limited literature on strategies to overcome the barriers to sperm banking among adolescent and young adult (AYA) males with cancer. By standardizing our process for offering sperm banking to AYA males before cancer treatment, we aimed to improve rates of sperm banking at our institution. Continuous process improvement is a technique that has recently been applied to improve health care delivery. We used continuous process improvement methodologies to create a standard process for fertility preservation for AYA males with cancer at our institution. We compared rates of sperm banking before and after standardization. In the 12-month period after implementation of a standardized process, 90% of patients were offered sperm banking. We demonstrated an 8-fold increase in the proportion of AYA males' sperm banking, and a 5-fold increase in the rate of sperm banking at our institution. Implementation of a standardized process for sperm banking for AYA males with cancer was associated with increased rates of sperm banking at our institution. This study supports the role of standardized health care in decreasing barriers to sperm banking.

A virtual patient educational activity to improve interprofessional competencies: A randomized trial.

PubMed

Shoemaker, Michael J; de Voest, Margaret; Booth, Andrew; Meny, Lisa; Victor, Justin

2015-01-01

The purpose of the present study was to determine whether an interprofessional virtual patient educational activity improved interprofessional competencies in pharmacy, physician assistant, and physical therapy graduate students. Seventy-two fifth semester pharmacy (n = 33), fourth semester physician assistant (n = 27) and fourth semester physical therapy (n = 12) graduate students participated in the study. Participants were stratified by discipline and randomized into control (n = 38) and experimental groups (n = 34). At baseline and at study completion, all participants completed an original, investigator-developed survey that measured improvement in selected Interprofessional Education Collaborative (IPEC) competencies and the Readiness for Interprofessional Learning Scale (RIPLS). The experimental group had statistically significantly greater odds of improving on a variety of IPEC competencies and RIPLS items. The use of a single, interprofessional educational activity resulted in having a greater awareness of other professions' scopes of practice, what other professions have to offer a given patient and how different professions can collaborate in patient care.

Effective multi-level, multi-sector, school-based obesity prevention programming improves weight, blood pressure, and academic performance, especially among low-income, minority children.

PubMed

Hollar, Danielle; Lombardo, Michelle; Lopez-Mitnik, Gabriella; Hollar, Theodore L; Almon, Marie; Agatston, Arthur S; Messiah, Sarah E

2010-05-01

Successfully addressing childhood onset obesity requires multilevel (individual, community, and governmental), multi-agency collaboration. The Healthier Options for Public Schoolchildren (HOPS)/OrganWise Guys (OWG) quasi-experimental controlled pilot study (four intervention schools, one control school, total N=3,769; 50.2% Hispanic) was an elementary school-based obesity prevention intervention designed to keep children at a normal, healthy weight, and improve health status and academic achievement. The HOPS/OWG included the following replicable, holistic components: (1) modified dietary offerings, (2) nutrition/lifestyle educational curricula; (3) physical activity component; and (4) wellness projects. Demographic, anthropometric (body mass index [BMI]), blood pressure, and academic data were collected during the two-year study period (2004-6). Statistically significant improvements in BMI, blood pressure, and academic scores, among low-income Hispanic and White children in particular, were seen in the intervention versus controls. Holistic school-based obesity prevention interventions can improve health outcomes and academic performance, in particular among high-risk populations.

A simple intervention improves the recording of vital signs in children presenting to the emergency department.

PubMed

Bird, C; Shea, A; Michie, C A; George, G

2009-10-01

Vital signs are often not documented in paediatric patients at triage. This study was conducted to find out whether the use of a small, laminated aide memoire and a short teaching session might improve this situation. A preliminary audit of the measurement of vital signs in 106 children aged less than 6 years was carried out in a district general hospital emergency department (ED). A small card illustrating normal values for these was then distributed-this could be attached to staff identity cards. At the same time doctors and nursing staff were given a teaching session on the importance of these measures. The audit was then repeated in a further 106 children. There was significant improvement in recording of all vital signs with the exception of blood pressure and temperature. A low-cost card together with a short period of training offers a useful strategy to improve the rate of documentation of vital signs in children presenting to the ED.

Breech presentation: an audit project as means of pursuing clinical excellence.

PubMed

Siassakos, D; Anderson, H; Panter, K

2005-10-01

Clinical audit is an effective quality improvement process to evaluate important clinical issues. Breech presentation is such an issue due to its contribution to the rising caesarean section (CS) rate. We set out to assess the management of breech presentation using, as standards, the delivery suite protocol and national guidelines. Our first audit revealed a low success rate of external cephalic version (ECV) and deficient documentation of written consent for ECV, other aspects of care being satisfactory. The results were presented to a multidisciplinary meeting and disseminated to relevant stakeholders. A re-audit was then performed. It confirmed significant improvement in the documentation of consent for ECV. It also revealed a good detection rate of breech, optimal offer rate of ECV and good neonatal outcome. However, uptake of ECV as well as the success rate could both be improved so as to reduce the CS rate for breech presentation. We discuss options for improving the uptake and success rate for ECV.

75 FR 27797 - Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-18

... Offering and Documenting Influenza Vaccination for Nursing Home Residents, Funding Opportunity Announcement... State Law Requiring Mandatory Influenza Vaccination of Hospital Employees, FOA IP10-003; and Improving... Offering and Documenting Influenza Vaccination for Nursing Home Residents, FOA IP10-001; Development...

Foods offered in Quebec school cafeterias: do they promote healthy eating habits? Results of a provincial survey.

PubMed

Morin, Pascale; Demers, Karine; Gray-Donald, Katherine; Mongeau, Lyne

2012-06-05

A school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The aim of this paper is to describe the food offered for lunch in the cafeteria service lines in Quebec schools on regular school days. A cross-sectional survey was conducted between November 2008 and June 2009 with a representative sample of 207 French-speaking schools in the province of Quebec. The response rate was 71%. The cafeteria food available from the service line was observed directly and systematically by research assistants trained in observational procedures. Bivariate and descriptive analyses were performed. While most schools offered a vegetable side dish, only 71% of primary schools, 71% of public secondary schools, and 54% of private secondary schools did not offer cold-cut dishes, stuffed pastry, or a fried food on their daily menus. The sandwiches available were rarely made with whole-grain bread. Public secondary schools had more cookies, biscuits, muffins, and chewing gum than private primary and secondary schools. Milk was available in 85% of the primary schools. Most of the schools had eliminated sodas but were still offering fruit cocktails instead of 100% fruit juice. The school eating environment changed significantly from 2002 to 2009, presumably as a result of the government action plan and the Framework Policy. Improvements must be made with respect to reducing added sugar in beverages and desserts and promoting baked rather than fried snacks. Vigilance is required since many new products are making their way into the market.

Medication monitoring attitudes and perceived determinants to offering medication adherence advice to older hypertensive adults: a factorial survey of community pharmacy interns.

PubMed

Dillon, Paul; Smith, Susan M; Gallagher, Paul; Cousins, Gráinne

2018-06-13

Community pharmacy is an ideal setting to monitor medication adherence, however, barriers to pharmacist-led interventions exist. Preparing future pharmacists for enhanced roles may overcome such barriers. Our objective was to identify medication monitoring attitudes and contextual factors that influence adherence monitoring by pharmacy interns to inform educational activities on medication adherence. An online factorial survey of all pharmacy interns (N = 123) in the Republic of Ireland, completing advanced community pharmacy experiential learning in May 2016 was undertaken to evaluate attitudes to medication monitoring and to identify respondent characteristics and contextual factors which influence adherence monitoring of older hypertensive adults during repeat dispensing. The medication monitoring attitude measure (MMAM) was used to evaluate interns' attitudes, and factorial vignette analysis was performed to identify factors influencing behavioural intention to offer adherence advice. There were 121 completed online surveys. Half of interns reported they felt uncomfortable and confrontational discussing adherence with patients. In factorial vignette analysis, higher medication monitoring attitudes resulted in higher likelihood to offer adherence advice; experiential-learning characteristics such as pharmacy ownership-type (nonchain store) and contextual factors including patients being treated for longer and time-pressures had a significant negative influence on pharmacy interns' likelihood to offer adherence advice. Medication monitoring attitudes and contextual factors influenced responses to offer adherence advice in hypothetical scenarios. Ensuring pharmacy students are educated on patterns of adherence and appropriate skills to address nonadherence, and engage in structured programmes to facilitate patient interactions during experiential learning, may improve medication monitoring attitudes and adherence monitoring. © 2018 Royal Pharmaceutical Society.

"We Thought It Might Encourage Participation." Using Lottery Incentives to Improve LibQUAL+[TM] Response Rates among Students

ERIC Educational Resources Information Center

Buck, Stefanie; Nutefall, Jennifer E.; Bridges, Laurie M.

2012-01-01

Libraries deploying the LibQUAL+[TM] survey can offer a lottery incentive and many do so in the hope of increasing response rates. Other libraries may be prohibited from offering one because of Institutional Review Board restrictions, as is the case at Oregon State University. We wanted to discover why libraries offer lottery incentives, what…

Day-Ahead Crude Oil Price Forecasting Using a Novel Morphological Component Analysis Based Model

PubMed Central

Zhu, Qing; Zou, Yingchao; Lai, Kin Keung

2014-01-01

As a typical nonlinear and dynamic system, the crude oil price movement is difficult to predict and its accurate forecasting remains the subject of intense research activity. Recent empirical evidence suggests that the multiscale data characteristics in the price movement are another important stylized fact. The incorporation of mixture of data characteristics in the time scale domain during the modelling process can lead to significant performance improvement. This paper proposes a novel morphological component analysis based hybrid methodology for modeling the multiscale heterogeneous characteristics of the price movement in the crude oil markets. Empirical studies in two representative benchmark crude oil markets reveal the existence of multiscale heterogeneous microdata structure. The significant performance improvement of the proposed algorithm incorporating the heterogeneous data characteristics, against benchmark random walk, ARMA, and SVR models, is also attributed to the innovative methodology proposed to incorporate this important stylized fact during the modelling process. Meanwhile, work in this paper offers additional insights into the heterogeneous market microstructure with economic viable interpretations. PMID:25061614

Tocolysis in term breech external cephalic version.

PubMed

Nor Azlin, M I; Haliza, H; Mahdy, Z A; Anson, I; Fahya, M N; Jamil, M A

2005-01-01

To study the effect of ritodrine tocolysis on the success of external cephalic version (ECV) and to assess the role of ECV in breech presentation at our centre. A prospective randomized double-blind-controlled trial comparing ritodrine and placebo in ECV of singleton term breech pregnancy at a tertiary hospital. Among the 60 patients who were recruited, there was a success rate of 36.7%. Ritodrine tocolysis significantly improved the success rate of ECV (50% vs. 23%; P=0.032). There was a marked effect of ritodrine tocolysis on the ECV success in nulliparae (36.4% vs. 13.0%) and multiparae (87.5% vs. 57.1%). External cephalic version has shown to reduce the rate of cesarean section for breech presentation by 33.5% in our unit. External cephalic version significantly reduced the rate of cesarean section in breech presentation, and ritodrine tocolysis improved the success of ECV and should be offered to both nulliparous and parous women in the case of term breech presentation.

Sexual risk behaviors for HIV infection in Spanish male sex workers: differences according to educational level, country of origin and sexual orientation.

PubMed

Ballester, R; Salmerón, P; Gil, M D; Gómez, S

2012-05-01

The stigma associated with male sex workers (MSW) hinders the prevention, treatment, and care of HIV infection in this population. These factors make social and public health resources less accessible to MSW. To improve the effectiveness of prevention strategies, this study examines social factors such as educational level, country of origin, and sexual orientation. Semi-structured interviews of 100 MSW in Castellón and Valencia (Spanish cities) indicate that knowledge of HIV transmission is good; nevertheless, MSW significantly overestimate or underestimate some sexual practices. Levels of condom use are high; notably, they are higher during anal sex. Levels of condom use are lower with intimate partners than with clients. MSW do not present differences in terms of the socio-demographic variables analyzed and sexual orientation. Furthermore, regression analyses are not significant. These results offer more accurate profiles of MSW than were previously available, which will ultimately help improve the effectiveness of prevention programs.

On use of the multistage dose-response model for assessing laboratory animal carcinogenicity

PubMed Central

Nitcheva, Daniella; Piegorsch, Walter W.; West, R. Webster

2007-01-01

We explore how well a statistical multistage model describes dose-response patterns in laboratory animal carcinogenicity experiments from a large database of quantal response data. The data are collected from the U.S. EPA’s publicly available IRIS data warehouse and examined statistically to determine how often higher-order values in the multistage predictor yield significant improvements in explanatory power over lower-order values. Our results suggest that the addition of a second-order parameter to the model only improves the fit about 20% of the time, while adding even higher-order terms apparently does not contribute to the fit at all, at least with the study designs we captured in the IRIS database. Also included is an examination of statistical tests for assessing significance of higher-order terms in a multistage dose-response model. It is noted that bootstrap testing methodology appears to offer greater stability for performing the hypothesis tests than a more-common, but possibly unstable, “Wald” test. PMID:17490794

Nuclear Thermal Rocket - Arc Jet Integrated System Model

NASA Technical Reports Server (NTRS)

Taylor, Brian D.; Emrich, William

2016-01-01

In the post-shuttle era, space exploration is moving into a new regime. Commercial space flight is in development and is planned to take on much of the low earth orbit space flight missions. With the development of a heavy lift launch vehicle, the Space Launch, System, NASA has become focused on deep space exploration. Exploration into deep space has traditionally been done with robotic probes. More ambitious missions such as manned missions to asteroids and Mars will require significant technology development. Propulsion system performance is tied to the achievability of these missions and the requirements of other developing technologies that will be required. Nuclear thermal propulsion offers a significant improvement over chemical propulsion while still achieving high levels of thrust. Opportunities exist; however, to build upon what would be considered a standard nuclear thermal engine to attain improved performance, thus further enabling deep space missions. This paper discuss the modeling of a nuclear thermal system integrated with an arc jet to further augment performance. The performance predictions and systems impacts are discussed.

Lightweight Damage Tolerant Radiators for In-Space Nuclear Electric Power and Propulsion

NASA Technical Reports Server (NTRS)

Craven, Paul; SanSoucie, Michael P.; Tomboulian, Briana; Rogers, Jan; Hyers, Robert

2014-01-01

Nuclear electric propulsion (NEP) is a promising option for high-speed in-space travel due to the high energy density of nuclear power sources and efficient electric thrusters. Advanced power conversion technologies for converting thermal energy from the reactor to electrical energy at high operating temperatures would benefit from lightweight, high temperature radiator materials. Radiator performance dictates power output for nuclear electric propulsion systems. Pitch-based carbon fiber materials have the potential to offer significant improvements in operating temperature and mass. An effort at the NASA Marshall Space Flight Center to show that woven high thermal conductivity carbon fiber mats can be used to replace standard metal and composite radiator fins to dissipate waste heat from NEP systems is ongoing. The goals of this effort are to demonstrate a proof of concept, to show that a significant improvement of specific power (power/mass) can be achieved, and to develop a thermal model with predictive capabilities. A description of this effort is presented.

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

PubMed

Kauric-Klein, Zorica

2012-01-01

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

Assessment of free-living nitrogen fixing microorganisms for commercial nitrogen fixation. [economic analysis of ammonia production

NASA Technical Reports Server (NTRS)

Stokes, B. O.; Wallace, C. J.

1978-01-01

Ammonia production by Klebsiella pneumoniae is not economical with present strains and improving nitrogen fixation to its theoretical limits in this organism is not sufficient to achieve economic viability. Because the value of both the hydrogen produced by this organism and the methane value of the carbon source required greatly exceed the value of the ammonia formed, ammonia (fixed nitrogen) should be considered the by-product. The production of hydrogen by KLEBSIELLA or other anaerobic nitrogen fixers should receive additional study, because the activity of nitrogenase offers a significant improvement in hydrogen production. The production of fixed nitrogen in the form of cell mass by Azotobacter is also uneconomical and the methane value of the carbon substrate exceeds the value of the nitrogen fixed. Parametric studies indicate that as efficiencies approach the theoretical limits the economics may become competitive. The use of nif-derepressed microorganisms, particularly blue-green algae, may have significant potential for in situ fertilization in the environment.

Day-ahead crude oil price forecasting using a novel morphological component analysis based model.

PubMed

Zhu, Qing; He, Kaijian; Zou, Yingchao; Lai, Kin Keung

2014-01-01

As a typical nonlinear and dynamic system, the crude oil price movement is difficult to predict and its accurate forecasting remains the subject of intense research activity. Recent empirical evidence suggests that the multiscale data characteristics in the price movement are another important stylized fact. The incorporation of mixture of data characteristics in the time scale domain during the modelling process can lead to significant performance improvement. This paper proposes a novel morphological component analysis based hybrid methodology for modeling the multiscale heterogeneous characteristics of the price movement in the crude oil markets. Empirical studies in two representative benchmark crude oil markets reveal the existence of multiscale heterogeneous microdata structure. The significant performance improvement of the proposed algorithm incorporating the heterogeneous data characteristics, against benchmark random walk, ARMA, and SVR models, is also attributed to the innovative methodology proposed to incorporate this important stylized fact during the modelling process. Meanwhile, work in this paper offers additional insights into the heterogeneous market microstructure with economic viable interpretations.

Neuromodulation in Pediatrics: Case Series.

PubMed

Kim, Eugene; Gamble, Sean; Schwartz, Adina; Cucchiaro, Giovanni

2018-05-22

Neuromodulation, particularly intrathecal drug delivery systems and spinal cord stimulators, can be a valuable tool when treating chronic pain in adults. However, there is a paucity of literature regarding its use in pediatrics. and Methods: We present a series of 14 children and adolescents with intractable pain who received a spinal cord stimulator or a pump for the intrathecal delivery of medications between 2010 and 2016 at our institution. During the study period, we placed 10 intrathecal pumps and 4 spinal cord stimulators with an average age of 17 years old. Pain scores significantly improved after the implant (P<0.007) and function improved in 79% of patients. Opioid use was also significantly reduced. Three patients eventually had their device removed due to psychiatric comorbidities. Four patients had complications that were treated without further sequelae. Neuromodulation can offer important options in treating some pediatric chronic pain patients. In-depth knowledge of primary disease and strict patient selection in the context of the patient's social situation is vital to successful treatment.

High-testosterone men reject low ultimatum game offers.

PubMed

Burnham, Terence C

2007-09-22

The ultimatum game is a simple negotiation with the interesting property that people frequently reject offers of 'free' money. These rejections contradict the standard view of economic rationality. This divergence between economic theory and human behaviour is important and has no broadly accepted cause. This study examines the relationship between ultimatum game rejections and testosterone. In a variety of species, testosterone is associated with male seeking dominance. If low ultimatum game offers are interpreted as challenges, then high-testosterone men may be more likely to reject such offers. In this experiment, men who reject low offers ($5 out of $40) have significantly higher testosterone levels than those who accept. In addition, high testosterone levels are associated with higher ultimatum game offers, but this second finding is not statistically significant.

End-of-life matters in chronic renal failure.

PubMed

Berman, Nathaniel

2014-12-01

The population considered eligible for dialysis has expanded dramatically over the past 4 decades, so that a significant proportion of patients receiving renal replacement therapy are elderly, frail and infirm. These patients have an extremely limited life expectancy and suffer from significant symptom burden, similar to patients with other end-stage organ failure or cancer. As dialysis has been offered more broadly, it is now initiated earlier than in decades past, further adding to cost and patient burden. The trend toward more expansive and intensive care has not been corroborated by robust data. In response, an increasing number of studies has focused on establishing reasonable limits to renal replacement therapy. Multiple authors have explored the role of conservative kidney management for high-risk dialysis patients as an alternative to dialysis, which may offer similar survival and improved quality of life in certain populations. For those who chose dialysis, deferring initiation until the patient becomes symptomatic may be a reasonable. Evidence-based symptom management guidelines for dialysis patients remain largely absent, with few proven approaches. Hospice and palliative care resources remain underutilized. For a subset of dialysis patients, palliative care and conservative kidney management are appropriate and underutilized. http://links.lww.com/COSPC/A8

Differences between African-American and Caucasian students on enrollment influences and barriers in kinesiology-based allied health education programs.

PubMed

Barfield, J P; Cobler, D C; Lam, Eddie T C; Zhang, James; Chitiyo, George

2012-06-01

Kinesiology departments have recently started to offer allied health education programs to attract additional students to teacher education units (9). Although allied health professions offer increased work opportunities, insufficient enrollment and training of minority students in these academic fields contribute to underrepresentation in the workforce (3). To improve workforce diversity, kinesiology departments must understand how enrollment influences and barriers differ by race among prospective students. Therefore, the purpose of this study was to identify differences in allied health education enrollment influences and enrollment barriers between minority and Caucasian students. Participants (n = 601) consisted of students enrolled in kinesiology-based allied health education programs. Multivariate ANOVA was used to compare group differences in enrollment decision making. "Personal influence," "career opportunity," and "physical self-efficacy" were all significantly stronger enrollment influences among African-American students than among Caucasian students, and "social influence," "experiential opportunity," "academic preparation," and "physical self-efficacy" were all perceived as significantly greater barriers compared with Caucasian students. Findings support the need to recruit African-American students through sport and physical education settings and to market program-based experiential opportunities.

Biometric identification: a holistic perspective

NASA Astrophysics Data System (ADS)

Nadel, Lawrence D.

2007-04-01

Significant advances continue to be made in biometric technology. However, the global war on terrorism and our increasingly electronic society have created the societal need for large-scale, interoperable biometric capabilities that challenge the capabilities of current off-the-shelf technology. At the same time, there are concerns that large-scale implementation of biometrics will infringe our civil liberties and offer increased opportunities for identity theft. This paper looks beyond the basic science and engineering of biometric sensors and fundamental matching algorithms and offers approaches for achieving greater performance and acceptability of applications enabled with currently available biometric technologies. The discussion focuses on three primary biometric system aspects: performance and scalability, interoperability, and cost benefit. Significant improvements in system performance and scalability can be achieved through careful consideration of the following elements: biometric data quality, human factors, operational environment, workflow, multibiometric fusion, and integrated performance modeling. Application interoperability hinges upon some of the factors noted above as well as adherence to interface, data, and performance standards. However, there are times when the price of conforming to such standards can be decreased local system performance. The development of biometric performance-based cost benefit models can help determine realistic requirements and acceptable designs.

Updates in the management of sinonasal mucosal melanoma.

PubMed

Crippen, Meghan M; Kılıç, Suat; Eloy, Jean A

2018-02-01

Sinonasal mucosal melanoma (SNMM) is an aggressive cancer with a poor prognosis. Although there is significant study surrounding the treatment of sinonasal malignancies and cutaneous melanomas, the rarity of this tumor has largely precluded robust outcomes analyses. The authors of this review seek to provide an overview of the recent literature related to the treatment of SNMM with added context from our institutional experience with this disease. In the surgical management of sinonasal malignancies and SNMM specifically, resection via endoscopic endonasal technique appears to offer comparable oncologic outcomes versus an open approach. The role of adjuvant therapy continues to be debated, but there is strong evidence for improved rates of local control with radiotherapy after complete resection. In the last few years, significant developments have been made in the study of systemic therapies for cutaneous melanoma. The identification of genetic mutations common to mucosal melanoma has allowed for early trials of targeted therapies, but study is ongoing. Although the study of SNMM is largely limited to small retrospective case series, treatment continues to evolve. Until effective systemic therapies can be identified, endoscopic resection with adjuvant radiotherapy may offer the best disease-free survival with acceptably low morbidity.

The effects of eszopiclone on sleep spindles and memory consolidation in schizophrenia: a randomized placebo-controlled trial.

PubMed

Wamsley, Erin J; Shinn, Ann K; Tucker, Matthew A; Ono, Kim E; McKinley, Sophia K; Ely, Alice V; Goff, Donald C; Stickgold, Robert; Manoach, Dara S

2013-09-01

In schizophrenia there is a dramatic reduction of sleep spindles that predicts deficient sleep-dependent memory consolidation. Eszopiclone (Lunesta), a non-benzodiazepine hypnotic, acts on γ-aminobutyric acid (GABA) neurons in the thalamic reticular nucleus where spindles are generated. We investigated whether eszopiclone could increase spindles and thereby improve memory consolidation in schizophrenia. In a double-blind design, patients were randomly assigned to receive either placebo or 3 mg of eszopiclone. Patients completed Baseline and Treatment visits, each consisting of two consecutive nights of polysomnography. On the second night of each visit, patients were trained on the motor sequence task (MST) at bedtime and tested the following morning. Academic research center. Twenty-one chronic, medicated schizophrenia outpatients. We compared the effects of two nights of eszopiclone vs. placebo on stage 2 sleep spindles and overnight changes in MST performance. Eszopiclone increased the number and density of spindles over baseline levels significantly more than placebo, but did not significantly enhance overnight MST improvement. In the combined eszopiclone and placebo groups, spindle number and density predicted overnight MST improvement. Eszopiclone significantly increased sleep spindles, which correlated with overnight motor sequence task improvement. These findings provide partial support for the hypothesis that the spindle deficit in schizophrenia impairs sleep-dependent memory consolidation and may be ameliorated by eszopiclone. Larger samples may be needed to detect a significant effect on memory. Given the general role of sleep spindles in cognition, they offer a promising novel potential target for treating cognitive deficits in schizophrenia.

Attention Deficit-Hyperactivity Disorder Group Visits Improve Parental Emotional Health and Perceptions of Child Behavior.

PubMed

Bauer, Nerissa S; Sullivan, Paula D; Szczepaniak, Dorota; Stelzner, Sarah M; Pottenger, Amy; Ofner, Susan; Downs, Stephen M; Carroll, Aaron E

2018-06-04

Group visits (GVs) are a promising intervention, but more work is needed to establish intervention effects. The objective was to evaluate the effectiveness of GVs and compare them with individual visits (INDs) for chronic care of attention deficit-hyperactivity disorder (ADHD). Caregivers and children (6-12 yrs) with ADHD participated in a comparative effectiveness trial from April 2014 to June 2015. Families were offered ADHD follow-up every 3 months as GVs versus INDs. Outcomes included ADHD core symptoms, child functioning at home, quality of life, perceived social support, and ADHD-related parenting challenges. Change scores from baseline to the study end were examined for parent and child outcomes within and between treatment conditions. Ninety-one children from 84 families participated. Eighteen families withdrew or were lost to follow-up. GV families attended more visits over 12 months, had significant improvement in mean parental emotional health (p = 0.04), and had a greater decrease in challenges related to misbehavior compared with IND families (p < 0.03). GV families experienced significant improvements in child functioning at home (p = 0.01) and reported more time for themselves, other siblings, and routine household activities (p < 0.01). Children receiving care as INDs reported a significant drop in mean emotional health. There were no significant changes in other outcomes. Families participating in GVs experienced multiple improvements related to family functioning and attended more follow-up visits. Findings confirm the effectiveness of the GV intervention in delivering critical parenting support as part of ADHD management.

Effect of cowpea hay, groundnut hay, cotton seed meal and maize meal supplementation to maize stover on intake, digestibility, microbial protein supply and acetate kinetics in weaner lambs.

PubMed

Chakeredza, S; ter Meulen, U; Ndlovu, L R

2002-02-01

Ten weaner lambs were used in a double 5 x 5 Latin square design to evaluate the effect of supplementing maize stover (MS) with cowpea hay (CW), groundnut hay (GN), cotton seed meal (CSM) or maize meal (MM) on the intake, digestion kinetics and acetate clearance rate. CW and GN were offered at 30% w/w to MS, while CSM and MM were given at 15 g/kg0.75 per day. Supplementation reduced (p < 0.01) MS intake but enhanced (p < 0.01) total dry matter intake. There were no significant differences (p > 0.05) in digestibility. However, the estimated ME intake was significantly (p < 0.05) improved by supplementation. The estimated microbial protein supply was almost significantly (p < 0.06) improved by 22.68%, 5.35%, 17.58% and 47.90% on the CW-, GN-, CSM- and MM-supplemented diets, compared to the control (7.85 g/day). Microbial protein synthesis efficiency was not significantly affected (p > 0.05) by diet, and nor were the acetate clearance rates (p > 0.05), which averaged 0.0475 +/- 0.0078/min. The improvement in ME intake may have been due to a faster flow rate of digesta and a better balance of nutrients in the end-products of digestion. These results demonstrate that small amounts of forage supplements can improve nutrient intake when animals consume low-quality forages and provide a basis for comparing such supplements with bought-in protein and energy supplements.

Massive open online nutrition and cooking course for improved eating behaviors and meal composition.

PubMed

Adam, Maya; Young-Wolff, Kelly C; Konar, Ellen; Winkleby, Marilyn

2015-12-03

Behavioral shifts in eating, favoring the increased consumption of highly processed foods over healthier, home-cooked alternatives, have led to widespread health problems. This study reports on the effectiveness of a massive open online course (MOOC), offering integrated nutrition and cooking instruction, for improving eating behaviors and meal composition among course participants. The course, consisting of 47 short (4-6 min.) videos, was offered through Coursera, an open, online learning platform, available to individuals worldwide who have access to the Internet. Beginning in January 2014, participants viewed course videos, completed quizzes and participated in optional cooking assignments, over a 5-week period. Participants were invited to complete optional pre- and post-course surveys assessing their eating behaviors, typical meal composition and perceived barriers to home cooking. McNemar-Bowker tests of symmetry and within subject t-tests were conducted to evaluate pre-post survey changes in the primary variables measured. 7,422 participants from more than 80 countries completed both pre- and post-course surveys, while 19,374 participants completed the pre-survey only. Class participants were primarily women in the child-rearing ages (20-49 years of age). There were significant positive changes in eating behaviors and meal composition over time, including an increase in the percentage of participants who reported cooking dinner at home using mostly fresh ingredients 5-7 times in the previous week (63.4 % to 71.4 %), and who felt that yesterday's dinner was very/extremely healthy (39.3 % to 56.4 %) and enjoyable (55.2 % to 66.7 %) (all p values < .0001). Integrated nutrition and cooking courses, delivered via open online learning platforms, offer a free and flexible venue for reaching adults worldwide and have the potential to catalyze powerful behavioral shifts that align well with efforts to improve eating behaviors and meal composition.

Qualitative differences in offline improvement of procedural memory by daytime napping and overnight sleep: An fMRI study.

PubMed

Sugawara, Sho K; Koike, Takahiko; Kawamichi, Hiroaki; Makita, Kai; Hamano, Yuki H; Takahashi, Haruka K; Nakagawa, Eri; Sadato, Norihiro

2017-09-20

Daytime napping offers various benefits for healthy adults, including enhancement of motor skill learning. It remains controversial whether napping can provide the same enhancement as overnight sleep, and if so, whether the same neural underpinning is recruited. To investigate this issue, we conducted functional MRI during motor skill learning, before and after a short day-nap, in 13 participants, and compared them with a larger group (n=47) who were tested following regular overnight sleep. Training in a sequential finger-tapping task required participants to press a keyboard in the MRI scanner with their non-dominant left hand as quickly and accurately as possible. The nap group slept for 60min in the scanner after the training run, and the previously trained skill was subsequently re-tested. The whole-night sleep group went home after the training, and was tested the next day. Offline improvement of speed was observed in both groups, whereas accuracy was significantly improved only in the whole-night sleep group. Correspondingly, the offline increment in task-related activation was significant in the putamen of the whole-night group. This finding reveals a qualitative difference in the offline improvement effect between daytime napping and overnight sleep. Copyright © 2017. Published by Elsevier B.V.

Assimilation of Terrestrial Water Storage from GRACE in a Snow-Dominated Basin

NASA Technical Reports Server (NTRS)

Forman, Barton A.; Reichle, R. H.; Rodell, M.

2011-01-01

Terrestrial water storage (TWS) information derived from Gravity Recovery and Climate Experiment (GRACE) measurements is assimilated into a land surface model over the Mackenzie River basin located in northwest Canada. Assimilation is conducted using an ensemble Kalman smoother (EnKS). Model estimates with and without assimilation are compared against independent observational data sets of snow water equivalent (SWE) and runoff. For SWE, modest improvements in mean difference (MD) and root mean squared difference (RMSD) are achieved as a result of the assimilation. No significant differences in temporal correlations of SWE resulted. Runoff statistics of MD remain relatively unchanged while RMSD statistics, in general, are improved in most of the sub-basins. Temporal correlations are degraded within the most upstream sub-basin, but are, in general, improved at the downstream locations, which are more representative of an integrated basin response. GRACE assimilation using an EnKS offers improvements in hydrologic state/flux estimation, though comparisons with observed runoff would be enhanced by the use of river routing and lake storage routines within the prognostic land surface model. Further, GRACE hydrology products would benefit from the inclusion of better constrained models of post-glacial rebound, which significantly affects GRACE estimates of interannual hydrologic variability in the Mackenzie River basin.

48 CFR 570.110 - Cost or pricing data and information other than cost or pricing data.

Code of Federal Regulations, 2013 CFR

2013-10-01

... competition. For price analysis of offered rental rates, the contracting officer may use a market survey, an... comparison, or other relevant market research data. For price analysis of offered tenant improvement costs...

48 CFR 570.110 - Cost or pricing data and information other than cost or pricing data.

Code of Federal Regulations, 2014 CFR

2014-10-01

... competition. For price analysis of offered rental rates, the contracting officer may use a market survey, an... comparison, or other relevant market research data. For price analysis of offered tenant improvement costs...

48 CFR 570.110 - Cost or pricing data and information other than cost or pricing data.

Code of Federal Regulations, 2011 CFR

2011-10-01

... competition. For price analysis of offered rental rates, the contracting officer may use a market survey, an... comparison, or other relevant market research data. For price analysis of offered tenant improvement costs...

Improving Global Analysis and Short-Range Forecast Using Rainfall and Moisture Observations Derived from TRMM and SSM/I Passive Microwave Instruments

NASA Technical Reports Server (NTRS)

Hou, Arthur Y.; Zhang, Sara Q.; daSilva, Arlindo M.; Olson, William S.; Kummerow, Christian D.; Simpson, Joanne

2000-01-01

The Global Precipitation Mission, a satellite project under consideration as a follow-on to the Tropical Rainfall Measuring Mission (TRMM) by the National Aeronautics and Space Agency (NASA) in the United States, the National Space Development Agency (NASDA) in Japan, and other international partners, comprises an improved TRMM-like satellite and a constellation of 8 satellites carrying passive microwave radiometers to provide global rainfall measurements at 3-hour intervals. The success of this concept relies on the merits of rainfall estimates derived from passive microwave radiometers. This article offers a proof-of-concept demonstration of the benefits of using, rainfall and total precipitable water (TPW) information derived from such instruments in global data assimilation with observations from the TRMM Microwave Imager (TMI) and 2 Special Sensor Microwave/Imager (SSM/I) instruments. Global analyses that optimally combine observations from diverse sources with physical models of atmospheric and land processes can provide a comprehensive description of the climate systems. Currently, such data analyses contain significant errors in primary hydrological fields such as precipitation and evaporation, especially in the tropics. We show that assimilating the 6-h averaged TMI and SSM/I surface rainrate and TPW retrievals improves not only the hydrological cycle but also key climate parameters such as clouds, radiation, and the upper tropospheric moisture in the analysis produced by the Goddard Earth Observing System (GEOS) Data Assimilation System, as verified against radiation measurements by the Clouds and the Earth's Radiant Energy System (CERES) instrument and brightness temperature observations by the TIROS Operational Vertical Sounder (TOVS) instruments. Typically, rainfall assimilation improves clouds and radiation in areas of active convection, as well as the latent heating and large-scale motions in the tropics, while TPW assimilation leads to reduced moisture biases and improved radiative fluxes in clear-sky regions. Ensemble forecasts initialized with analyses that incorporate TMI and SSM/I rainfall and TPW data also yield better short-range predictions of geopotential heights, winds, and precipitation in the tropics. This study offers a compelling illustration of the potential of using rainfall and TPW information derived from passive microwave instruments to significantly improve the quality of 4-dimensional global datasets for climate analysis and weather forecasting applications.

Optimal preparation for ESRD.

PubMed

Narva, Andrew S

2009-12-01

Clinical guidelines for the care of patients with progressive chronic kidney disease (CKD) have been developed by a broad range of organizations within the kidney community. Despite consensus among these guidelines and significant effort on the part of federal agencies, voluntary health organizations, and professional groups, existing data suggest that much work remains to achieve acceptable levels of recommended care. Several small studies have described CKD interventions to improve outcomes, but there are few examples of large-scale attempts to improve CKD care in a systematic way. Southern California Kaiser Permanente has developed a population management approach to CKD in a health maintenance organization setting that has improved outcomes. The Indian Health Service, an agency of the Public Health Service that provides direct care to American Indians and Alaska Natives, has enhanced its diabetes care delivery system to address the renal complications of diabetes. This effort may explain a significant decrease in the incidence rate of ESRD among American Indians with diabetes. Because much of the burden of CKD falls on ethnic and racial groups with decreased access to care, enhancing CKD care in the primary setting may offer the best opportunity to improve outcomes. The National Kidney Disease Education Program in collaboration with community heath centers has developed a model to improve outcomes through application of the chronic care model to CKD management in primary settings that serve high-risk populations.

Piloting improved cookstoves in India.

PubMed

Lewis, Jessica J; Bhojvaid, Vasundhara; Brooks, Nina; Das, Ipsita; Jeuland, Marc A; Patange, Omkar; Pattanayak, Subhrendu K

2015-01-01

Despite the potential of improved cookstoves to reduce the adverse environmental and health impacts of solid fuel use, their adoption and use remains low. Social marketing-with its focus on the marketing mix of promotion, product, price, and place-offers a useful way to understand household behaviors and design campaigns to change biomass fuel use. We report on a series of pilots across 3 Indian states that use different combinations of the marketing mix. We find sales varying from 0% to 60%. Behavior change promotion that combined door-to-door personalized demonstrations with information pamphlets was effective. When given a choice amongst products, households strongly preferred an electric stove over improved biomass-burning options. Among different stove attributes, reduced cooking time was considered most valuable by those adopting a new stove. Households clearly identified price as a significant barrier to adoption, while provision of discounts (e.g., rebates given if households used the stove) or payments in installments were related to higher purchase. Place-based factors such as remoteness and nongovernmental organization operations significantly affected the ability to supply and convince households to buy and use improved cookstoves. Collectively, these pilots point to the importance of continued and extensive testing of messages, pricing models, and different stove types before scale-up. Thus, we caution that a one-size-fits-all approach will not boost improved cookstove adoption.

Efficient amplitude-modulated pulses for triple- to single-quantum coherence conversion in MQMAS NMR.

PubMed

Colaux, Henri; Dawson, Daniel M; Ashbrook, Sharon E

2014-08-07

The conversion between multiple- and single-quantum coherences is integral to many nuclear magnetic resonance (NMR) experiments of quadrupolar nuclei. This conversion is relatively inefficient when effected by a single pulse, and many composite pulse schemes have been developed to improve this efficiency. To provide the maximum improvement, such schemes typically require time-consuming experimental optimization. Here, we demonstrate an approach for generating amplitude-modulated pulses to enhance the efficiency of the triple- to single-quantum conversion. The optimization is performed using the SIMPSON and MATLAB packages and results in efficient pulses that can be used without experimental reoptimisation. Most significant signal enhancements are obtained when good estimates of the inherent radio-frequency nutation rate and the magnitude of the quadrupolar coupling are used as input to the optimization, but the pulses appear robust to reasonable variations in either parameter, producing significant enhancements compared to a single-pulse conversion, and also comparable or improved efficiency over other commonly used approaches. In all cases, the ease of implementation of our method is advantageous, particularly for cases with low sensitivity, where the improvement is most needed (e.g., low gyromagnetic ratio or high quadrupolar coupling). Our approach offers the potential to routinely improve the sensitivity of high-resolution NMR spectra of nuclei and systems that would, perhaps, otherwise be deemed "too challenging".

Efficient Amplitude-Modulated Pulses for Triple- to Single-Quantum Coherence Conversion in MQMAS NMR

PubMed Central

2014-01-01

The conversion between multiple- and single-quantum coherences is integral to many nuclear magnetic resonance (NMR) experiments of quadrupolar nuclei. This conversion is relatively inefficient when effected by a single pulse, and many composite pulse schemes have been developed to improve this efficiency. To provide the maximum improvement, such schemes typically require time-consuming experimental optimization. Here, we demonstrate an approach for generating amplitude-modulated pulses to enhance the efficiency of the triple- to single-quantum conversion. The optimization is performed using the SIMPSON and MATLAB packages and results in efficient pulses that can be used without experimental reoptimisation. Most significant signal enhancements are obtained when good estimates of the inherent radio-frequency nutation rate and the magnitude of the quadrupolar coupling are used as input to the optimization, but the pulses appear robust to reasonable variations in either parameter, producing significant enhancements compared to a single-pulse conversion, and also comparable or improved efficiency over other commonly used approaches. In all cases, the ease of implementation of our method is advantageous, particularly for cases with low sensitivity, where the improvement is most needed (e.g., low gyromagnetic ratio or high quadrupolar coupling). Our approach offers the potential to routinely improve the sensitivity of high-resolution NMR spectra of nuclei and systems that would, perhaps, otherwise be deemed “too challenging”. PMID:25047226

How to build up the actionable knowledge base: the role of ‘best fit’ framework synthesis for studies of improvement in healthcare

PubMed Central

Booth, Andrew; Carroll, Christopher

2015-01-01

Increasing recognition of the role and value of theory in improvement work in healthcare offers the prospect of capitalising upon, and consolidating, actionable lessons from synthesis of improvement projects and initiatives. We propose that informed use of theory can (i) provide a mechanism by which to collect and organise data from a body of improvement work, (ii) offer a framework for analysis and identification of lessons learnt and (iii) facilitate an evaluation of the feasibility, effectiveness and acceptability of improvement programmes. Improvement practitioners can benefit from using an underpinning external structure as a lens by which to examine the specific achievements of their own projects alongside comparable initiatives led by others. We demonstrate the utility of a method known as ‘best fit framework synthesis’ (BFFS) in offering a ubiquitous and versatile means by which to collect, analyse and evaluate improvement work in healthcare. First reported in 2011, BFFS represents a pragmatic, flexible approach to integrating theory with findings from practice. A deductive phase, where a review team seeks to accommodate a substantial part of the data, is followed by an inductive phase, in which the team explores data not accommodated by the framework. We explore the potential for BFFS within improvement work by drawing upon the evidence synthesis methodology literature and practical examples of improvement work reported in BMJ Quality and Safety (2011–2015). We suggest four variants of BFFS that may have particular value in synthesising a body of improvement work. We conclude that BFFS, alongside other approaches that seek to optimise the contribution of theory to improvement work, represents one important enabling mechanism by which to establish the rigour and scientific credentials of the emerging discipline of ‘improvement science’. PMID:26306609

Virtual reality-based simulation training for ventriculostomy: an evidence-based approach.

PubMed

Schirmer, Clemens M; Elder, J Bradley; Roitberg, Ben; Lobel, Darlene A

2013-10-01

Virtual reality (VR) simulation-based technologies play an important role in neurosurgical resident training. The Congress of Neurological Surgeons (CNS) Simulation Committee developed a simulation-based curriculum incorporating VR simulators to train residents in the management of common neurosurgical disorders. To enhance neurosurgical resident training for ventriculostomy placement using simulation-based training. A course-based neurosurgical simulation curriculum was introduced at the Neurosurgical Simulation Symposium at the 2011 and 2012 CNS annual meetings. A trauma module was developed to teach ventriculostomy placement as one of the neurosurgical procedures commonly performed in the management of traumatic brain injury. The course offered both didactic and simulator-based instruction, incorporating written and practical pretests and posttests and questionnaires to assess improvement in skill level and to validate the simulators as teaching tools. Fourteen trainees participated in the didactic component of the trauma module. Written scores improved significantly from pretest (75%) to posttest (87.5%; P < .05). Seven participants completed the ventriculostomy simulation. Significant improvements were observed in anatomy (P < .04), burr hole placement (P < .03), final location of the catheter (P = .05), and procedure completion time (P < .004). Senior residents planned a significantly better trajectory (P < .01); junior participants improved most in terms of identifying the relevant anatomy (P < .03) and the time required to complete the procedure (P < .04). VR ventriculostomy placement as part of the CNS simulation trauma module complements standard training techniques for residents in the management of neurosurgical trauma. Improvement in didactic and hands-on knowledge by course participants demonstrates the usefulness of the VR simulator as a training tool.

Randomised double blind placebo controlled trial of the effect of botulinum toxin on walking in cerebral palsy

PubMed Central

Ubhi, T; Bhakta, B; Ives, H; Allgar, V; Roussounis, S

2000-01-01

BACKGROUND—Cerebral palsy is the commonest cause of severe physical disability in childhood. For many years treatment has centred on the use of physiotherapy and orthotics to overcome the problems of leg spasticity, which interferes with walking and can lead to limb deformity. Intramuscular botulinum toxin (BT-A) offers a targeted form of therapy to reduce spasticity in specific muscle groups.
AIMS—To determine whether intramuscular BT-A can improve walking in children with cerebral palsy.
DESIGN—Randomised, double blind, placebo controlled trial.
METHODS—Forty patients with spastic diplegia or hemiplegia were enrolled. Twenty two received botulinum toxin and 18 received placebo. The primary outcome measure was video gait analysis and secondary outcome measures were gross motor function measure (GMFM), physiological cost index (PCI), and passive ankle dorsiflexion.
RESULTS—Video gait analysis showed clinically and statistically significant improvement in initial foot contact following BT-A at six weeks and 12 weeks compared to placebo. Forty eight per cent of BT-A treated children showed clinical improvement in VGA compared to 17% of placebo treated children. The GMFM (walking dimension) showed a statistically significant improvement in favour of the botulinum toxin treated group. Changes in PCI and passive ankle dorsiflexion were not statistically significant.
CONCLUSION—The study gives further support to the use of intramuscular botulinum toxin type A as an adjunct to conventional physiotherapy and orthoses to reduce spasticity and improve functional mobility in children with spastic diplegic or hemiplegic cerebral palsy.

 PMID:11087280

Narrative methods in quality improvement research

PubMed Central

Greenhalgh, T; Russell, J; Swinglehurst, D

2005-01-01



 This paper reviews and critiques the different approaches to the use of narrative in quality improvement research. The defining characteristics of narrative are chronology (unfolding over time); emplotment (the literary juxtaposing of actions and events in an implicitly causal sequence); trouble (that is, harm or the risk of harm); and embeddedness (the personal story nests within a particular social, historical and organisational context). Stories are about purposeful action unfolding in the face of trouble and, as such, have much to offer quality improvement researchers. But the quality improvement report (a story about efforts to implement change), which is common, must be distinguished carefully from narrative based quality improvement research (focused systematic enquiry that uses narrative methods to generate new knowledge), which is currently none. We distinguish four approaches to the use of narrative in quality improvement research—narrative interview; naturalistic story gathering; organisational case study; and collective sense-making—and offer a rationale, describe how data can be collected and analysed, and discuss the strengths and limitations of each using examples from the quality improvement literature. Narrative research raises epistemological questions about the nature of narrative truth (characterised by sense-making and emotional impact rather than scientific objectivity), which has implications for how rigour should be defined (and how it might be achieved) in this type of research. We offer some provisional guidance for distinguishing high quality narrative research in a quality improvement setting from other forms of narrative account such as report, anecdote, and journalism. PMID:16326792

A multilevel health promotion intervention in minority-owned workplaces

PubMed Central

Bowen, Deborah J.; Briant, Katherine J.; Harris, Jeffrey; Hannon, Peggy; Buchwald, Dedra

2015-01-01

Introduction Changing health behaviors and health-related environments is important in reducing chronic disease. Minority workplaces are potential venues to provide regular, effective health promotion opportunities to underserved individuals. The purpose of this study was to test the feasibility of changing workplace policy, programs, and practices in minority-owned workplaces. Methods Four minority Native American-owned businesses were recruited to participate in this study. The intervention was a set of recommended standards and guidelines gleaned from the US Preventive Task Force and The Community Guide relevant to workplaces. Each workplace selected between 4 and 6 target areas to improve over the year-long intervention period. The evaluation tool was a semi-structured survey conducted at baseline and at one-year follow-up, with workplace staff responsible for benefits and services to employees. Feasibility was evaluated by assessing the likelihood that the workplaces implemented health promotion activities in the year-long intervention. Results Several practices and policies changed significantly during the intervention in the four workplaces, including coverage for nicotine replacement therapy (NRT), elimination of out of pocket costs for screening and tobacco cessation, accountability systems for providers, posted stair use, cessation line availability that included NRT, offering weight loss programs, offering physical activity programs, and conducting targeted communication programs about health promotion. Other practices and polices changed in the expected direction, but were not significant. Conclusion Changing workplace programs, practices, and policies is feasible in minority workplaces, with support and tools provided by outside organizations. These findings could drive a full-scale test of the intervention in minority businesses in order to improve the health of disadvantaged workers. PMID:26693135

Improving the efficiency of telephone-based disease management programs: getting the population and the timing right using hospital admission data.

PubMed

Watts, Jennifer J; Jolley, Damien; Wainer, Jo; Atchison, Rory

2012-12-01

Telephone-based disease management (DM) programs can improve health outcomes and provide a positive return on investment to funders. However, there is scant evidence about how to use hospital admission episode data to identify patients who are most likely to participate in a DM program. The objective of this study was to use hospital admission episode data held by health insurers to determine those factors that predict members with chronic disease joining and remaining in a DM program for at least 6 months. A multivariable logistic regression model was constructed to determine predictors of participating in a DM program for an insured population who had been admitted to hospital for congestive heart failure, coronary artery disease, or chronic obstructive pulmonary disease. The outcome variable was binary: did the member both opt into the DM program and remain in the program for at least 6 months? The study population included 9874 private health fund members. Time from a related hospital admission was a significant predictor, with those offered the program within 3 to 6 months being 71% more likely (95% confidence interval [CI]: 33%, 113%) to participate. The length of time from offer to commencement also was a significant predictor, with those commencing within 3 to 4 months being 75% (95% CI: 44%, 112%) as likely to remain in the program. It is possible to predict which individuals are most likely to participate in a telephone-based DM program using hospital admission episode data. Once individuals are identified, timely commencement of a DM program is an important predictor of success.

Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review.

PubMed

Horigan, G; Davies, M; Findlay-White, F; Chaney, D; Coates, V

2017-01-01

To identify the reasons why those offered a place on diabetes education programmes declined the opportunity. It is well established that diabetes education is critical to optimum diabetes care; it improves metabolic control, prevents complications, improves quality of life and empowers people to make informed choices to manage their condition. Despite the significant clinical and personal rewards offered by diabetes education, programmes are underused, with a significant proportion of patients choosing not to attend. A systematic search of the following databases was conducted for the period from 2005-2015: Medline; EMBASE; Scopus; CINAHL; and PsycINFO. Studies that met the inclusion criteria focusing on patient-reported reasons for non-attendance at structured diabetes education were selected. A total of 12 studies spanning quantitative and qualitative methodologies were included. The selected studies were published in Europe, USA, Pakistan, Canada and India, with a total sample size of 2260 people. Two broad categories of non-attender were identified: 1) those who could not attend for logistical, medical or financial reasons (e.g. timing, costs or existing comorbidities) and 2) those who would not attend because they perceived no benefit from doing so, felt they had sufficient knowledge already or had emotional and cultural reasons (e.g. no perceived problem, denial or negative feelings towards education). Diabetes education was declined for many reasons, and the range of expressed reasons was more diverse and complex than anticipated. New and innovative methods of delivering diabetes education are required which address the needs of people with diabetes whilst maintaining quality and efficiency. © 2016 Diabetes UK.

The Mitochondria-Targeted Antioxidant Mitoquinone Protects against Cold Storage Injury of Renal Tubular Cells and Rat Kidneys

PubMed Central

Mitchell, Tanecia; Rotaru, Dumitru; Saba, Hamida; Smith, Robin A. J.; Murphy, Michael P.

2011-01-01

The majority of kidneys used for transplantation are obtained from deceased donors. These kidneys must undergo cold preservation/storage before transplantation to preserve tissue quality and allow time for recipient selection and transport. However, cold storage (CS) can result in tissue injury, kidney discardment, or long-term renal dysfunction after transplantation. We have previously determined mitochondrial superoxide and other downstream oxidants to be important signaling molecules that contribute to CS plus rewarming (RW) injury of rat renal proximal tubular cells. Thus, this study's purpose was to determine whether adding mitoquinone (MitoQ), a mitochondria-targeted antioxidant, to University of Wisconsin (UW) preservation solution could offer protection against CS injury. CS was initiated by placing renal cells or isolated rat kidneys in UW solution alone (4 h at 4°C) or UW solution containing MitoQ or its control compound, decyltriphenylphosphonium bromide (DecylTPP) (1 μM in vitro; 100 μM ex vivo). Oxidant production, mitochondrial function, cell viability, and alterations in renal morphology were assessed after CS exposure. CS induced a 2- to 3-fold increase in mitochondrial superoxide generation and tyrosine nitration, partial inactivation of mitochondrial complexes, and a significant increase in cell death and/or renal damage. MitoQ treatment decreased oxidant production ∼2-fold, completely prevented mitochondrial dysfunction, and significantly improved cell viability and/or renal morphology, whereas DecylTPP treatment did not offer any protection. These findings implicate that MitoQ could potentially be of therapeutic use for reducing organ preservation damage and kidney discardment and/or possibly improving renal function after transplantation. PMID:21159749

The mitochondria-targeted antioxidant mitoquinone protects against cold storage injury of renal tubular cells and rat kidneys.

PubMed

Mitchell, Tanecia; Rotaru, Dumitru; Saba, Hamida; Smith, Robin A J; Murphy, Michael P; MacMillan-Crow, Lee Ann

2011-03-01

The majority of kidneys used for transplantation are obtained from deceased donors. These kidneys must undergo cold preservation/storage before transplantation to preserve tissue quality and allow time for recipient selection and transport. However, cold storage (CS) can result in tissue injury, kidney discardment, or long-term renal dysfunction after transplantation. We have previously determined mitochondrial superoxide and other downstream oxidants to be important signaling molecules that contribute to CS plus rewarming (RW) injury of rat renal proximal tubular cells. Thus, this study's purpose was to determine whether adding mitoquinone (MitoQ), a mitochondria-targeted antioxidant, to University of Wisconsin (UW) preservation solution could offer protection against CS injury. CS was initiated by placing renal cells or isolated rat kidneys in UW solution alone (4 h at 4°C) or UW solution containing MitoQ or its control compound, decyltriphenylphosphonium bromide (DecylTPP) (1 μM in vitro; 100 μM ex vivo). Oxidant production, mitochondrial function, cell viability, and alterations in renal morphology were assessed after CS exposure. CS induced a 2- to 3-fold increase in mitochondrial superoxide generation and tyrosine nitration, partial inactivation of mitochondrial complexes, and a significant increase in cell death and/or renal damage. MitoQ treatment decreased oxidant production ~2-fold, completely prevented mitochondrial dysfunction, and significantly improved cell viability and/or renal morphology, whereas DecylTPP treatment did not offer any protection. These findings implicate that MitoQ could potentially be of therapeutic use for reducing organ preservation damage and kidney discardment and/or possibly improving renal function after transplantation.

Real-time monitoring through the use of technology to enhance performances throughout HIV cascades.

PubMed

Avery, Matthew; Mills, Stephen J; Stephan, Eric

2017-09-01

Controlling the HIV epidemic requires strong linkages across a 'cascade' of prevention, testing, and treatment services. Information and communications technology (ICT) offers the potential to monitor and improve the performance of this HIV cascade in real time. We assessed recent (<18 months) peer-reviewed publications regarding uses of ICT to improve performance through expanded and targeted reach, improved clinical service delivery, and reduced loss to follow-up. Research on ICT has tended to focus on a specific 'silo' of the HIV cascade rather than on tracking individuals or program performance across the cascade. Numerous innovations have been described, including use of social media to expand reach and improve programmatic targeting; technology in healthcare settings to strengthen coordination, guide clinical decision-making and improve clinical interactions; and telephone-based follow-up to improve treatment retention and adherence. With exceptions, publications have tended to be descriptive rather than evaluative, and the evidence-base for the effectiveness of ICT-driven interventions remains mixed. There is widespread recognition of the potential for ICT to improve HIV cascade performance, but with significant challenges. Successful implementation of real-time cascade monitoring will depend upon stakeholder engagement, compatibility with existing workflows, appropriate resource allocation, and managing expectations.

Employers' Perspective on Childcare Services for Hired Farm Workers.

PubMed

Lee, Barbara C; Salzwedel, Marsha A; Chyou, Po-Huang; Liebman, Amy K

2017-01-01

The goal of this project was to protect children while parents work in agriculture by improving off-farm services for children of migrant and seasonal farm workers. Large agricultural enterprises have policies forbidding children in the worksite. At the same time, their employees, who are trying to generate income, seek as many work hours as possible but often lack viable options for childcare services. As employers strive to increase their labor pool, and workers seek off-farm childcare, there is mutual interest in improving access to childcare services in agricultural regions dependent on large numbers of full-time and seasonal workers. This report describes the employers' perspectives on childcare needs of hired farm workers' families and their barriers and motivators to facilitating off-farm childcare services. Using descriptive survey research methodology, data were collected from a convenience sample of 102 agribusiness owners and Human Resource directors attending an agricultural conference regarding labor laws or personnel management. Results revealed significant differences for those companies employing more than 25 workers compared to their counterparts. Primary motivators for offering childcare as an employment benefit were improved employee morale, enhanced company reputation, and a more stable workforce. A major barrier was that half of large-scale enterprises lack guidance on how to provide childcare options for their workers. Survey results are being used to facilitate collaboration among employers, farm workers, and childcare providers to offer a safe, nurturing environment for children while their parents work in agriculture.

A physical fitness programme during paid working hours - impact on health and work ability among women working in the social service sector: a three year follow up study.

PubMed

Vingård, Eva; Blomkvist, Vanja; Rosenblad, Andreas; Lindberg, Per; Voss, Margaretha; Alfredsson, Lars; Josephson, Malin

2009-01-01

In order to study the influence of a physical fitness programme on work ability among women employed in the social sector an intervention was offered to 205 women working in the social care sector in a municipality in Sweden. The reference group comprised 165 women from the same sector working in another municipality. All participants were employed and answered questionnaires at baseline and after 36 months. For women younger than 45 years, work ability and general health improved significantly while for women, 45 years or older, future work expectations improved. For women with less musculoskeletal pain, improvements were observed regarding future work expectations, as well as work ability and general health while for women with more musculoskeletal pain, improvements were observed for general health and future work expectations. Well-structured physical fitness programmes at the worksite can be useful in contributing to individual's experiences of improvements in their own capacity as well as increased health and wellbeing.

An Informed Approach to Improving Quantitative Literacy and Mitigating Math Anxiety in Undergraduates Through Introductory Science Courses

NASA Astrophysics Data System (ADS)

Follette, K.; McCarthy, D.

2012-08-01

Current trends in the teaching of high school and college science avoid numerical engagement because nearly all students lack basic arithmetic skills and experience anxiety when encountering numbers. Nevertheless, such skills are essential to science and vital to becoming savvy consumers, citizens capable of recognizing pseudoscience, and discerning interpreters of statistics in ever-present polls, studies, and surveys in which our society is awash. Can a general-education collegiate course motivate students to value numeracy and to improve their quantitative skills in what may well be their final opportunity in formal education? We present a tool to assess whether skills in numeracy/quantitative literacy can be fostered and improved in college students through the vehicle of non-major introductory courses in astronomy. Initial classroom applications define the magnitude of this problem and indicate that significant improvements are possible. Based on these initial results we offer this tool online and hope to collaborate with other educators, both formal and informal, to develop effective mechanisms for encouraging all students to value and improve their skills in basic numeracy.

Burnout and productivity among Iranian nurses.

PubMed

Nayeri, Nahid Dehghan; Negarandeh, Reza; Vaismoradi, Mojtaba; Ahmadi, Fazlollah; Faghihzadeh, Soghrat

2009-09-01

The concept of burnout describes a number of destructive aspects in the health-care system, especially in nursing. A descriptive study was carried out in order to investigate the relationship between burnout and productivity among 200 baccalaureate nurses working in educational hospitals in Tehran, Iran. Burnout and productivity questionnaires were employed and the data were analyzed by using descriptive and inferential statistics. The results showed that emotional exhaustion and depersonalization had significant negative correlations with productivity. Also, a significant positive correlation was found between personal accomplishment and productivity. Efforts to alleviate burnout among nurses should lead to an increased quality of patient care and improved quality of work life; if not, health-care systems will pay the price for nurses' burnout through the quality of services that they offer.

NASA Workshop on Distributed Parameter Modeling and Control of Flexible Aerospace Systems

NASA Technical Reports Server (NTRS)

Marks, Virginia B. (Compiler); Keckler, Claude R. (Compiler)

1994-01-01

Although significant advances have been made in modeling and controlling flexible systems, there remains a need for improvements in model accuracy and in control performance. The finite element models of flexible systems are unduly complex and are almost intractable to optimum parameter estimation for refinement using experimental data. Distributed parameter or continuum modeling offers some advantages and some challenges in both modeling and control. Continuum models often result in a significantly reduced number of model parameters, thereby enabling optimum parameter estimation. The dynamic equations of motion of continuum models provide the advantage of allowing the embedding of the control system dynamics, thus forming a complete set of system dynamics. There is also increased insight provided by the continuum model approach.

Molecular excited states from the SCAN functional

NASA Astrophysics Data System (ADS)

Tozer, David J.; Peach, Michael J. G.

2018-06-01

The performance of the strongly constrained and appropriately normed (SCAN) meta-generalised gradient approximation exchange-correlation functional is investigated for the calculation of time-dependent density-functional theory molecular excitation energies of local, charge-transfer and Rydberg character, together with the excited ? potential energy curve in H2. The SCAN results frequently resemble those obtained using a global hybrid functional, with either a standard or increased fraction of exact orbital exchange. For local excitations, SCAN can exhibit significant triplet instability problems, resulting in imaginary triplet excitation energies for a number of cases. The Tamm-Dancoff approximation offers a simple approach to improve the situation, but the excitation energies are still significantly underestimated. Understanding the origin of these (near)-triplet instabilities may provide useful insight into future functional development.

North American cattle marketing and bovine respiratory disease (BRD).

PubMed

Smith, Robert A

2009-12-01

The risk of bovine respiratory disease (BRD) has a significant effect on the value of cattle in the marketplace. Calves sold in larger groups have $6.37/45.45 kg more value than those sold as singles or in small groups. Morbidity is higher in unweaned commingled calves than those marketed in groups more than 45 days following weaning. Calves with an aggressive disposition have significantly less value than docile calves, due largely to depressed performance and less carcass value. The value of cattle in the marketplace can be improved by offering larger, uniform lots of cattle that have been weaned at least 45 days. Cattle that suffer BRD in the feedlot have from $23.23 to $151.18 less value than those remaining healthy.

Dry ice blasting

NASA Astrophysics Data System (ADS)

Lonergan, Jeffrey M.

1992-04-01

As legal and societal pressures against the use of hazardous waste generating materials has increased, so has the motivation to find safe, effective, and permanent replacements. Dry ice blasting is a technology which uses CO2 pellets as a blasting medium. The use of CO2 for cleaning and stripping operations offers potential for significant environmental, safety, and productivity improvements over grit blasting, plastic media blasting, and chemical solvent cleaning. Because CO2 pellets break up and sublime upon impact, there is no expended media to dispose of. Unlike grit or plastic media blasting which produce large quantities of expended media, the only waste produced by CO2 blasting is the material removed. The quantity of hazardous waste produced, and thus the cost of hazardous waste disposal is significantly reduced.

Photometry with FORS

NASA Astrophysics Data System (ADS)

Freudling, W.; Møller, P.; Patat, F.; Moehler, S.; Romaniello, M.; Jehin, E.; O'Brien, K.; Izzo, C.; Pompei, E.

Photometric calibration observations are routinely carried out with all ESO imaging cameras in every clear night. The nightly zeropoints derived from these observations are accurate to about 10%. Recently, we have started the FORS Absolute Photometry Project (FAP) to investigate, if and how percent-level absolute photometric accuracy can be achieved with FORS1, and how such photometric calibration can be offered to observers. We found that there are significant differences between the sky-flats and the true photometric response of the instrument which partially depend on the rotator angle. A second order correction to the sky-flat significantly improves the relative photometry within the field. We demonstrate the feasibility of percent level photometry and describe the calibrations necessary to achieve that level of accuracy.