Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital health care system.

PubMed

Smith, Matthew; Triulzi, Darrell J; Yazer, Mark H; Rollins-Raval, Marian A; Waters, Jonathan H; Raval, Jay S

2014-12-01

Prescriber adherence to institutional blood component ordering guidelines can be low. The goal of this study was to decrease red blood cell (RBC) and plasma orders that did not meet institutional transfusion guidelines by using data within the laboratory information system to trigger alerts in the computerized order entry (CPOE) system at the time of order entry. At 10 hospitals within a regional health care system, discernment rules were created for RBC and plasma orders utilizing transfusion triggers of hemoglobin <8 gm/dl and INR >1.6, respectively, with subsequent alert generation that appears within the CPOE system when a prescriber attempts to order RBCs or plasma on a patient whose antecedent laboratory values do not suggest that a transfusion is indicated. Orders and subsequent alerts were tracked for RBCs and plasma over evaluation periods of 15 and 10 months, respectively, along with the hospital credentials of the ordering health care providers (physician or nurse). Alerts triggered which were heeded remained steady and averaged 11.3% for RBCs and 19.6% for plasma over the evaluation periods. Overall, nurses and physicians canceled statistically identical percentages of alerted RBC (10.9% vs. 11.5%; p = 0.78) and plasma (21.3% vs. 18.7%; p = 0.22) orders. Implementing a simple evidence-based transfusion alert system at the time of order entry decreased non-evidence based transfusion orders by both nurse and physician providers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Data Mining on Numeric Error in Computerized Physician Order Entry System Prescriptions.

PubMed

Wu, Xue; Wu, Changxu

2017-01-01

This study revealed the numeric error patterns related to dosage when doctors prescribed in computerized physician order entry system. Error categories showed that the '6','7', and '9' key produced a higher incidence of errors in Numpad typing, while the '2','3', and '0' key produced a higher incidence of errors in main keyboard digit line typing. Errors categorized as omission and substitution were higher in prevalence than transposition and intrusion.

Outpatient CPOE orders discontinued due to 'erroneous entry': prospective survey of prescribers' explanations for errors.

PubMed

Hickman, Thu-Trang T; Quist, Arbor Jessica Lauren; Salazar, Alejandra; Amato, Mary G; Wright, Adam; Volk, Lynn A; Bates, David W; Schiff, Gordon

2018-04-01

Computerised prescriber order entry (CPOE) systems users often discontinue medications because the initial order was erroneous. To elucidate error types by querying prescribers about their reasons for discontinuing outpatient medication orders that they had self-identified as erroneous. During a nearly 3 year retrospective data collection period, we identified 57 972 drugs discontinued with the reason 'Error (erroneous entry)." Because chart reviews revealed limited information about these errors, we prospectively studied consecutive, discontinued erroneous orders by querying prescribers in near-real-time to learn more about the erroneous orders. From January 2014 to April 2014, we prospectively emailed prescribers about outpatient drug orders that they had discontinued due to erroneous initial order entry. Of 2 50 806 medication orders in these 4 months, 1133 (0.45%) of these were discontinued due to error. From these 1133, we emailed 542 unique prescribers to ask about their reason(s) for discontinuing these mediation orders in error. We received 312 responses (58% response rate). We categorised these responses using a previously published taxonomy. The top reasons for these discontinued erroneous orders included: medication ordered for wrong patient (27.8%, n=60); wrong drug ordered (18.5%, n=40); and duplicate order placed (14.4%, n=31). Other common discontinued erroneous orders related to drug dosage and formulation (eg, extended release versus not). Oxycodone (3%) was the most frequent drug discontinued error. Drugs are not infrequently discontinued 'in error.' Wrong patient and wrong drug errors constitute the leading types of erroneous prescriptions recognised and discontinued by prescribers. Data regarding erroneous medication entries represent an important source of intelligence about how CPOE systems are functioning and malfunctioning, providing important insights regarding areas for designing CPOE more safely in the future. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Regenstrief Institute's Medical Gopher: a next-generation homegrown electronic medical record system.

PubMed

Duke, Jon D; Morea, Justin; Mamlin, Burke; Martin, Douglas K; Simonaitis, Linas; Takesue, Blaine Y; Dixon, Brian E; Dexter, Paul R

2014-03-01

Regenstrief Institute developed one of the seminal computerized order entry systems, the Medical Gopher, for implementation at Wishard Hospital nearly three decades ago. Wishard Hospital and Regenstrief remain committed to homegrown software development, and over the past 4 years we have fully rebuilt Gopher with an emphasis on usability, safety, leveraging open source technologies, and the advancement of biomedical informatics research. Our objective in this paper is to summarize the functionality of this new system and highlight its novel features. Applying a user-centered design process, the new Gopher was built upon a rich-internet application framework using an agile development process. The system incorporates order entry, clinical documentation, result viewing, decision support, and clinical workflow. We have customized its use for the outpatient, inpatient, and emergency department settings. The new Gopher is now in use by over 1100 users a day, including an average of 433 physicians caring for over 3600 patients daily. The system includes a wizard-like clinical workflow, dynamic multimedia alerts, and a familiar 'e-commerce'-based interface for order entry. Clinical documentation is enhanced by real-time natural language processing and data review is supported by a rapid chart search feature. As one of the few remaining academically developed order entry systems, the Gopher has been designed both to improve patient care and to support next-generation informatics research. It has achieved rapid adoption within our health system and suggests continued viability for homegrown systems in settings of close collaboration between developers and providers. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

75 FR 48387 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-10

... of the PULSe order entry workstation and to make a technical correction to the numbering of the text in the fees schedule. The PULSe workstation is a front-end order entry system designed for use with...\\ In conjunction with the launch of the PULSe workstation, the Exchange waived various fees. To...

Orders on file but no labs drawn: investigation of machine and human errors caused by an interface idiosyncrasy.

PubMed

Schreiber, Richard; Sittig, Dean F; Ash, Joan; Wright, Adam

2017-09-01

In this report, we describe 2 instances in which expert use of an electronic health record (EHR) system interfaced to an external clinical laboratory information system led to unintended consequences wherein 2 patients failed to have laboratory tests drawn in a timely manner. In both events, user actions combined with the lack of an acknowledgment message describing the order cancellation from the external clinical system were the root causes. In 1 case, rapid, near-simultaneous order entry was the culprit; in the second, astute order management by a clinician, unaware of the lack of proper 2-way interface messaging from the external clinical system, led to the confusion. Although testing had shown that the laboratory system would cancel duplicate laboratory orders, it was thought that duplicate alerting in the new order entry system would prevent such events. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Impact of Computerized Provider Order Entry on Pharmacist Productivity

PubMed Central

Hatfield, Mark D.; Cox, Rodney; Mhatre, Shivani K.; Flowers, W. Perry

2014-01-01

Abstract Purpose: To examine the impact of computerized provider order entry (CPOE) implementation on average time spent on medication order entry and the number of order actions processed. Methods: An observational time and motion study was conducted from March 1 to March 17, 2011. Two similar community hospital pharmacies were compared: one without CPOE implementation and the other with CPOE implementation. Pharmacists in the central pharmacy department of both hospitals were observed in blocks of 1 hour, with 24 hours of observation in each facility. Time spent by pharmacists on distributive, administrative, clinical, and miscellaneous activities associated with order entry were recorded using time and motion instrument documentation. Information on medication order actions and order entry/verifications was obtained using the pharmacy network system. Results: The mean ± SD time spent by pharmacists per hour in the CPOE pharmacy was significantly less than the non-CPOE pharmacy for distributive activities (43.37 ± 7.75 vs 48.07 ± 8.61) and significantly greater than the non-CPOE pharmacy for administrative (8.58 ± 5.59 vs 5.72 ± 6.99) and clinical (7.38 ± 4.27 vs 4.22 ± 3.26) activities. The CPOE pharmacy was associated with a significantly higher number of order actions per hour (191.00 ± 82.52 vs 111.63 ± 25.66) and significantly less time spent (in minutes per hour) on order entry and order verification combined (28.30 ± 9.25 vs 36.56 ± 9.14) than the non-CPOE pharmacy. Conclusion: The implementation of CPOE facilitated pharmacists to allocate more time to clinical and administrative functions and increased the number of order actions processed per hour, thus enhancing workflow efficiency and productivity of the pharmacy department. PMID:24958959

An Efficient User Interface Design for Nursing Information System Based on Integrated Patient Order Information.

PubMed

Chu, Chia-Hui; Kuo, Ming-Chuan; Weng, Shu-Hui; Lee, Ting-Ting

2016-01-01

A user friendly interface can enhance the efficiency of data entry, which is crucial for building a complete database. In this study, two user interfaces (traditional pull-down menu vs. check boxes) are proposed and evaluated based on medical records with fever medication orders by measuring the time for data entry, steps for each data entry record, and the complete rate of each medical record. The result revealed that the time for data entry is reduced from 22.8 sec/record to 3.2 sec/record. The data entry procedures also have reduced from 9 steps in the traditional one to 3 steps in the new one. In addition, the completeness of medical records is increased from 20.2% to 98%. All these results indicate that the new user interface provides a more user friendly and efficient approach for data entry than the traditional interface.

Core drug-drug interaction alerts for inclusion in pediatric electronic health records with computerized prescriber order entry.

PubMed

Harper, Marvin B; Longhurst, Christopher A; McGuire, Troy L; Tarrago, Rod; Desai, Bimal R; Patterson, Al

2014-03-01

The study aims to develop a core set of pediatric drug-drug interaction (DDI) pairs for which electronic alerts should be presented to prescribers during the ordering process. A clinical decision support working group composed of Children's Hospital Association (CHA) members was developed. CHA Pharmacists and Chief Medical Information Officers participated. Consensus was reached on a core set of 19 DDI pairs that should be presented to pediatric prescribers during the order process. We have provided a core list of 19 high value drug pairs for electronic drug-drug interaction alerts to be recommended for inclusion as high value alerts in prescriber order entry software used with a pediatric patient population. We believe this list represents the most important pediatric drug interactions for practical implementation within computerized prescriber order entry systems.

Chemotherapy Order Entry by a Clinical Support Pharmacy Technician in an Outpatient Medical Day Unit

PubMed Central

Neville, Heather; Broadfield, Larry; Harding, Claudia; Heukshorst, Shelley; Sweetapple, Jennifer; Rolle, Megan

2016-01-01

Background: Pharmacy technicians are expanding their scope of practice, often in partnership with pharmacists. In oncology, such a shift in responsibilities may lead to workflow efficiencies, but may also cause concerns about patient risk and medication errors. Objectives: The primary objective was to compare the time spent on order entry and order-entry checking before and after training of a clinical support pharmacy technician (CSPT) to perform chemotherapy order entry. The secondary objectives were to document workflow interruptions and to assess medication errors. Methods: This before-and-after observational study investigated chemotherapy order entry for ambulatory oncology patients. Order entry was performed by pharmacists before the process change (phase 1) and by 1 CSPT after the change (phase 2); order-entry checking was performed by a pharmacist during both phases. The tasks were timed by an independent observer using a personal digital assistant. A convenience sample of 125 orders was targeted for each phase. Data were exported to Microsoft Excel software, and timing differences for each task were tested with an unpaired t test. Results: Totals of 143 and 128 individual orders were timed for order entry during phase 1 (pharmacist) and phase 2 (CSPT), respectively. The mean total time to perform order entry was greater during phase 1 (1:37 min versus 1:20 min; p = 0.044). Totals of 144 and 122 individual orders were timed for order-entry checking (by a pharmacist) in phases 1 and 2, respectively, and there was no difference in mean total time for order-entry checking (1:21 min versus 1:20 min; p = 0.69). There were 33 interruptions not related to order entry (totalling 39:38 min) during phase 1 and 25 interruptions (totalling 30:08 min) during phase 2. Three errors were observed during order entry in phase 1 and one error during order-entry checking in phase 2; the errors were rated as having no effect on patient care. Conclusions: Chemotherapy order entry by a trained CSPT appeared to be just as safe and efficient as order entry by a pharmacist. Changes in pharmacy technicians’ scope of practice could increase the amount of time available for pharmacists to provide direct patient care in the oncology setting. PMID:27402999

Chemotherapy Order Entry by a Clinical Support Pharmacy Technician in an Outpatient Medical Day Unit.

PubMed

Neville, Heather; Broadfield, Larry; Harding, Claudia; Heukshorst, Shelley; Sweetapple, Jennifer; Rolle, Megan

2016-01-01

Pharmacy technicians are expanding their scope of practice, often in partnership with pharmacists. In oncology, such a shift in responsibilities may lead to workflow efficiencies, but may also cause concerns about patient risk and medication errors. The primary objective was to compare the time spent on order entry and order-entry checking before and after training of a clinical support pharmacy technician (CSPT) to perform chemotherapy order entry. The secondary objectives were to document workflow interruptions and to assess medication errors. This before-and-after observational study investigated chemotherapy order entry for ambulatory oncology patients. Order entry was performed by pharmacists before the process change (phase 1) and by 1 CSPT after the change (phase 2); order-entry checking was performed by a pharmacist during both phases. The tasks were timed by an independent observer using a personal digital assistant. A convenience sample of 125 orders was targeted for each phase. Data were exported to Microsoft Excel software, and timing differences for each task were tested with an unpaired t test. Totals of 143 and 128 individual orders were timed for order entry during phase 1 (pharmacist) and phase 2 (CSPT), respectively. The mean total time to perform order entry was greater during phase 1 (1:37 min versus 1:20 min; p = 0.044). Totals of 144 and 122 individual orders were timed for order-entry checking (by a pharmacist) in phases 1 and 2, respectively, and there was no difference in mean total time for order-entry checking (1:21 min versus 1:20 min; p = 0.69). There were 33 interruptions not related to order entry (totalling 39:38 min) during phase 1 and 25 interruptions (totalling 30:08 min) during phase 2. Three errors were observed during order entry in phase 1 and one error during order-entry checking in phase 2; the errors were rated as having no effect on patient care. Chemotherapy order entry by a trained CSPT appeared to be just as safe and efficient as order entry by a pharmacist. Changes in pharmacy technicians' scope of practice could increase the amount of time available for pharmacists to provide direct patient care in the oncology setting.

Power User Interface

NASA Technical Reports Server (NTRS)

Pfister, Robin; McMahon, Joe

2006-01-01

Power User Interface 5.0 (PUI) is a system of middleware, written for expert users in the Earth-science community, PUI enables expedited ordering of data granules on the basis of specific granule-identifying information that the users already know or can assemble. PUI also enables expert users to perform quick searches for orderablegranule information for use in preparing orders. PUI 5.0 is available in two versions (note: PUI 6.0 has command-line mode only): a Web-based application program and a UNIX command-line- mode client program. Both versions include modules that perform data-granule-ordering functions in conjunction with external systems. The Web-based version works with Earth Observing System Clearing House (ECHO) metadata catalog and order-entry services and with an open-source order-service broker server component, called the Mercury Shopping Cart, that is provided separately by Oak Ridge National Laboratory through the Department of Energy. The command-line version works with the ECHO metadata and order-entry process service. Both versions of PUI ultimately use ECHO to process an order to be sent to a data provider. Ordered data are provided through means outside the PUI software system.

A case study on the impacts of computerized provider order entry (CPOE) system on hospital clinical workflow.

PubMed

Mominah, Maher; Yunus, Faisel; Househ, Mowafa S

2013-01-01

Computerized provider order entry (CPOE) is a health informatics system that helps health care providers create and manage orders for medications and other health care services. Through the automation of the ordering process, CPOE has improved the overall efficiency of hospital processes and workflow. In Saudi Arabia, CPOE has been used for years, with only a few studies evaluating the impacts of CPOE on clinical workflow. In this paper, we discuss the experience of a local hospital with the use of CPOE and its impacts on clinical workflow. Results show that there are many issues related to the implementation and use of CPOE within Saudi Arabia that must be addressed, including design, training, medication errors, alert fatigue, and system dep Recommendations for improving CPOE use within Saudi Arabia are also discussed.

Effect of closed-loop order processing on the time to initial antimicrobial therapy.

PubMed

Panosh, Nicole; Rew, Richardd; Sharpe, Michelle

2012-08-15

The results of a study comparing the average time to initiation of i.v. antimicrobial therapy with closed-versus open-loop order entry and processing are reported. A retrospective cohort study was performed to compare order-to-administration times for initial doses of i.v. antimicrobials before and after a closed-loop order-processing system including computerized prescriber order entry (CPOE) was implemented at a large medical center. A total of 741 i.v. antimicrobial administrations to adult patients during designated five-month preimplementation and postimplementation study periods were assessed. Drug-use reports generated by the pharmacy database were used to identify order-entry times, and medication administration records were reviewed to determine times of i.v. antimicrobial administration. The mean ± S.D. order-to-administration times before and after the implementation of the CPOE system and closed-loop order processing were 3.18 ± 2.60 and 2.00 ± 1.89 hours, respectively, a reduction of 1.18 hours (p < 0.0001). Closed-loop order processing was associated with significant reductions in the average time to initiation of i.v. therapy in all patient care areas evaluated (cardiology, general medicine, and oncology). The study results suggest that CPOE-based closed-loop order processing can play an important role in achieving compliance with current practice guidelines calling for increased efforts to ensure the prompt initiation of i.v. antimicrobials for severe infections (e.g., sepsis, meningitis). Implementation of a closed-loop order-processing system resulted in a significant decrease in order-to-administration times for i.v. antimicrobial therapy.

Implementation of home-based medication order entry at a community hospital.

PubMed

Thorne, Alicia; Williamson, Sarah; Jellison, Tara; Jellison, Chris

2009-11-01

The implementation of a home-based order-entry program at a community hospital is described. Parkview Hospital is a 600-bed, community-based facility located in Fort Wayne, Indiana, that provides 24-hour pharmacy services. The main purpose for establishing a home-based order-entry program was to provide extra pharmacist coverage during the event of a spontaneous order surge in an effort to maintain excellent customer service. A virtual private network (VPN) was created to ensure the security and confidentiality of patients' health care information. The names of volunteer pharmacists who met specific criteria and who were capable of performing home-based order entry were collected. These pharmacists were trained and tested in the home-based order-entry process. When home-based order-entry is needed, the lead pharmacist contacts the pharmacists on the list by telephone. If available, the pharmacists (maximum of three) are notified to log into the Internet, access the VPN, and perform order entry with the same vigilance, confidentiality, and care as they would onsite. Home-based order entry is discontinued when off-trigger points are met. Pharmacists entering orders from home are paid by the time spent conducting order entry. Pharmacists reported that the program was easy to contact home-based order-entry volunteers, there were no problems with logging into the VPNs, and turnaround time was close to our target of 25 minutes. A community-based hospital successfully implemented a home-based medication order-entry program. The program alleviated the shortage of pharmacists during spontaneous surges of medication orders.

Creation of a Book Order Management System Using a Microcomputer and a DBMS.

ERIC Educational Resources Information Center

Neill, Charlotte; And Others

1985-01-01

Describes management decisions and resultant technology-based system that allowed a medical library to meet increasing workloads without accompanying increases in resources available. Discussion covers system analysis; capabilities of book-order management system, "BOOKDIRT;" software and training; hardware; data files; data entry;…

Clinicians' views on displaying cost information to increase clinician cost-consciousness.

PubMed

Kruger, Jenna F; Chen, Alice Hm; Rybkin, Alex; Leeds, Kiren; Frosch, Dominick L; Goldman, Elizabeth

2014-01-01

To evaluate 1) clinician attitudes towards incorporating cost information into decision making when ordering imaging studies; and 2) clinician reactions to the display of Medicare reimbursement information for imaging studies at clinician electronic order entry. Focus group study with inductive thematic analysis. We conducted focus groups of primary care clinicians and subspecialty physicians (nephrology, pulmonary, and neurology) (N = 50) who deliver outpatient care in 12 hospital-based clinics and community health centers in an urban safety net health system. We analyzed focus group transcripts using an inductive framework to identify emergent themes and illustrative quotations. Clinicians believed that their knowledge of healthcare costs was low and wanted access to relevant cost information for reference. However, many clinicians believed it was inappropriate and unethical to consider costs in individual patient care decisions. Among clinicians' negative reactions toward displaying costs at order entry, 4 underlying themes emerged: 1) belief that ordering is already limited to clinically necessary tests; 2) importance of prioritizing responsibility to patients above that to the healthcare system; 3) concern about worsening healthcare disparities; and 4) perceived lack of accountability for healthcare costs in the system. Although clinicians want relevant cost information, many voiced concerns about displaying cost information at clinician order entry in safety net health systems. Alternative approaches to increasing cost-consciousness may be more acceptable to clinicians.

A study of renal function influence by integrating cloud-based manometers and physician order entry systems.

PubMed

Lin, Yuh-Feng; Sheng, Li-Huei; Wu, Mei-Yi; Zheng, Cai-Mei; Chang, Tian-Jong; Li, Yu-Chuan; Huang, Yu-Hui; Lu, Hsi-Peng

2014-12-01

No evidence exists from randomized trials to support using cloud-based manometers integrated with available physician order entry systems for tracking patient blood pressure (BP) to assist in the control of renal function deterioration. We investigated how integrating cloud-based manometers with physician order entry systems benefits our outpatient chronic kidney disease patients compared with typical BP tracking systems. We randomly assigned 36 chronic kidney disease patients to use cloud-based manometers integrated with physician order entry systems or typical BP recording sheets, and followed the patients for 6 months. The composite outcome was that the patients saw improvement both in BP and renal function. We compared the systolic and diastolic BP (SBP and DBP), and renal function of our patients at 0 months, 3 months, and 6 months after using the integrated manometers and typical BP monitoring sheets. Nighttime SBP and DBP were significantly lower in the study group compared with the control group. Serum creatinine level in the study group improved significantly compared with the control group after the end of Month 6 (2.83 ± 2.0 vs. 4.38 ± 3.0, p = 0.018). Proteinuria improved nonsignificantly in Month 6 in the study group compared with the control group (1.05 ± 0.9 vs. 1.90 ± 1.3, p = 0.09). Both SBP and DBP during the nighttime hours improved significantly in the study group compared with the baseline. In pre-end-stage renal disease patients, regularly monitoring BP by integrating cloud-based manometers appears to result in a significant decrease in creatinine and improvement in nighttime BP control. Estimated glomerular filtration rate and proteinuria were found to be improved nonsignificantly, and thus, larger population and longer follow-up studies may be needed.

Development Of A Combined Sensor System For Atmospheric Entry Missions

NASA Astrophysics Data System (ADS)

Preci, A.; Eswein, N.; Herdrich, G.; Fasoulas, S.; Roser, H.-P.; Auweter-Kurtz, M.

2011-05-01

The payload COMPARE is developed at the Institute of Space Systems for various entry scenarios. It was previously laid out for a Mars entry mission and afterwards redesigned for the German Aerospace Centre suborbital re-entry mission SHEFEX II, which had its successful roll-out in July 2010 and is due to be launched in September 2011. The sensor system aims to simultaneously measure the temperature of the thermal protection shield, the radiation from the plasma and the pressure. The most recent development of COMPARE is a combined sensor system for ablative thermal protection systems enabling a separation of the radiative heat flux from the total heat flux. Furthermore, it enables also the detection of specific species in the plasma by measuring the radiative heat flux at a defined wavelength range. In the frame of an ESA funded project a breadboard has been build and tested in a plasma wind tunnel in order to prove the feasibility of such a sensor system for upcoming entry missions. Results of these measurements are presented in this work.

76 FR 33794 - Self-Regulatory Organizations; Chicago Stock Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-09

... types and indications that are eligible for entry to and accepted by the Matching System. The Exchange... Exchange with the ability to determine on an order type by order type basis which orders and indications... Rule 43.2 relating to the types of orders handled on the CBOE's Screen Based Trading System (``SBT...

Individualization through standardization: electronic orders for subcutaneous insulin in the hospital.

PubMed

Kennihan, Mary; Zohra, Tatheer; Devi, Radha; Srinivasan, Chitra; Diaz, Josefina; Howard, Bradley S; Braithwaite, Susan S

2012-01-01

The objective was to design electronic order sets that would promote safe, effective, and individualized order entry for subcutaneous insulin in the hospital, based on a review of best practices. Saint Francis Hospital in Evanston, Illinois, a community teaching hospital, was selected as the pilot site for 6 hospitals in the Health Care System to introduce an electronic medical record. Articles dealing with management of hospital hyperglycemia, medical order entry systems, and patient safety were reviewed selectively. In the published literature on institutional glycemic management programs and insulin order sets, features were identified that improve safety and effectiveness of subcutaneous insulin therapy. Subcutaneous electronic insulin order sets were created, designated in short: "patients eating", "patients not eating", and "patients receiving overnight enteral feedings." Together with an option for free text entry, menus of administration instructions were designed within each order set that were applicable to specific insulin orders and expressed in standardized language, such as "hold if tube feeds stop" or "do not withhold." Two design features are advocated for electronic order sets for subcutaneous insulin that will both standardize care and protect individualization. First, within the order sets, the glycemic management plan should be matched to the carbohydrate exposure of the patients, with juxtaposition of appropriate orders for both glucose monitoring and insulin. Second, in order to convey precautions of insulin use to pharmacy and nursing staff, the prescriber must be able to attach administration instructions to specific insulin orders.

Effectiveness of Provider Education Followed by Computerized Provider Order Entry Alerts in Reducing Inappropriate Red Blood Cell Transfusion.

PubMed

Patel, Vijay M; Rains, Anna W; Clark, Christopher T

2016-01-01

To reduce the rate of inappropriate red blood cell transfusion, a provider education program, followed by alerts in the computerized provider order entry system (CPOE), was established to encourage AABB transfusion guidelines. Metrics were established for nonemergent inpatient transfusions. Service lines with high order volume were targeted with formal education regarding AABB 2012 transfusion guidelines. Transfusion orders were reviewed in real time with email communications sent to ordering providers falling outside of AABB recommendations. After 12 months of provider education, alerts were activated in CPOE. With provider education alone, the incidence of pretransfusion hemoglobin levels greater than 8 g/dL decreased from 16.64% to 6.36%, posttransfusion hemoglobin levels greater than 10 g/dL from 14.03% to 3.78%, and number of nonemergent two-unit red blood cell orders from 45.26% to 22.66%. Red blood cell utilization decreased by 13%. No additional significant reduction in nonemergent two-unit orders was observed with CPOE alerts. Provider education, an effective and low-cost method, should be considered as a first-line method for reducing inappropriate red blood cell transfusion rates in stable adult inpatients. Alerts in the computerized order entry system did not significantly lower the percentage of two-unit red blood cells orders but may help to maintain educational efforts.

A framework for analyzing the cognitive complexity of computer-assisted clinical ordering.

PubMed

Horsky, Jan; Kaufman, David R; Oppenheim, Michael I; Patel, Vimla L

2003-01-01

Computer-assisted provider order entry is a technology that is designed to expedite medical ordering and to reduce the frequency of preventable errors. This paper presents a multifaceted cognitive methodology for the characterization of cognitive demands of a medical information system. Our investigation was informed by the distributed resources (DR) model, a novel approach designed to describe the dimensions of user interfaces that introduce unnecessary cognitive complexity. This method evaluates the relative distribution of external (system) and internal (user) representations embodied in system interaction. We conducted an expert walkthrough evaluation of a commercial order entry system, followed by a simulated clinical ordering task performed by seven clinicians. The DR model was employed to explain variation in user performance and to characterize the relationship of resource distribution and ordering errors. The analysis revealed that the configuration of resources in this ordering application placed unnecessarily heavy cognitive demands on the user, especially on those who lacked a robust conceptual model of the system. The resources model also provided some insight into clinicians' interactive strategies and patterns of associated errors. Implications for user training and interface design based on the principles of human-computer interaction in the medical domain are discussed.

The process of development of a prioritization tool for a clinical decision support build within a computerized provider order entry system: Experiences from St Luke's Health System.

PubMed

Wolf, Matthew; Miller, Suzanne; DeJong, Doug; House, John A; Dirks, Carl; Beasley, Brent

2016-09-01

To establish a process for the development of a prioritization tool for a clinical decision support build within a computerized provider order entry system and concurrently to prioritize alerts for Saint Luke's Health System. The process of prioritizing clinical decision support alerts included (a) consensus sessions to establish a prioritization process and identify clinical decision support alerts through a modified Delphi process and (b) a clinical decision support survey to validate the results. All members of our health system's physician quality organization, Saint Luke's Care as well as clinicians, administrators, and pharmacy staff throughout Saint Luke's Health System, were invited to participate in this confidential survey. The consensus sessions yielded a prioritization process through alert contextualization and associated Likert-type scales. Utilizing this process, the clinical decision support survey polled the opinions of 850 clinicians with a 64.7 percent response rate. Three of the top rated alerts were approved for the pre-implementation build at Saint Luke's Health System: Acute Myocardial Infarction Core Measure Sets, Deep Vein Thrombosis Prophylaxis within 4 h, and Criteria for Sepsis. This study establishes a process for developing a prioritization tool for a clinical decision support build within a computerized provider order entry system that may be applicable to similar institutions. © The Author(s) 2015.

Aerodynamic and Aerothermal TPS Instrumentation Reference Guide

NASA Technical Reports Server (NTRS)

Woollard, Bryce A.; Braun, Robert D.; Bose, Deepack

2016-01-01

The hypersonic regime of planetary entry combines the most severe environments that an entry vehicle will encounter with the greatest amount of uncertainty as to the events unfolding during that time period. This combination generally leads to conservatism in the design of an entry vehicle, specifically that of the thermal protection system (TPS). Each planetary entry provides a valuable aerodynamic and aerothermal testing opportunity; the utilization of this opportunity is paramount in better understanding how a specific entry vehicle responds to the demands of the hypersonic entry environment. Previous efforts have been made to instrument entry vehicles in order to collect data during the entry period and reconstruct the corresponding vehicle response. The purpose of this paper is to cumulatively document past TPS instrumentation designs for applicable planetary missions, as well as to list pertinent results and any explainable shortcomings.

Entry, Descent and Landing Systems Analysis: Exploration Class Simulation Overview and Results

NASA Technical Reports Server (NTRS)

DwyerCianciolo, Alicia M.; Davis, Jody L.; Shidner, Jeremy D.; Powell, Richard W.

2010-01-01

NASA senior management commissioned the Entry, Descent and Landing Systems Analysis (EDL-SA) Study in 2008 to identify and roadmap the Entry, Descent and Landing (EDL) technology investments that the agency needed to make in order to successfully land large payloads at Mars for both robotic and exploration or human-scale missions. The year one exploration class mission activity considered technologies capable of delivering a 40-mt payload. This paper provides an overview of the exploration class mission study, including technologies considered, models developed and initial simulation results from the EDL-SA year one effort.

Computerized provider order entry systems.

PubMed

2001-01-01

Computerized provider order entry (CPOE) systems are designed to replace a hospital's paper-based ordering system. They allow users to electronically write the full range of orders, maintain an online medication administration record, and review changes made to an order by successive personnel. They also offer safety alerts that are triggered when an unsafe order (such as for a duplicate drug therapy) is entered, as well as clinical decision support to guide caregivers to less expensive alternatives or to choices that better fit established hospital protocols. CPOE systems can, when correctly configured, markedly increase efficiency and improve patient safety and patient care. However, facilities need to recognize that currently available CPOE systems require a tremendous amount of time and effort to be spent in customization before their safety and clinical support features can be effectively implemented. What's more, even after they've been customized, the systems may still allow certain unsafe orders to be entered. Thus, CPOE systems are not currently a quick or easy remedy for medical errors. ECRI's Evaluation of CPOE systems--conducted in collaboration with the Institute for Safe Medication Practices (ISMP)--discusses these and other related issues. It also examines and compares CPOE systems from three suppliers: Eclipsys Corp., IDX Systems Corp., and Siemens Medical Solutions Health Services Corp. Our testing focuses primarily on the systems' interfacing capabilities, patient safeguards, and ease of use.

Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events?

PubMed

Charles, Krista; Cannon, Margaret; Hall, Robert; Coustasse, Alberto

2014-01-01

Computerized provider order entry (CPOE) systems allow physicians to prescribe patient services electronically. In hospitals, CPOE essentially eliminates the need for handwritten paper orders and achieves cost savings through increased efficiency. The purpose of this research study was to examine the benefits of and barriers to CPOE adoption in hospitals to determine the effects on medical errors and adverse drug events (ADEs) and examine cost and savings associated with the implementation of this newly mandated technology. This study followed a methodology using the basic principles of a systematic review and referenced 50 sources. CPOE systems in hospitals were found to be capable of reducing medical errors and ADEs, especially when CPOE systems are bundled with clinical decision support systems designed to alert physicians and other healthcare providers of pending lab or medical errors. However, CPOE systems face major barriers associated with adoption in a hospital system, mainly high implementation costs and physicians' resistance to change.

Development of Thermal Protection Materials for Future Mars Entry, Descent and Landing Systems

NASA Technical Reports Server (NTRS)

Cassell, Alan M.; Beck, Robin A. S.; Arnold, James O.; Hwang, Helen; Wright, Michael J.; Szalai, Christine E.; Blosser, Max; Poteet, Carl C.

2010-01-01

Entry Systems will play a crucial role as NASA develops the technologies required for Human Mars Exploration. The Exploration Technology Development Program Office established the Entry, Descent and Landing (EDL) Technology Development Project to develop Thermal Protection System (TPS) materials for insertion into future Mars Entry Systems. An assessment of current entry system technologies identified significant opportunity to improve the current state of the art in thermal protection materials in order to enable landing of heavy mass (40 mT) payloads. To accomplish this goal, the EDL Project has outlined a framework to define, develop and model the thermal protection system material concepts required to allow for the human exploration of Mars via aerocapture followed by entry. Two primary classes of ablative materials are being developed: rigid and flexible. The rigid ablatives will be applied to the acreage of a 10x30 m rigid mid L/D Aeroshell to endure the dual pulse heating (peak approx.500 W/sq cm). Likewise, flexible ablative materials are being developed for 20-30 m diameter deployable aerodynamic decelerator entry systems that could endure dual pulse heating (peak aprrox.120 W/sq cm). A technology Roadmap is presented that will be used for facilitating the maturation of both the rigid and flexible ablative materials through application of decision metrics (requirements, key performance parameters, TRL definitions, and evaluation criteria) used to assess and advance the various candidate TPS material technologies.

Woven Thermal Protection System (WTPS) a Novel Approach to Meet NASA's Most Demanding Reentry Missions

NASA Technical Reports Server (NTRS)

Stackpoole, Mairead

2014-01-01

NASA's future robotic missions to Venus and outer planets, namely, Saturn, Uranus, Neptune, result in extremely high entry conditions that exceed the capabilities of current mid-density ablators (PICA or Avcoat). Therefore mission planners assume the use of a fully dense carbon phenolic heat shield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic (CP) is a robust Thermal Protection System (TPS) however its high density and thermal conductivity constrain mission planners to steep entries, high heat fluxes, pressures and short entry durations, in order for CP to be feasible from a mass perspective. The high entry conditions pose certification challenges in existing ground based test facilities. In 2012 the Game Changing Development Program in NASA's Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System (WTPS) to meet the needs of NASA's most challenging entry missions. This presentation will summarize maturation of the WTPS project.

31 CFR 357.20 - Securities account in Legacy Treasury Direct ®.

Code of Federal Regulations, 2011 CFR

2011-07-01

... number. (c) If a bill is transferred from one Legacy Treasury Direct account to another, the price shown...-ENTRY TREASURY BONDS, NOTES AND BILLS HELD IN TREASURY/RESERVE AUTOMATED DEBT ENTRY SYSTEM (TRADES) AND... securities portfolio associated with an account master record. (c) Account master record. In order for a...

31 CFR 357.20 - Securities account in Legacy Treasury Direct ®.

Code of Federal Regulations, 2014 CFR

2014-07-01

... number. (c) If a bill is transferred from one Legacy Treasury Direct account to another, the price shown... BOOK-ENTRY TREASURY BONDS, NOTES AND BILLS HELD IN TREASURY/RESERVE AUTOMATED DEBT ENTRY SYSTEM (TRADES... the securities portfolio associated with an account master record. (c) Account master record. In order...

31 CFR 357.20 - Securities account in Legacy Treasury Direct ®.

Code of Federal Regulations, 2013 CFR

2013-07-01

... number. (c) If a bill is transferred from one Legacy Treasury Direct account to another, the price shown...-ENTRY TREASURY BONDS, NOTES AND BILLS HELD IN TREASURY/RESERVE AUTOMATED DEBT ENTRY SYSTEM (TRADES) AND... securities portfolio associated with an account master record. (c) Account master record. In order for a...

31 CFR 357.20 - Securities account in Legacy Treasury Direct ®.

Code of Federal Regulations, 2012 CFR

2012-07-01

... number. (c) If a bill is transferred from one Legacy Treasury Direct account to another, the price shown...-ENTRY TREASURY BONDS, NOTES AND BILLS HELD IN TREASURY/RESERVE AUTOMATED DEBT ENTRY SYSTEM (TRADES) AND... securities portfolio associated with an account master record. (c) Account master record. In order for a...

A programmable rules engine to provide clinical decision support using HTML forms.

PubMed

Heusinkveld, J; Geissbuhler, A; Sheshelidze, D; Miller, R

1999-01-01

The authors have developed a simple method for specifying rules to be applied to information on HTML forms. This approach allows clinical experts, who lack the programming expertise needed to write CGI scripts, to construct and maintain domain-specific knowledge and ordering capabilities within WizOrder, the order-entry and decision support system used at Vanderbilt Hospital. The clinical knowledge base maintainers use HTML editors to create forms and spreadsheet programs for rule entry. A test environment has been developed which uses Netscape to display forms; the production environment displays forms using an embedded browser.

Woven Thermal Protection System (WTPS) a Novel Approach to Meet Nasa's Most Demanding Reentry Missions

NASA Technical Reports Server (NTRS)

Stackpoole, Margaret M.; Ellerby, Donald T.; Gasch, Matt; Ventkatapathy, Ethiraj; Beerman, Adam; Boghozian, Tane; Gonzales, Gregory; Feldman, Jay; Peterson, Keith; Prabhu, Dinesh

2014-01-01

NASA's future robotic missions to Venus and other planets, namely, Saturn, Uranus, Neptune, result in extremely high entry conditions that exceed the capabilities of current mid density ablators (PICA or Avcoat). Therefore mission planners assume the use of a fully dense carbon phenolic heatshield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic is a robust TPS, however, its high density and thermal conductivity constrain mission planners to steep entries, high fluxes, pressures and short entry durations, in order for CP to be feasible from a mass perspective. The high entry conditions pose certification challenges in existing ground based test facilities. In 2012 the Game Changing Development Program in NASA's Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System to meet the needs of NASA's most challenging entry missions. This presentation will summarize the maturation of the WTPS project.

Effect of a Computerized Provider Order Entry (CPOE) System on Medication Orders at a Community Hospital and University Hospital

PubMed Central

Wess, Mark L.; Embi, Peter J.; Besier, James L.; Lowry, Chad H.; Anderson, Paul F.; Besier, James C.; Thelen, Geriann; Hegner, Catherine

2007-01-01

Computerized Provider Order Entry (CPOE) has been demonstrated to improve the medication ordering process, but most published studies have been performed at academic hospitals. Little is known about the effects of CPOE at community hospitals. With a pre-post study design, we assessed the effects of a CPOE system on the medication ordering process at both a community and university hospital. The time from provider ordering to pharmacist verification decreased by two hours with CPOE at the community hospital (p<0.0001) and by one hour at the university hospital (p<0.0001). The rate of medication clarifications requiring signature was 2.80 percent pre-CPOE and 0.40 percent with CPOE (p<0.0001) at the community hospital. The university hospital was 2.76 percent pre-CPOE and 0.46 percent with CPOE (p<0.0001). CPOE improved medication order processing at both community and university hospitals. These findings add to the limited literature on CPOE in community hospitals. PMID:18693946

CPOE in Iran--a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital.

PubMed

Kazemi, Alireza; Ellenius, Johan; Tofighi, Shahram; Salehi, Aref; Eghbalian, Fatemeh; Fors, Uno G

2009-03-01

In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems provide significant benefits. A pilot study in a limited setting and a comprehensive analysis of health outcomes and economic indicators should be performed, to assess the merits of introducing Computerised Physician Order Entry with decision support capabilities in Iran.

Develop and Implement an Integrated Enterprise Information System for a Computer-Integrated Apparel Enterprise (CIAE).

DTIC Science & Technology

1998-01-24

the Apparel Manufacturing Architecture (AMA), a generic architecture for an apparel enterprise. ARN-AIMS consists of three modules - Order Processing , Order...Tracking and Shipping & Invoicing. The Order Processing Module is designed to facilitate the entry of customer orders for stock and special

Analytic Development of a Reference Profile for the First Entry in a Skip Atmospheric Entry

NASA Technical Reports Server (NTRS)

Garcia-Llama, Eduardo

2010-01-01

This note shows that a feasible reference drag profile for the first entry portion of a skip entry can be generated as a polynomial expression of the velocity. The coefficients of that polynomial are found through the resolution of a system composed of m + 1 equations, where m is the degree of the drag polynomial. It has been shown that a minimum of five equations (m = 4) are required to establish the range and the initial and final conditions on velocity and flight path angle. It has been shown that at least one constraint on the trajectory can be imposed through the addition of one extra equation in the system, which must be accompanied by the increase in the degree of the drag polynomial. In order to simplify the resolution of the system of equations, the drag was considered as being a probability density function of the velocity, with the velocity as a distribution function of the drag. Combining this notion with the introduction of empirically derived constants, it has been shown that the system of equations required to generate the drag profile can be successfully reduced to a system of linear algebraic equations. For completeness, the resulting drag profiles have been flown using the feedback linearization method of differential geometric control as a guidance law with the error dynamics of a second order homogeneous equation in the form of a damped oscillator. Satisfactory results were achieved when the gains in the error dynamics were changed at a certain point along the trajectory that is dependent on the velocity and the curvature of the drag as a function of the velocity. Future work should study the capacity to update the drag profile in flight when dispersions are introduced. Also, future studies should attempt to link the first entry, as presented and controlled in this note, with a more standard control concept for the second entry, such as the Apollo entry guidance, to try to assess the overall skip entry performance. A guidance law that includes an integral feedback term, as is the case in the actual Space Shuttle entry guidance and as is proposed in Ref 29, could be tried in future studies to assess whether its use results in an improvement of the tracking performance, and to evaluate the design needs when determining the control gains.

Performance analysis of different database in new internet mapping system

NASA Astrophysics Data System (ADS)

Yao, Xing; Su, Wei; Gao, Shuai

2017-03-01

In the Mapping System of New Internet, Massive mapping entries between AID and RID need to be stored, added, updated, and deleted. In order to better deal with the problem when facing a large number of mapping entries update and query request, the Mapping System of New Internet must use high-performance database. In this paper, we focus on the performance of Redis, SQLite, and MySQL these three typical databases, and the results show that the Mapping System based on different databases can adapt to different needs according to the actual situation.

Entry, Descent and Landing Systems Analysis Study: Phase 1 Report

NASA Technical Reports Server (NTRS)

DwyerCianciolo, Alicia M.; Davis, Jody L.; Komar, David R.; Munk, Michelle M.; Samareh, Jamshid A.; Powell, Richard W.; Shidner, Jeremy D.; Stanley, Douglas O.; Wilhite, Alan W.; Kinney, David J.;

76 FR 37826 - Public Land Order No. 7773; Emergency Withdrawal of Public and National Forest System Lands...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-28

...] Public Land Order No. 7773; Emergency Withdrawal of Public and National Forest System Lands, Coconino and... Forest System lands from location and entry under the 1872 Mining Law for a period of 6 months under the... described above aggregate approximately 1,010,776 acres public and National Forest System lands in Coconino...

75 FR 57061 - Public Land Order No. 7749; Extension of Public Land Order Nos. 6801 and 6812; Arizona

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-17

... National Forest System lands from location or entry under the United States mining laws (30 U.S.C. chapter... Service Coronado National Forest Office, Federal Building, 300 West Congress Street, Tucson, Arizona 85701.... Public Land Order No. 6801 (55 FR 38550, (1990)) that withdrew 61.356 acres of National Forest System...

System Level Aerothermal Testing for the Adaptive Deployable Entry and Placement Technology (ADEPT)

NASA Technical Reports Server (NTRS)

Cassell, Alan; Gorbunov, Sergey; Yount, Bryan; Prabhu, Dinesh; de Jong, Maxim; Boghozian, Tane; Hui, Frank; Chen, Y.-K.; Kruger, Carl; Poteet, Carl;

A programmable rules engine to provide clinical decision support using HTML forms.

PubMed Central

Heusinkveld, J.; Geissbuhler, A.; Sheshelidze, D.; Miller, R.

1999-01-01

The authors have developed a simple method for specifying rules to be applied to information on HTML forms. This approach allows clinical experts, who lack the programming expertise needed to write CGI scripts, to construct and maintain domain-specific knowledge and ordering capabilities within WizOrder, the order-entry and decision support system used at Vanderbilt Hospital. The clinical knowledge base maintainers use HTML editors to create forms and spreadsheet programs for rule entry. A test environment has been developed which uses Netscape to display forms; the production environment displays forms using an embedded browser. Images Figure 1 PMID:10566470

Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two ‘early adopter’ hospitals

PubMed Central

Cresswell, Kathrin M; Bates, David W; Williams, Robin; Morrison, Zoe; Slee, Ann; Coleman, Jamie; Robertson, Ann; Sheikh, Aziz

2014-01-01

Objective To understand the medium-term consequences of implementing commercially procured computerized physician order entry (CPOE) and clinical decision support (CDS) systems in ‘early adopter’ hospitals. Materials and methods In-depth, qualitative case study in two hospitals using a CPOE or a CDS system for at least 2 years. Both hospitals had implemented commercially available systems. Hospital A had implemented a CPOE system (with basic decision support), whereas hospital B invested additional resources in a CDS system that facilitated order entry but which was integrated with electronic health records and offered more advanced CDS. We used a combination of documentary analysis of the implementation plans, audiorecorded semistructured interviews with system users, and observations of strategic meetings and systems usage. Results We collected 11 documents, conducted 43 interviews, and conducted a total of 21.5 h of observations. We identified three major themes: (1) impacts on individual users, including greater legibility of prescriptions, but also some accounts of increased workloads; (2) the introduction of perceived new safety risks related to accessibility and usability of hardware and software, with users expressing concerns that some problems such as duplicate prescribing were more likely to occur; and (3) realizing organizational benefits through secondary uses of data. Conclusions We identified little difference in the medium-term consequences of a CPOE and a CDS system. It is important that future studies investigate the medium- and longer-term consequences of CPOE and CDS systems in a wider range of hospitals. PMID:24431334

Impact of electronic order management on the timeliness of antibiotic administration in critical care patients.

PubMed

Cartmill, Randi S; Walker, James M; Blosky, Mary Ann; Brown, Roger L; Djurkovic, Svetolik; Dunham, Deborah B; Gardill, Debra; Haupt, Marilyn T; Parry, Dean; Wetterneck, Tosha B; Wood, Kenneth E; Carayon, Pascale

2012-11-01

To examine the effect of implementing electronic order management on the timely administration of antibiotics to critical-care patients. We used a prospective pre-post design, collecting data on first-dose IV antibiotic orders before and after the implementation of an integrated electronic medication-management system, which included computerized provider order entry (CPOE), pharmacy order processing and an electronic medication administration record (eMAR). The research was performed in a 24-bed adult medical/surgical ICU in a large, rural, tertiary medical center. Data on the time of ordering, pharmacy processing and administration were prospectively collected and time intervals for each stage and the overall process were calculated. The overall turnaround time from ordering to administration significantly decreased from a median of 100 min before order management implementation to a median of 64 min after implementation. The first part of the medication use process, i.e., from order entry to pharmacy processing, improved significantly whereas no change was observed in the phase from pharmacy processing to medication administration. The implementation of an electronic order-management system improved the timeliness of antibiotic administration to critical-care patients. Additional system changes are required to further decrease the turnaround time. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

77 FR 28647 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-15

... calculating the ratio between (i) entered orders, weighted by the distance of the order from the national best... with an ``Order Entry Ratio'' of more than 100. The Order Entry Ratio is calculated, and the Excess Order Fee imposed, on a monthly basis. For each MPID, the Order Entry Ratio is the ratio of (i) the MPID...

Mission Sizing and Trade Studies for Low Ballistic Coefficient Entry Systems to Venus

NASA Technical Reports Server (NTRS)

Dutta, Soumyo; Smith, Brandon; Prabhu, Dinesh; Venkatapathy, Ethiraj

2012-01-01

The U.S and the U.S.S.R. have sent seventeen successful atmospheric entry missions to Venus. Past missions to Venus have utilized rigid aeroshell systems for entry. This rigid aeroshell paradigm sets performance limitations since the size of the entry vehicle is constrained by the fairing diameter of the launch vehicle. This has limited ballistic coefficients (beta) to well above 100 kg/m2 for the entry vehicles. In order to maximize the science payload and minimize the Thermal Protection System (TPS) mass, these missions have entered at very steep entry flight path angles (gamma). Due to Venus thick atmosphere and the steep-gamma, high- conditions, these entry vehicles have been exposed to very high heat flux, very high pressures and extreme decelerations (upwards of 100 g's). Deployable aeroshells avoid the launch vehicle fairing diameter constraint by expanding to a larger diameter after the launch. Due to the potentially larger wetted area, deployable aeroshells achieve lower ballistic coefficients (well below 100 kg/m2), and if they are flown at shallower flight path angles, the entry vehicle can access trajectories with far lower decelerations (50-60 g's), peak heat fluxes (400 W/cm2) and peak pressures. The structural and TPS mass of the shallow-gamma, low-beta deployables are lower than their steep-gamma, high-beta rigid aeroshell counterparts at larger diameters, contributing to lower areal densities and potentially higher payload mass fractions. For example, at large diameters, deployables may attain aeroshell areal densities of 10 kg/m2 as opposed to 50 kg/m2 for rigid aeroshells. However, the low-beta, shallow-gamma paradigm also raises issues, such as the possibility of skip-out during entry. The shallow-gamma could also increase the landing footprint of the vehicle. Furthermore, the deployable entry systems may be flexible, so there could be fluid-structure interaction, especially in the high altitude, low-density regimes. The need for precision in guidance, navigation and control during entry also has to be better understood. This paper investigates some of the challenges facing the design of a shallow-gamma, low-beta entry system.

EntrySat: A 3U CubeStat to study the reentry atmospheric environment

NASA Astrophysics Data System (ADS)

Anthony, Sournac; Raphael, Garcia; David, Mimoun; Jeremie, Chaix

2016-04-01

ISAE France Entrysat has for main scientific objective the study of uncontrolled atmospheric re-entry. This project, is developed by ISAE in collaboration with ONERA and University of Toulouse, is funded by CNES, in the overall frame of the QB50 project. This nano-satellite is a 3U Cubesat measuring 34*10*10 cm3, similar to secondary debris produced during the break up of a spacecraft. EntrySat will collect the external and internal temperatures, pressure, heat flux, attitude variations and drag force of the satellite between ≈150 and 90 km before its destruction in the atmosphere, and transmit them during the re-entry using the IRIDIUM satellite network. The result will be compared with the computations of MUSIC/FAST, a new 6-degree of freedom code developed by ONERA to predict the trajectory of space debris. In order to fulfil the scientific objectives, the satellite will acquire 18 re-entry sensors signals, convert them and compress them, thanks to an electronic board developed by ISAE students in cooperation with EREMS. In order to transmit these data every second during the re-entry phase, the satellite will use an IRIDIUM connection. In order to keep a stable enough attitudes during this phase, a simple attitude orbit and control system using magnetotorquers and an inertial measurement unit (IMU) is developed at ISAE by students. A commercial GPS board is also integrated in the satellite into Entry Sat to determine its position and velocity which are necessary during the re-entry phase. This GPS will also be used to synchronize the on-board clock with the real-time UTC data. During the orbital phase (≈2 year) EntrySat measurements will be recorded transmitted through a more classical "UHF/VHF" connection. Preference for presentation: Poster Most suitable session: Author for correspondence: Dr Raphael F. Garcia ISAE 10, ave E. Belin, 31400 Toulouse, France Raphael.GARCIA@isae.fr +33 5 61 33 81 14

75 FR 41886 - Public Land Order No. 7744; Withdrawal of National Forest System Land for Inyan Kara Area; WY

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-19

... National Forest System land other than the mining laws (30 U.S.C. Ch. 2). 3. This withdrawal will expire 20... Order No. 7744; Withdrawal of National Forest System Land for Inyan Kara Area; WY AGENCY: Bureau of Land... Forest System land from location and entry under the United States mining laws for a period of 20 years...

[The electronic health record: computerised provider order entry and the electronic instruction document as new functionalities].

PubMed

Derikx, Joep P M; Erdkamp, Frans L G; Hoofwijk, A G M

2013-01-01

An electronic health record (EHR) should provide 4 key functionalities: (a) documenting patient data; (b) facilitating computerised provider order entry; (c) displaying the results of diagnostic research; and (d) providing support for healthcare providers in the clinical decision-making process.- Computerised provider order entry into the EHR enables the electronic receipt and transfer of orders to ancillary departments, which can take the place of handwritten orders.- By classifying the computer provider order entries according to disorders, digital care pathways can be created. Such care pathways could result in faster and improved diagnostics.- Communicating by means of an electronic instruction document that is linked to a computerised provider order entry facilitates the provision of healthcare in a safer, more efficient and auditable manner.- The implementation of a full-scale EHR has been delayed as a result of economic, technical and legal barriers, as well as some resistance by physicians.

75 FR 72855 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-26

... . NASDAQ has safeguards in place to protect the market from inadvertent entry of large orders. Each member that requests connectivity through an order entry port is required to specify the maximum order size... and procedures in place to ensure the proper entry and monitoring of orders entered into NASDAQ...

78 FR 3928 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Order Disapproving Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-17

... system protocol, to the NASDAQ matching engine or to the NASDAQ router as needed to complete the... Order application to the order entry gateway of NASDAQ's matching engine, but the amount of time gained... proposal represents another example of the blurring borders between exchanges and broker-dealers, and...

HL7 Structured Product Labeling - electronic prescribing information for provider order entry decision support.

PubMed

Schadow, Gunther

2005-01-01

Prescribing errors are an important cause of adverse events, and lack of knowledge of the drug is a root cause for prescribing errors. The FDA is issuing new regulations that will make the drug labels much more useful not only to physicians, but also to computerized order entry systems that support physicians to practice safe prescribing. For this purpose, FDA works with HL7 to create the Structured Product Label (SPL) standard that includes a document format as well as a drug knowledge representation, this poster introduces the basic concepts of SPL.

RPMIS: The Roswell Park Management Information System

PubMed Central

Priore, R.L.; Lane, W.W.; Edgerton, F.T.; Naeher, C.H.; Reese, P.A.

1978-01-01

This paper presents a generalized approach to data entry and editing utilizing formatted video computer terminals. The purpose of the system developed is to facilitate the creation of many small data bases, with a minimum of implementation time, while maintaining extensive editing capability and preserving ease of use by data entry personnel. RPMIS has demonstrated its utility in shortening the time between research activities and clinical application of results. The system allows entry and retrieval of overlapping subsets of the patient's record in an order and format most appropriate to the individual application. It is used for production of synoptic presentations of information from the labs, the ward and the clinic. RPMIS was designed for the clinical trials setting and has been well received and implemented for numerous such studies. Additional uses have included several registries, screening clinics, retrospective studies, and epidemiologic investigations. The system has found fortuitous use in maintaining curriculum vitae, publications lists and continuing medical education credits.

Micromechanical Characterization and Testing of Carbon Based Woven Thermal Protection Materials

NASA Technical Reports Server (NTRS)

Agrawal, Parul; Pham, John T.; Arnold, James O.; Peterson, Keith; Venkatapathy, Ethiraj

2013-01-01

Woven thermal protection system (TPS) materials are one of the enabling technologies for mechanically deployable hypersonic decelerator systems. These materials can be simultaneously used for thermal protection and as structural load bearing members during the entry, descent and landing operations. In order to ensure successful thermal and structural performance during the atmospheric entry, it is important to characterize the properties of these materials, once they have been subjected to entry like conditions. The present paper focuses on mechanical characteristics of pre-and post arc-jet tested woven TPS samples at different scales. It also presents the observations from scanning electron microscope and computed tomography images, and explains the changes in microstructure after being subjected to combined thermal-mechanical loading environments.

A Comparison of Two Skip Entry Guidance Algorithms

NASA Technical Reports Server (NTRS)

Rea, Jeremy R.; Putnam, Zachary R.

2007-01-01

The Orion capsule vehicle will have a Lift-to-Drag ratio (L/D) of 0.3-0.35. For an Apollo-like direct entry into the Earth's atmosphere from a lunar return trajectory, this L/D will give the vehicle a maximum range of about 2500 nm and a maximum crossrange of 216 nm. In order to y longer ranges, the vehicle lift must be used to loft the trajectory such that the aerodynamic forces are decreased. A Skip-Trajectory results if the vehicle leaves the sensible atmosphere and a second entry occurs downrange of the atmospheric exit point. The Orion capsule is required to have landing site access (either on land or in water) inside the Continental United States (CONUS) for lunar returns anytime during the lunar month. This requirement means the vehicle must be capable of flying ranges of at least 5500 nm. For the L/D of the vehicle, this is only possible with the use of a guided Skip-Trajectory. A skip entry guidance algorithm is necessary to achieve this requirement. Two skip entry guidance algorithms have been developed: the Numerical Skip Entry Guidance (NSEG) algorithm was developed at NASA/JSC and PredGuid was developed at Draper Laboratory. A comparison of these two algorithms will be presented in this paper. Each algorithm has been implemented in a high-fidelity, 6 degree-of-freedom simulation called the Advanced NASA Technology Architecture for Exploration Studies (ANTARES). NASA and Draper engineers have completed several monte carlo analyses in order to compare the performance of each algorithm in various stress states. Each algorithm has been tested for entry-to-target ranges to include direct entries and skip entries of varying length. Dispersions have been included on the initial entry interface state, vehicle mass properties, vehicle aerodynamics, atmosphere, and Reaction Control System (RCS). Performance criteria include miss distance to the target, RCS fuel usage, maximum g-loads and heat rates for the first and second entry, total heat load, and control system saturation. The comparison of the performance criteria has led to a down select and guidance merger that will take the best ideas from each algorithm to create one skip entry guidance algorithm for the Orion vehicle.

SHEFEX - the vehicle and sub-systems for a hypersonic re-entry flight experiment

NASA Astrophysics Data System (ADS)

Turner, John; Hörschgen, Marcus; Turner, Peter; Ettl, Josef; Jung, Wolfgang; Stamminger, Andreas

2005-08-01

The purpose of the Sharp Edge Flight Experiment (SHEFEX) is to investigate the aerodynamic behaviour and thermal problems of an unconventional shape for re-entry vehicles, comprising multi-facetted surfaces with sharp edges. The main object of this experiment is the correlation of numerical analysis with real flight data in terms of the aerodynamic effects and structural concept for the thermal protection system (TPS). The Mobile Rocket Base of the German Aerospace Center (DLR) is responsible for the test flight of SHEFEX on a two stage unguided solid propellant sounding rocket which is required to provide a velocity of the order of March 7 for more than 30 seconds during atmospheric re-entry. This paper discusses the problems associated with the mission requirements and the solutions developed for the vehicle and sub-systems.

Orion Entry Monitor

NASA Technical Reports Server (NTRS)

Smith, Kelly M.

2016-01-01

NASA is scheduled to launch the Orion spacecraft atop the Space Launch System on Exploration Mission 1 in late 2018. When Orion returns from its lunar sortie, it will encounter Earth's atmosphere with speeds in excess of 11 kilometers per second, and Orion will attempt its first precision-guided skip entry. A suite of flight software algorithms collectively called the Entry Monitor has been developed in order to enhance crew situational awareness and enable high levels of onboard autonomy. The Entry Monitor determines the vehicle capability footprint in real-time, provides manual piloting cues, evaluates landing target feasibility, predicts the ballistic instantaneous impact point, and provides intelligent recommendations for alternative landing sites if the primary landing site is not achievable. The primary engineering challenges of the Entry Monitor is in the algorithmic implementation in making a highly reliable, efficient set of algorithms suitable for onboard applications.

17 CFR 10.7 - Date of entry of orders.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Date of entry of orders. 10.7 Section 10.7 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION RULES OF PRACTICE General Provisions § 10.7 Date of entry of orders. In computing any period of time involving the date of...

Venus In Situ Explorer Mission design using a mechanically deployed aerodynamic decelerator

NASA Astrophysics Data System (ADS)

Smith, B.; Venkatapathy, E.; Wercinski, P.; Yount, B.; Prabhu, D.; Gage, P.; Glaze, L.; Baker, C.

The Venus In Situ Explorer (VISE) Mission addresses the highest priority science questions within the Venus community outlined in the National Research Council's Decadal Survey. The heritage Venus atmospheric entry system architecture, a 45° sphere-cone rigid aeroshell with a carbon phenolic thermal protection system, may no longer be the preferred entry system architecture compared to other viable alternatives being explored at NASA. A mechanically-deployed aerodynamic decelerator, known as the Adaptive Deployable Entry and Placement Technology (ADEPT), is an entry system alternative that can provide key operational benefits and risk reduction compared to a rigid aeroshell. This paper describes a mission feasibility study performed with the objectives of identifying potential adverse interactions with other mission elements and establishing requirements on decelerator performance. Feasibility is assessed through a launch-to-landing mission design study where the Venus Intrepid Tessera Lander (VITaL), a VISE science payload designed to inform the Decadal Survey results, is repackaged from a rigid aeroshell into the ADEPT decelerator. It is shown that ADEPT reduces the deceleration load on VITaL by an order of magnitude relative to a rigid aeroshell. The more benign entry environment opens up the VISE mission design environment for increased science return, reduced risk, and reduced cost. The ADEPT-VITAL mission concept of operations is presented and details of the entry vehicle structures and mechanisms are given. Finally, entry aerothermal analysis is presented that defines the operational requirements for a revolutionary structural-TPS material employed by ADEPT: three-dimensionally woven carbon cloth. Ongoing work to mitigate key risks identified in this feasibility study is presented.

Implementation of an integrated computerized prescriber order-entry system for chemotherapy in a multisite safety-net health system.

PubMed

Chung, Clement; Patel, Shital; Lee, Rosetta; Fu, Lily; Reilly, Sean; Ho, Tuyet; Lionetti, Jason; George, Michael D; Taylor, Pam

2018-03-15

The development of a computerized prescriber order-entry (CPOE) system for chemotherapy in a multisite safety-net health system and the challenges to its successful implementation are described. Before CPOE for chemotherapy was first implemented and embedded in the electronic medical record system of Harris Health System (HHS), pharmacy personnel relied on regimen-specific preprinted order sets. However, due to differences in practice styles and workflow logistics, the paper orders across the 3 facilities were mostly site specific, with varying clinical content. Many of these order sets had not been approved by the oncology subcommittee. In addition, disparities in clinical knowledge and lack of communication contributed to inconsistencies in order set development. Led by medical directors from medical oncology departments at the 3 facilities, pharmacy administrators, and information technology representatives, HHS committed resources to supporting the adoption and use of a CPOE system for chemotherapy. Five practical lessons of broad applicability have been learned: engagement of interprofessional stakeholders, optimization of workflow before CPOE implementation, requirement of verification tool for CPOE, consolidation of protocols, and commitment to ongoing training and support. Evaluation of the CPOE system demonstrated a systemwide reduction in medication errors by 75% ( p < 0.05). Satisfaction with the CPOE system varied among sites and was unchanged institutionwide 6 months after the CPOE implementation. The development and implementation of CPOE for chemotherapy at a multisite safety-net health system created opportunities to optimize patient care and reduce variations through interprofessional collaborations. Initial evaluation suggested that CPOE reduced the medication-order error rate and improved user satisfaction in 1 of 3 facilities. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Attitude determination with three-axis accelerometer for emergency atmospheric entry

NASA Technical Reports Server (NTRS)

Garcia-Llama, Eduardo (Inventor)

2012-01-01

Two algorithms are disclosed that, with the use of a 3-axis accelerometer, will be able to determine the angles of attack, sideslip and roll of a capsule-type spacecraft prior to entry (at very high altitudes, where the atmospheric density is still very low) and during entry. The invention relates to emergency situations in which no reliable attitude and attitude rate are available. Provided that the spacecraft would not attempt a guided entry without reliable attitude information, the objective of the entry system in such case would be to attempt a safe ballistic entry. A ballistic entry requires three controlled phases to be executed in sequence: First, cancel initial rates in case the spacecraft is tumbling; second, maneuver the capsule to a heat-shield-forward attitude, preferably to the trim attitude, to counteract the heat rate and heat load build up; and third, impart a ballistic bank or roll rate to null the average lift vector in order to prevent prolonged lift down situations. Being able to know the attitude, hence the attitude rate, will allow the control system (nominal or backup, automatic or manual) to cancel any initial angular rates. Also, since a heat-shield forward attitude and the trim attitude can be specified in terms of the angles of attack and sideslip, being able to determine the current attitude in terms of these angles will allow the control system to maneuver the vehicle to the desired attitude. Finally, being able to determine the roll angle will allow for the control of the roll ballistic rate during entry.

Predictors of re-entry into the child protection system in Singapore: a cumulative ecological-transactional risk model.

PubMed

Li, Dongdong; Chu, Chi Meng; Ng, Wei Chern; Leong, Wai

2014-11-01

This study examines the risk factors of re-entry for 1,750 child protection cases in Singapore using a cumulative ecological-transactional risk model. Using administrative data, the present study found that the overall percentage of Child Protection Service (CPS) re-entry in Singapore is 10.5% based on 1,750 cases, with a range from 3.9% (within 1 year) to 16.5% (within 8 years after case closure). One quarter of the re-entry cases were observed to occur within 9 months from case closure. Seventeen risk factors, as identified from the extant literature, were tested for their utility to predict CPS re-entry in this study using a series of Cox regression analyses. A final list of seven risk factors (i.e., children's age at entry, case type, case closure result, duration of case, household income, family size, and mother's employment status) was used to create a cumulative risk score. The results supported the cumulative risk model in that higher risk score is related to higher risk of CPS re-entry. Understanding the prevalence of CPS re-entry and the risk factors associated with re-entry is the key to informing practice and policy in a culturally relevant way. The results from this study could then be used to facilitate critical case management decisions in order to enhance positive outcomes of families and children in Singapore's care system. Copyright © 2014 Elsevier Ltd. All rights reserved.

Lessons from a Successful Implementation of a Computerized Provider Order Entry System

PubMed Central

Jacobs, Brian R.; Hallstrom, Craig K.; Hart, Kim Ward; Mahoney, Daniela; Lykowski, Gayle

2007-01-01

OBJECTIVES The electronic health record (EHR) can improve patient safety, care efficiency, cost effectiveness and regulatory compliance. Cincinnati Children's Hospital Medical Center (CCHMC) has successfully implemented an Integrating Clinical Information System (ICIS) that includes Computerized Provider Order Entry (CPOE). This review describes some of the unanticipated challenges and solutions identified during the implementation of ICIS. METHODS Data for this paper was derived from user-generated feedback within the ICIS. Feedback reports were reviewed and placed into categories based on root cause of the issue. Recurring issues or problems which led to potential or actual patient injury are included. RESULTS Nine distinct challenges were identified: 1) Deterioration in communication; 2) Excessive system alerts to users; 3) Unrecognized discontinuation of medications; 4) Unintended loss of orders; 5) Loss of orders during implementation; 6) Amplification of errors; 7) Unintentional generation of patient care orders by system analysts; 8) Persistence of specific patient care order instructions; 9) Verbal orders entered under the incorrect clinician. CONCLUSIONS Unanticipated challenges are expected when implementing EHRs. The implementation plan for any EHR should include methods to identify, evaluate and repair problems quickly. While continued challenges with this complex system are expected, we believe that the EHR will continue to facilitate improved patient care and safety. The lessons learned at CCHMC will permit other institutions to avoid some of these challenges and design robust processes to detect and respond to problems in a timely fashion to ensure implementation success. PMID:23055847

Prevention of prescription errors by computerized, on-line, individual patient related surveillance of drug order entry.

PubMed

Oliven, A; Zalman, D; Shilankov, Y; Yeshurun, D; Odeh, M

2002-01-01

Computerized prescription of drugs is expected to reduce the number of many preventable drug ordering errors. In the present study we evaluated the usefullness of a computerized drug order entry (CDOE) system in reducing prescription errors. A department of internal medicine using a comprehensive CDOE, which included also patient-related drug-laboratory, drug-disease and drug-allergy on-line surveillance was compared to a similar department in which drug orders were handwritten. CDOE reduced prescription errors to 25-35%. The causes of errors remained similar, and most errors, on both departments, were associated with abnormal renal function and electrolyte balance. Residual errors remaining on the CDOE-using department were due to handwriting on the typed order, failure to feed patients' diseases, and system failures. The use of CDOE was associated with a significant reduction in mean hospital stay and in the number of changes performed in the prescription. The findings of this study both quantity the impact of comprehensive CDOE on prescription errors and delineate the causes for remaining errors.

Ordering the Senses in a Monolingual Dictionary Entry.

ERIC Educational Resources Information Center

Gold, David L.

1986-01-01

Reviews issues to be considered in determining the order of meanings for a lexeme in a dictionary entry and compares techniques for deciding order. Types of ordering include importance, frequency, logical ordering, dominant meaning, syntactic, and historical. (MSE)

Optimizing radiologist e-prescribing of CT oral contrast agent using a protocoling portal.

PubMed

Wasser, Elliot J; Galante, Nicholas J; Andriole, Katherine P; Farkas, Cameron; Khorasani, Ramin

2013-12-01

The purpose of this study is to quantify the time expenditure associated with radiologist ordering of CT oral contrast media when using an integrated protocoling portal and to determine radiologists' perceptions of the ordering process. This prospective study was performed at a large academic tertiary care facility. Detailed timing information for CT inpatient oral contrast orders placed via the computerized physician order entry (CPOE) system was gathered over a 14-day period. Analyses evaluated the amount of physician time required for each component of the ordering process. Radiologists' perceptions of the ordering process were assessed by survey. Descriptive statistics and chi-square analysis were performed. A total of 96 oral contrast agent orders were placed by 13 radiologists during the study period. The average time necessary to create a protocol for each case was 40.4 seconds (average range by subject, 20.0-130.0 seconds; SD, 37.1 seconds), and the average total time to create and sign each contrast agent order was 27.2 seconds (range, 10.0-50.0 seconds; SD, 22.4 seconds). Overall, 52.5% (21/40) of survey respondents indicated that radiologist entry of oral contrast agent orders improved patient safety. A minority of respondents (15% [6/40]) indicated that contrast agent order entry was either very or extremely disruptive to workflow. Radiologist e-prescribing of CT oral contrast agents using CPOE can be embedded in a protocol workflow. Integration of health IT tools can help to optimize user acceptance and adoption.

Analysis of Management Control Techniques for the Data Processing Department at the Navy Finance Center, Cleveland, Ohio.

DTIC Science & Technology

1983-03-01

Sysiem are: Order processinq coordinators Order processing management Credit and collections Accounts receivable Support management Admin ianagemenr...or sales secretary, then by order processing (OP). Phone-in orders go directly to OP. The infor- mation is next Transcribed onto an order entry... ORDER PROCESSING : The central systems validate The order items and codes t!, processing them against the customer file, the prodicT or PA? ts file, and

76 FR 13004 - Self-Regulatory Organizations; C2 Options Exchange, Incorporated; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-09

... Schedule to reduce an away-market routing fee and extend a fee waiver related to the PULSe workstation. The... waiver related to the PULSe workstation. By way of background, the PULSe workstation is a front-end order entry system designed for use with respect to orders that may be sent to the trading systems of C2. In...

Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry.

PubMed

Heffner, John E; Brower, Kathleen; Ellis, Rosemary; Brown, Shirley

2004-07-01

The high cost of computerized physician order entry (CPOE) and physician resistance to standardized care have delayed implementation. An intranet-based order set system can provide some of CPOE's benefits and offer opportunities to acculturate physicians toward standardized care. INTRANET CLINICIAN ORDER FORMS (COF): The COF system at the Medical University of South Carolina (MUSC) allows caregivers to enter and print orders through the intranet at points of care and to access decision support resources. Work on COF began in March 2000 with transfer of 25 MUSC paper-based order set forms to an intranet site. Physician groups developed additional order sets, which number more than 200. Web traffic increased progressively during a 24-month period, peaking at more than 6,400 hits per month to COF. Decision support tools improved compliance with Centers for Medicare & Medicaid Services core indicators. Clinicians demonstrated a willingness to develop and use order sets and decision support tools posted on the COF site. COF provides a low-cost method for preparing caregivers and institutions to adopt CPOE and standardization of care. The educational resources, relevant links to external resources, and communication alerts will all link to CPOE, thereby providing a head start in CPOE implementation.

Optimizing the user interface of a data entry module for an electronic patient record for cardiac rehabilitation: A mixed method usability approach.

PubMed

van Engen-Verheul, Mariëtte M; Peute, Linda W P; de Keizer, Nicolette F; Peek, Niels; Jaspers, Monique W M

2016-03-01

Cumbersome electronic patient record (EPR) interfaces may complicate data-entry in clinical practice. Completeness of data entered in the EPR determines, among other things, the value of computerized clinical decision support (CCDS). Quantitative usability evaluations can provide insight into mismatches between the system design model of data entry and users' data entry behavior, but not into the underlying causes for these mismatches. Mixed method usability evaluation studies may provide these insights, and thus support generating redesign recommendations for improving an EPR system's data entry interface. To improve the usability of the data entry interface of an EPR system with CCDS in the field of cardiac rehabilitation (CR), and additionally, to assess the value of a mixed method usability approach in this context. Seven CR professionals performed a think-aloud usability evaluation both before (beta-version) and after the redesign of the system. Observed usability problems from both evaluations were analyzed and categorized using Zhang et al.'s heuristic principles of good interface design. We combined the think-aloud usability evaluation of the system's beta-version with the measurement of a new usability construct: users' deviations in action sequence from the system's predefined data entry order sequence. Recommendations for redesign were implemented. We assessed whether the redesign improved CR professionals' (1) task efficacy (with respect to the completeness of data they collected), and (2) task efficiency (with respect to the average number of mouse clicks they needed to complete data entry subtasks). With the system's beta version, 40% of health care professionals' navigation actions through the system deviated from the predefined next system action. The causes for these deviations as revealed by the think-aloud method mostly concerned mismatches between the system design model for data entry action sequences and users expectations of these action sequences, based on their paper-based daily routines. This caused non completion of data entry tasks (31% of main tasks completed), and more navigation actions than minimally required (146% of the minimum required). In the redesigned system the data entry navigational structure was organized in a flexible way around an overview screen to better mimic users' paper-based daily routines of collecting patient data. This redesign resulted in an increased number of completed main tasks (70%) and a decrease in navigation actions (133% of the minimum required). The think-aloud usability evaluation of the redesigned system showed that remaining problems concerned flexibility (e.g., lack of customization options) and consistency (mainly with layout and position of items on the screen). The mixed method usability evaluation was supportive in revealing the magnitude and causes of mismatches between the system design model of data-entry with users' data entry behavior. However, as both task efficacy and efficiency were still not optimal with the redesigned EPR, we advise to perform a cognitive analysis on end users' mental processes and behavior patterns in daily work processes specifically during the requirements analysis phase of development of interactive healthcare information systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Use of Order Sets in Inpatient Computerized Provider Order Entry Systems: A Comparative Analysis of Usage Patterns at Seven Sites

PubMed Central

Wright, Adam; Feblowitz, Joshua C.; Pang, Justine E.; Carpenter, James D.; Krall, Michael A.; Middleton, Blackford; Sittig, Dean F.

2012-01-01

Background Many computerized provider order entry (CPOE) systems include the ability to create electronic order sets: collections of clinically-related orders grouped by purpose. Order sets promise to make CPOE systems more efficient, improve care quality and increase adherence to evidence-based guidelines. However, the development and implementation of order sets can be expensive and time-consuming and limited literature exists about their utilization. Methods Based on analysis of order set usage logs from a diverse purposive sample of seven sites with commercially- and internally-developed inpatient CPOE systems, we developed an original order set classification system. Order sets were categorized across seven non-mutually exclusive axes: admission/discharge/transfer (ADT), perioperative, condition-specific, task-specific, service-specific, convenience, and personal. In addition, 731 unique subtypes were identified within five axes: four in ADT (S=4), three in perioperative, 144 in condition-specific, 513 in task-specific, and 67 in service-specific. Results Order sets (n=1,914) were used a total of 676,142 times at the participating sites during a one-year period. ADT and perioperative order sets accounted for 27.6% and 24.2% of usage respectively. Peripartum/labor, chest pain/Acute Coronary Syndrome/Myocardial Infarction and diabetes order sets accounted for 51.6% of condition-specific usage. Insulin, angiography/angioplasty and arthroplasty order sets accounted for 19.4% of task-specific usage. Emergency/trauma, Obstetrics/Gynecology/Labor Delivery and anesthesia accounted for 32.4% of service-specific usage. Overall, the top 20% of order sets accounted for 90.1% of all usage. Additional salient patterns are identified and described. Conclusion We observed recurrent patterns in order set usage across multiple sites as well as meaningful variations between sites. Vendors and institutional developers should identify high-value order set types through concrete data analysis in order to optimize the resources devoted to development and implementation. PMID:22819199

Woven Thermal Protection System Based Heat-shield for Extreme Entry Environments Technology (HEEET)

NASA Technical Reports Server (NTRS)

Ellerby, Donald; Venkatapathy, Ethiraj; Stackpoole, Margaret; Chinnapongse, Ronald; Munk, Michelle; Dillman, Robert; Feldman, Jay; Prabhu, Dinesh; Beerman, Adam

2013-01-01

NASA's future robotic missions utilizing an entry system into Venus and the outer planets, namely, Saturn, Uranus, Neptune, result in extremely high entry conditions that exceed the capabilities of state of the art low to mid density ablators such as PICA or Avcoat. Therefore mission planners typically assume the use of a fully dense carbon phenolic heat shield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic is a robust TPS material however its high density and relatively high thermal conductivity constrain mission planners to steep entries, with high heat fluxes and pressures and short entry durations, in order for CP to be feasible from a mass perspective. The high entry conditions pose challenges for certification in existing ground based test facilities and the longer-term sustainability of CP will continue to pose challenges. In 2012 the Game Changing Development Program (GCDP) in NASA's Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System (WTPS) to meet the needs of NASA's most challenging entry missions. This project was highly successful demonstrating that a Woven TPS solution compares favorably to CP in performance in simulated reentry environments and provides the opportunity to manufacture graded materials that should result in overall reduced mass solutions and enable a much broader set of missions than does CP. Building off the success of the WTPS project GCDP has funded a follow on project to further mature and scale up the WTPS concept for insertion into future NASA robotic missions. The matured WTPS will address the CP concerns associated with ground based test limitations and sustainability. This presentation will briefly discuss results from the WTPS Project and the plans for WTPS maturation into a heat-shield for extreme entry environment.

Woven Thermal Protection System Based Heat-shield for Extreme Entry Environments Technology (HEEET)

NASA Technical Reports Server (NTRS)

Chinnapongse, Ronald; Ellerbe, Donald; Stackpoole, Maragaret; Venkatapathy, Ethiraj; Beerman, Adam; Feldman, Jay; Peterson Keith; Prabhu, Dinesh; Dillman, Robert; Munk, Michelle

2013-01-01

NASA's future robotic missions utilizing an entry system into Venus and the outer planets, namely, Saturn, Uranus, Neptune, result in extremely severe entry conditions that exceed the capabilities of state of the art low to mid density ablators such as PICA or Avcoat. Therefore mission planners typically assume the use of a fully dense carbon phenolic heat shield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic (CP) is a robust TPS material however its high density and relatively high thermal conductivity constrain mission planners to steep entries, with high heat fluxes and pressures and short entry durations, in order for CP to be feasible from a mass perspective. The high entry conditions pose challenges for certification in existing ground based test facilities and the longer-­-term sustainability of CP will continue to pose challenges. In 2012 the Game Changing Development Program (GCDP) in NASA's Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System (WTPS) to meet the needs of NASA's most challenging entry missions. This project was highly successful demonstrating that a Woven TPS solution compares favorably to CP in performance in simulated reentry environments and provides the opportunity to manufacture graded materials that should result in overall reduced mass solutions and enable a much broader set of missions than does CP. Building off the success of the WTPS project GCDP has funded a follow on project to further mature and scale up the WTPS concept for insertion into future NASA robotic missions. The matured WTPS will address the CP concerns associated with ground based test limitations and sustainability. This presentation will briefly discuss results from the WTPS Project and the plans for WTPS maturation into a heat-­-shield for extreme entry environment.

Design and Use of a Joint Order Vocabulary Knowledge Representation Tier in a Multi-tier CPOE Architecture

PubMed Central

Rucker, Donald W.; Steele, Andrew W.; Douglas, Ivor S.; Couderc, Carmela A.; Hardel, Gary G.

2006-01-01

Two major barriers to adoption of computerized physician order entry (CPOE) systems are the initial physician effort to learn the system and ongoing time costs to use the system. These barriers stem from the CPOE system’s need to reformulate physician orders into services that can be electronically communicated to ancillary clinical systems such as pharmacy, nursing, lab or radiology as well as to billing systems. Typical CPOE systems use significant custom user interface programming to match the terms used by physicians to order services as well as the aggregation of those orders into order sets with the underlying orderable services. We describe the design and implementation of a commercial CPOE system that has a formal separate intermediate mapping layer to match physician screen vocabulary and ordering behaviors to underlying services, both individually and in groups, supported by powerful search tools. PMID:17238425

Analytic Guidance for the First Entry in a Skip Atmospheric Entry

NASA Technical Reports Server (NTRS)

Garcia-Llama, Eduardo

2007-01-01

This paper presents an analytic method to generate a reference drag trajectory for the first entry portion of a skip atmospheric entry. The drag reference, expressed as a polynomial function of the velocity, will meet the conditions necessary to fit the requirements of the complete entry phase. The generic method proposed to generate the drag reference profile is further simplified by thinking of the drag and the velocity as density and cumulative distribution functions respectively. With this notion it will be shown that the reference drag profile can be obtained by solving a linear algebraic system of equations. The resulting drag profile is flown using the feedback linearization method of differential geometric control as guidance law with the error dynamics of a second order homogeneous equation in the form of a damped oscillator. This approach was first proposed as a revisited version of the Space Shuttle Orbiter entry guidance. However, this paper will show that it can be used to fly the first entry in a skip entry trajectory. In doing so, the gains in the error dynamics will be changed at a certain point along the trajectory to improve the tracking performance.

Care provider order entry (CPOE): a perspective on factors leading to success or to failure.

PubMed

Ozdas, A; Miller, R A

2007-01-01

Authors provide a perspective on factors leading to successful care provider order entry (CPOE) implementations. Viewpoint of authors supported by background literature review. Authors review both benefits and challenges related to CPOE implementation using three guiding principles: (1) a clinical approach to clinical systems, which claims that CPOE implementation is analogous to a "good" clinician delivering care to a patient; (2) a commitment to quality, which advocates that no compromises should be made in implementing system functionality and clinical system content - the highest objective for CPOE implementation is to provide better quality of care and increased safety for patients; (3) a commitment to fairness, as evidenced by respect for individuals and support of local autonomy, which advocates for minimizing disruptions to clinician-users' workflows, and adequate local control over CPOE system design and evolution, including clinical content management. Past experiences with CPOE implementation can inform future installation attempts. Sociocultural factors dominate in determining the success of implementation, and should govern technical factors.

Shuttle Entry Air Data System (SEADS) hardware development. Volume 1: Summary

NASA Technical Reports Server (NTRS)

While, D. M.

1983-01-01

Hardware development of the Shuttle Entry Data System (SEADS) is described. The system consists of an array of fourteen pressure ports, installed in an Orbiter nose cap, which, when coupled with existing fuselage mounted static pressure ports permits computation of entry flight parameters. Elements of the system that are described include the following: (1) penetration assemblies to place pressure port openings at the surface of the nose cap; (2) pressure tubes to transmit the surface pressure to transducers; (3) support posts or manifolds to provide support for, and reduce the length of, the individual pressure tubes; (4) insulation for the manifolds; and (5) a SEADS nose cap. Design, analyses, and tests to develop and certify design for flight are described. Specific tests include plasma arc exposure, radiant thermal, vibration, and structural. Volume one summarizes highlights of the program, particularly as they relate to the final design of SEADS. Volume two summarizes all of the Vought responsible activities in essentially a chronological order.

Shuttle Entry Air Data System (SEADS) hardware development. Volume 2: History

NASA Technical Reports Server (NTRS)

While, D. M.

1983-01-01

Hardware development of the Shuttle Entry Air Data System (SEADS) is described. The system consists of an array of fourteen pressure ports, installed in an Orbiter nose cap, which, when coupled with existing fuselage mounted static pressure ports permits computation of entry flight parameters. Elements of the system that are described include the following: (1) penetration assemblies to place pressure port openings at the surface of the nose cap; (2) pressure tubes to transmit the surface pressure to transducers; (3) support posts or manifolds to provide support for, and reduce the length of, the individual pressure tubes; (4) insulation for the manifolds; and (5) a SEADS nose cap. Design, analyses, and tests to develop and certify design for flight are described. Specific tests included plasma arc exposure, radiant thermal, vibration, and structural. Volume one summarizes highlights of the program, particularly as they relate to the final design of SEADS. Volume two summarizes all of the Vought responsible activities in essentially a chronological order.

Computerized Physician Order Entry

PubMed Central

Khanna, Raman; Yen, Tony

2014-01-01

Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks. PMID:24381708

Evaluation and implementation of chemotherapy regimen validation in an electronic health record.

PubMed

Diaz, Amber H; Bubalo, Joseph S

2014-12-01

Computerized provider order entry of chemotherapy regimens is quickly becoming the standard for prescribing chemotherapy in both inpatient and ambulatory settings. One of the difficulties with implementation of chemotherapy regimen computerized provider order entry lies in verifying the accuracy and completeness of all regimens built in the system library. Our goal was to develop, implement, and evaluate a process for validating chemotherapy regimens in an electronic health record. We describe our experience developing and implementing a process for validating chemotherapy regimens in the setting of a standard, commercially available computerized provider order entry system. The pilot project focused on validating chemotherapy regimens in the adult inpatient oncology setting and adult ambulatory hematologic malignancy setting. A chemotherapy regimen validation process was defined as a result of the pilot project. Over a 27-week pilot period, 32 chemotherapy regimens were validated using the process we developed. Results of the study suggest that by validating chemotherapy regimens, the amount of time spent by pharmacists in daily chemotherapy review was decreased. In addition, the number of pharmacist modifications required to make regimens complete and accurate were decreased. Both physician and pharmacy disciplines showed improved satisfaction and confidence levels with chemotherapy regimens after implementation of the validation system. Chemotherapy regimen validation required a considerable amount of planning and time but resulted in increased pharmacist efficiency and improved provider confidence and satisfaction. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

75 FR 43590 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of Proposed Rule...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-26

... PHLX, Inc. Relating to Order Re-Entry July 20, 2010. Pursuant to section 19(b)(1) of the Securities... a system enhancement that automatically re-enters unexecuted contracts when, after trading at the..., upon the written instruction of the member that initially submitted the order, re-submit unexecuted...

17 CFR Appendix A to Part 37 - Guidance on Compliance With Registration Criteria

Code of Federal Regulations, 2011 CFR

2011-04-01

... facility should include the system's trade-matching algorithm and order entry procedures. A submission involving a trade-matching algorithm that is based on order priority factors other than on a best price/earliest time basis should include a brief explanation of the alternative algorithm. (b) A board of trade's...

17 CFR Appendix A to Part 37 - Guidance on Compliance With Registration Criteria

Code of Federal Regulations, 2012 CFR

2012-04-01

... facility should include the system's trade-matching algorithm and order entry procedures. A submission involving a trade-matching algorithm that is based on order priority factors other than on a best price/earliest time basis should include a brief explanation of the alternative algorithm. (b) A board of trade's...

19 CFR 143.35 - Procedure for electronic entry summary.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 2 2012-04-01 2012-04-01 false Procedure for electronic entry summary. 143.35...; DEPARTMENT OF THE TREASURY (CONTINUED) SPECIAL ENTRY PROCEDURES Electronic Entry Filing § 143.35 Procedure for electronic entry summary. In order to obtain entry summary processing electronically, the filer...

19 CFR 143.35 - Procedure for electronic entry summary.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 2 2011-04-01 2011-04-01 false Procedure for electronic entry summary. 143.35...; DEPARTMENT OF THE TREASURY (CONTINUED) SPECIAL ENTRY PROCEDURES Electronic Entry Filing § 143.35 Procedure for electronic entry summary. In order to obtain entry summary processing electronically, the filer...

19 CFR 143.35 - Procedure for electronic entry summary.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Procedure for electronic entry summary. 143.35...; DEPARTMENT OF THE TREASURY (CONTINUED) SPECIAL ENTRY PROCEDURES Electronic Entry Filing § 143.35 Procedure for electronic entry summary. In order to obtain entry summary processing electronically, the filer...

[Health personnel assessment about medical order entry systems of pharmacologic treatments in hospitalized patients].

PubMed

Villamañán, E; Larrubia, Y; Ruano, M; Moro, M; Sierra, A; Pérez, E; Herrero, A; Álvarez-Sala, R

2013-01-01

to evaluate health personnel perceptions about medical order entry systems concerning the effect on workflow, medication errors risk and assessment of its potential advantages. A cross-section opinion interview was conducted in a tertiary care hospital. Questionnaire consisted of three sections: perception of its effect on workflow, influence on medication error risk and assessment of potential advantages. We also asked them to assess drawbacks and provide suggestions about this prescription system. 76 health professionals were interviewed (58 physicians, 9 pharmacists and 9 nurses). They were satisfied mainly due to decrease the workload (85.5%; IC 95%: 75.58-92.55). They thought that the main characteristics that contribute to reduce medication errors are clinical decision supports related to predefined aspects which the program provided by default. Among potential benefits of medical order entry systems, legibility and warnings triggered by the program (98.7%; IC 95%: 92.90-99.97 and 97,4%; IC 95%: 90.81-99.68 respectively) were the most valuable. High technology dependence, IT failures and lack of infrastructure and medication therapy discontinuities at times of transition between different hospitals' units were the main drawbacks considered. The most repeated suggestion was related to the improvement of links between other health informatics applications used in the hospital. health personnel were highly satisfied with the CPOE system, which is considered to be effective and safe. Technology dependence and IT failures were the main disadvantages reported. According to them, a greater coordination and unification of all software applications available in the hospital would be desirable. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

Human Mars Entry, Descent and Landing Architectures Study Overview

NASA Technical Reports Server (NTRS)

Polsgrove, Tara T.; Dwyer Cianciolo, Alicia

2016-01-01

Landing humans on Mars will require entry, descent and landing (EDL) capability beyond the current state of the art. Nearly twenty times more delivered payload and an order of magnitude improvement in precision landing capability will be necessary. Several EDL technologies capable of meeting the human class payload delivery requirements are being considered. The EDL technologies considered include low lift-to-drag vehicles like Hypersonic Inflatable Aerodynamic Decelerators (HIAD), Adaptable Deployable Entry and Placement Technology (ADEPT), and mid range lift-to-drag vehicles like rigid aeroshell configurations. To better assess EDL technology options and sensitivities to future human mission design variations, a series of design studies has been conducted. The design studies incorporate EDL technologies with conceptual payload arrangements defined by the Evolvable Mars Campaign to evaluate the integrated system with higher fidelity than have been performed to date. This paper describes the results of the design studies for a lander design using the HIAD, ADEPT and rigid shell entry technologies and includes system and subsystem design details including mass and power estimates. This paper will review the point design for three entry configurations capable of delivering a 20 t human class payload to the surface of Mars.

77 FR 71185 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-29

... dependents.'' Categories of records in the system: Delete entry and replace with ``Name, Social Security..., security clearance, spouse information, child information, military records, military orders and expense... collection of spouse and child information to be used for updates to the military member's dependency status...

Aeronautical engineering, a special bibliography, September 1971 (supplement 10)

NASA Technical Reports Server (NTRS)

1971-01-01

This supplement to Aeronautical Engineering-A Special Bibliography (NASA SP-7037) lists 413 reports, journal articles, and other documents originally announced in September 1971 in Scientific and Technical Aerospace Reports (STAR) or in International Aerospace Abstracts (IAA). The coverage includes documents on the engineering and theoretical aspects of design, construction, evaluation, testing, operation, and performance of aircraft (including aircraft engines) and associated components, equipment, and systems. It also includes research and development in aerodynamics, aeronautics, and ground support equipment for aeronautical vehicles. Each entry in the bibliography consists of a standard bibliographic citation accompanied by an abstract. The listing of the entries is arranged in two major sections, IAA Entries and STAR Entries in that order. The citations and abstracts are reproduced exactly as they appeared originally in IAA or STAR, including the original accession numbers from the respective announcement journals.

76 FR 30417 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-25

... Change Amending Rule 7.31(h)(5) To Reduce the Minimum Order Entry Size of a Mid-Point Passive Liquidity... order entry size of a Mid-Point Passive Liquidity Order (``MPL Order'') from 100 shares to one share...

Mechanical Testing of Carbon Based Woven Thermal Protection Materials

NASA Technical Reports Server (NTRS)

Pham, John; Agrawal, Parul; Arnold, James O.; Peterson, Keith; Venkatapathy, Ethiraj

2013-01-01

Three Dimensional Woven thermal protection system (TPS) materials are one of the enabling technologies for mechanically deployable hypersonic decelerator systems. These materials have been shown capable of serving a dual purpose as TPS and as structural load bearing members during entry and descent operations. In order to ensure successful structural performance, it is important to characterize the mechanical properties of these materials prior to and post exposure to entry-like heating conditions. This research focuses on the changes in load bearing capacity of woven TPS materials after being subjected to arcjet simulations of entry heating. Preliminary testing of arcjet tested materials [1] has shown a mechanical degradation. However, their residual strength is significantly more than the requirements for a mission to Venus [2]. A systematic investigation at the macro and microstructural scales is reported here to explore the potential causes of this degradation. The effects of heating on the sizing (an epoxy resin coating used to reduce friction and wear during fiber handling) are discussed as one of the possible causes for the decrease in mechanical properties. This investigation also provides valuable guidelines for margin policies for future mechanically deployable entry systems.

Introducing Physician Order Entry at a Major Academic Medical Center: I. Impact on Organizational Culture and Behavior.

ERIC Educational Resources Information Center

Massaro, Thomas A.

1993-01-01

Implementation of the University of Virginia Medical Center's computerized system for mandatory recordkeeping of physician orders is discussed, focusing on administrative issues: delays, costs, disruption of work routine and behavior, and the need to bring in a senior management team. Recommendations are made for institutions with similar…

Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems.

PubMed

Aziz, Muhammad Tahir; Ur-Rehman, Tofeeq; Qureshi, Sadia; Bukhari, Nadeem Irfan

Medication errors in chemotherapy are frequent and lead to patient morbidity and mortality, as well as increased rates of re-admission and length of stay, and considerable extra costs. Objective: This study investigated the proposition that computerised chemotherapy ordering reduces the incidence and severity of chemotherapy protocol errors. A computerised physician order entry of chemotherapy order (C-CO) with clinical decision support system was developed in-house, including standardised chemotherapy protocol definitions, automation of pharmacy distribution, clinical checks, labeling and invoicing. A prospective study was then conducted in a C-CO versus paper based chemotherapy order (P-CO) in a 30-bed chemotherapy bay of a tertiary hospital. Both C-CO and P-CO orders, including pharmacoeconomic analysis and the severity of medication errors, were checked and validated by a clinical pharmacist. A group analysis and field trial were also conducted to assess clarity, feasibility and decision making. The C-CO was very usable in terms of its clarity and feasibility. The incidence of medication errors was significantly lower in the C-CO compared with the P-CO (10/3765 [0.26%] versus 134/5514 [2.4%]). There was also a reduction in dispensing time of chemotherapy protocols in the C-CO. The chemotherapy computerisation with clinical decision support system resulted in a significant decrease in the occurrence and severity of medication errors, improvements in chemotherapy dispensing and administration times, and reduction of chemotherapy cost.

Computerized physician order entry: promise, perils, and experience.

PubMed

Khanna, Raman; Yen, Tony

2014-01-01

Computerized physician order entry (CPOE) has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice. In practice, however, CPOE affects health care delivery in complex ways, with benefits as well as risks. Every implementation of CPOE is associated with both generally recognized and unique local factors that can facilitate or confound its rollout, and neurohospitalists will often be at the forefront of such rollouts. In this article, we review the literature on CPOE, beginning with definitions and proceeding to comparisons to the standard of care. We then proceed to discuss clinical decision support systems, negative aspects of CPOE, and cultural context of CPOE implementation. Before concluding, we follow the experiences of a Chief Medical Information Officer and neurohospitalist who rolled out a CPOE system at his own health care organization and managed the resulting workflow changes and setbacks.

Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior.

PubMed

Kawamoto, Kensaku; Lobach, David F

2003-01-01

Computerized physician order entry (CPOE) systems represent an important tool for providing clinical decision support. In undertaking this systematic review, our objective was to identify the features of CPOE-based clinical decision support systems (CDSSs) most effective at modifying clinician behavior. For this review, two independent reviewers systematically identified randomized controlled trials that evaluated the effectiveness of CPOE-based CDSSs in changing clinician behavior. Furthermore, each included study was assessed for the presence of 14 CDSS features. We screened 10,023 citations and included 11 studies. Of the 10 studies comparing a CPOE-based CDSS intervention against a non-CDSS control group, 7 reported a significant desired change in professional practice. Moreover, meta-regression analysis revealed that automatic provision of the decision support was strongly associated with improved professional practice (adjusted odds ratio, 23.72; 95% confidence interval, 1.75-infiniti). Thus, we conclude that automatic provision of decision support is a critical feature of successful CPOE-based CDSS interventions.

Electronic security device

DOEpatents

Eschbach, E.A.; LeBlanc, E.J.; Griffin, J.W.

1992-03-17

The present invention relates to a security device having a control box containing an electronic system and a communications loop over which the system transmits a signal. The device is constructed so that the communications loop can extend from the control box across the boundary of a portal such as a door into a sealed enclosure into which access is restricted whereby the loop must be damaged or moved in order for an entry to be made into the enclosure. The device is adapted for detecting unauthorized entries into such enclosures such as rooms or containers and for recording the time at which such entries occur for later reference. Additionally, the device detects attempts to tamper or interfere with the operation of the device itself and records the time at which such events take place. In the preferred embodiment, the security device includes a microprocessor-based electronic system and a detection module capable of registering changes in the voltage and phase of the signal transmitted over the loop. 11 figs.

Electronic security device

DOEpatents

Eschbach, Eugene A.; LeBlanc, Edward J.; Griffin, Jeffrey W.

1992-01-01

The present invention relates to a security device having a control box (12) containing an electronic system (50) and a communications loop (14) over which the system transmits a signal. The device is constructed so that the communications loop can extend from the control box across the boundary of a portal such as a door into a sealed enclosure into which access is restricted whereby the loop must be damaged or moved in order for an entry to be made into the enclosure. The device is adapted for detecting unauthorized entries into such enclosures such as rooms or containers and for recording the time at which such entries occur for later reference. Additionally, the device detects attempts to tamper or interfere with the operation of the device itself and records the time at which such events take place. In the preferred embodiment, the security device includes a microprocessor-based electronic system (50) and a detection module (72) capable of registering changes in the voltage and phase of the signal transmitted over the loop.

78 FR 9749 - Self-Regulatory Organizations; EDGA Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-11

... physical port that connects to the Exchange's System via 1 gigabyte Fiber circuits; and $1,000 per physical port that connects to the Exchange's System via 10 gigabyte Fiber circuits. In addition, the Exchange...-Members to connect to the Exchange's System \\5\\ for order entry and the receipt of Exchange data, among...

78 FR 9763 - Self-Regulatory Organizations; EDGX Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-11

... physical port that connects to the Exchange's System via 1 gigabyte Fiber circuits; and $1,000 per physical port that connects to the Exchange's System via 10 gigabyte Fiber circuits. In addition, the Exchange...-Members to connect to the Exchange's System \\5\\ for order entry and the receipt of Exchange data, among...

Automation of Command and Data Entry in a Glovebox Work Volume: An Evaluation of Data Entry Devices

NASA Technical Reports Server (NTRS)

Steele, Marianne K.; Nakamura, Gail; Havens, Cindy; LeMay, Moira

1996-01-01

The present study was designed to examine the human-computer interface for data entry while performing experimental procedures within a glovebox work volume in order to make a recommendation to the Space Station Biological Research Project for a data entry system to be used within the Life Sciences Glovebox. Test subjects entered data using either a manual keypad, similar to a standard computer numerical keypad located within the glovebox work volume, or a voice input system using a speech recognition program with a microphone headset. Numerical input and commands were programmed in an identical manner between the two systems. With both electronic systems, a small trackball was available within the work volume for cursor control. Data, such as sample vial identification numbers, sample tissue weights, and health check parameters of the specimen, were entered directly into procedures that were electronically displayed on a video monitor within the glovebox. A pen and paper system with a 'flip-chart' format for procedure display, similar to that currently in use on the Space Shuttle, was used as a baseline data entry condition. Procedures were performed by a single operator; eight test subjects were used in the study. The electronic systems were tested under both a 'nominal' or 'anomalous' condition. The anomalous condition was introduced into the experimental procedure to increase the probability of finding limitations or problems with human interactions with the electronic systems. Each subject performed five test runs during a test day: two procedures each with voice and keypad, one with and one without anomalies, and one pen and paper procedure. The data collected were both quantitative (times, errors) and qualitative (subjective ratings of the subjects).

Aerodynamic Interactions of Propulsive Deceleration and Reaction Control System Jets on Mars-Entry Aeroshells

NASA Astrophysics Data System (ADS)

Alkandry, Hicham

Future missions to Mars, including sample-return and human-exploration missions, may require alternative entry, descent, and landing technologies in order to perform pinpoint landing of heavy vehicles. Two such alternatives are propulsive deceleration (PD) and reaction control systems (RCS). PD can slow the vehicle during Mars atmospheric descent by directing thrusters into the incoming freestream. RCS can provide vehicle control and steering by inducing moments using thrusters on the hack of the entry capsule. The use of these PD and RCS jets, however, involves complex flow interactions that are still not well understood. The fluid interactions induced by PD and RCS jets for Mars-entry vehicles in hypersonic freestream conditions are investigated using computational fluid dynamics (CFD). The effects of central and peripheral PD configurations using both sonic and supersonic jets at various thrust conditions are examined in this dissertation. The RCS jet is directed either parallel or transverse to the freestream flow at different thrust conditions in order to examine the effects of the thruster orientation with respect to the center of gravity of the aeroshell. The physical accuracy of the computational method is also assessed by comparing the numerical results with available experimental data. The central PD configuration decreases the drag force acting on the entry capsule due to a shielding effect that prevents mass and momentum in the hypersonic freestream from reaching the aeroshell. The peripheral PD configuration also decreases the drag force by obstructing the flow around the aeroshell and creating low surface pressure regions downstream of the PD nozzles. The Mach number of the PD jets, however, does not have a significant effect on the induced fluid interactions. The reaction control system also alters the flowfield, surface, and aerodynamic properties of the aeroshell, while the jet orientation can have a significant effect on the control effectiveness of the RCS.

A Cross-site Qualitative Study of Physician Order Entry

PubMed Central

Ash, Joan S.; Gorman, Paul N.; Lavelle, Mary; Payne, Thomas H.; Massaro, Thomas A.; Frantz, Gerri L.; Lyman, Jason A.

2003-01-01

Objective: To describe the perceptions of diverse professionals involved in computerized physician order entry (POE) at sites where POE has been successfully implemented and to identify differences between teaching and nonteaching hospitals. Design: A multidisciplinary team used observation, focus groups, and interviews with clinical, administrative, and information technology staff to gather data at three sites. Field notes and transcripts were coded using an inductive approach to identify patterns and themes in the data. Measurements: Patterns and themes concerning perceptions of POE were identified. Results: Four high-level themes were identified: (1) organizational issues such as collaboration, pride, culture, power, politics, and control; (2) clinical and professional issues involving adaptation to local practices, preferences, and policies; (3) technical/implementation issues, including usability, time, training and support; and (4) issues related to the organization of information and knowledge, such as system rigidity and integration. Relevant differences between teaching and nonteaching hospitals include extent of collaboration, staff longevity, and organizational missions. Conclusion: An organizational culture characterized by collaboration and trust and an ongoing process that includes active clinician engagement in adaptation of the technology were important elements in successful implementation of physician order entry at the institutions that we studied. PMID:12595408

Effectiveness of a real-time clinical decision support system for computerized physician order entry of plasma orders.

PubMed

Yazer, Mark H; Triulzi, Darrell J; Reddy, Vivek; Waters, Jonathan H

2013-12-01

We investigated the effect of implementing adaptive plasma ordering criteria in the computerized physician order entry (CPOE) system, with alerts that were automatically generated if the recipient's antecedent international normalized ratio (INR) did not meet the institutional criteria. In a regional health care system consisting of 11 hospitals using a common CPOE, data on the number of plasma orders and alerts that were generated were collected over a 4-month period before prescribers were required to select an indication for plasma. When adaptive ordering was implemented prescribers had to choose from prepopulated indications for plasma: INR of 1.6 or greater with bleeding, INR of 1.6 or greater before an invasive procedure, therapeutic exchange, massive transfusion, and other. Regardless of the antecedent INR the alert did not trigger if massive transfusion or plasmapheresis was selected. Information on prescribers and recipients was collected during this 5-month period. In the 4-month period before the adaptive alerts were implemented, 42.9% of the plasma orders generated an alert; in the 5-month period thereafter the alert rate was significantly lower at 27.9% (p < 0.0001). The percentage of heeded alerts increased during the adaptive alert period (24.3% vs. 17.1%, respectively, p = 0.004). A significant percentage (45%) of other plasma orders were for periprocedure or bleeding patients whose antecedent INR was less than 1.6. There were significant differences in prescriber specialties among those who ordered plasma using the other indication compared to all plasma orders. Electronic interventions improve compliance with plasma guidelines but as implemented are not sufficient to completely curtail non-evidence-based ordering. © 2013 American Association of Blood Banks.

Passive vs. Parachute System Architecture for Robotic Sample Return Vehicles

NASA Technical Reports Server (NTRS)

Maddock, Robert W.; Henning, Allen B.; Samareh, Jamshid A.

2016-01-01

The Multi-Mission Earth Entry Vehicle (MMEEV) is a flexible vehicle concept based on the Mars Sample Return (MSR) EEV design which can be used in the preliminary sample return mission study phase to parametrically investigate any trade space of interest to determine the best entry vehicle design approach for that particular mission concept. In addition to the trade space dimensions often considered (e.g. entry conditions, payload size and mass, vehicle size, etc.), the MMEEV trade space considers whether it might be more beneficial for the vehicle to utilize a parachute system during descent/landing or to be fully passive (i.e. not use a parachute). In order to evaluate this trade space dimension, a simplified parachute system model has been developed based on inputs such as vehicle size/mass, payload size/mass and landing requirements. This model works in conjunction with analytical approximations of a mission trade space dataset provided by the MMEEV System Analysis for Planetary EDL (M-SAPE) tool to help quantify the differences between an active (with parachute) and a passive (no parachute) vehicle concept.

Trajectory Guidance for Mars Robotic Precursors: Aerocapture, Entry, Descent, and Landing

NASA Technical Reports Server (NTRS)

Sostaric, Ronald R.; Zumwalt, Carlie; Garcia-Llama, Eduardo; Powell, Richard; Shidner, Jeremy

2011-01-01

Future crewed missions to Mars require improvements in landed mass capability beyond that which is possible using state-of-the-art Mars Entry, Descent, and Landing (EDL) systems. Current systems are capable of an estimated maximum landed mass of 1-1.5 metric tons (MT), while human Mars studies require 20-40 MT. A set of technologies were investigated by the EDL Systems Analysis (SA) project to assess the performance of candidate EDL architectures. A single architecture was selected for the design of a robotic precursor mission, entitled Exploration Feed Forward (EFF), whose objective is to demonstrate these technologies. In particular, inflatable aerodynamic decelerators (IADs) and supersonic retro-propulsion (SRP) have been shown to have the greatest mass benefit and extensibility to future exploration missions. In order to evaluate these technologies and develop the mission, candidate guidance algorithms have been coded into the simulation for the purposes of studying system performance. These guidance algorithms include aerocapture, entry, and powered descent. The performance of the algorithms for each of these phases in the presence of dispersions has been assessed using a Monte Carlo technique.

Evaluation of real-time clinical decision support systems for platelet and cryoprecipitate orders.

PubMed

Collins, Ryan A; Triulzi, Darrell J; Waters, Jonathan H; Reddy, Vivek; Yazer, Mark H

2014-01-01

To evaluate cryoprecipitate and platelet ordering practices after the implementation of real-time clinical decision support systems (CDSSs) in a computerized physician order entry (CPOE) system. Uniform platelet and cryoprecipitate transfusion thresholds were implemented at 11 hospitals in a regional health care system with a common CPOE system. Over 6 months, a variety of information was collected on the ordering physicians and the number of alerts generated by the CDSSs when these products were ordered outside of the institutional guidelines. There were 1,889 orders for platelets and 152 orders for cryoprecipitate placed in 6 months. Of these, 1,102 (58.3%) platelet and 74 (48.7%) cryoprecipitate orders triggered an alert. The proportion of orders canceled after an alert was generated ranged from 13.5% to 17.9% for platelets and 0% to 50.0% for cryoprecipitate orders. CDSS alerts reduce, but do not eliminate, platelet and cryoprecipitate transfusions that do not meet institutional guidelines.

High-Value, Cost-Conscious Care: Iterative Systems-Based Interventions to Reduce Unnecessary Laboratory Testing.

PubMed

Sadowski, Brett W; Lane, Alison B; Wood, Shannon M; Robinson, Sara L; Kim, Chin Hee

2017-09-01

Inappropriate testing contributes to soaring healthcare costs within the United States, and teaching hospitals are vulnerable to providing care largely for academic development. Via its "Choosing Wisely" campaign, the American Board of Internal Medicine recommends avoiding repetitive testing for stable inpatients. We designed systems-based interventions to reduce laboratory orders for patients admitted to the wards at an academic facility. We identified the computer-based order entry system as an appropriate target for sustainable intervention. The admission order set had allowed multiple routine tests to be ordered repetitively each day. Our iterative study included interventions on the automated order set and cost displays at order entry. The primary outcome was number of routine tests controlled for inpatient days compared with the preceding year. Secondary outcomes included cost savings, delays in care, and adverse events. Data were collected over a 2-month period following interventions in sequential years and compared with the year prior. The first intervention led to 0.97 fewer laboratory tests per inpatient day (19.4%). The second intervention led to sustained reduction, although by less of a margin than order set modifications alone (15.3%). When extrapolating the results utilizing fees from the Centers for Medicare and Medicaid Services, there was a cost savings of $290,000 over 2 years. Qualitative survey data did not suggest an increase in care delays or near-miss events. This series of interventions targeting unnecessary testing demonstrated a sustained reduction in the number of routine tests ordered, without adverse effects on clinical care. Published by Elsevier Inc.

Changes, disruption and innovation: An investigation of the introduction of new health information technology in a microbiology laboratory.

PubMed

Toouli, George; Georgiou, Andrew; Westbrook, Johanna

2012-01-01

It is expected that health information technology (HIT) will deliver a safer, more efficient and effective health care system. The aim of this study was to undertake a qualitative and video-ethnographic examination of the impact of information technologies on work processes in the reception area of a Microbiology Department, to ascertain what changed, how it changed and the impact of the change. The setting for this study was the microbiology laboratory of a large tertiary hospital in Sydney. The study consisted of qualitative (interview and focus group) data and observation sessions for the period August 2005 to October 2006 along with video footage shot in three sessions covering the original system and the two stages of the Cerner implementation. Data analysis was assisted by NVivo software and process maps were produced from the video footage. There were two laboratory information systems observed in the video footage with computerized provider order entry introduced four months later. Process maps highlighted the large number of pre data entry steps with the original system whilst the newer system incorporated many of these steps in to the data entry stage. However, any time saved with the new system was offset by the requirement to complete some data entry of patient information not previously required. Other changes noted included the change of responsibilities for the reception staff and the physical changes required to accommodate the increased activity around the data entry area. Implementing a new HIT is always an exciting time for any environment but ensuring that the implementation goes smoothly and with minimal trouble requires the administrator and their team to plan well in advance for staff training, physical layout and possible staff resource reallocation.

76 FR 75900 - Notice of Application for Withdrawal Extension and Opportunity for Public Meeting; Wyoming

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-05

... of National Forest System land in the Shoshone National Forest from mining in order to protect the... of National Forest System land in the Shoshone National Forest from location and entry under the... of Land Management, Interior. ACTION: Notice. SUMMARY: The United States Forest Service (USFS) has...

76 FR 62881 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated: Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-11

..., the PULSe workstation is a front-end order entry system designed for use with respect to orders that... reasonable in that it is designed to help attract and encourage use of the PULSe workstation. The Exchange... amend its Fees Schedule as it relates to the PULSe workstation. The text of the proposed rule change is...

Power selective optical filter devices and optical systems using same

DOEpatents

Koplow, Jeffrey P

2014-10-07

In an embodiment, a power selective optical filter device includes an input polarizer for selectively transmitting an input signal. The device includes a wave-plate structure positioned to receive the input signal, which includes at least one substantially zero-order, zero-wave plate. The zero-order, zero-wave plate is configured to alter a polarization state of the input signal passing in a manner that depends on the power of the input signal. The zero-order, zero-wave plate includes an entry and exit wave plate each having a fast axis, with the fast axes oriented substantially perpendicular to each other. Each entry wave plate is oriented relative to a transmission axis of the input polarizer at a respective angle. An output polarizer is positioned to receive a signal output from the wave-plate structure and selectively transmits the signal based on the polarization state.

The Unparalleled Systems Engineering of MSL's Backup Entry, Descent, and Landing System: Second Chance

NASA Technical Reports Server (NTRS)

Roumeliotis, Chris; Grinblat, Jonathan; Reeves, Glenn

2013-01-01

Second Chance (SECC) was a bare bones version of Mars Science Laboratory's (MSL) Entry Descent & Landing (EDL) flight software that ran on Curiosity's backup computer, which could have taken over swiftly in the event of a reset of Curiosity's prime computer, in order to land her safely on Mars. Without SECC, a reset of Curiosity's prime computer would have lead to catastrophic mission failure. Even though a reset of the prime computer never occurred, SECC had the important responsibility as EDL's guardian angel, and this responsibility would not have seen such success without unparalleled systems engineering. This paper will focus on the systems engineering behind SECC: Covering a brief overview of SECC's design, the intense schedule to use SECC as a backup system, the verification and validation of the system's "Do No Harm" mandate, the system's overall functional performance, and finally, its use on the fateful day of August 5th, 2012.

Comparison of alphabetical versus categorical display format for medication order entry in a simulated touch screen anesthesia information management system: an experiment in clinician-computer interaction in anesthesia.

PubMed

Marian, Anil A; Dexter, Franklin; Tucker, Peter; Todd, Michael M

2012-05-29

Anesthesia information management system (AIMS) records should be designed and configured to facilitate the accurate and prompt recording of multiple drugs administered coincidentally or in rapid succession. We proposed two touch-screen display formats for use with our department's new EPIC touch-screen AIMS. In one format, medication "buttons" were arranged in alphabetical order (i.e. A-C, D-H etc.). In the other, buttons were arranged in categories (Common, Fluids, Cardiovascular, Coagulation etc.). Both formats were modeled on an iPad screen to resemble the AIMS interface. Anesthesia residents, anesthesiologists, and Certified Registered Nurse Anesthetists (n = 60) were then asked to find and touch the correct buttons for a series of medications whose names were displayed to the side of the entry screen. The number of entries made within 2 minutes was recorded. This was done 3 times for each format, with the 1st format chosen randomly. Data were analyzed from the third trials with each format to minimize differences in learning. The categorical format had a mean of 5.6 more drugs entered using the categorical method in two minutes than the alphabetical format (95% confidence interval [CI] 4.5 to 6.8, P < 0.0001). The findings were the same regardless of the order of testing (i.e. alphabetical-categorical vs. categorical - alphabetical) and participants' years of clinical experience. Most anesthesia providers made no (0) errors for most trials (N = 96/120 trials, lower 95% limit 73%, P < 0.0001). There was no difference in error rates between the two formats (P = 0.53). The use of touch-screen user interfaces in healthcare is increasingly common. Arrangement of drugs names in a categorical display format in the medication order-entry touch screen of an AIMS can result in faster data entry compared to an alphabetical arrangement of drugs. Results of this quality improvement project were used in our department's design of our final intraoperative electronic anesthesia record. This testing approach using cognitive and usability engineering methods can be used to objectively design and evaluate many aspects of the clinician-computer interaction in electronic health records.

Comparison of alphabetical versus categorical display format for medication order entry in a simulated touch screen anesthesia information management system: an experiment in clinician-computer interaction in anesthesia

PubMed Central

2012-01-01

Background Anesthesia information management system (AIMS) records should be designed and configured to facilitate the accurate and prompt recording of multiple drugs administered coincidentally or in rapid succession. Methods We proposed two touch-screen display formats for use with our department’s new EPIC touch-screen AIMS. In one format, medication “buttons” were arranged in alphabetical order (i.e. A-C, D-H etc.). In the other, buttons were arranged in categories (Common, Fluids, Cardiovascular, Coagulation etc.). Both formats were modeled on an iPad screen to resemble the AIMS interface. Anesthesia residents, anesthesiologists, and Certified Registered Nurse Anesthetists (n = 60) were then asked to find and touch the correct buttons for a series of medications whose names were displayed to the side of the entry screen. The number of entries made within 2 minutes was recorded. This was done 3 times for each format, with the 1st format chosen randomly. Data were analyzed from the third trials with each format to minimize differences in learning. Results The categorical format had a mean of 5.6 more drugs entered using the categorical method in two minutes than the alphabetical format (95% confidence interval [CI] 4.5 to 6.8, P < 0.0001). The findings were the same regardless of the order of testing (i.e. alphabetical-categorical vs. categorical - alphabetical) and participants’ years of clinical experience. Most anesthesia providers made no (0) errors for most trials (N = 96/120 trials, lower 95% limit 73%, P < 0.0001). There was no difference in error rates between the two formats (P = 0.53). Conclusions The use of touch-screen user interfaces in healthcare is increasingly common. Arrangement of drugs names in a categorical display format in the medication order-entry touch screen of an AIMS can result in faster data entry compared to an alphabetical arrangement of drugs. Results of this quality improvement project were used in our department’s design of our final intraoperative electronic anesthesia record. This testing approach using cognitive and usability engineering methods can be used to objectively design and evaluate many aspects of the clinician-computer interaction in electronic health records. PMID:22643058

77 FR 60917 - Trinexapac-ethyl; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

... ``hog, meat by-products'' in order to correct inadvertent errors in the final rule tolerance table for...'' is revised to ``hog, meat by-products.'' V. Statutory and Executive Order Reviews This final rule... alphabetical order an entry for ``Hog, meat by-products''. 0 iii. Revising the entries for ``Wheat, forage...

Impact of providing fee data on laboratory test ordering: a controlled clinical trial.

PubMed

Feldman, Leonard S; Shihab, Hasan M; Thiemann, David; Yeh, Hsin-Chieh; Ardolino, Margaret; Mandell, Steven; Brotman, Daniel J

2013-05-27

Inpatient care providers often order laboratory tests without any appreciation for the costs of the tests. To determine whether we could decrease the number of laboratory tests ordered by presenting providers with test fees at the time of order entry in a tertiary care hospital, without adding extra steps to the ordering process. Controlled clinical trial. Tertiary care hospital. All providers, including physicians and nonphysicians, who ordered laboratory tests through the computerized provider order entry system at The Johns Hopkins Hospital. We randomly assigned 61 diagnostic laboratory tests to an "active" arm (fee displayed) or to a control arm (fee not displayed). During a 6-month baseline period (November 10, 2008, through May 9, 2009), we did not display any fee data. During a 6-month intervention period 1 year later (November 10, 2009, through May 9, 2010), we displayed fees, based on the Medicare allowable fee, for active tests only. We examined changes in the total number of orders placed, the frequency of ordered tests (per patient-day), and total charges associated with the orders according to the time period (baseline vs intervention period) and by study group (active test vs control). For the active arm tests, rates of test ordering were reduced from 3.72 tests per patient-day in the baseline period to 3.40 tests per patient-day in the intervention period (8.59% decrease; 95% CI, -8.99% to -8.19%). For control arm tests, ordering increased from 1.15 to 1.22 tests per patient-day from the baseline period to the intervention period (5.64% increase; 95% CI, 4.90% to 6.39%) (P < .001 for difference over time between active and control tests). Presenting fee data to providers at the time of order entry resulted in a modest decrease in test ordering. Adoption of this intervention may reduce the number of inappropriately ordered diagnostic tests.

Current and emerging business models in the health care information technology industry: a view from wall street.

PubMed

Frank, Seth

2003-01-01

When we think about health care IT, we don't just think about clinical automation with the movement to computerized physician order entry (CPOE), but also the need to upgrade legacy financial and administrative systems to interact with clinical systems. Technology acceptance by physicians remains low, and computer use by physicians for data entry and analysis remains minimal. We expect this trend to change, and expect increased automation to represent gradual change. The HCIT space is dynamic, with many opportunities, but also many challenges. The unique nature of the end market buyers, existing business models, and nature of the technology makes this a challenging but dynamic area for equity investment.

A comprehensive inpatient discharge system.

PubMed Central

O'Connell, E. M.; Teich, J. M.; Pedraza, L. A.; Thomas, D.

1996-01-01

Our group has developed a computer system that supports all phases of the inpatient discharge process. The system fills in most of the physician's discharge order form and the nurse's discharge abstract, using information available from sign-out, order entry, scheduling, and other databases. It supplies information for referrals to outside institutions, and provides a variety of instruction materials for patients. Discharge forms can be completed in advance, so that the patient is not waiting for final paperwork. Physicians and nurses can work on their components independently, rather than in series. Response to the system has been very favorable. PMID:8947755

Development of Supersonic Retro-Propulsion for Future Mars Entry, Descent, and Landing Systems

NASA Technical Reports Server (NTRS)

Edquist, Karl T.; Dyakonov, Artem A.; Shidner, Jeremy D.; Studak, Joseph W.; Tiggers, Michael A.; Kipp, Devin M.; Prakash, Ravi; Trumble, Kerry A.; Dupzyk, Ian C.; Korzun, Ashley M.

2010-01-01

Recent studies have concluded that Viking-era entry system technologies are reaching their practical limits and must be succeeded by new methods capable of delivering large payloads (greater than 10 metric tons) required for human exploration of Mars. One such technology, termed Supersonic Retro-Propulsion, has been proposed as an enabling deceleration technique. However, in order to be considered for future NASA flight projects, this technology will require significant maturation beyond its current state. This paper proposes a roadmap for advancing the component technologies to a point where Supersonic Retro-Propulsion can be reliably used on future Mars missions to land much larger payloads than are currently possible using Viking-based systems. The development roadmap includes technology gates that are achieved through testing and/or analysis, culminating with subscale flight tests in Earth atmosphere that demonstrate stable and controlled flight. The component technologies requiring advancement include large engines capable of throttling, computational models for entry vehicle aerodynamic/propulsive force and moment interactions, aerothermodynamic environments modeling, entry vehicle stability and control methods, integrated systems engineering and analyses, and high-fidelity six degree-of-freedom trajectory simulations. Quantifiable metrics are also proposed as a means to gage the technical progress of Supersonic Retro-Propulsion. Finally, an aggressive schedule is proposed for advancing the technology through sub-scale flight tests at Earth by 2016.

Post-Secondary Education and Rural-Urban Migration

ERIC Educational Resources Information Center

Synge, J.

1974-01-01

This study examined education and career plans of Scottish rural youth who entered post-secondary education in order to determine the extent to which the educational system offers rural youth not only specific training but only entry to the urban labour market. (Author/RK)

Usability Evaluation at the Point-of-Care: A Method to Identify User Information Needs in CPOE Applications

PubMed Central

Washburn, Jeff; Fiol, Guilherme Del; Rocha, Roberto A.

2006-01-01

Point of care usability evaluation may help identify information needs that occur during the process of providing care. We describe the process of using usability-specific recording software to record Computerized Physician Order Entry (CPOE) ordering sessions on admitted adult and pediatric patients at two urban tertiary hospitals in the Intermountain Healthcare system of hospitals. PMID:17238756

76 FR 2741 - Self-Regulatory Organizations; C2 Options Exchange, Incorporated: Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-14

... is to extend a fee waiver related to the PULSe workstation. By way of background, the PULSe workstation is a front-end order entry system designed for use with respect to orders that may be sent to the... extend a fee waiver related to the PULSe workstation. The text of the proposed rule change is available...

78 FR 16731 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-18

... International Securities Exchange offers PRECISE TRADE as a means for users to enter orders and Chicago Board... users to develop their own internal front-end order entry systems and may provide savings to users in.../NASDAQOMXPHLXTools/PlatformViewer.asp?selectednode=chp%5F1%5F4&manual=%2Fnasdaqomxphlx%2Fphlx%2Fphlx%2Drulesbrd%2F...

Outcomes of Computerized Physician Order Entry in an Electronic Health Record After Implementation in an Outpatient Oncology Setting

PubMed Central

Harshberger, Cara A.; Harper, Abigail J.; Carro, George W.; Spath, Wayne E.; Hui, Wendy C.; Lawton, Jessica M.; Brockstein, Bruce E.

2011-01-01

Purpose: Computerized physician order entry (CPOE) in electronic health records (EHR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after implementation of an outpatient oncology EHR/ CPOE system in a hospital-based outpatient cancer center within three treatment sites. Methods: This study is a retrospective chart review of 90 patients who received one of the following regimens between 1999 and 2006: FOLFOX, AC, carboplatin + paclitaxel, ABVD, cisplatin + etoposide, R-CHOP, and clinical trials. Documentation completeness scores were assigned to each chart based on the number of documented data points found out of the total data points assessed. EHR/CPOE documentation completeness was compared with completeness of paper charts orders of the same regimens. A user satisfaction survey of the paper chart and EHR/CPOE system was conducted among the physicians, nurses, and pharmacists who worked with both systems. Results: The mean percentage of identified data points successfully found in the EHR/CPOE charts was 93% versus 67% in the paper charts (P < .001). Regimen complexity did not alter the number of data points found. The survey response rate was 64%, and the results showed that satisfaction was statistically significant in favor of the EHR/CPOE system. Conclusion: Using EHR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. EHR/CPOE requires constant vigilance and maintenance to optimize patient safety. PMID:22043187

Mars2020 Entry, Descent, and Landing Instrumentation (MEDLI2): Science Objectives and Instrument Requirements

NASA Technical Reports Server (NTRS)

Bose, Deepak; White, Todd; Schoenenberger, Mark; Karlgaard, Chris; Wright, Henry

2015-01-01

NASAs exploration and technology roadmaps call for capability advancements in Mars entry, descent, and landing (EDL) systems to enable increased landed mass, a higher landing precision, and a wider planetary access. It is also recognized that these ambitious EDL performance goals must be met while maintaining a low mission risk in order to pave the way for future human missions. As NASA is engaged in developing new EDL systems and technologies via testing at Earth, instrumentation of existing Mars missions is providing valuable engineering data for performance improvement, risk reduction, and an improved definition of entry loads and environment. The most notable recent example is the Mars Entry, Descent and Landing Instrument (MEDLI) suite hosted by Mars Science Laboratory for its entry in Aug 2012. The MEDLI suite provided a comprehensive dataset for Mars entry aerodynamics, aerothermodynamics and thermal protection system (TPS) performance. MEDLI data has since been used for unprecedented reconstruction of aerodynamic drag, vehicle attitude, in-situ atmospheric density, aerothermal heating, and transition to turbulence, in-depth TPS performance and TPS ablation. [1,2] In addition to validating predictive models, MEDLI data has demonstrated extra margin available in the MSL forebody TPS, which can potentially be used to reduce vehicle parasitic mass. The presentation will introduce a follow-on MEDLI instrumentation suite (called MEDLI2) that is being developed for Mars-2020 mission. MEDLI2 has an enhanced scope that includes backshell instrumentation, a wider forebody coverage, and instruments that specifically target supersonic aerodynamics. Similar to MEDLI, MEDLI2 uses thermal plugs with embedded thermocouples and ports through the TPS to measure surface pressure. MEDLI2, however, also includes heat flux sensors in the backshell and a low range pressure transducer to measure afterbody pressure.

Computerised Order Entry Systems and Pathology Services - A Synthesis of the Evidence

PubMed Central

Georgiou, Andrew; Westbrook, Johanna I

2006-01-01

Computerised Physician Order Entry (CPOE) systems have been promoted in Australia and internationally for their potential to improve the quality of care. The existing research of the effect of CPOE on pathology laboratories has been variable, pointing to the potential to increase efficiency and effectiveness and contribute to enhancing the quality of patient care on the one hand, while leading to significant disruptions in work organisation with a negative impact on departmental relations on the other hand. In this paper we provide an overview of the research evidence about the impact of CPOE on four areas associated with pathology services; a) efficiency of the ordering process, e.g. test turnaround times, b) effectiveness as measured by test ordering volumes and test order appropriateness, c) quality of care, particularly its effects on patient care and d) work organisation patterns, which can be severely disrupted by CPOE. We discuss the possible ramifications of CPOE and offer three broad, but important recommendations for pathology laboratories, based on our own research experience investigating CPOE implementations over three years. Firstly, pathology laboratories need to be active participants in planning the implementation of CPOE. Secondly, the importance of building a firm organisational foundation for the introduction of the new system that includes openness and responsiveness to feedback. And thirdly, the implementation process needs to be underpinned by a strong commitment to a multi-method evaluation at every stage of the process to be able to measure the impact of the system on work practices and outcomes. PMID:17077878

Computerized provider order entry systems - Research imperatives and organizational challenges facing pathology services.

PubMed

Georgiou, Andrew; Westbrook, Johanna; Braithwaite, Jeffrey

2010-07-13

Information and communication technologies (ICT) are contributing to major changes taking place in pathology and within health services more generally. In this article, we draw on our research experience for over 7 years investigating the implementation and diffusion of computerized provider order entry (CPOE) systems to articulate some of the key informatics challenges confronting pathology laboratories. The implementation of these systems, with their improved information management and decision support structures, provides the potential for enhancing the role that pathology services play in patient care pathways. Beyond eliminating legibility problems, CPOE systems can also contribute to the efficiency and safety of healthcare, reducing the duplication of test orders and diminishing the risk of misidentification of patient samples and orders. However, despite the enthusiasm for CPOE systems, their diffusion across healthcare settings remains variable and is often beset by implementation problems. Information systems like CPOE may have the ability to integrate work, departments and organizations, but unfortunately, health professionals, departments and organizations do not always want to be integrated in ways that information systems allow. A persistent theme that emerges from the research evidence is that one size does not fit all, and system success or otherwise is reliant on the conditions and circumstances in which they are located. These conditions and circumstances are part of what is negotiated in the complex, messy and challenging area of ICT implementation. The solution is not likely to be simple and easy, but current evidence suggests that a combination of concerted efforts, better research designs, more sophisticated theories and hypotheses as well as more skilled, multidisciplinary research teams, tackling this area of study will bring substantial benefits, improving the effectiveness of pathology services, and, as a direct corollary, the quality of patient care.

A diffusion of innovations model of physician order entry.

PubMed

Ash, J S; Lyman, J; Carpenter, J; Fournier, L

2001-01-01

To interpret the results of a cross-site study of physician order entry (POE) in hospitals using a diffusion of innovations theory framework. Qualitative study using observation, focus groups, and interviews. Data were analyzed by an interdisciplinary team of researchers using a grounded approach to identify themes. Themes were then interpreted using classical Diffusion of Innovations (DOI) theory as described by Rogers [1]. Four high level themes were identified: organizational issues; clinical and professional issues; technology implementation issues; and issues related to the organization of information and knowledge. Further analysis using the DOI framework indicated that POE is an especially complex information technology innovation when one considers communication, time, and social system issues in addition to attributes of the innovation itself. Implementation strategies for POE should be designed to account for its complex nature. The ideal would be a system that is both customizable and integrated with other parts of the information system, is implemented with maximum involvement of users and high levels of support, and is surrounded by an atmosphere of trust and collaboration.

An inventory of publications on electronic medical records revisited.

PubMed

Moorman, P W; Schuemie, M J; van der Lei, J

2009-01-01

In this short review we provide an update of our earlier inventories of publications indexed in MedLine with the MeSH term 'Medical Records Systems, Computerized'. We retrieved and analyzed all references to English articles published before January 1, 2008, and indexed in PubMed with the MeSH term 'Medical Records Systems, Computerized'. We retrieved a total of 11,924 publications, of which 3937 (33%) appeared in a journal with an impact factor. Since 2002 the number of yearly publications, and the number of journals in which those publications appeared, increased. A cluster analysis revealed three clusters: an organizational issues cluster, a technically oriented cluster and a cluster about order-entry and research. Although our previous inventory in 2003 suggested a constant yearly production of publications on electronic medical records since 1998, the current inventory shows another rise in production since 2002. In addition, many new journals and countries have shown interest during the last five years. In the last 15 years, interest in organizational issues remained fairly constant, order entry and research with systems gained attention, while interest in technical issues relatively decreased.

78 FR 48752 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing of Proposed Rule Change to...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

... particular MPID has been made by calculating the ratio between (i) entered orders, weighted by the distance... in part. The fee has been imposed on MPIDs with an ``Order Entry Ratio'' of more than 100. The Order Entry Ratio is calculated, and the Excess Order Fee imposed, on a monthly basis. BX is now proposing to...

Will Decision Support in Medications Order Entry Save Money? A Return On Investment Analysis of the Case of the Hong Kong Hospital Authority

PubMed Central

Fung, Kin Wah; Vogel, Lynn Harold

2003-01-01

The computerized medications order entry system currently used in the public hospitals of Hong Kong does not have decision support features. Plans are underway to add decision support to this system to alert physicians on drug-allergy conflicts, drug-lab result conflicts, drug-drug interactions and atypical dosages. A return on investment analysis is done on this enhancement, both as an examination of whether there is a positive return on the investment and as a contribution to the ongoing discussion of the use of return on investment models in health care information technology investments. It is estimated that the addition of decision support will reduce adverse drug events by 4.2 – 8.4%. Based on this estimate, a total net saving of $44,000 – $586,000 is expected over five years. The breakeven period is estimated to be between two to four years. PMID:14728171

24 CFR 350.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Security) maintained in the Book-entry System, as set forth in Federal Reserve Bank Operating Circulars. (b...: Book-entry Ginnie Mae Security. A Ginnie Mae Security issued or maintained in the Book-entry System... Reserve Banks. Book-entry System. The automated book-entry system operated by the Federal Reserve Banks...

CPOE system design aspects and their qualitative effect on usability.

PubMed

Khajouei, Reza; Jaspers, Monique W M

2008-01-01

Although many studies have discussed the benefits of Computerized Provider Order Entry (CPOE) systems, their configuration can have a great impact on clinicians' adoption of these systems. Poorly designed CPOE systems can lead to usability problems, users' dissatisfaction and may disrupt normal flow of clinical activities. This paper reports on a literature review focused on the identification of CPOE medication systems' design aspects that impact CPOE systems' usability and create opportunities for medication errors. Our review is based on a systematic literature search in PubMed, EMBASE and Ovid MEDLINE for relevant publications from 1986-2006. We categorized the design aspects extracted from relevant publications into six different groups: 1) timing of alerts, 2) log in/out procedures, 3) pick lists and drop down menus, 4) clues and guidelines, 5) documentation and data entry options, and 6) screen display and layout. Our review shows that the manner in which a CPOE system is configured can have a high impact on ease of system use, task behavior of clinicians in ordering drugs, and medication errors. Characterization of consequences associated with certain CPOE design aspects provides insight into how CPOE system designs can be improved to enhance physicians' adoption of these systems and their success. Recommendations are provided to enable CPOE system designers to create CPOE systems that are not only more user friendly and efficient but safer.

78 FR 76642 - Public Land Order No. 7822; Partial Revocation of Secretarial Order Dated May 2, 1919; Wyoming

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-18

... closed to settlement, sale, location, or entry under the general land laws, including the United States mining laws, until the Bureau of Land Management completes a planning review. Order By virtue of the... withdrew lands from settlement, sale location, or entry under the general land laws, including the United...

Structured physician order entry for trauma CT: value in improving clinical information transfer and billing efficiency.

PubMed

Wortman, Jeremy R; Goud, Asha; Raja, Ali S; Marchello, Dana; Sodickson, Aaron

2014-12-01

The purpose of this study was to measure the effects of use of a structured physician order entry system for trauma CT on the communication of clinical information and on coding practices and reimbursement efficiency. This study was conducted between April 1, 2011, and January 14, 2013, at a level I trauma center with 59,000 annual emergency department visits. On March 29, 2012, a structured order entry system was implemented for head through pelvis trauma CT, so-called pan-scan CT. This study compared the following factors before and after implementation: communication of clinical signs and symptoms and mechanism of injury, primary International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) code category, success of reimbursement, and time required for successful reimbursement for the examination. Chi-square statistics were used to compare all categoric variables before and after the intervention, and the Wilcoxon rank sum test was used to compare billing cycle times. A total of 457 patients underwent pan-scan CT in 2734 distinct examinations. After the intervention, there was a 62% absolute increase in requisitions containing clinical signs or symptoms (from 0.4% to 63%, p<0.0001) and a 99% absolute increase in requisitions providing mechanism of injury (from 0.4% to 99%, p<0.0001). There was a 19% absolute increase in primary ICD-9-CM codes representing clinical signs or symptoms (from 2.9% to 21.8%, p<0.0001), and a 7% absolute increase in reimbursement success for examinations submitted to insurance carriers (from 83.0% to 89.7%, p<0.0001). For reimbursed studies, there was a 14.7-day reduction in mean billing cycle time (from 68.4 days to 53.7 days, p=0.008). Implementation of structured physician order entry for trauma CT was associated with significant improvement in the communication of clinical history to radiologists. The improvement was also associated with changes in coding practices, greater billing efficiency, and an increase in reimbursement success.

Research and development for Onboard Navigation (ONAV) ground based expert/trainer system: ONAV entry expert system code

NASA Technical Reports Server (NTRS)

Bochsler, Daniel C.

1988-01-01

A complete listing is given of the expert system rules for the Entry phase of the Onboard Navigation (ONAV) Ground Based Expert Trainer System for aircraft/space shuttle navigation. These source listings appear in the same format as utilized and required by the C Language Integrated Production System (CLIPS) expert system shell which is the basis for the ONAV entry system. A schematic overview is given of how the rules are organized. These groups result from a partitioning of the rules according to the overall function which a given set of rules performs. This partitioning was established and maintained according to that established in the knowledge specification document. In addition, four other groups of rules are specified. The four groups (control flow, operator inputs, output management, and data tables) perform functions that affect all the other functional rule groups. As the name implies, control flow ensures that the rule groups are executed in the order required for proper operation; operator input rules control the introduction into the CLIPS fact base of various kinds of data required by the expert system; output management rules control the updating of the ONAV expert system user display screen during execution of the system; and data tables are static information utilized by many different rule sets gathered in one convenient place.

Decision Support Alerts for Medication Ordering in a Computerized Provider Order Entry (CPOE) System

PubMed Central

Beccaro, M. A. Del; Villanueva, R.; Knudson, K. M.; Harvey, E. M.; Langle, J. M.; Paul, W.

2010-01-01

Objective We sought to determine the frequency and type of decision support alerts by location and ordering provider role during Computerized Provider Order Entry (CPOE) medication ordering. Using these data we adjusted the decision support tools to reduce the number of alerts. Design Retrospective analyses were performed of dose range checks (DRC), drug-drug interaction and drug-allergy alerts from our electronic medical record. During seven sampling periods (each two weeks long) between April 2006 and October 2008 all alerts in these categories were analyzed. Another audit was performed of all DRC alerts by ordering provider role from November 2008 through January 2009. Medication ordering error counts were obtained from a voluntary error reporting system. Measurement/Results Between April 2006 and October 2008 the percent of medication orders that triggered a dose range alert decreased from 23.9% to 7.4%. The relative risk (RR) for getting an alert was higher at the start of the interventions versus later (RR= 2.40, 95% CI 2.28-2.52; p< 0.0001). The percentage of medication orders that triggered alerts for drug-drug interactions also decreased from 13.5% to 4.8%. The RR for getting a drug interaction alert at the start was 1.63, 95% CI 1.60-1.66; p< 0.0001. Alerts decreased in all clinical areas without an increase in reported medication errors. Conclusion We reduced the quantity of decision support alerts in CPOE using a systematic approach without an increase in reported medication errors PMID:23616845

Neural Network Assisted Inverse Dynamic Guidance for Terminally Constrained Entry Flight

PubMed Central

Chen, Wanchun

2014-01-01

This paper presents a neural network assisted entry guidance law that is designed by applying Bézier approximation. It is shown that a fully constrained approximation of a reference trajectory can be made by using the Bézier curve. Applying this approximation, an inverse dynamic system for an entry flight is solved to generate guidance command. The guidance solution thus gotten ensures terminal constraints for position, flight path, and azimuth angle. In order to ensure terminal velocity constraint, a prediction of the terminal velocity is required, based on which, the approximated Bézier curve is adjusted. An artificial neural network is used for this prediction of the terminal velocity. The method enables faster implementation in achieving fully constrained entry flight. Results from simulations indicate improved performance of the neural network assisted method. The scheme is expected to have prospect for further research on automated onboard control of terminal velocity for both reentry and terminal guidance laws. PMID:24723821

An Automated System for Generating Situation-Specific Decision Support in Clinical Order Entry from Local Empirical Data

ERIC Educational Resources Information Center

Klann, Jeffrey G.

2011-01-01

Clinical Decision Support is one of the only aspects of health information technology that has demonstrated decreased costs and increased quality in healthcare delivery, yet it is extremely expensive and time-consuming to create, maintain, and localize. Consequently, a majority of health care systems do not utilize it, and even when it is…

The Future of Access Technology for Blind and Visually Impaired People.

ERIC Educational Resources Information Center

Schreier, E. M.

1990-01-01

This article describes potential use of new technological products and services by blind/visually impaired people. Items discussed include computer input devices, public telephones, automatic teller machines, airline and rail arrival/departure displays, ticketing machines, information retrieval systems, order-entry terminals, optical character…

Thermal Testing of Woven TPS Materials in Extreme Entry Environments

NASA Technical Reports Server (NTRS)

Gonzales, G.; Stackpoole, M.

2014-01-01

NASAs future robotic missions to Venus and outer planets, namely, Saturn, Uranus, Neptune, result in extremely high entry conditions that exceed the capabilities of current mid density ablators (PICA or Avcoat). Therefore mission planners assume the use of a fully dense carbon phenolic heatshield similar to what was flown on Pioneer Venus and Galileo. Carbon phenolic (CP) is a robust TPS however its high density and thermal conductivity constrain mission planners to steep entries, high heat fluxes, high pressures and short entry durations, in order for CP to be feasible from a mass perspective. In 2012 the Game Changing Development Program in NASAs Space Technology Mission Directorate funded NASA ARC to investigate the feasibility of a Woven Thermal Protection System to meet the needs of NASAs most challenging entry missions. The high entry conditions pose certification challenges in existing ground based test facilities. Recent updates to NASAs IHF and AEDCs H3 high temperature arcjet test facilities enable higher heatflux (2000 Wcm2) and high pressure (5 atm) testing of TPS. Some recent thermal tests of woven TPS will be discussed in this paper. These upgrades have provided a way to test higher entry conditions of potential outer planet and Venus missions and provided a baseline against carbon phenolic material. The results of these tests have given preliminary insight to sample configuration and physical recession profile characteristics.

39 CFR 761.8 - Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Servicing book-entry Postal Service securities... POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.8 Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

39 CFR 761.8 - Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

Code of Federal Regulations, 2012 CFR

2012-07-01

... 39 Postal Service 1 2012-07-01 2012-07-01 false Servicing book-entry Postal Service securities... POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.8 Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

39 CFR 761.8 - Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

Code of Federal Regulations, 2014 CFR

2014-07-01

... 39 Postal Service 1 2014-07-01 2014-07-01 false Servicing book-entry Postal Service securities... POSTAL SERVICE POSTAL SERVICE DEBT OBLIGATIONS; DISBURSEMENT POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.8 Servicing book-entry Postal Service securities; payment of interest, payment at maturity or upon...

A Fast Proceduere for Optimizing Thermal Protection Systems of Re-Entry Vehicles

NASA Astrophysics Data System (ADS)

Ferraiuolo, M.; Riccio, A.; Tescione, D.; Gigliotti, M.

The aim of the present work is to introduce a fast procedure to optimize thermal protection systems for re-entry vehicles subjected to high thermal loads. A simplified one-dimensional optimization process, performed in order to find the optimum design variables (lengths, sections etc.), is the first step of the proposed design procedure. Simultaneously, the most suitable materials able to sustain high temperatures and meeting the weight requirements are selected and positioned within the design layout. In this stage of the design procedure, simplified (generalized plane strain) FEM models are used when boundary and geometrical conditions allow the reduction of the degrees of freedom. Those simplified local FEM models can be useful because they are time-saving and very simple to build; they are essentially one dimensional and can be used for optimization processes in order to determine the optimum configuration with regard to weight, temperature and stresses. A triple-layer and a double-layer body, subjected to the same aero-thermal loads, have been optimized to minimize the overall weight. Full two and three-dimensional analyses are performed in order to validate those simplified models. Thermal-structural analyses and optimizations are executed by adopting the Ansys FEM code.

[Information management in multicenter studies: the Brazilian longitudinal study for adult health].

PubMed

Duncan, Bruce Bartholow; Vigo, Álvaro; Hernandez, Émerson; Luft, Vivian Cristine; Ahlert, Hubert; Bergmann, Kaiser; Mota, Eduardo

2013-06-01

Information management in large multicenter studies requires a specialized approach. The Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil - Brazilian Longitudinal Study for Adult Health) has created a Datacenter to enter and manage its data system. The aim of this paper is to describe the steps involved, including the information entry, transmission and management methods. A web system was developed in order to allow, in a safe and confidential way, online data entry, checking and editing, as well as the incorporation of data collected on paper. Additionally, a Picture Archiving and Communication System was implemented and customized for echocardiography and retinography. It stores the images received from the Investigation Centers and makes them available at the Reading Centers. Finally, data extraction and cleaning processes were developed to create databases in formats that enable analyses in multiple statistical packages.

Entry Guidance for the Reusable Launch Vehicle

NASA Technical Reports Server (NTRS)

Lu, Ping

1999-01-01

The X-33 Advanced Technology Demonstrator is a half-scale prototype developed to test the key technologies needed for a full-scale single-stage reusable launch vehicle (RLV). The X-33 is a suborbital vehicle that will be launched vertically, and land horizontally. The goals of this research were to develop an alternate entry guidance scheme for the X-33 in parallel to the actual X-33 entry guidance algorithms, provide comparative and complementary study, and identify potential new ways to improve entry guidance performance. Toward these goals, the nominal entry trajectory is defined by a piecewise linear drag-acceleration-versus-energy profile, which is in turn obtained by the solution of a semi-analytical parameter optimization problem. The closed-loop guidance is accomplished by tracking the nominal drag profile with primarily bank-angle modulation on-board. The bank-angle is commanded by a single full-envelope nonlinear trajectory control law. Near the end of the entry flight, the guidance logic is switched to heading control in order to meet strict conditions at the terminal area energy management interface. Two methods, one on ground-track control and the other on heading control, were proposed and examined for this phase of entry guidance where lateral control is emphasized. Trajectory dispersion studies were performed to evaluate the effectiveness of the entry guidance algorithms against a number of uncertainties including those in propulsion system, atmospheric properties, winds, aerodynamics, and propellant loading. Finally, a new trajectory-regulation method is introduced at the end as a promising precision entry guidance method. The guidance principle is very different and preliminary application in X-33 entry guidance simulation showed high precision that is difficult to achieve by existing methods.

Communications Blackout Predictions for Atmospheric Entry of Mars Science Laboratory

NASA Technical Reports Server (NTRS)

Morabito, David D.; Edquist, Karl

2005-01-01

The Mars Science Laboratory (MSL) is expected to be a long-range, long-duration science laboratory rover on the Martian surface. MSL will provide a significant milestone that paves the way for future landed missions to Mars. NASA is studying options to launch MSL as early as 2009. MSL will be the first mission to demonstrate the new technology of 'smart landers', which include precision landing and hazard avoidance in order to -land at scientifically interesting sites that would otherwise be unreachable. There are three elements to the spacecraft; carrier (cruise stage), entry vehicle, and rover. The rover will have an X-band direct-to-Earth (DTE) link as well as a UHF proximity link. There is also a possibility of an X-band proximity link. Given the importance of collecting critical event telemetry data during atmospheric entry, it is important to understand the ability of a signal link to be maintained, especially during the period near peak convective heating. The received telemetry during entry (or played back later) will allow for the performance of the Entry-Descent-Landing technologies to be assessed. These technologies include guided entry for precision landing, hazard avoidance, a new sky-crane landing system and powered descent. MSL will undergo an entry profile that may result in a potential communications blackout caused by ionized plasma for short periods near peak heating. The vehicle will use UHF and possibly X-band during the entry phase. The purpose of this report is to quantify or bound the likelihood of any such blackout at UHF frequencies (401 MHz) and X-band frequencies (8.4 GHz). Two entry trajectory scenarios were evaluated: a stressful entry trajectory to quantify an upper-bound for any possible blackout period, and a nominal likely trajectory to quantify likelihood of blackout for such cases.

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... General Information § 357.0 Book-entry systems. (a) Treasury securities. Treasury securities are...-entry system is the book-entry system in which Treasury securities are held in a tiered system through securities intermediaries such as financial institutions or brokerage firms. A Treasury security is...

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... General Information § 357.0 Book-entry systems. (a) Treasury securities. Treasury securities are...-entry system is the book-entry system in which Treasury securities are held in a tiered system through securities intermediaries such as financial institutions or brokerage firms. A Treasury security is...

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... General Information § 357.0 Book-entry systems. (a) Treasury securities. Treasury securities are...-entry system is the book-entry system in which Treasury securities are held in a tiered system through securities intermediaries such as financial institutions or brokerage firms. A Treasury security is...

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... General Information § 357.0 Book-entry systems. (a) Treasury securities. Treasury securities are...-entry system is the book-entry system in which Treasury securities are held in a tiered system through securities intermediaries such as financial institutions or brokerage firms. A Treasury security is...

Radiative Heating in MSL Entry: Comparison of Flight Heating Discrepancy to Ground Test and Predictive Models

NASA Technical Reports Server (NTRS)

Cruden, Brett A.; Brandis, Aaron M.; White, Todd R.; Mahzari, Milad; Bose, Deepak

2014-01-01

During the recent entry of the Mars Science Laboratory (MSL), the heat shield was equipped with thermocouple stacks to measure in-depth heating of the thermal protection system (TPS). When only convective heating was considered, the derived heat flux from gauges in the stagnation region was found to be underpredicted by as much as 17 W/sq cm, which is significant compared to the peak heating of 32 W/sq cm. In order to quantify the contribution of radiative heating phenomena to the discrepancy, ground tests and predictive simulations that replicated the MSL entry trajectory were performed. An analysis is carried through to assess the quality of the radiation model and the impact to stagnation line heating. The impact is shown to be significant, but does not fully explain the heating discrepancy.

31 CFR 306.23 - Securities eligible to be held in the Legacy Treasury Direct® Book-entry Securities System.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Legacy Treasury Direct® Book-entry Securities System. 306.23 Section 306.23 Money and Finance: Treasury... Securities eligible to be held in the Legacy Treasury Direct® Book-entry Securities System. (a) Eligible... book-entry securities system. (b) Conversion of Registered Security to book-entry form to be held in...

39 CFR 761.3 - Scope and effect of book-entry procedure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 39 Postal Service 1 2012-07-01 2012-07-01 false Scope and effect of book-entry procedure. 761.3... POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.3 Scope and effect of book-entry procedure. (a) A Reserve Bank as fiscal agent of the United States acting on behalf of the Postal Service may apply the book...

39 CFR 761.3 - Scope and effect of book-entry procedure.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 39 Postal Service 1 2013-07-01 2013-07-01 false Scope and effect of book-entry procedure. 761.3... POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.3 Scope and effect of book-entry procedure. (a) A Reserve Bank as fiscal agent of the United States acting on behalf of the Postal Service may apply the book...

39 CFR 761.3 - Scope and effect of book-entry procedure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 39 Postal Service 1 2014-07-01 2014-07-01 false Scope and effect of book-entry procedure. 761.3... POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.3 Scope and effect of book-entry procedure. (a) A Reserve Bank as fiscal agent of the United States acting on behalf of the Postal Service may apply the book...

39 CFR 761.3 - Scope and effect of book-entry procedure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 39 Postal Service 1 2010-07-01 2010-07-01 false Scope and effect of book-entry procedure. 761.3... POSTAL MONEY ORDERS BOOK-ENTRY PROCEDURES § 761.3 Scope and effect of book-entry procedure. (a) A Reserve Bank as fiscal agent of the United States acting on behalf of the Postal Service may apply the book...

A comparative analysis of the dissemination of best practice measures for key populations.

PubMed

Lundy, Jennifer; Santangelo, Jennifer; Rogers, Patrick; Kuehn, Lynn; Christensen, Sharon; Bournique, Judy; Mekhjian, Hagop; Kamal, Jyoti

2008-11-06

In collaboration with the department of Quality and Operations Improvement, Clinical Applications and the Information Warehouse, we have leveraged available Information Warehouse data to build a Best Practice Compliance Measurement Dashboard. This tool combines information from our operating room charting system, our order entry system and coding information from the patient billing and management system to provide 'previous day', data on a patients current course of treatment.

Computerized N-acetylcysteine physician order entry by template protocol for acetaminophen toxicity.

PubMed

Thompson, Trevonne M; Lu, Jenny J; Blackwood, Louisa; Leikin, Jerrold B

2011-01-01

Some medication dosing protocols are logistically complex for traditional physician ordering. The use of computerized physician order entry (CPOE) with templates, or order sets, may be useful to reduce medication administration errors. This study evaluated the rate of medication administration errors using CPOE order sets for N-acetylcysteine (NAC) use in treating acetaminophen poisoning. An 18-month retrospective review of computerized inpatient pharmacy records for NAC use was performed. All patients who received NAC for the treatment of acetaminophen poisoning were included. Each record was analyzed to determine the form of NAC given and whether an administration error occurred. In the 82 cases of acetaminophen poisoning in which NAC was given, no medication administration errors were identified. Oral NAC was given in 31 (38%) cases; intravenous NAC was given in 51 (62%) cases. In this retrospective analysis of N-acetylcysteine administration using computerized physician order entry and order sets, no medication administration errors occurred. CPOE is an effective tool in safely executing complicated protocols in an inpatient setting.

Mars Sample Return Using Commercial Capabilities: Propulsive Entry, Descent, and Landing of a Capsule Form Vehicle

NASA Technical Reports Server (NTRS)

Gonzales, Andrew A.; Lemke, Lawrence G.; Huynh, Loc C.

2014-01-01

This paper describes a critical portion of the work that has been done at NASA, Ames Research Center regarding the use of the commercially developed Dragon capsule as a delivery vehicle for the elements of a high priority Mars Sample Return mission. The objective of the investigation was to determine entry and landed mass capabilities that cover anticipated mission conditions. The "Red Dragon", Mars configuration, uses supersonic retro-propulsion, with no required parachute system, to perform Entry, Descent, and Landing (EDL) maneuvers. The propulsive system proposed for use is the same system that will perform an abort, if necessary, for a human rated version of the Dragon capsule. Standard trajectory analysis tools are applied to publically available information about Dragon and other legacy capsule forms in order to perform the investigation. Trajectory simulation parameters include entry velocity, flight path angle, lift to drag Ratio (L/D), landing site elevation, atmosphere density, and total entry mass, in addition engineering assumptions for the performance of the propulsion system are stated. Mass estimates for major elements of the overall proposed architecture are coupled to this EDL analysis to close the overall architecture. Three synodic launch opportunities, beginning with the 2022 opportunity, define the arrival conditions. Results state the relations between the analysis parameters as well as sensitivities to those parameters. The EDL performance envelope includes landing altitudes between 0 and -4 km referenced to the Mars Orbiter Laser Altimeter datum as well as minimum and maximum atmosphere density. Total entry masses between 7 and 10 mt are considered with architecture closure occurring between 9.0 and 10 mt. Propellant mass fractions for each major phase of the EDL - Entry, Terminal Descent, and Hazard Avoidance - have been derived. An assessment of the effect of the entry conditions on the Thermal Protection System (TPS) currently in use for Dragon missions shows no significant stressors. A useful payload mass of 2.0 mt is provided and includes mass and grow allowance for a Mars Ascent Vehicle (MAV), Earth Return Vehicle (ERV), and mission unique equipment. The useful payload supports an architecture that receives a sample from another surface asset and sends it directly back to Earth for recovery in a high Earth orbit. The work shows that emerging commercial capabilities as well as previously studied EDL methodologies can be used to efficiently support an important planetary science objective. The work also has applications for human exploration missions that will also use propulsive EDL techniques

The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review.

PubMed

Niazkhani, Zahra; Pirnejad, Habibollah; Berg, Marc; Aarts, Jos

2009-01-01

Previous studies have shown the importance of workflow issues in the implementation of CPOE systems and patient safety practices. To understand the impact of CPOE on clinical workflow, we developed a conceptual framework and conducted a literature search for CPOE evaluations between 1990 and June 2007. Fifty-one publications were identified that disclosed mixed effects of CPOE systems. Among the frequently reported workflow advantages were the legible orders, remote accessibility of the systems, and the shorter order turnaround times. Among the frequently reported disadvantages were the time-consuming and problematic user-system interactions, and the enforcement of a predefined relationship between clinical tasks and between providers. Regarding the diversity of findings in the literature, we conclude that more multi-method research is needed to explore CPOE's multidimensional and collective impact on especially collaborative workflow.

Vertical Spin Tunnel Testing and Stability Analysis of Multi-Mission Earth Entry Vehicles

NASA Technical Reports Server (NTRS)

Glaab, Louis J.; Morelli, Eugene A.; Fremaux, C. Michael; Bean, Jacob

2014-01-01

Multi-Mission Earth Entry Vehicles (MMEEVs) are blunt-body vehicles designed with the purpose of transporting payloads from space to the surface of the Earth. To achieve high reliability and minimum weight, MMEEVs avoid using limited-reliability systems, such as parachutes, retro-rockets, and reaction control systems and rely on the natural aerodynamic stability of the vehicle throughout the Entry, Descent, and Landing phases of flight. Testing in NASA Langley's 20-FT Vertical Spin Tunnel (20-FT VST), dynamically-scaled MMEEV models was conducted to improve subsonic aerodynamic models and validate stability criteria for this class of vehicle. This report documents the resulting data from VST testing for an array of 60-deg sphere-cone MMEEVs. Model configurations included were 1.2 meter, and 1.8 meter designs. The addition of a backshell extender, which provided a 150% increase in backshell diameter for the 1.2 meter design, provided a third test configuration. Center of Gravity limits were established for all MMEEV configurations. An application of System Identification (SID) techniques was performed to determine the aerodynamic coefficients in order to provide databases for subsequent 6-degree-of-freedom simulations.

Controlled trials to improve antibiotic utilization: a systematic review of experience, 1984-2004.

PubMed

Parrino, Thomas A

2005-02-01

To review the effectiveness of interventions designed to improve antibiotic prescribing patterns in clinical practice and to draw inferences about the most practical methods for optimizing antibiotic utilization in hospital and ambulatory settings. A literature search using online databases for the years 1975-2004 identified controlled trials of strategies for improving antibiotic utilization. Due to variation in study settings and design, quantitative meta-analysis was not feasible. Therefore, a qualitative literature review was conducted. Forty-one controlled trials met the search criteria. Interventions consisted of education, peer review and feedback, physician participation, rewards and penalties, administrative methods, and combined approaches. Social marketing directed at patients and prescribers was effective in varying contexts, as was implementation of practice guidelines. Authorization systems with structured order entry, formulary restriction, and mandatory consultation were also effective. Peer review and feedback were more effective when combined with dissemination of relevant information or social marketing than when used alone. Several practices were effective in improving antibiotic utilization: social marketing, practice guidelines, authorization systems, and peer review and feedback. Online systems providing clinical information, structured order entry, and decision support may be the most promising approach. Further studies, including economic analyses, are needed to confirm or refute this hypothesis.

Assessment of Pharmacy Information System Performance in Three Hospitals in Eastern Province, Saudi Arabia

PubMed Central

El.Mahalli, Azza; El-Khafif, Sahar H.; Yamani, Wid

2016-01-01

The pharmacy information system is one of the central pillars of a hospital information system. This research evaluated a pharmacy information system according to six aspects of the medication process in three hospitals in Eastern Province, Saudi Arabia. System administrators were interviewed to determine availability of functionalities. Then, system users within the hospital were targeted to evaluate their level of usage of these functionalities. The study was cross-sectional. Two structured surveys were designed. The overall response rate of hospital users was 31.7 percent. In all three hospitals studied, the electronic health record is hybrid, implementation has been completed and the system is running, and the systems have computerized provider order entry and clinical decision support. Also, the pharmacy information systems are integrated with the electronic health record, and computerized provider order entry and almost all prescribing and transcription functionalities are available; however, drug dispensing is a mostly manual process. However, the study hospitals do not use barcode-assisted medication administration systems to verify patient identity and electronically check dose administration, and none of them have computerized adverse drug event monitoring that uses the electronic health record. The numbers of users who used different functionalities most or all of the time was generally low. The highest frequency of utilization was for patient administration records (56.8 percent), and the lowest was for linkage of the pharmacy information system to pharmacy stock (9.1 percent). Encouraging users to use different functionalities was highly recommended. PMID:26903780

Assessment of Pharmacy Information System Performance in Three Hospitals in Eastern Province, Saudi Arabia.

PubMed

El Mahalli, Azza; El-Khafif, Sahar H; Yamani, Wid

2016-01-01

The pharmacy information system is one of the central pillars of a hospital information system. This research evaluated a pharmacy information system according to six aspects of the medication process in three hospitals in Eastern Province, Saudi Arabia. System administrators were interviewed to determine availability of functionalities. Then, system users within the hospital were targeted to evaluate their level of usage of these functionalities. The study was cross-sectional. Two structured surveys were designed. The overall response rate of hospital users was 31.7 percent. In all three hospitals studied, the electronic health record is hybrid, implementation has been completed and the system is running, and the systems have computerized provider order entry and clinical decision support. Also, the pharmacy information systems are integrated with the electronic health record, and computerized provider order entry and almost all prescribing and transcription functionalities are available; however, drug dispensing is a mostly manual process. However, the study hospitals do not use barcode-assisted medication administration systems to verify patient identity and electronically check dose administration, and none of them have computerized adverse drug event monitoring that uses the electronic health record. The numbers of users who used different functionalities most or all of the time was generally low. The highest frequency of utilization was for patient administration records (56.8 percent), and the lowest was for linkage of the pharmacy information system to pharmacy stock (9.1 percent). Encouraging users to use different functionalities was highly recommended.

Principles for a Successful Computerized Physician Order Entry Implementation

PubMed Central

Ash, Joan S.; Fournier, Lara; Stavri, P. Zoë; Dykstra, Richard

2003-01-01

To identify success factors for implementing computerized physician order entry (CPOE), our research team took both a top-down and bottom-up approach and reconciled the results to develop twelve overarching principles to guide implementation. A consensus panel of experts produced ten Considerations with nearly 150 sub-considerations, and a three year project using qualitative methods at multiple successful sites for a grounded theory approach yielded ten general themes with 24 sub-themes. After reconciliation using a meta-matrix approach, twelve Principles, which cluster into groups forming the mnemonic CPOE emerged. Computer technology principles include: temporal concerns; technology and meeting information needs; multidimensional integration; and costs. Personal principles are: value to users and tradeoffs; essential people; and training and support. Organizational principles include: foundational underpinnings; collaborative project management; terms, concepts and connotations; and improvement through evaluation and learning. Finally, Environmental issues include the motivation and context for implementing such systems. PMID:14728129

Displaying radiation exposure and cost information at order entry for outpatient diagnostic imaging: a strategy to inform clinician ordering.

PubMed

Kruger, Jenna F; Chen, Alice Hm; Rybkin, Alex; Leeds, Kiren; Guzman, David; Vittinghoff, Eric; Goldman, L Elizabeth

2016-12-01

Displaying radiation exposure and cost information at electronic order entry may encourage clinicians to consider the value of diagnostic imaging. An urban safety-net health system displayed radiation exposure information for CT and cost information for CT, MRI and ultrasound on an electronic referral system for outpatient ordering. We assessed whether there were differences in numbers of outpatient CT scans and MRIs per month relative to ultrasounds before and after the intervention, and evaluated primary care clinicians' responses to the intervention. There were 23 171 outpatient CTs, 15 052 MRIs and 43 266 ultrasounds from 2011 to 2014. The ratio of CTs to ultrasounds decreased by 15% (95% CI 9% to 21%), from 58.2 to 49.6 CTs per 100 ultrasounds; the ratio of MRIs to ultrasounds declined by 13% (95% CI 7% to 19%), from 37.5 to 32.5 per 100. Of 300 invited, 190 (63%) completed the web-based survey in 17 clinics. 154 (81%) noticed the radiation exposure information and 158 (83.2%) noticed the cost information. Clinicians believed radiation exposure information was more influential than cost information: when unsure clinically about ordering a test (radiation=69.7%; cost=46.4%), when a patient wanted a test not clinically indicated (radiation=77.5%; cost=54.8%), when they had a choice between imaging modalities (radiation=77.9%; cost=66.6%), in patient care discussions (radiation=71.9%; cost=43.2%) and in trainee discussions (radiation=56.5%; cost=53.7%). Resident physicians and nurse practitioners were more likely to report that the cost information influenced them (p<0.05). Displaying radiation exposure and cost information at order entry may improve clinician awareness about diagnostic imaging safety risks and costs. More clinicians reported the radiation information influenced their clinical practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Thermal Protection System Mass Estimating Relationships for Blunt-Body, Earth Entry Spacecraft

NASA Technical Reports Server (NTRS)

Sepka, Steven A.; Samareh, Jamshid A.

2015-01-01

System analysis and design of any entry system must balance the level fidelity for each discipline against the project timeline. One way to inject high fidelity analysis earlier in the design effort is to develop surrogate models for the high-fidelity disciplines. Surrogate models for the Thermal Protection System (TPS) are formulated as Mass Estimating Relationships (MERs). The TPS MERs are presented that predict the amount of TPS necessary for safe Earth entry for blunt-body spacecraft using simple correlations that closely match estimates from NASA's high-fidelity ablation modeling tool, the Fully Implicit Ablation and Thermal Analysis Program (FIAT). These MERs provide a first order estimate for rapid feasibility studies. There are 840 different trajectories considered in this study, and each TPS MER has a peak heating limit. MERs for the vehicle forebody include the ablators Phenolic Impregnated Carbon Ablator (PICA) and Carbon Phenolic atop Advanced Carbon-Carbon. For the aftbody, the materials are Silicone Impregnated Reusable Ceramic Ablator (SIRCA), Acusil II, SLA-561V, and LI-900. The MERs are accurate to within 14% (at one standard deviation) of FIAT prediction, and the most any MER under predicts FIAT TPS thickness is 18.7%. This work focuses on the development of these MERs, the resulting equations, model limitations, and model accuracy.

Discrimination of bullet types using analysis of lead isotopes deposited in gunshot entry wounds.

PubMed

Wunnapuk, Klintean; Minami, Takeshi; Durongkadech, Piya; Tohno, Setsuko; Ruangyuttikarn, Werawan; Moriwake, Yumi; Vichairat, Karnda; Sribanditmongkol, Pongruk; Tohno, Yoshiyuki

2009-01-01

In order to discriminate bullet types used in firearms, of which the victims died, the authors investigated lead isotope ratios in gunshot entry wounds from nine lead (unjacketed) bullets, 15 semi-jacketed bullets, and 14 full-jacketed bullets by inductively coupled plasma-mass spectrometry. It was found that the lead isotope ratio of 207/206 in gunshot entry wounds was the highest with lead bullets, and it decreased in order from full-jacketed to semi-jacketed bullets. Lead isotope ratios of 208/206 or 208/207 to 207/206 at the gunshot entry wound were able to discriminate semi-jacketed bullets from lead and full-jacketed ones, but it was difficult to discriminate between lead and full-jacketed bullets. However, a combination of element and lead isotope ratio analyses in gunshot entry wounds enabled discrimination between lead, semi-jacketed, and full-jacketed bullets.

Autonomous atmospheric entry on mars: Performance improvement using a novel adaptive control algorithm

NASA Astrophysics Data System (ADS)

Ulrich, Steve; de Lafontaine, Jean

2007-12-01

Upcoming landing missions to Mars will require on-board guidance and control systems in order to meet the scientific requirement of landing safely within hundreds of meters to the target of interest. More specifically, in the longitudinal plane, the first objective of the entry guidance and control system is to bring the vehicle to its specified velocity at the specified altitude (as required for safe parachute deployment), while the second objective is to reach the target position in the longitudinal plane. This paper proposes an improvement to the robustness of the constant flight path angle guidance law for achieving the first objective. The improvement consists of combining this guidance law with a novel adaptive control scheme, derived from the so-called Simple Adaptive Control (SAC) technique. Monte-Carlo simulation results are shown to demonstrate the accuracy and the robustness of the proposed guidance and adaptive control system.

77 FR 49846 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-17

...: (i) Significantly affect the protection of investors or the public interest; (ii) impose any... market and a national market system, and, in general, to protect investors and the public interest. \\4... benefit investors and the public interest and encourage more efficient order entry practices by Market...

A Development of Automatic Audit System for Written Informed Consent using Machine Learning.

PubMed

Yamada, Hitomi; Takemura, Tadamasa; Asai, Takahiro; Okamoto, Kazuya; Kuroda, Tomohiro; Kuwata, Shigeki

2015-01-01

In Japan, most of all the university and advanced hospitals have implemented both electronic order entry systems and electronic charting. In addition, all medical records are subjected to inspector audit for quality assurance. The record of informed consent (IC) is very important as this provides evidence of consent from the patient or patient's family and health care provider. Therefore, we developed an automatic audit system for a hospital information system (HIS) that is able to evaluate IC automatically using machine learning.

Does the physician order-entry system increase the revenue of a general hospital?

PubMed

Park, Woong-Sub; Kim, Joon S; Chae, Young Moon; Yu, Seung-Hum; Kim, Chang-Yup; Kim, Sang-A; Jung, Sang Hyuk

2003-08-01

The purpose of this study was to examine whether the physician order-entry system (POE) could increase the outpatient and inpatient revenue of hospitals. We analyzed the inpatient and outpatient revenue data of all general hospitals (212) in South Korea obtained from the Korean National Health Insurance Corporation (KNHIC) during the period from 1996 to 1999 using the mixed model for repeated measure data. Analysis of the 4-years' panel data showed that both outpatient and inpatient revenues increased significantly after POE introduction. The hospital characteristics significantly influencing inpatient revenue were the number of beds, number of physicians and the tertiary status of a hospital; whereas those for outpatient revenue were the number of beds, number of physicians, the private status of a hospital, the tertiary status of a hospital and the urban status of a hospital. The revenues from both outpatients and inpatients were found to be increased after the introduction of the POE, while controlling for population size, competition, income, hospital location, hospital size, tertiary status and public status.

Atmospheric Entry Heating of Micrometeorites Revisited: Higher Temperatures and Potential Biases

NASA Technical Reports Server (NTRS)

Love, S.; Alexander, C. M. OD.

2001-01-01

The atmospheric entry heating model of Love and Brownlee appears to have overestimated evaporation rates by as much as two orders of magnitude. Here we revisit the issue of atmospheric entry heating, using a revised prescription for evaporation rates. Additional information is contained in the original extended abstract.

43 CFR 2521.5 - Annual proof.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Procedures § 2521.5 Annual proof. (a) Showing required. (1) In order to test the sincerity and good faith of claimants under the desert... a desert-land entry unless made on account of that particular entry, and expenditures once credited...

43 CFR 2521.5 - Annual proof.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Procedures § 2521.5 Annual proof. (a) Showing required. (1) In order to test the sincerity and good faith of claimants under the desert... a desert-land entry unless made on account of that particular entry, and expenditures once credited...

43 CFR 2521.5 - Annual proof.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OF THE INTERIOR LAND RESOURCE MANAGEMENT (2000) DESERT-LAND ENTRIES Procedures § 2521.5 Annual proof. (a) Showing required. (1) In order to test the sincerity and good faith of claimants under the desert... a desert-land entry unless made on account of that particular entry, and expenditures once credited...

Legacy system integration using web technology

NASA Astrophysics Data System (ADS)

Kennedy, Richard L.; Seibert, James A.; Hughes, Chris J.

2000-05-01

As healthcare moves towards a completely digital, multimedia environment there is an opportunity to provide for cost- effective, highly distributed physician access to clinical information including radiology-based imaging. In order to address this opportunity a Universal Clinical Desktop (UCD) system was developed. A UCD provides a single point of entry into an integrated view of all types of clinical data available within a network of disparate healthcare information systems. In order to explore the application of a UCD in a hospital environment, a pilot study was established with the University of California Davis Medical Center using technology from Trilix Information Systems. Within this pilot environment the information systems integrated under the UCD include a radiology information system (RIS), a picture archive and communication system (PACS) and a laboratory information system (LIS).

Observations of Shock Diffusion and Interactions in Supersonic Freestreams with Counterflowing Jets

NASA Technical Reports Server (NTRS)

Daso, Endwell O.; Pritchett, Victor E.; Wang, Ten-See; Blankson, Isiah M.; Auslender, Aaron H.

2006-01-01

One of the technical challenges in long-duration space exploration and interplanetary missions is controlled entry and re-entry into planetary and Earth atmospheres, which requires the dissipation of considerable kinetic energy as the spacecraft decelerates and penetrates the atmosphere. Efficient heat load management of stagnation points and acreage heating remains a technological challenge and poses significant risk, particularly for human missions. An innovative approach using active flow control concept is proposed to significantly modify the external flow field about the spacecraft in planetary atmospheric entry and re-entry in order to mitigate the harsh aerothermal environments, and significantly weaken and disperse the shock-wave system to reduce aerothermal loads and wave drag, as well as improving aerodynamic performance. To explore the potential benefits of this approach, we conducted fundamental experiments in a trisonic blow down wind tunnel to investigate the effects of counterflowing sonic and supersonic jets against supersonic freestreams to gain a better understanding of the flow physics of the interactions of the opposing flows and the resulting shock structure.

31 CFR 306.23 - Securities eligible to be held in the TREASURY DIRECT Book-entry Securities System.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TREASURY DIRECT Book-entry Securities System. 306.23 Section 306.23 Money and Finance: Treasury Regulations... Securities eligible to be held in the TREASURY DIRECT Book-entry Securities System. (a) Eligible issues. The... conversion to the TREASURY DIRECT Book-entry Securities System. The notice shall specify the period during...

Computerized Provider Order Entry and Health Care Quality on Hospital Level among Pediatric Patients during 2006-2009

ERIC Educational Resources Information Center

Wang, Liya

2016-01-01

This study examined the association between Computerized Physician Order Entry (CPOE) application and healthcare quality in pediatric patients at hospital level. This was a retrospective study among 1,428 hospitals with pediatric setting in Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) and Health Information and…

75 FR 80101 - Self-Regulatory Organizations; New York Stock Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-21

... entry, cancellation of such orders and the calculation and publication of imbalances. In particular... a Mandatory MOC/LOC Imbalance Publication. The rule therefore suggests that members or member... all MOC/LOC orders that would join the same side of a published MOC/LOC imbalance and the entry of MOC...

19 CFR 145.12 - Entry of merchandise.

Code of Federal Regulations, 2011 CFR

2011-04-01

... formal entry, even though they reach Customs at the same time and are covered by a single order or contract in excess of $2,000, unless there was a splitting of shipments in order to avoid the payment of... Postal Service for delivery and collection of duty. If the addressee has arranged to pick up such a...

19 CFR 145.12 - Entry of merchandise.

Code of Federal Regulations, 2010 CFR

2010-04-01

... formal entry, even though they reach Customs at the same time and are covered by a single order or contract in excess of $2,000, unless there was a splitting of shipments in order to avoid the payment of... Postal Service for delivery and collection of duty. If the addressee has arranged to pick up such a...

19 CFR 148.77 - Entry of effects on termination of assignment to extended duty, or on evacuation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... unaccompanied personal and household effects by either a United States Dispatch Agent or a designated... entry if there is a valid reason evident from the owner's travel orders or information at hand why the... of Government employee) Travel orders and information on hand in this office show that the named...

76 FR 38293 - Risk Management Controls for Brokers or Dealers With Market Access

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... securities to give broker- dealers with market access additional time to develop, test, and implement the... that exceed appropriate pre-set credit or capital thresholds,\\5\\ or that appear to be erroneous.\\6\\ The... satisfied on a pre-order entry basis,\\7\\ prevent the entry of orders that the broker- dealers or customer is...

Simulation and analysis of a proposed replacement for the McCook port of entry inspection station

DOT National Transportation Integrated Search

1999-04-01

This report describes a study of a proposed replacement for the McCook Port of Entry inspection station at the entry to South Dakota. In order to assess the potential for a low-speed weigh in motion (WIM) scale within the station to pre-screen trucks...

Changes in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units.

PubMed

Hoonakker, Peter L T; Carayon, Pascale; Brown, Roger L; Cartmill, Randi S; Wetterneck, Tosha B; Walker, James M

2013-01-01

Implementation of Computerized Provider Order Entry (CPOE) has many potential advantages. Despite the potential benefits of CPOE, several attempts to implement CPOE systems have failed or met with high levels of user resistance. Implementation of CPOE can fail or meet high levels of user resistance for a variety of reasons, including lack of attention to users' needs and the significant workflow changes required by CPOE. User satisfaction is a critical factor in information technology implementation. Little is known about how end-user satisfaction with CPOE changes over time. To examine ordering provider and nurse satisfaction with CPOE implementation over time. We conducted a repeated cross-sectional questionnaire survey in four intensive care units of a large hospital. We analyzed the questionnaire data as well as the responses to two open-ended questions about advantages and disadvantages of CPOE. Users were moderately satisfied with CPOE and there were interesting differences between user groups: ordering providers and nurses. User satisfaction with CPOE did not change over time for providers, but it did improve significantly for nurses. Results also show that nurses and providers are satisfied with different aspects of CPOE.

A Decentralized Event-Triggered Dissipative Control Scheme for Systems With Multiple Sensors to Sample the System Outputs.

PubMed

Zhang, Xian-Ming; Han, Qing-Long

2016-12-01

This paper is concerned with decentralized event-triggered dissipative control for systems with the entries of the system outputs having different physical properties. Depending on these different physical properties, the entries of the system outputs are grouped into multiple nodes. A number of sensors are used to sample the signals from different nodes. A decentralized event-triggering scheme is introduced to select those necessary sampled-data packets to be transmitted so that communication resources can be saved significantly while preserving the prescribed closed-loop performance. First, in order to organize the decentralized data packets transmitted from the sensor nodes, a data packet processor (DPP) is used to generate a new signal to be held by the zero-order-hold once the signal stored by the DPP is updated at some time instant. Second, under the mechanism of the DPP, the resulting closed-loop system is modeled as a linear system with an interval time-varying delay. A sufficient condition is derived such that the closed-loop system is asymptotically stable and strictly (Q 0 ,S 0 ,R 0 ) -dissipative, where Q 0 ,S 0 , and R 0 are real matrices of appropriate dimensions with Q 0 and R 0 symmetric. Third, suitable output-based controllers can be designed based on solutions to a set of a linear matrix inequality. Finally, two examples are given to demonstrate the effectiveness of the proposed method.

Implementation of a pharmacy automation system (robotics) to ensure medication safety at Norwalk hospital.

PubMed

Bepko, Robert J; Moore, John R; Coleman, John R

2009-01-01

This article reports an intervention to improve the quality and safety of hospital patient care by introducing the use of pharmacy robotics into the medication distribution process. Medication safety is vitally important. The integration of pharmacy robotics with computerized practitioner order entry and bedside medication bar coding produces a significant reduction in medication errors. The creation of a safe medication-from initial ordering to bedside administration-provides enormous benefits to patients, to health care providers, and to the organization as well.

Integrated Clinical Information System Collaboration Project (CPOE)

DTIC Science & Technology

2009-10-01

variation in care, represents an extraordinary opportunity to  positively  impact  current and future quality outcomes.      General  Patient  Outcomes...those of the author(s) and should not be construed as an official Department of the Army position , policy or decision unless so designated by...process for submitting orders. This study examined the impact of the transition from paper order entry to CPOE on patient care by the adoption of

Sustained User Engagement in Health Information Technology: The Long Road from Implementation to System Optimization of Computerized Physician Order Entry and Clinical Decision Support Systems for Prescribing in Hospitals in England.

PubMed

Cresswell, Kathrin M; Lee, Lisa; Mozaffar, Hajar; Williams, Robin; Sheikh, Aziz

2017-10-01

To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. Six hospitals in England, United Kingdom. Qualitative case study. We undertook qualitative semi-structured interviews, non-participant observations of meetings and system use, and collected organizational documents over three time periods from six hospitals. Thematic analysis was initially undertaken within individual cases, followed by cross-case comparisons. We conducted 173 interviews, conducted 24 observations, and collected 17 documents between 2011 and 2015. We found that perceived individual and safety benefits among different user groups tended to facilitate engagement in some, while other less engaged groups developed resistance and unsanctioned workarounds if systems were perceived to be inadequate. We identified both the opportunity and need for sustained engagement across user groups around system enhancement (e.g., through customizing software) and the development of user competencies and effective use. There is an urgent need to move away from an episodic view of engagement focused on the preimplementation phase, to more continuous holistic attempts to engage with and respond to end-users. © Health Research and Educational Trust.

Analysis of Low Appropriateness Score Exam Trends in Decision Support-based Radiology Order Entry System.

PubMed

Gupta, Supriya; Klein, Kandace; Singh, Anand H; Thrall, James H

2017-05-01

Awareness of imaging utilization increased after implementation of Radiology Order Entry with decision support systems (ROE-DS). Our hypothesis is few exams with low Clinical Appropriateness Score (CAS) on ROE-DS are performed. Clinical indications of exams with CAS less than 3 (9-point scale) were re-reviewed and reports analyzed. Structured Query Language-based query retrieved exams with CAS less than 3 in ROE-DS from January 2007 to December 2011. Reasons provided by physicians for ordering these exams and reports of exams performed were analyzed. For each indication, number of exams ordered and performed was calculated. Statistical significance was assessed using Student's t test and χ 2 analysis (P < .05). From 445,984 exams, 12,615 exams (2.8%) had CAS less than 3, and 7,956 exams (63%) were performed. Reasons for ordering of 12,615 low CAS exams were as follows: Requests by physician specialists without further explanation (4,516 = 35.8%), notation of special clinical circumstances (2,877 = 22.8%), requests by nonphysician staff without further explanation (1,383 = 10.9%), absence of suspected finding on previous modality (1,099 = 8.7%), patient preference (737 = 5.8%), and requests based on radiologists' recommendations (706 = 5.6%). Difference between male and female (male < female) preferences for low CAS exams was statistically significant (P < .01). Imaging outcome was highest for extremity MRI cases (66.7%; P < .01). Less than 3% of exams ordered had low CAS and about two-thirds of these were performed. Most common indication for ordering these exams was physician specialist request based on opinion of medical necessity without specification. Extremity MRI constituted the highest positive findings for low CAS exams performed. Published by Elsevier Inc.

40 CFR 141.26 - Monitoring frequency and compliance requirements for radionuclides in community water systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... beta emitters and iodine-131 and annual samples for tritium and strontium-90 at each entry point to the... recommended. (ii) For iodine-131, a composite of five consecutive daily samples shall be analyzed once each quarter. As ordered by the State, more frequent monitoring shall be conducted when iodine-131 is...

40 CFR 141.26 - Monitoring frequency and compliance requirements for radionuclides in community water systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... beta emitters and iodine-131 and annual samples for tritium and strontium-90 at each entry point to the... recommended. (ii) For iodine-131, a composite of five consecutive daily samples shall be analyzed once each quarter. As ordered by the State, more frequent monitoring shall be conducted when iodine-131 is...

40 CFR 141.26 - Monitoring frequency and compliance requirements for radionuclides in community water systems.

Code of Federal Regulations, 2011 CFR

2011-07-01

... beta emitters and iodine-131 and annual samples for tritium and strontium-90 at each entry point to the... recommended. (ii) For iodine-131, a composite of five consecutive daily samples shall be analyzed once each quarter. As ordered by the State, more frequent monitoring shall be conducted when iodine-131 is...

19 CFR 141.58 - Single entry for separately arriving portions of unassembled or disassembled entities.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., third of six portions). If both the carrier and the importer are automated, such adjustments may be made electronically through the CBP Automated Commercial System (ACS). The release of each portion upon arrival as... information for that portion of the ordered entity (for example, detailed packing lists). (f) Examination. CBP...

19 CFR 141.58 - Single entry for separately arriving portions of unassembled or disassembled entities.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., third of six portions). If both the carrier and the importer are automated, such adjustments may be made electronically through the CBP Automated Commercial System (ACS). The release of each portion upon arrival as... information for that portion of the ordered entity (for example, detailed packing lists). (f) Examination. CBP...

19 CFR 141.58 - Single entry for separately arriving portions of unassembled or disassembled entities.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., third of six portions). If both the carrier and the importer are automated, such adjustments may be made electronically through the CBP Automated Commercial System (ACS). The release of each portion upon arrival as... information for that portion of the ordered entity (for example, detailed packing lists). (f) Examination. CBP...

19 CFR 141.58 - Single entry for separately arriving portions of unassembled or disassembled entities.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., third of six portions). If both the carrier and the importer are automated, such adjustments may be made electronically through the CBP Automated Commercial System (ACS). The release of each portion upon arrival as... information for that portion of the ordered entity (for example, detailed packing lists). (f) Examination. CBP...

19 CFR 141.58 - Single entry for separately arriving portions of unassembled or disassembled entities.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., third of six portions). If both the carrier and the importer are automated, such adjustments may be made electronically through the CBP Automated Commercial System (ACS). The release of each portion upon arrival as... information for that portion of the ordered entity (for example, detailed packing lists). (f) Examination. CBP...

76 FR 13003 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-09

... PULSe workstation. The Exchange is also proposing to make a non-substantive formatting change to its Fee... related to the PULSe workstation. The Exchange is also proposing to make a non-substantive formatting change to its Fee Schedule. By way of background, the PULSe workstation is a front-end order entry system...

76 FR 40965 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated: Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-12

... way of background, the PULSe workstation is a front-end order entry system designed for use with... extend a fee waiver related to the PULSe workstation and to adopt a limited fee waiver for new users of the PULSe workstation. In addition, the Exchange is proposing to make a non-substantive numbering...

75 FR 21036 - Notice of Proposed Withdrawal Extension and Opportunity for Public Meeting; Oregon

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-22

...,400 acres of National Forest System land from mining in order to protect the major anadromous fish...: Bureau of Land Management, Interior. ACTION: Notice. SUMMARY: The United States Forest Service (USFS) has..., from location and entry under the United States mining laws (30 U.S.C. ch. 2), for an additional 20...

A New Patient Record System Using the Laser Card

PubMed Central

Brown, J.H.U.; Vallbona, Carlos

1988-01-01

A method of handling medical data in the form of patient records including physical findings such as x-rays has been devised using a laser card coupled to a p.c. for data input and output. A satisfactory software system which encompasses a formalized medical record system dealing with events rather than chronological order of entry has been devised and is now under test in a community health clinic. Future directions of the card research are discussed and expanded upon. ImagesFig. 7

31 CFR 357.0 - Book-entry systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Book-entry systems. 357.0 Section 357..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING BOOK-ENTRY TREASURY BONDS, NOTES AND BILLS HELD IN LEGACY TREASURY DIRECT General Information § 357.0 Book-entry systems. (a) Treasury...

Impact of Hospital Information Systems on Emergency Patient Processing

PubMed Central

Rusnak, James E.

1981-01-01

The Emergency Department offers the Hospital Information System's designer some unique problems to solve in the operational areas of patient registration, order entry, charge recording, and treatment processing. In a number of instances, Hospital Information Systems implementers have encountered serious difficulties in trying to design system components to support the requirements of the Emergency Services Department's operations. Washington Hospital has developed a very effective system for Emergency Services. The system's features are designed to meet the special requirements of the department and to maximize the use of the data captured by the Hospital Information System. The system supports accurate and timely charging for services. The treatment of the patient has been dramatically improved through the use of a computerized order processing and control. The installed systems resulted in a higher quality of care and cost effective operations.

Mid-Term Assessment of English 10 Students: A Comparison of Methods of Entry into the Course.

ERIC Educational Resources Information Center

Isonio, Steven

In spring 1992, a mid-term assessment of English 10 students was conducted at Golden West College, in California, in order to compare four course placement methods. English 10, "Writing Essentials," is a nontransferrable course which focuses on paragraph writing and grammar review in order to prepare students for entry into English 100.…

20 CFR 655.665 - Notice to the Department of Homeland Security and the Employment and Training Administration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Training Administration. (a) The Administrator shall promptly notify the DHS and ETA of the entry of a... part, unless the Administrator notifies the DHS and ETA of the entry of a subsequent order lifting the... the cease and desist order, without having on file with ETA an attestation pursuant to § 655.520 of...

76 FR 55166 - Actions Taken Pursuant to Executive Order 13382 Related to the Islamic Republic of Iran Shipping...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-06

... Order 13382 Related to the Islamic Republic of Iran Shipping Lines (IRISL) AGENCY: Office of Foreign... connection to the Islamic Republic of Iran Shipping Lines (IRISL) and is updating the entries on OFAC's list... as property of the Islamic Republic of Iran Shipping Lines (IRISL) and updated the entries on OFAC's...

19 CFR 351.213 - Administrative review of orders and suspension agreements under section 751(a)(1) of the Act.

Code of Federal Regulations, 2010 CFR

2010-04-01

... concludes that, during the period covered by the review, there were no entries, exports, or sales of the... administrative review under this section will cover, as appropriate, entries, exports, or sales during the period... 19 Customs Duties 3 2010-04-01 2010-04-01 false Administrative review of orders and suspension...

77 FR 69688 - Self-Regulatory Organizations; New York Stock Exchange LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-20

... Items I, II and III below, which Items have been prepared by the Exchange. The Commission is publishing... Management Gateway service (``RMG'') would not be charged for order/ quote entry ports if such ports are... for order/quote entry ports that connect to the Exchange via the DMM Gateway.\\7\\ \\5\\ The Exchange...

Mars Pathfinder flight system integration and test.

NASA Astrophysics Data System (ADS)

Muirhead, B. K.

This paper describes the system integration and test experiences, problems and lessons learned during the assembly, test and launch operations (ATLO) phase of the Mars Pathfinder flight system scheduled to land on the surface of Mars on July 4, 1997. The Mars Pathfinder spacecraft consists of three spacecraft systems: cruise stage, entry vehicle and lander. The cruise stage carries the entry and lander vehicles to Mars and is jettisoned prior to entry. The entry vehicle, including aeroshell, parachute and deceleration rockets, protects the lander during the direct entry and reduces its velocity from 7.6 to 0 km/s in stages during the 5 min entry sequence. The lander's touchdown is softened by airbags which are retracted once stopped on the surface. The lander then uprights itself, opens up fully and begins surface operations including deploying its camera and rover. This paper overviews the system design and the results of the system integration and test activities, including the entry, descent and landing subsystem elements. System test experiences including science instruments, the microrover, Sojourner, and software are discussed. The final qualification of the entry, descent and landing subsystems during this period is also discussed.

National trends in safety performance of electronic health record systems in children's hospitals.

PubMed

Chaparro, Juan D; Classen, David C; Danforth, Melissa; Stockwell, David C; Longhurst, Christopher A

2017-03-01

To evaluate the safety of computerized physician order entry (CPOE) and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the US using the Leapfrog Group's pediatric CPOE evaluation tool. The Leapfrog pediatric CPOE evaluation tool, a previously validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm, was used to evaluate 41 pediatric hospitals over a 2-year period. Evaluation of the last available test for each institution was performed, assessing performance overall as well as by decision support category (eg, drug-drug, dosing limits). Longitudinal analysis of test performance was also carried out to assess the impact of testing and the overall trend of CPOE performance in pediatric hospitals. Pediatric CPOE systems were able to identify 62% of potential medication errors in the test scenarios, but ranged widely from 23-91% in the institutions tested. The highest scoring categories included drug-allergy interactions, dosing limits (both daily and cumulative), and inappropriate routes of administration. We found that hospitals with longer periods since their CPOE implementation did not have better scores upon initial testing, but after initial testing there was a consistent improvement in testing scores of 4 percentage points per year. Pediatric computerized physician order entry (CPOE) systems on average are able to intercept a majority of potential medication errors, but vary widely among implementations. Prospective and repeated testing using the Leapfrog Group's evaluation tool is associated with improved ability to intercept potential medication errors. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients.

PubMed

Vermeulen, K M; van Doormaal, J E; Zaal, R J; Mol, P G M; Lenderink, A W; Haaijer-Ruskamp, F M; Kosterink, J G W; van den Bemt, P M L A

2014-08-01

Prescribing medication is an important aspect of almost all in-hospital treatment regimes. Besides their obviously beneficial effects, medicines can also cause adverse drug events (ADE), which increase morbidity, mortality and health care costs. Partially, these ADEs arise from medication errors, e.g. at the prescribing stage. ADEs caused by medication errors are preventable ADEs. Until now, medication ordering was primarily a paper-based process and consequently, it was error prone. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) is considered to enhance patient safety. Limited information is available on the balance between the health gains and the costs that need to be invested in order to achieve these positive effects. Aim of this study was to study the balance between the effects and costs of CPOE/CDSS compared to the traditional paper-based medication ordering. The economic evaluation was performed alongside a clinical study (interrupted time series design) on the effectiveness of CPOE/CDSS, including a cost minimization and a cost-effectiveness analysis. Data collection took place between 2005 and 2008. Analyses were performed from a hospital perspective. The study was performed in a general teaching hospital and a University Medical Centre on general internal medicine, gastroenterology and geriatric wards. Computerized Physician Order Entry, combined with basic Clinical Decision Support System (CPOE/CDSS) was compared to a traditional paper based system. All costs of both medication ordering systems are based on resources used and time invested. Prices were expressed in Euros (price level 2009). Effectiveness outcomes were medication errors and preventable adverse drug events. During the paper-based prescribing period 592 patients were included, and during the CPOE/CDSS period 603. Total costs of the paper-based system and CPOE/CDSS amounted to €12.37 and €14.91 per patient/day respectively. The Incremental Cost-Effectiveness Ratio (ICER) for medication errors was 3.54 and for preventable adverse drug events 322.70, indicating the extra amount (€) that has to be invested in order to prevent one medication error or one pADE. CPOE with basic CDSS contributes to a decreased risk of preventable harm. Overall, the extra costs of CPOE/CDSS needed to prevent one ME or one pADE seem to be acceptable. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A cognitive task analysis of information management strategies in a computerized provider order entry environment.

PubMed

Weir, Charlene R; Nebeker, Jonathan J R; Hicken, Bret L; Campo, Rebecca; Drews, Frank; Lebar, Beth

2007-01-01

Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques. Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers. Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified. Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented. Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system.

76 FR 47148 - Application(s) for Duty-Free Entry of Scientific Instruments

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

... work in microbiology and pathology, to study biological materials in order to identify bacterial or viral pathogens with clinical significance in veterinary medicine. Justification for Duty-Free Entry: No...

Knowledge Translation of the PERC Rule for Suspected Pulmonary Embolism: A Blueprint for Reducing the Number of CT Pulmonary Angiograms.

PubMed

Drescher, Michael J; Fried, Jeremy; Brass, Ryan; Medoro, Amanda; Murphy, Timothy; Delgado, João

2017-10-01

Computerized decision support decreases the number of computed tomography pulmonary angiograms (CTPA) for pulmonary embolism (PE) ordered in emergency departments, but it is not always well accepted by emergency physicians. We studied a department-endorsed, evidence-based clinical protocol that included the PE rule-out criteria (PERC) rule, multi-modal education using principles of knowledge translation (KT), and clinical decision support embedded in our order entry system, to decrease the number of unnecessary CTPA ordered. We performed a historically controlled observational before-after study for one year pre- and post-implementation of a departmentally-endorsed protocol. We included patients > 18 in whom providers suspected PE and who did not have a contraindication to CTPA. Providers entered clinical information into a diagnostic pathway via computerized order entry. Prior to protocol implementation, we provided education to ordering providers. The primary outcome measure was the number of CTPA ordered per 1,000 visits one year before vs. after implementation. CTPA declined from 1,033 scans for 98,028 annual visits (10.53 per 1,000 patient visits (95% CI [9.9-11.2]) to 892 scans for 101,172 annual visits (8.81 per 1,000 patient visits (95% CI [8.3-9.4]) p<0.001. The absolute reduction in PACT ordered was 1.72 per 1,000 visits (a 16% reduction). Patient characteristics were similar for both periods. Knowledge translation clinical decision support using the PERC rule significantly reduced the number of CTPA ordered.

Roles of Engineering Correlations in Hypersonic Entry Boundary Layer Transition Prediction

NASA Technical Reports Server (NTRS)

Campbell, Charles H.; Anderson, Brian P.; King, Rudolph A.; Kegerise, Michael A.; Berry, Scott A.; Horvath, Thomas J.

2010-01-01

Efforts to design and operate hypersonic entry vehicles are constrained by many considerations that involve all aspects of an entry vehicle system. One of the more significant physical phenomenon that affect entry trajectory and thermal protection system design is the occurrence of boundary layer transition from a laminar to turbulent state. During the Space Shuttle Return To Flight activity following the loss of Columbia and her crew of seven, NASA's entry aerothermodynamics community implemented an engineering correlation based framework for the prediction of boundary layer transition on the Orbiter. The methodology for this implementation relies upon similar correlation techniques that have been is use for several decades. What makes the Orbiter boundary layer transition correlation implementation unique is that a statistically significant data set was acquired in multiple ground test facilities, flight data exists to assist in establishing a better correlation and the framework was founded upon state of the art chemical nonequilibrium Navier Stokes flow field simulations. Recent entry flight testing performed with the Orbiter Discovery now provides a means to validate this engineering correlation approach to higher confidence. These results only serve to reinforce the essential role that engineering correlations currently exercise in the design and operation of entry vehicles. The framework of information related to the Orbiter empirical boundary layer transition prediction capability will be utilized to establish a fresh perspective on this role, and to discuss the characteristics which are desirable in a next generation advancement. The details of the paper will review the experimental facilities and techniques that were utilized to perform the implementation of the Orbiter RTF BLT Vsn 2 prediction capability. Statistically significant results for multiple engineering correlations from a ground testing campaign will be reviewed in order to describe why only certain correlations were selected for complete implementation to support the Shuttle Program. Historical Orbiter flight data on early boundary layer transition due to protruding gap fillers will be described in relation to the selected empirical correlations. In addition, Orbiter entry flight testing results from the BLT Flight Experiment will be discussed in relation to these correlations. Applicability of such correlations to the entry design problem will be reviewed, and finally a perspective on the desirable characteristics for a next generation capability based on high fidelity physical models will be provided.

Entry order as a consideration for innovation strategies.

PubMed

Cohen, Fredric J

2006-04-01

Prior studies have defined an effect of market entry order on commercial success that depends on attributes of the underlying technology, the rate of change in technology improvement, consumer expectations of these attributes and the degree of unmet demand. Analyses of pharmaceutical sales data suggest that the commercial success of drugs is subject to similar forces. These findings have important implications for innovation strategies.

24 CFR 350.11 - Notice of Attachment for Ginnie Mae Securities in Book-entry System.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Securities in Book-entry System. 350.11 Section 350.11 Housing and Urban Development Regulations Relating to... AND URBAN DEVELOPMENT BOOK-ENTRY PROCEDURES § 350.11 Notice of Attachment for Ginnie Mae Securities in Book-entry System. The interest of a debtor in a Security Entitlement may be reached by a creditor only...

24 CFR 350.11 - Notice of Attachment for Ginnie Mae Securities in Book-entry System.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Securities in Book-entry System. 350.11 Section 350.11 Housing and Urban Development Regulations Relating to... AND URBAN DEVELOPMENT BOOK-ENTRY PROCEDURES § 350.11 Notice of Attachment for Ginnie Mae Securities in Book-entry System. The interest of a debtor in a Security Entitlement may be reached by a creditor only...

24 CFR 350.11 - Notice of Attachment for Ginnie Mae Securities in Book-entry System.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Securities in Book-entry System. 350.11 Section 350.11 Housing and Urban Development Regulations Relating to... AND URBAN DEVELOPMENT BOOK-ENTRY PROCEDURES § 350.11 Notice of Attachment for Ginnie Mae Securities in Book-entry System. The interest of a debtor in a Security Entitlement may be reached by a creditor only...

47 CFR 11.14 - Primary Entry Point (PEP) System.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 1 2010-10-01 2010-10-01 false Primary Entry Point (PEP) System. 11.14 Section 11.14 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL EMERGENCY ALERT SYSTEM (EAS) General § 11.14 Primary Entry Point (PEP) System. The PEP system is a nationwide network of broadcast...

47 CFR 11.14 - Primary Entry Point (PEP) System.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 1 2011-10-01 2011-10-01 false Primary Entry Point (PEP) System. 11.14 Section 11.14 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL EMERGENCY ALERT SYSTEM (EAS) General § 11.14 Primary Entry Point (PEP) System. The PEP system is a nationwide network of broadcast...

Calculation of Water Entry Problem for Free-falling Bodies Using a Developed Cartesian Cut Cell Mesh

NASA Astrophysics Data System (ADS)

Wenhua, Wang; Yanying, Wang

2010-05-01

This paper describes the development of free surface capturing method on Cartesian cut cell mesh to water entry problem for free-falling bodies with body-fluid interaction. The incompressible Euler equations for a variable density fluid system are presented as governing equations and the free surface is treated as a contact discontinuity by using free surface capturing method. In order to be convenient for dealing with the problem with moving body boundary, the Cartesian cut cell technique is adopted for generating the boundary-fitted mesh around body edge by cutting solid regions out of a background Cartesian mesh. Based on this mesh system, governing equations are discretized by finite volume method, and at each cell edge inviscid flux is evaluated by means of Roe's approximate Riemann solver. Furthermore, for unsteady calculation in time domain, a time accurate solution is achieved by a dual time-stepping technique with artificial compressibility method. For the body-fluid interaction, the projection method of momentum equations and exact Riemann solution are applied in the calculation of fluid pressure on the solid boundary. Finally, the method is validated by test case of water entry for free-falling bodies.

The anatomy of decision support during inpatient care provider order entry (CPOE): Empirical observations from a decade of CPOE experience at Vanderbilt

PubMed Central

Miller, Randolph A.; Waitman, Lemuel R.; Chen, Sutin; Rosenbloom, S. Trent

2006-01-01

The authors describe a pragmatic approach to the introduction of clinical decision support at the point of care, based on a decade of experience in developing and evolving Vanderbilt’s inpatient “WizOrder” care provider order entry (CPOE) system. The inpatient care setting provides a unique opportunity to interject CPOE-based decision support features that restructure clinical workflows, deliver focused relevant educational materials, and influence how care is delivered to patients. From their empirical observations, the authors have developed a generic model for decision support within inpatient CPOE systems. They believe that the model’s utility extends beyond Vanderbilt, because it is based on characteristics of end-user workflows and on decision support considerations that are common to a variety of inpatient settings and CPOE systems. The specific approach to implementing a given clinical decision support feature within a CPOE system should involve evaluation along three axes: what type of intervention to create (for which the authors describe 4 general categories); when to introduce the intervention into the user’s workflow (for which the authors present 7 categories), and how disruptive, during use of the system, the intervention might be to end-users’ workflows (for which the authors describe 6 categories). Framing decision support in this manner may help both developers and clinical end-users plan future alterations to their systems when needs for new decision support features arise. PMID:16290243

76 FR 33809 - Amendment and Update to the Entry for an Individual Named in the Annex to Executive Order 13219...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-09

... Specially Designated Nationals and Blocked Persons (``SDN List''). The individual's date of birth has been amended and two addresses and an alternate place of birth have been added to the SDN List entry. The... entry of this individual on the SDN List is effective May 26, 2011. FOR FURTHER INFORMATION CONTACT...

31 CFR 357.22 - Transfers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND BILLS HELD IN LEGACY TREASURY DIRECT Legacy Treasury Direct Book-Entry Securities System (Legacy...-entry system, and TreasuryDirect ®. A security may also be transferred between accounts in Legacy... system. A transfer of a security from Legacy Treasury Direct to the commercial book-entry system is...

A system to improve medication safety in the setting of acute kidney injury: initial provider response.

PubMed

McCoy, Allison B; McCoy, Allison Beck; Peterson, Josh F; Gadd, Cynthia S; Gadd, Cindy; Danciu, Ioana; Waitman, Lemuel R

2008-11-06

Clinical decision support systems can decrease common errors related to inappropriate or excessive dosing for nephrotoxic or renally cleared drugs. We developed a comprehensive medication safety intervention with varying levels of workflow intrusiveness within computerized provider order entry to continuously monitor for and alert providers about early-onset acute kidney injury. Initial provider response to the interventions shows potential success in improving medication safety and suggests future enhancements to increase effectiveness.

12 CFR 615.5450 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AND OPERATIONS, AND FUNDING OPERATIONS Book-Entry Procedures for Farm Credit Securities § 615.5450... the claimant for another person to hold, transfer, or deal with the security. (b) Book-entry security means a Farm Credit security issued or maintained in the Book-entry System. (c) Book-entry System means...

78 FR 66803 - Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... Transfer of U.S. Treasury Book-Entry Securities Held on the National Book-Entry System AGENCY: Bureau of... (Treasury) is announcing a new fee schedule applicable to transfers of U.S. Treasury book-entry securities maintained on the National Book-Entry System (NBES) that occur on or after January 2, 2014. DATES: Effective...

Computerized Physician Order Entry: Reluctance of Physician Adoption of Technology Linked to Improving Health Care

ERIC Educational Resources Information Center

Ulinski, Don

2013-01-01

Physicians are the influential force in the complex field of patient care delivery. Physicians determine when and where patient healthcare is delivered and affect 80% of the money spent on it. Computerized systems used in the delivery of healthcare information have become an integral part that physicians use to provide patient care. This study…

76 FR 62879 - Self-Regulatory Organizations; C2 Options Exchange, Incorporated: Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-11

.... By way of background, the PULSe workstation is a front-end order entry system designed for use with... Schedule as it relates to the PULSe workstation. The text of the proposed rule change is available on the... workstations. The Exchange is also proposing some non-substantive changes to the fees schedule text to clarify...

76 FR 11705 - Office of the Attorney General; Certification Process for State Capital Counsel Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-03

..., Office of Legal Counsel, Re: The Scope of the Attorney General's Authority in Certifying Whether a State... rule sets out the mechanics of the certification process for States seeking to opt in to chapter 154... mechanism must provide for the entry of an order by a court of record-- (1) Appointing one or more attorneys...

75 FR 28281 - Notice of Proposed Withdrawal Extension and Public Meeting; Oregon

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-20

... approximately 11,675.51 acres of National Forest System land from mining in order to protect the scientific and... Natural Area. The withdrawal created by PLO No. 6880 will expire on September 29, 2011, unless extended... County, Oregon, from location and entry under the United States mining laws (30 U.S.C. ch. 2). The area...

77 FR 30574 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-23

... otherwise be a market for that person to close-out the position even at the $1 cabinet price (e.g., the... Options Audit Trail (``COATS'') requirements of Exchange Rule 6.67 Order Format and System Entry... transactions in the same format as the COATS data is maintained. In this regard, all transactions for less than...

76 FR 27122 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-10

... be a market for that person to close-out the position even at the $1 cabinet price (e.g., the series... Trail (``COATS'') requirements of Exchange Rule 6.67 Order Format and System Entry Requirements. However... same format as the COATS data is maintained. In this regard, all transactions for less than $1 must be...

75 FR 77932 - Self-Regulatory Organizations; NYSE Amex LLC; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-14

... the position even at the $1 cabinet price (e.g., the series might be quoted no bid). \\5\\ Currently the... (``COATS'') requirements of Exchange Rule 955NY. Order Format and System Entry Requirements. However, the... as the COATS data is maintained. In this regard, all transactions for less than $1 must be reported...

76 FR 27136 - Self-Regulatory Organizations; NYSE Amex LLC; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-10

... be a market for that person to close-out the position even at the $1 cabinet price (e.g., the series... Trail (``COATS'') requirements of Exchange Rule 955NY Order Format and System Entry Requirements... the same format as the COATS data is maintained. In this regard, all transactions for less than $1...

75 FR 1109 - Self-Regulatory Organizations; BATS Exchange, Inc.; Notice of Filing of Proposed Rule Change To...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-08

.... \\5\\ A ``pair'' of ports refers to one port at the site of the Exchange's primary data center... for physical ports used to connect to the Exchange's system for order entry and receipt of data from... receipt of Exchange data,\\4\\ but does not currently charge for the ``physical'' ports needed to connect to...

Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process.

PubMed

Pirnejad, Habibollah; Niazkhani, Zahra; van der Sijs, Heleen; Berg, Marc; Bal, Roland

2008-11-01

Due to their efficiency and safety potential, computerized physician order entry (CPOE) systems are gaining considerable attention in in-patient settings. However, recent studies have shown that these systems may undermine the efficiency and safety of the medication process by impeding nurse-physician collaboration. To evaluate the effects of a CPOE system on the mechanisms whereby nurses and physicians maintain their collaboration in the medication process. SETTING AND METHODOLOGY: Six internal medicine wards at the Erasmus Medical Centre were included in this study. A questionnaire was used to record nurses' attitudes towards the effectiveness of the former paper-based system. A similar questionnaire was used to evaluate nurses' attitudes with respect to a CPOE system that replaced the paper-based system. The data were complemented and triangulated through interviews with physicians and nurses. Response rates for the analyzed questions in the pre- and post-implementation questionnaires were 54.3% (76/140) and 52.14% (73/140). The CPOE system had a mixed impact on medication work: while it improved the main non-supportive features of the paper-based system, it lacked its main supportive features. The interviews revealed more detailed supportive and non-supportive features of the two systems. A comparison of supportive features of the paper-based system with non-supportive features of the CPOE system showed that synchronisation and feedback mechanisms in nurse-physician collaborations have been impaired after the CPOE system was introduced. This study contributes to an understanding of the affected mechanisms in nurse-physician collaboration using a CPOE system. It provides recommendations for repairing the impaired mechanisms and for redesigning the CPOE system and thus for better supporting these structures.

31 CFR 356.4 - What are the book-entry systems in which auctioned Treasury securities may be issued or maintained?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false What are the book-entry systems in... BUREAU OF THE PUBLIC DEBT SALE AND ISSUE OF MARKETABLE BOOK-ENTRY TREASURY BILLS, NOTES, AND BONDS... book-entry systems in which auctioned Treasury securities may be issued or maintained? There are three...

Reducing duplicate testing: a comparison of two clinical decision support tools.

PubMed

Procop, Gary W; Keating, Catherine; Stagno, Paul; Kottke-Marchant, Kandice; Partin, Mary; Tuttle, Robert; Wyllie, Robert

2015-05-01

Unnecessary duplicate laboratory testing is common and costly. Systems-based means to avert unnecessary testing should be investigated and employed. We compared the effectiveness and cost savings associated with two clinical decision support tools to stop duplicate testing. The Hard Stop required telephone contact with the laboratory and justification to have the duplicate test performed, whereas the Smart Alert allowed the provider to bypass the alert at the point of order entry without justification. The Hard Stop alert was significantly more effective than the Smart Alert (92.3% vs 42.6%, respectively; P < .0001). The cost savings realized per alert activation was $16.08/alert for the Hard Stop alert vs $3.52/alert for the Smart Alert. Structural and process changes that require laboratory contact and justification for duplicate testing are more effective than interventions that allow providers to bypass alerts without justification at point of computerized physician order entry. Copyright© by the American Society for Clinical Pathology.

Implementation of computerized physician order entry in National Guard Hospitals: assessment of critical success factors.

PubMed

Altuwaijri, Majid M; Bahanshal, Abdullah; Almehaid, Mona

2011-09-01

The purpose of this study is to describe the needs, process and experience of implementing a computerized physician order entry (CPOE) system in a leading healthcare organization in Saudi Arabia. The National Guard Health Affairs (NGHA) deployed the CPOE in a pilot department, which was the intensive care unit (ICU) in order to assess its benefits and risks and to test the system. After the CPOE was implemented in the ICU area, a survey was sent to the ICU clinicians to assess their perception on the importance of 32 critical success factors (CSFs) that was acquired from the literature. The project team also had several meetings to gather lessons learned from the pilot project in order to utilize them for the expansion of the project to other NGHA clinics and hospitals. The results of the survey indicated that the selected CSFs, even though they were developed with regard to international settings, are very much applicable for the pilot area. The top three CSFs rated by the survey respondents were: The "before go-live training", the adequate clinical resources during implementation, and the ordering time. After the assessment of the survey and the lessons learned from the pilot project, NGHA decided that the potential benefits of the CPOE are expected to be greater the risks expected. The project was then expanded to cover all NGHA clinics and hospitals in a phased approach. Currently, the project is in its final stages and expected to be completed by the end of 2011. The role of CPOE systems is very important in hospitals in order to reduce medication errors and to improve the quality of care. In spite of their great benefits, many studies suggest that a high percentage of these projects fail. In order to increase the chances of success and due to the fact that CPOE is a clinical system, NGHA implemented the system first in a pilot area in order to test the system without putting patients at risk and to learn from mistakes before expanding the system to other areas. As a result of the pilot project, NGHA developed a list of CSFs to increase the likelihood of project success for the expansion of the system to other clinics and hospitals. The authors recommend a future study for the CPOE implementation to be done that covers the implementation in all the four NGHA hospitals. The results of the study can then be generalized to other hospitals in Saudi Arabia.

Implementing computerized physician order entry: the importance of special people.

PubMed

Ash, Joan S; Stavri, P Zoë; Dykstra, Richard; Fournier, Lara

2003-03-01

To articulate important lessons learned during a study to identify success factors for implementing computerized physician order entry (CPOE) in inpatient and outpatient settings. Qualitative study by a multidisciplinary team using data from observation, focus groups, and both formal and informal interviews. Data were analyzed using a grounded approach to develop a taxonomy of patterns and themes from the transcripts and field notes. The theme we call Special People is explored here in detail. A taxonomy of types of Special People includes administrative leaders, clinical leaders (champions, opinion leaders, and curmudgeons), and bridgers or support staff who interface directly with users. The recognition and nurturing of Special People should be among the highest priorities of those implementing computerized physician order entry. Their education and training must be a goal of teaching programs in health administration and medical informatics.

12 CFR 615.5560 - Book-entry Procedure for Farm Credit System Financial Assistance Corporation Securities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... OPERATIONS Farm Credit System Financial Assistance Corporation Securities § 615.5560 Book-entry Procedure for Farm Credit System Financial Assistance Corporation Securities. (a) The Farm Credit System Financial... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Book-entry Procedure for Farm Credit System...

78 FR 14290 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-05

... Fitness File (June 11, 1997, 62 FR 31793). * * * * * Changes: System ID: Delete entry and replace with ``F036 AF A1 I.'' System Name: Delete entry and replace with ``Air Force Fitness Program.'' System location: Delete entry and replace with ``Air Force Fitness Management System (AFFMS) is located at Defense...

Overview of the Phoenix Entry, Descent and Landing System

NASA Technical Reports Server (NTRS)

Grover, Rob

2005-01-01

A viewgraph presentation on the entry, descent and landing system of Phoenix is shown. The topics include: 1) Phoenix Mission Goals; 2) Payload; 3) Aeroshell/Entry Comparison; 4) Entry Trajectory Comparison; 5) Phoenix EDL Timeline; 6) Hypersonic Phase; 7) Parachute Phase; 8) Terminal Descent Phase; and 9) EDL Communications.

Orion Entry Display Feeder and Interactions with the Entry Monitor System

NASA Technical Reports Server (NTRS)

Baird, Darren; Bernatovich, Mike; Gillespie, Ellen; Kadwa, Binaifer; Matthews, Dave; Penny, Wes; Zak, Tim; Grant, Mike; Bihari, Brian

2010-01-01

The Orion spacecraft is designed to return astronauts to a landing within 10 km of the intended landing target from low Earth orbit, lunar direct-entry, and lunar skip-entry trajectories. Al pile the landing is nominally controlled autonomously, the crew can fly precision entries manually in the event of an anomaly. The onboard entry displays will be used by the crew to monitor and manually fly the entry, descent, and landing, while the Entry Monitor System (EMS) will be used to monitor the health and status of the onboard guidance and the trajectory. The entry displays are driven by the entry display feeder, part of the Entry Monitor System (EMS). The entry re-targeting module, also part of the EMS, provides all the data required to generate the capability footprint of the vehicle at any point in the trajectory, which is shown on the Primary Flight Display (PFD). It also provides caution and warning data and recommends the safest possible re-designated landing site when the nominal landing site is no longer within the capability of the vehicle. The PFD and the EMS allow the crew to manually fly an entry trajectory profile from entry interface until parachute deploy having the flexibility to manually steer the vehicle to a selected landing site that best satisfies the priorities of the crew. The entry display feeder provides data from the ENIS and other components of the GNC flight software to the displays at the proper rate and in the proper units. It also performs calculations that are specific to the entry displays and which are not made in any other component of the flight software. In some instances, it performs calculations identical to those performed by the onboard primary guidance algorithm to protect against a guidance system failure. These functions and the interactions between the entry display feeder and the other components of the EMS are described.

Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system.

PubMed

Dekarske, Brian M; Zimmerman, Christopher R; Chang, Robert; Grant, Paul J; Chaffee, Bruce W

2015-12-01

Computerized provider order entry systems commonly contain alerting mechanisms for patient allergies, incorrect doses, or drug-drug interactions when ordering medications. Providers have the option to override (bypass) these alerts and continue with the order unchanged. This study examines the effect of customizing medication alert override options on the appropriateness of override selection related to patient allergies, drug dosing, and drug-drug interactions when ordering medications in an electronic medical record. In this prospective, randomized crossover study, providers were randomized into cohorts that required a reason for overriding a medication alert from a customized or non-customized list of override reasons and/or by free-text entry. The primary outcome was to compare override responses that appropriately correlate with the alert type between the customized and non-customized configurations. The appropriateness of a subset of free-text responses that represented an affirmative and active acknowledgement of the alert without further explanation was classified as "indeterminate." Results were analyzed in three different ways by classifying indeterminate answers as either appropriate, inappropriate, or excluded entirely. Secondary outcomes included the appropriateness of override reasons when comparing cohorts and individual providers, reason selection based on order within the override list, and the determination of the frequency of free-text use, nonsensical responses, and multiple selection responses. Twenty-two clinicians were randomized into 2 cohorts and a total of 1829 alerts with a required response were generated during the study period. The customized configuration had a higher rate of appropriateness when compared to the non-customized configuration regardless of how indeterminate responses were classified (p<0.001). When comparing cohorts, appropriateness was significantly higher in the customized configuration regardless of the classification of indeterminate responses (p<0.001) with one exception: when indeterminate responses were considered inappropriate for the cohort of providers that were first exposed to the non-customized list (p=0.103). Free-text use was higher in the customized configuration overall (p<0.001), and there was no difference in nonsensical response between configurations (p=0.39). There is a benefit realized by using a customized list for medication override reasons. Poor application design or configuration can negatively affect provider behavior when responding to important medication alerts. Copyright © 2015. Published by Elsevier Ireland Ltd.

Orion Entry Performance-Based Center-of-Gravity Box

NASA Technical Reports Server (NTRS)

Rea, Jeremy R.

2010-01-01

The Orion capsule is designed both for Low Earth Orbit missions to the ISS and for missions to the moon. For ISS class missions, the capsule will use an Apollo-style direct entry. For lunar return missions, depending on the timing of the mission, the capsule could perform a direct entry or a skip entry of up to 4800 n.mi. in order to land in the coastal waters of California. The physics of atmospheric re-entry determine the capability of the Orion vehicle. For a given vehicle mass and shape, physics tells us that the driving parameters for an entry vehicle are the hypersonic lift-to-drag ratio (L/D) and the flight path angle at entry interface (gamma(sub EI)). The design of the Orion atmospheric re-entry must meet constraints during both nominal and dispersed flight conditions on landing accuracy, heating rate, total heat load, sensed acceleration, and proper disposal of the Service Module. These constraints define an entry corridor in the space of L/D-gamma(sub EI); if the vehicle falls within this corridor, then all constraints are met. The gamma(sub EI) dimension of the corridor can be further constrained by the gloads experienced during emergency entries. Thus, the entry performance for the Orion vehicle can be described completely by the L/D. Bounds on the hypersonic L/D necessary to achieve all the mission requirements can be defined for the given entry corridor. Landing accuracy performance drives the lower limit on L/D. In order to achieve the desired landing accuracy, a minimum L/D must be ensured. The design of the Thermal Protection System (TPS) drives the upper limit on L/D. A higher L/D can drive mass into the design of the TPS. Conversely, once the TPS is designed, the L/D must be ensured to stay below a certain limit in order for the TPS to stay within its design envelop. The L/D must stay within its upper and lower bounds during dispersed flight conditions. L/D is a function of both the aerodynamics and the center-of-gravity (CG) of the vehicle. The aerodynamics of the vehicle are determined by Computational Fluid Mechanics (CFD) and wind tunnel tests. However, the aerodynamics are not known precisely. Instead, an aerodynamic database has been developed where the aerodynamic coefficients are known to fall within a probabilistic band defined by upper and lower bounds. It is expected that the probabilistic band will shrink after the first missions are flown and real-world data is collected. Until that time, the Orion must be designed to the current aerodynamic database. Thus, for a given aerodynamic database with given uncertainties, the allowable range in L/D can be mapped to an allowable box for the CG location. The CG box is used to set requirements on the dispersions allowed for vehicle packaging and cargo storage. As the aerodynamic uncertainties decrease, the size of the CG box can increase. This paper discusses the technique used to map the minimum and maximum L/D bounds set by the entry performance requirements to the allowable dispersions in CG while accounting for aerodynamic uncertainties. The L/D is defined as the ratio of the lift force to the drag force. It is equivalent to the ratio of lift coefficient (C(sub L)) over drag coefficient (C(sub D)). C(sub L) and C(sub D) are functions of Mach number (M) and angle of attack (alpha). A Mach number of 25 is used as a measuring point of the hypersonic L/D. Variations in C(sub L), C(sub D) and alpha cause variations in L/D. Equation (1) shows the three contributions to the variation in L/D.

Health systems: changes in hospital efficiency and profitability.

PubMed

Büchner, Vera Antonia; Hinz, Vera; Schreyögg, Jonas

2016-06-01

This study investigates potential changes in hospital performance after health system entry, while differentiating between hospital technical and cost efficiency and hospital profitability. In the first stage we obtained (bootstrapped) data envelopment analysis (DEA) efficiency scores. Then, genetic matching is used as a novel matching procedure in this context along with a difference-in-difference approach within a panel regression framework. With the genetic matching procedure, independent and health system hospitals are matched along a number of environmental and organizational characteristics. The results show that health system entry increases hospital technical and cost efficiency by between 0.6 and 3.4 % in four alternative post-entry periods, indicating that health system entry has not a transitory but rather a permanent effect on hospital efficiency. Regarding hospital profitability, the results reveal an increase in hospital profitability only 1 year after health system entry, and the estimations suggest that this effect is a transitional phenomenon. Overall, health system entry may serve as an appropriate management instrument for decision makers to increase hospital performance.

What systems participants know about access and service entry and why managers should listen.

PubMed

Duncombe, Rohena

2017-08-01

Objective The present study looked at the views of people directly involved in the entry process for community health counselling using the frame of the health access literature. The concurrence of system participants' views with the access literature highlights access issues, particularly for people who are vulnerable or disadvantaged. The paper privileges the voices of the system participants, inviting local health services to consider using participatory design to improve access at the entry point. Methods People involved in the entry process for community health counselling explored the question, 'What, for you, are the features of a good intake system?' They also commented on themes identified during pilot interviews. These were thematically analysed for each participant group by the researcher to develop a voice for each stakeholder group. Results People accessing the service could be vulnerable and the entry process failed to take that into account. People directly involved in the counselling service entry system, system participants, consisted of: professionals referring in, people seeking services and reception staff taking first enquiries. They shared substantially the same concerns as each other. The responses from these system participants are consistent with the international literature on access and entry into health services. Conclusion Participatory service design could improve primary healthcare service entry at the local level. Canvassing the experiences of system participants is important for delivering services to those who have the least access and, in that way, could contribute to health equity. What is known about the topic? People with the highest health needs receive the fewest services. Health inequality is increasing. What does this paper add? System participants can provide advice consistent with the academic research literature that is useful for improving service entry at the local level. What are the implications for practitioners? Participatory design can inform policy makers and service providers. Entry systems could acknowledge the potential vulnerability or disadvantage of people approaching the service.

77 FR 19642 - Low Enriched Uranium From France: Final Results of Antidumping Duty Changed Circumstances Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-02

... in U.S. customs territory, and (ii) are re-exported within eighteen (18) months of entry of the LEU... amend the scope of the order and to extend the deadline for the re-exportation of this sole LEU entry... transporter(s) while in U.S. customs territory, and (ii) are re-exported within eighteen (18) months of entry...

User satisfaction with computerized order entry system and its effect on workplace level of stress.

PubMed

Ghahramani, Nasrollah; Lendel, Irina; Haque, Rehan; Sawruk, Kathryn

2009-06-01

To evaluate the impact of Computerized Provider Order Entry (CPOE) on workplace stress and overall job performance, as perceived by medical students, housestaff, attending physicians and nurses, after CPOE implementation at Penn State-Milton S. Hershey Medical Center, an academic tertiary care facility, in 2005. Using an online survey, the authors studied attitudes towards CPOE among 862 health care professionals. The main outcome measures were job performance and perceived stress levels. Statistical analyses were conducted using the Statistical Analytical Software (SAS Inc, Carey, NC). A total of413 respondents completed the entire survey (47.9 % response rate). Respondents in the younger age group were more familiar with the system, used it more frequently, and were more satisfied with it. Interns and residents were the most satisfied groups with the system, while attending physicians expressed the least satisfaction. Attending physicians and fellows found the system least user friendly compared with other groups, and also tended to express more stress and frustration with the system. Participants with previous CPOE experience were more familiar with the system, would use the system more frequently and were more likely to perceive the system as user friendly. User satisfaction with CPOE increases by familiarity and frequent use of the system. Improvement in system characteristics and avoidance of confusing terminology and inconsistent display of data is expected to enhance user satisfaction. Training in the use of CPOE should start early, ideally integrated into medical and nursing school curricula and form a continuous, long-term and user-specific process. This is expected to increase familiarity with the system, reducing stress and leading to improved user satisfaction and to subsequent enhanced safety and efficiency.

Shuttle launched flight tests - Supporting technology for planetary entry missions

NASA Technical Reports Server (NTRS)

Vetter, H. C.; Mcneilly, W. R.; Siemers, P. M., III; Nachtsheim, P. R.

1975-01-01

The feasibility of conducting Space Shuttle-launched earth entry flight tests to enhance the technology base for second generation planetary entry missions is examined. Outer planet entry environments are reviewed, translated into earth entry requirements and used to establish entry test system design and cost characteristics. Entry speeds up to those needed to simulate radiative heating levels of more than 30 kW/sq cm are shown to be possible. A standardized recoverable test bed concept is described that is capable of accommodating a wide range of entry technology experiments. The economic advantage of shared Shuttle launches are shown to be achievable through a test system configured to the volume constraints of a single Spacelab pallet using existing propulsion components.

Impact of Training Method on the Behavior of Physicians towards the Use of Computerized Provider Order Entry Systems

ERIC Educational Resources Information Center

Martinez, Fernando

2012-01-01

The use of workflow or simulated training has been used in the training of medical students for several decades. As technology emerged, training using simulation has grown as an effective way of enhancing training outcomes and increasing the clinical effectiveness of medical students. As a result of a heightened focus on the integration of…

75 FR 77930 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-14

... market for that person to close-out the position even at the $1 cabinet price (e.g., the series might be... Consolidated Options Audit Trail (``COATS'') requirements of Exchange Rule 6.67 Order Format and System Entry... transactions in the same format as the COATS data is maintained. In this regard, all transactions for less than...

Proceedings of the Annual Midwest Research-to-Practice Conference in Adult and Continuing Education (2nd, DeKalb, Illinois, November 4-5, 1983).

ERIC Educational Resources Information Center

Northern Illinois Univ., De Kalb. Coll. of Continuing Education.

These proceedings consist of 26 presentations. They include, in alphabetical order by author, "Time and Distance: Crucial Factors in Selection of Training and Vocation by Re-entry Women" (Cynthia Bagley), "Using Learner Surveys to Enhance Continuing Education Programs" (Carol Brown), "Designing Inservice Training as a Learning System: The Case of…

Information Retrieval Performance of Probabilistically Generated, Problem-Specific Computerized Provider Order Entry Pick-Lists: A Pilot Study

PubMed Central

Rothschild, Adam S.; Lehmann, Harold P.

2005-01-01

Objective: The aim of this study was to preliminarily determine the feasibility of probabilistically generating problem-specific computerized provider order entry (CPOE) pick-lists from a database of explicitly linked orders and problems from actual clinical cases. Design: In a pilot retrospective validation, physicians reviewed internal medicine cases consisting of the admission history and physical examination and orders placed using CPOE during the first 24 hours after admission. They created coded problem lists and linked orders from individual cases to the problem for which they were most indicated. Problem-specific order pick-lists were generated by including a given order in a pick-list if the probability of linkage of order and problem (PLOP) equaled or exceeded a specified threshold. PLOP for a given linked order-problem pair was computed as its prevalence among the other cases in the experiment with the given problem. The orders that the reviewer linked to a given problem instance served as the reference standard to evaluate its system-generated pick-list. Measurements: Recall, precision, and length of the pick-lists. Results: Average recall reached a maximum of .67 with a precision of .17 and pick-list length of 31.22 at a PLOP threshold of 0. Average precision reached a maximum of .73 with a recall of .09 and pick-list length of .42 at a PLOP threshold of .9. Recall varied inversely with precision in classic information retrieval behavior. Conclusion: We preliminarily conclude that it is feasible to generate problem-specific CPOE pick-lists probabilistically from a database of explicitly linked orders and problems. Further research is necessary to determine the usefulness of this approach in real-world settings. PMID:15684134

Message passing with parallel queue traversal

DOEpatents

Underwood, Keith D [Albuquerque, NM; Brightwell, Ronald B [Albuquerque, NM; Hemmert, K Scott [Albuquerque, NM

2012-05-01

In message passing implementations, associative matching structures are used to permit list entries to be searched in parallel fashion, thereby avoiding the delay of linear list traversal. List management capabilities are provided to support list entry turnover semantics and priority ordering semantics.

Evaluation of Mars Entry Reconstructured Trajectories Based on Hypothetical 'Quick-Look' Entry Navigation Data

NASA Technical Reports Server (NTRS)

Pastor, P. Rick; Bishop, Robert H.; Striepe, Scott A.

2000-01-01

A first order simulation analysis of the navigation accuracy expected from various Navigation Quick-Look data sets is performed. Here quick-look navigation data are observations obtained by hypothetical telemetried data transmitted on the fly during a Mars probe's atmospheric entry. In this simulation study, navigation data consists of 3-axis accelerometer sensor and attitude information data. Three entry vehicle guidance types are studied: I. a Maneuvering entry vehicle (as with Mars 01 guidance where angle of attack and bank angle are controlled); II. Zero angle-of-attack controlled entry vehicle (as with Mars 98); and III. Ballistic, or spin stabilized entry vehicle (as with Mars Pathfinder);. For each type, sensitivity to progressively under sampled navigation data and inclusion of sensor errors are characterized. Attempts to mitigate the reconstructed trajectory errors, including smoothing, interpolation and changing integrator characteristics are also studied.

Application of the FADS system on the Re-entry Module

NASA Astrophysics Data System (ADS)

Zhen, Huang

2016-07-01

The aerodynamic model for Flush Air Data Sensing System (FADS) is built based on the surface pressure distribution obtained through the pressure orifices laid on specific positions of the surface,and the flight parameters,such as angle of attack,angle of side-slip,Mach number,free-stream static pressure and dynamic pressure are inferred from the aerodynamic model.The flush air data sensing system (FADS) has been used on several flight tests of aircraft and re-entry vehicle,such as,X-15,space shuttle,F-14,X-33,X-43A and so on. This paper discusses the application of the FADS on the re-entry module with blunt body to obtain high-precision aerodynamic parameters.First of all,a basic theory and operating principle of the FADS is shown.Then,the applications of the FADS on typical aircrafts and re-entry vehicles are described.Thirdly,the application mode on the re-entry module with blunt body is discussed in detail,including aerodynamic simulation,pressure distribution,trajectory reconstruction and the hardware shoule be used,such as flush air data sensing system(FADS),inertial navigation system (INS),data acquisition system,data storage system.Finally,ablunt module re-entry flight test from low earth orbit (LEO) is planned to obtain aerodynamic parameters and amend the aerodynamic model with this FADS system data.The results show that FADS system can be applied widely in re-entry module with blunt bodies.

31 CFR 356.4 - What are the book-entry systems in which auctioned Treasury securities may be issued?

Code of Federal Regulations, 2010 CFR

2010-07-01

... in which auctioned Treasury securities may be issued? There are three book-entry securities systems... marketable Treasury securities. We maintain and transfer securities in these three book-entry systems at... inflation. Securities may be transferred from one system to the other, unless the securities are not...

18 CFR 1314.2 - Definition of terms.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PROCEDURES FOR TVA POWER SECURITIES ISSUED THROUGH THE FEDERAL RESERVE BANKS § 1314.2 Definition of terms... applicable. (a) Book-entry System means the automated book-entry system operated by the Reserve Banks acting... issued or maintained in the Book-entry System of the Reserve Banks. (c) CUSIP Number is a unique...

An assessment of the impact of transition on advanced winged entry vehicle thermal protection system mass

NASA Technical Reports Server (NTRS)

Wurster, K. E.

1981-01-01

This study examines the impact of turbulent heating on thermal protection system (TPS) mass for advanced winged entry vehicles. Four basic systems are considered: insulative, metallic hot structures, metallic standoff, and hybrid systems. TPS sizings are performed using entry trajectories tailored specifically to the characteristics of each TPS concept under consideration. Comparisons are made between systems previously sized under the assumption of all laminar heating and those sized using a baseline estimate of transition and turbulent heating. The relative effect of different transition criteria on TPS mass requirements is also examined. Also investigated are entry trajectories tailored to alleviate turbulent heating. Results indicate the significant impact of turbulent heating on TPS mass and demonstrate the importance of both accurate transition criteria and entry trajectory tailoring.

Ames Infusion Stories for NASA Annual Technology Report: Nano Entry System for CubeSat-Class Payloads

NASA Technical Reports Server (NTRS)

Smith, Brandon; Jan, Darrell Leslie; Venkatapathy, Etiraj

2015-01-01

The Nano Entry System for CubeSat-Class Payloads led to the development of the Nano-Adaptable Deployable Entry and Placement Technology ("Nano-ADEPT"). Nano-ADEPT is a mechanically deployed entry, descent, and landing (EDL) system that stows during launch and cruise (like an umbrella) and serves as both heat shield and primary structure during EDL. It is especially designed for small spacecraft where volume is a limiting constraint.

Enabling Venus In-Situ Science - Deployable Entry System Technology, Adaptive Deployable Entry and Placement Technology (ADEPT): A Technology Development Project funded by Game Changing Development Program of the Space Technology Program

NASA Technical Reports Server (NTRS)

Wercinski, Paul F.; Venkatapathy, Ethiraj; Gage, Peter J.; Yount, Bryan C.; Prabhu, Dinesh K.; Smith, Brandon; Arnold, James O.; Makino, alberto; Peterson, Keith Hoppe; Chinnapongse, Ronald I.

2012-01-01

Venus is one of the important planetary destinations for scientific exploration, but: The combination of extreme entry environment coupled with extreme surface conditions have made mission planning and proposal efforts very challenging. We present an alternate, game-changing approach (ADEPT) where a novel entry system architecture enables more benign entry conditions and this allows for greater flexibility and lower risk in mission design

Evaluation and Certification of Computerized Provider Order Entry Systems

PubMed Central

Classen, David C.; Avery, Anthony J.; Bates, David W.

2007-01-01

Computerized physician order entry (CPOE) is an application that is used to electronically write physician orders either in the hospital or in the outpatient setting. It is used in about 15% of U.S. Hospitals and a smaller percentage of ambulatory clinics. It is linked with clinical decision support, which provides much of the value of implementing it. A number of studies have assessed the impact of CPOE with respect to a variety of parameters, including costs of care, medication safety, use of guidelines or protocols, and other measures of the effectiveness or quality of care. Most of these studies have been undertaken at CPOE exemplar sites with homegrown clinical information systems. With the increasing implementation of commercial CPOE systems in various settings of care has come evidence that some implementation approaches may not achieve previously published results or may actually cause new errors or even harm. This has lead to new initiatives to evaluate CPOE systems, which have been undertaken by both vendors and other groups who evaluate vendors, focused on CPOE vendor capabilities and effective approaches to implementation that can achieve benefits seen in published studies. In addition, an electronic health record (EHR) vendor certification process is ongoing under the province of the Certification Commission for Health Information Technology (CCHIT) (which includes CPOE) that will affect the purchase and use of these applications by hospitals and clinics and their participation in public and private health insurance programs. Large employers have also joined this focus by developing flight simulation tools to evaluate the capabilities of these CPOE systems once implemented, potentially linking the results of such programs to reimbursement through pay for performance programs. The increasing role of CPOE systems in health care has invited much more scrutiny about the effectiveness of these systems in actual practice which has the potential to improve their ultimate performance. PMID:17077453

Evaluation and certification of computerized provider order entry systems.

PubMed

Classen, David C; Avery, Anthony J; Bates, David W

2007-01-01

Computerized physician order entry (CPOE) is an application that is used to electronically write physician orders either in the hospital or in the outpatient setting. It is used in about 15% of U.S. Hospitals and a smaller percentage of ambulatory clinics. It is linked with clinical decision support, which provides much of the value of implementing it. A number of studies have assessed the impact of CPOE with respect to a variety of parameters, including costs of care, medication safety, use of guidelines or protocols, and other measures of the effectiveness or quality of care. Most of these studies have been undertaken at CPOE exemplar sites with homegrown clinical information systems. With the increasing implementation of commercial CPOE systems in various settings of care has come evidence that some implementation approaches may not achieve previously published results or may actually cause new errors or even harm. This has lead to new initiatives to evaluate CPOE systems, which have been undertaken by both vendors and other groups who evaluate vendors, focused on CPOE vendor capabilities and effective approaches to implementation that can achieve benefits seen in published studies. In addition, an electronic health record (EHR) vendor certification process is ongoing under the province of the Certification Commission for Health Information Technology (CCHIT) (which includes CPOE) that will affect the purchase and use of these applications by hospitals and clinics and their participation in public and private health insurance programs. Large employers have also joined this focus by developing flight simulation tools to evaluate the capabilities of these CPOE systems once implemented, potentially linking the results of such programs to reimbursement through pay for performance programs. The increasing role of CPOE systems in health care has invited much more scrutiny about the effectiveness of these systems in actual practice which has the potential to improve their ultimate performance.

The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran

PubMed Central

Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Barati, Omid; Keshtkaran, Ali; Sabetian, Golnar; Shahrokh, , Nasim; Setoodezadeh, Fatemeh

2017-01-01

Background: One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. Methods: We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. Results: The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). Conclusion: In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals. PMID:29445698

The impact of computerized physician order entry on prescription orders: A quasi-experimental study in Iran.

PubMed

Khammarnia, Mohammad; Sharifian, Roxana; Zand, Farid; Barati, Omid; Keshtkaran, Ali; Sabetian, Golnar; Shahrokh, Nasim; Setoodezadeh, Fatemeh

2017-01-01

Background: One way to reduce medical errors associated with physician orders is computerized physician order entry (CPOE) software. This study was conducted to compare prescription orders between 2 groups before and after CPOE implementation in a hospital. Methods: We conducted a before-after prospective study in 2 intensive care unit (ICU) wards (as intervention and control wards) in the largest tertiary public hospital in South of Iran during 2014 and 2016. All prescription orders were validated by a clinical pharmacist and an ICU physician. The rates of ordering the errors in medical orders were compared before (manual ordering) and after implementation of the CPOE. A standard checklist was used for data collection. For the data analysis, SPSS Version 21, descriptive statistics, and analytical tests such as McNemar, chi-square, and logistic regression were used. Results: The CPOE significantly decreased 2 types of errors, illegible orders and lack of writing the drug form, in the intervention ward compared to the control ward (p< 0.05); however, the 2 errors increased due to the defect in the CPOE (p< 0.001). The use of CPOE decreased the prescription errors from 19% to 3% (p= 0.001), However, no differences were observed in the control ward (p<0.05). In addition, more errors occurred in the morning shift (p< 0.001). Conclusion: In general, the use of CPOE significantly reduced the prescription errors. Nonetheless, more caution should be exercised in the use of this system, and its deficiencies should be resolved. Furthermore, it is recommended that CPOE be used to improve the quality of delivered services in hospitals.

A Cognitive Task Analysis of Information Management Strategies in a Computerized Provider Order Entry Environment

PubMed Central

Weir, Charlene R.; Nebeker, Jonathan J.R.; Hicken, Bret L.; Campo, Rebecca; Drews, Frank; LeBar, Beth

2007-01-01

Objective Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques. Design Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers. Measurements Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified. Results Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented. Conclusion Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system. PMID:17068345

Implementation of Hospital Computerized Physician Order Entry Systems in a Rural State: Feasibility and Financial Impact

PubMed Central

Ohsfeldt, Robert L.; Ward, Marcia M.; Schneider, John E.; Jaana, Mirou; Miller, Thomas R.; Lei, Yang; Wakefield, Douglas S.

2005-01-01

Objective The aim of this study was to estimate the costs of implementing computerized physician order entry (CPOE) systems in hospitals in a rural state and to evaluate the financial implications of statewide CPOE implementation. Methods A simulation model was constructed using estimates of initial and ongoing CPOE costs mapped onto all general hospitals in Iowa by bed quantity and current clinical information system (CIS) status. CPOE cost estimates were obtained from a leading CPOE vendor. Current CIS status was determined through mail survey of Iowa hospitals. Patient care revenue and operating cost data published by the Iowa Hospital Association were used to simulate the financial impact of CPOE adoption on hospitals. Results CPOE implementation would dramatically increase operating costs for rural and critical access hospitals in the absence of substantial costs savings associated with improved efficiency or improved patient safety. For urban and rural referral hospitals, the cost impact is less dramatic but still substantial. However, relatively modest benefits in the form of patient care cost savings or revenue enhancement would be sufficient to offset CPOE costs for these larger hospitals. Conclusion Implementation of CPOE in rural or critical access hospitals may depend on net increase in operating costs. Adoption of CPOE may be financially infeasible for these small hospitals in the absence of increases in hospital payments or ongoing subsidies from third parties. PMID:15492033

Medication-related clinical decision support in computerized provider order entry systems: a review.

PubMed

Kuperman, Gilad J; Bobb, Anne; Payne, Thomas H; Avery, Anthony J; Gandhi, Tejal K; Burns, Gerard; Classen, David C; Bates, David W

2007-01-01

While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs. To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand what classes of CDS their CPOE systems can support, assure that clinical knowledge underlying their CDS systems is reasonable, and appropriately represent electronic patient data. These issues often influence to what extent an institution will succeed with its CPOE implementation and achieve its desired goals. Medication-related decision support is probably best introduced into healthcare organizations in two stages, basic and advanced. Basic decision support includes drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug-drug interaction checking. Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug-disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.

Adjustable Bracket For Entry Of Welding Wire

NASA Technical Reports Server (NTRS)

Gilbert, Jeffrey L.; Gutow, David A.

1993-01-01

Wire-entry bracket on welding torch in robotic welding system provides for adjustment of angle of entry of welding wire over range of plus or minus 30 degrees from nominal entry angle. Wire positioned so it does not hide weld joint in view of through-the-torch computer-vision system part of robot-controlling and -monitoring system. Swiveling bracket also used on nonvision torch on which wire-feed-through tube interferes with workpiece. Angle simply changed to one giving sufficient clearance.

Easily configured real-time CPOE Pick Off Tool supporting focused clinical research and quality improvement.

PubMed

Rosenbaum, Benjamin P; Silkin, Nikolay; Miller, Randolph A

2014-01-01

Real-time alerting systems typically warn providers about abnormal laboratory results or medication interactions. For more complex tasks, institutions create site-wide 'data warehouses' to support quality audits and longitudinal research. Sophisticated systems like i2b2 or Stanford's STRIDE utilize data warehouses to identify cohorts for research and quality monitoring. However, substantial resources are required to install and maintain such systems. For more modest goals, an organization desiring merely to identify patients with 'isolation' orders, or to determine patients' eligibility for clinical trials, may adopt a simpler, limited approach based on processing the output of one clinical system, and not a data warehouse. We describe a limited, order-entry-based, real-time 'pick off' tool, utilizing public domain software (PHP, MySQL). Through a web interface the tool assists users in constructing complex order-related queries and auto-generates corresponding database queries that can be executed at recurring intervals. We describe successful application of the tool for research and quality monitoring.

Intermediate Experimental Vehicle, ESA Program IXV ATDB Tool and Aerothermodynamic Characterization

NASA Astrophysics Data System (ADS)

Mareschi, Vincenzo; Ferrarella, Daniela; Zaccagnino, Elio; Tribot, Jean-Pierre; Vallee, Jean-Jacques; Haya-Ramos, Rodrigo; Rufolo, Giuseppe; Mancuso, Salvatore

2011-05-01

In the complex domain of the space technologies and among the different applications available in Europe, a great interest has been placed since several years in the development of re-entry technologies. Among the different achievements obtained in that field it is to be recalled the experience of the Atmospheric Re-entry Vehicle flight in 1998 and a certain number of important investments per-formed at Agency and national levels like Hermes, MSTP, Festip, X-38, FLPP, TRP, GSTP, HSTS, AREV, Pre-X. IXV (Intermediate eXperimental V ehicle) builds on these past experiences and studies and it is conceived to be the next technological step forward with respect to ARD With respect to previous European ballistic or quasi- ballistic demonstrators, IXV will have an increased in- flight manoeuvrability and the planned mission will allow verifying the performances of the required technologies against a wider re-entry corridor. This will imply from the pure technological aspect to increase the level of engagement on critical technologies and disciplines like aerodynamics/aerothermodynamics, guidance, navigation, control, thermal protection materials and in flight measurements. In order to support the TPS design and the other sub- systems, an AeroThermodynamicDataBase Tool has been developed by Dassault Aviation and integrated by Thales Alenia Space with the Functional Engineering Simulator (used for GNC performances evaluation) in order to characterize the aerothermodynamic behaviour of the vehicle. This paper will describe: - The methodology used to develop the ATDB tool, based on the processing of CFD computations and WTT campaigns results. - The utilization of the ATDB tool, by means of its integration into the System process. - The methodology used for the aerothermal characterization of IXV.

Single-particle tracking and modulation of cell entry pathways of a tetrahedral DNA nanostructure in live cells.

PubMed

Liang, Le; Li, Jiang; Li, Qian; Huang, Qing; Shi, Jiye; Yan, Hao; Fan, Chunhai

2014-07-21

DNA is typically impermeable to the plasma membrane due to its polyanionic nature. Interestingly, several different DNA nanostructures can be readily taken up by cells in the absence of transfection agents, which suggests new opportunities for constructing intelligent cargo delivery systems from these biocompatible, nonviral DNA nanocarriers. However, the underlying mechanism of entry of the DNA nanostructures into the cells remains unknown. Herein, we investigated the endocytotic internalization and subsequent transport of tetrahedral DNA nanostructures (TDNs) by mammalian cells through single-particle tracking. We found that the TDNs were rapidly internalized by a caveolin-dependent pathway. After endocytosis, the TDNs were transported to the lysosomes in a highly ordered, microtubule-dependent manner. Although the TDNs retained their structural integrity within cells over long time periods, their localization in the lysosomes precludes their use as effective delivery agents. To modulate the cellular fate of the TDNs, we functionalized them with nuclear localization signals that directed their escape from the lysosomes and entry into the cellular nuclei. This study improves our understanding of the entry into cells and transport pathways of DNA nanostructures, and the results can be used as a basis for designing DNA-nanostructure-based drug delivery nanocarriers for targeted therapy. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Systems design study of the Pioneer Venus spacecraft. Appendices to volume 1, section 7 (part 2 of 3). [procedures for predicting aeroheating environment of Venus entry probes

NASA Technical Reports Server (NTRS)

1973-01-01

The procedures for predicting the aeroheating environment of Venus entry probes are outlined. After some consideration, a number of assumptions were adopted in order to make the prediction techniques tractable. Among these assumptions are thermochemical equilibrium, uncoupled radiative and convective processes, and uncoupled ablation products effects. The single strip method of integral relations, appropriately constrained, is shown to provide adequate inviscid results as a basis for heating calculations on blunt configurations. Techniques for prediction of the laminar, transitional, and turbulent convective environment are outlined and shown to agree with data. The prediction of radiative heating in C, N, and O gas mixtures is discussed and a practical scheme adopted. A comparison with LRC calculations is made.

An intravenous medication safety system: preventing high-risk medication errors at the point of care.

PubMed

Hatcher, Irene; Sullivan, Mark; Hutchinson, James; Thurman, Susan; Gaffney, F Andrew

2004-10-01

Improving medication safety at the point of care--particularly for high-risk drugs--is a major concern of nursing administrators. The medication errors most likely to cause harm are administration errors related to infusion of high-risk medications. An intravenous medication safety system is designed to prevent high-risk infusion medication errors and to capture continuous quality improvement data for best practice improvement. Initial testing with 50 systems in 2 units at Vanderbilt University Medical Center revealed that, even in the presence of a fully mature computerized prescriber order-entry system, the new safety system averted 99 potential infusion errors in 8 months.

Optimizing TLB entries for mixed page size storage in contiguous memory

DOEpatents

Chen, Dong; Gara, Alan; Giampapa, Mark E.; Heidelberger, Philip; Kriegel, Jon K.; Ohmacht, Martin; Steinmacher-Burow, Burkhard

2013-04-30

A system and method for accessing memory are provided. The system comprises a lookup buffer for storing one or more page table entries, wherein each of the one or more page table entries comprises at least a virtual page number and a physical page number; a logic circuit for receiving a virtual address from said processor, said logic circuit for matching the virtual address to the virtual page number in one of the page table entries to select the physical page number in the same page table entry, said page table entry having one or more bits set to exclude a memory range from a page.

Creating Resilient IT: How the Sign-Out Sheet Shows Clinicians Make Healthcare Work

PubMed Central

Nemeth, Christopher; Nunnally, Mark; O’Connor, Michael; Cook, Richard

2006-01-01

Information technology (IT) systems have been described as brittle and prone to automation surprises. Recent report of information system failure, particularly computerized physician order entry (CPOE) systems, shows the result of IT failure in actual practice. Such mismatches with healthcare work requirements necessitate improvement to IT research and development. Efforts to develop successful IT systems for healthcare’s sharp end must incorporate properties that reflect workers’ initiative in respose to domain constraints. Resilience is the feature of some systems that makes it possible for them to respond to sudden, unanticipated demands for performance and return to normal operation quickly, with minimum decrement in performance. Workers create resilience at healthcare’s sharp end by daily confronting constraints and obstacles that need to be surmounted in order to accomplish results. The sign-out sheet is an example of resilience that can be used to guide IT development. PMID:17238408

An Integrated Computerized Triage System in the Emergency Department

PubMed Central

Aronsky, Dominik; Jones, Ian; Raines, Bill; Hemphill, Robin; Mayberry, Scott R; Luther, Melissa A; Slusser, Ted

2008-01-01

Emergency department (ED) triage is a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need. This paper describes the experiences with an integrated, computerized triage application. The system exchanges information with other information systems, including the ED patient tracking board, the longitudinal electronic medical record, the computerized provider order entry, and the medication reconciliation application. The application includes decision support capabilities such as assessing the patient’s acuity level, age-dependent alerts for vital signs, and clinical reminders. The browser-based system utilizes the institution’s controlled vocabulary, improves data completeness and quality, such as compliance with capturing required data elements and screening questions, initiates clinical processes, such as pneumococcal vaccination ordering, and reminders to start clinical pathways, issues alerts for clinical trial eligibility, and facilitates various reporting needs. The system has supported the triage documentation of >290,000 pediatric and adult patients. PMID:18999190

Recent advances in ophthalmic drug delivery

PubMed Central

Kompella, Uday B; Kadam, Rajendra S; Lee, Vincent HL

2011-01-01

Topical ocular drug bioavailability is notoriously poor, in the order of 5% or less. This is a consequence of effective multiple barriers to drug entry, comprising nasolacrimal drainage, epithelial drug transport barriers and clearance from the vasculature in the conjunctiva. While sustained drug delivery to the back of the eye is now feasible with intravitreal implants such as Vitrasert™ (~6 months), Retisert™ (~3 years) and Iluvien™ (~3 years), currently there are no marketed delivery systems for long-term drug delivery to the anterior segment of the eye. The purpose of this article is to summarize the resurgence in interest to prolong and improve drug entry from topical administration. These approaches include mucoadhesives, viscous polymer vehicles, transporter-targeted prodrug design, receptor-targeted functionalized nanoparticles, iontophoresis, punctal plug and contact lens delivery systems. A few of these delivery systems might be useful in treating diseases affecting the back of the eye. Their effectiveness will be compared against intravitreal implants (upper bound of effectiveness) and trans-scleral systems (lower bound of effectiveness). Refining the animal model by incorporating the latest advances in microdialysis and imaging technology is key to expanding the knowledge central to the design, testing and evaluation of the next generation of innovative ocular drug delivery systems. PMID:21399724

An electronic safety screening process during inpatient computerized physician order entry improves the efficiency of magnetic resonance imaging exams.

PubMed

Schneider, Erika; Ruggieri, Paul; Fromwiller, Lauren; Underwood, Reginald; Gurland, Brooke; Yurkschatt, Cynthia; Kubiak, Kevin; Obuchowski, Nancy A

2013-12-01

Delays between order and magnetic resonance (MR) exam often result when using the conventional paper-based MR safety screening process. The impact of an electronic MR safety screening process imbedded in a computerized physician order entry (CPOE) system was evaluated. Retrospective chart review of 4 months of inpatient MR exam orders and reports was performed before and after implementation of electronic MR safety documentation. Time from order to MR exam completion, time from MR exam completion to final radiology report, and time from first order to final report were analyzed by exam anatomy. Length of stay (LOS) and date of service within the admission were also analyzed. We evaluated 1947 individual MR orders in 1549 patients under an institutional review board exemption and a waiver of informed consent. Implementation of the electronic safety screening process resulted in a significant decrease of 1.1 hours (95% confidence interval 1.0-1.3 hours) in the mean time between first order to final report and a nonsignificant decrease of 0.8 hour in the median time from first order to exam end. There was a 1-day reduction (P = .697) in the time from admission to the MR exam compared to the paper process. No significant change in LOS was found except in neurological intensive care patients imaged within the first 24 hours of their admission, where a mean 0.9-day decrease was found. Benefits of an electronic process for MR safety screening include enabling inpatients to have decreased time to MR exams, thus enabling earlier diagnosis and treatment and reduced LOS. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Official Military Personnel Files, Micrographics System Study.

DTIC Science & Technology

1984-01-27

readable flashcards . Since new General Orders and awards are being issued constantly, it may alternatively be appropriate to microfilm and index these...card locations. The label on the face of the cartridge should contain the location of flashcards . (Indexing for each entry could be performed at a later...approximate frame location within the roll. The label indicating the location of flashcards should be placed on the face of the cartridge that is

Considerations in Designing and Implementing Enhancements to COSTAR

PubMed Central

Piggins, Judith; McLatchey, John; Zielstorff, Rita; Barrett, Suzanne; Smith, Monica; Weidman-Dahl, Frances; Brown, Kibbe; Barnett, G. Octo

1982-01-01

The addition of enhancements to a COSTAR system can involve a significant investment of effort. This paper describes recent experience in implementing two major COSTAR enhancements, namely a patient-specific encounter form and an order entry and dispatch subsystem. A number of points to be considered in regard to planning and implementing such enhancements are raised, and the relative success of these two enhancements at one particular site is discussed.

Improving adherence to the Epic Beacon ambulatory workflow.

PubMed

Chackunkal, Ellen; Dhanapal Vogel, Vishnuprabha; Grycki, Meredith; Kostoff, Diana

2017-06-01

Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% ( p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.

ATV reentry

NASA Image and Video Library

2012-10-03

ISS033-E-009232 (3 Oct. 2012) --- This still photo taken by the Expedition 33 crew members aboard the International Space Station shows evidence of the fiery plunge through Earth?s atmosphere and the destructive re-entry of the European Automated Transfer Vehicle-3 (ATV-3) spacecraft, also known as ?Edoardo Amaldi.? The end of the ATV took place over a remote swath of the Pacific Ocean where any surviving debris safely splashed down a short time later, at around 1:30 a.m. (GMT) on Oct. 3, thus concluding the highly successful ATV-3 mission. Aboard the craft during re-entry was the Re Entry Breakup Recorder (REBR), a spacecraft ?black box? designed to gather data on vehicle disintegration during re-entry in order to improve future spacecraft re-entry models.

Comprehensive analysis of a medication dosing error related to CPOE.

PubMed

Horsky, Jan; Kuperman, Gilad J; Patel, Vimla L

2005-01-01

This case study of a serious medication error demonstrates the necessity of a comprehensive methodology for the analysis of failures in interaction between humans and information systems. The authors used a novel approach to analyze a dosing error related to computer-based ordering of potassium chloride (KCl). The method included a chronological reconstruction of events and their interdependencies from provider order entry usage logs, semistructured interviews with involved clinicians, and interface usability inspection of the ordering system. Information collected from all sources was compared and evaluated to understand how the error evolved and propagated through the system. In this case, the error was the product of faults in interaction among human and system agents that methods limited in scope to their distinct analytical domains would not identify. The authors characterized errors in several converging aspects of the drug ordering process: confusing on-screen laboratory results review, system usability difficulties, user training problems, and suboptimal clinical system safeguards that all contributed to a serious dosing error. The results of the authors' analysis were used to formulate specific recommendations for interface layout and functionality modifications, suggest new user alerts, propose changes to user training, and address error-prone steps of the KCl ordering process to reduce the risk of future medication dosing errors.

Clinical Information Systems Integration in New York City's First Mobile Stroke Unit.

PubMed

Kummer, Benjamin R; Lerario, Michael P; Navi, Babak B; Ganzman, Adam C; Ribaudo, Daniel; Mir, Saad A; Pishanidar, Sammy; Lekic, Tim; Williams, Olajide; Kamel, Hooman; Marshall, Randolph S; Hripcsak, George; Elkind, Mitchell S V; Fink, Matthew E

2018-01-01

Mobile stroke units (MSUs) reduce time to thrombolytic therapy in acute ischemic stroke. These units are widely used, but the clinical information systems underlying MSU operations are understudied. The first MSU on the East Coast of the United States was established at New York Presbyterian Hospital (NYP) in October 2016. We describe our program's 7-month pilot, focusing on the integration of our hospital's clinical information systems into our MSU to support patient care and research efforts. NYP's MSU was staffed by two paramedics, one radiology technologist, and a vascular neurologist. The unit was equipped with four laptop computers and networking infrastructure enabling all staff to access the hospital intranet and clinical applications during operating hours. A telephone-based registration procedure registered patients from the field into our admit/discharge/transfer system, which interfaced with the institutional electronic health record (EHR). We developed and implemented a computerized physician order entry set in our EHR with prefilled values to permit quick ordering of medications, imaging, and laboratory testing. We also developed and implemented a structured clinician note to facilitate care documentation and clinical data extraction. Our MSU began operating on October 3, 2016. As of April 27, 2017, the MSU transported 49 patients, of whom 16 received tissue plasminogen activator (t-PA). Zero technical problems impacting patient care were reported around registration, order entry, or intranet access. Two onboard network failures occurred, resulting in computed tomography scanner malfunctions, although no patients became ineligible for time-sensitive treatment as a result. Thirteen (26.5%) clinical notes contained at least one incomplete time field. The main technical challenges encountered during the integration of our hospital's clinical information systems into our MSU were onboard network failures and incomplete clinical documentation. Future studies are necessary to determine whether such integrative efforts improve MSU care quality, and which enhancements to information systems will optimize clinical care and research efforts. Schattauer GmbH Stuttgart.

Aerodynamic Heating Computations for Projectiles. Volume 1. In-Depth Heat Conduction Modifications to the ABRES Shape Change Code (BRLASCC)

DTIC Science & Technology

1984-06-01

preceding the corresponding pressure group of the surface thermochemistry deck as described below. The temperature entries within each section must be... pressure group the transfer coefficient values will be ordered. Within each transfer coefficient section, ablation rate entries need not he ordered in any...may not exceed 5 (and may be only I); the number of transfer coefficient values in each pressure group may not exceed 5 but may be only 1. If no

Competing power-generating technologies for the 21st century

NASA Astrophysics Data System (ADS)

Troost, G. K.

1994-04-01

Several new and advanced power-generating systems are presently being developed, e.g., fuel cells, advanced heat pumps, high-performance gas turbines. An analysis of these systems is presented and is based on projections of comparative studies and relevant trends. For advanced systems, a trade-off between efficiency gain and projected development cost is crucial. Projections for market conditions in the 21st century and, in particular, environmental issues are made in order to assess market-entry opportunities. Results from various case studies indicate challenging opportunities in process and metallurgical industries; several process-integrated configurations are being studied.

8 CFR 1.1 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... successive re-delegation, the terms mean, to the extent that authority has been delegated to such official... having changed. Such status terminates upon entry of a final administrative order of exclusion... come into the United States at a port-of-entry, or an alien seeking transit through the United States...

VizieR Online Data Catalog: Chromospherically Active Binaries. Third version (Eker+, 2008)

NASA Astrophysics Data System (ADS)

Eker, Z.; Filiz-Ak, N.; Bilir, S.; Dogru, D.; Tuysuz, M.; Soydugan, E.; Bakis, H.; Ugras, B.; Soydugan, F.; Erdem, A.; Demircan, O.

2008-06-01

Chromospherically Active Binaries (CAB) catalogue have been revised and updated. With 203 new identifications, the number of CAB stars is increased to 409. Catalogue is available in electronic format where each system has various number of lines (sub-orders) with a unique order number. Columns contain data of limited number of selected cross references, comments to explain peculiarities and position of the binarity in case it belongs to a multiple system, classical identifications (RS CVn, BY Dra), brightness and colours, photometric and spectroscopic data, description of emission features (Ca II H&K, Hα, UV, IR), X-Ray luminosity, radio flux, physical quantities and orbital information, where each basic entry are referenced so users can go original sources. (10 data files).

Thermal Protection for Mars Sample Return Earth Entry Vehicle: A Grand Challenge for Design Methodology and Reliability Verification

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj; Gage, Peter; Wright, Michael J.

2017-01-01

Mars Sample Return is our Grand Challenge for the coming decade. TPS (Thermal Protection System) nominal performance is not the key challenge. The main difficulty for designers is the need to verify unprecedented reliability for the entry system: current guidelines for prevention of backward contamination require that the probability of spores larger than 1 micron diameter escaping into the Earth environment be lower than 1 million for the entire system, and the allocation to TPS would be more stringent than that. For reference, the reliability allocation for Orion TPS is closer to 11000, and the demonstrated reliability for previous human Earth return systems was closer to 1100. Improving reliability by more than 3 orders of magnitude is a grand challenge indeed. The TPS community must embrace the possibility of new architectures that are focused on reliability above thermal performance and mass efficiency. MSR (Mars Sample Return) EEV (Earth Entry Vehicle) will be hit with MMOD (Micrometeoroid and Orbital Debris) prior to reentry. A chute-less aero-shell design which allows for self-righting shape was baselined in prior MSR studies, with the assumption that a passive system will maximize EEV robustness. Hence the aero-shell along with the TPS has to take ground impact and not break apart. System verification will require testing to establish ablative performance and thermal failure but also testing of damage from MMOD, and structural performance at ground impact. Mission requirements will demand analysis, testing and verification that are focused on establishing reliability of the design. In this proposed talk, we will focus on the grand challenge of MSR EEV TPS and the need for innovative approaches to address challenges in modeling, testing, manufacturing and verification.

Computerized decision support for medication dosing in renal insufficiency: a randomized, controlled trial.

PubMed

Terrell, Kevin M; Perkins, Anthony J; Hui, Siu L; Callahan, Christopher M; Dexter, Paul R; Miller, Douglas K

2010-12-01

Emergency physicians prescribe several discharge medications that require dosage adjustment for patients with renal disease. The hypothesis for this research was that decision support in a computerized physician order entry system would reduce the rate of excessive medication dosing for patients with renal impairment. This was a randomized, controlled trial in an academic emergency department (ED), in which computerized physician order entry was used to write all prescriptions for patients being discharged from the ED. The sample included 42 physicians who were randomized to the intervention (21 physicians) or control (21 physicians) group. The intervention was decision support that provided dosing recommendations for targeted medications for patients aged 18 years and older when the patient's estimated creatinine clearance level was below the threshold for dosage adjustment. The primary outcome was the proportion of targeted medications that were excessively dosed. For 2,783 (46%) of the 6,015 patient visits, the decision support had sufficient information to estimate the patient's creatinine clearance level. The average age of these patients was 46 years, 1,768 (64%) were women, and 1,523 (55%) were black. Decision support was provided 73 times to physicians in the intervention group, who excessively dosed 31 (43%) prescriptions. In comparison, control physicians excessively dosed a significantly larger proportion of medications: 34 of 46, 74% (effect size=31%; 95% confidence interval 14% to 49%; P=.001). Emergency physicians often prescribed excessive doses of medications that require dosage adjustment for renal impairment. Computerized physician order entry with decision support significantly reduced excessive dosing of targeted medications. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Entry, Descent, and Landing With Propulsive Deceleration

NASA Technical Reports Server (NTRS)

Palaszewski, Bryan

2012-01-01

The future exploration of the Solar System will require innovations in transportation and the use of entry, descent, and landing (EDL) systems at many planetary landing sites. The cost of space missions has always been prohibitive, and using the natural planetary and planet s moons atmospheres for entry, descent, and landing can reduce the cost, mass, and complexity of these missions. This paper will describe some of the EDL ideas for planetary entry and survey the overall technologies for EDL that may be attractive for future Solar System missions.

8 CFR 235.7 - Automated inspection services.

Code of Federal Regulations, 2012 CFR

2012-01-01

...—(i) Port Passenger Accelerated Service System (PORTPASS). A system in which certain ports-of-entry... application for entry by the alien program participants on the date PORTPASS is used. United States citizens... Service. Non-United States citizens must meet all applicable documentary and entry eligibility...

75 FR 5579 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-03

... with re-entry controlled by passwords. The DLA Enterprise Hotline Program Database is also password...: * * * * * System location: Delete entry and replace with ``Director, DLA Accountability Office (DA), Headquarters....'' * * * * * Retention and disposal: Delete entry and replace with ``Records are destroyed/deleted 10 years after...

8 CFR 235.7 - Automated inspection services.

Code of Federal Regulations, 2013 CFR

2013-01-01

...—(i) Port Passenger Accelerated Service System (PORTPASS). A system in which certain ports-of-entry... application for entry by the alien program participants on the date PORTPASS is used. United States citizens... Service. Non-United States citizens must meet all applicable documentary and entry eligibility...

8 CFR 235.7 - Automated inspection services.

Code of Federal Regulations, 2011 CFR

2011-01-01

...—(i) Port Passenger Accelerated Service System (PORTPASS). A system in which certain ports-of-entry... application for entry by the alien program participants on the date PORTPASS is used. United States citizens... Service. Non-United States citizens must meet all applicable documentary and entry eligibility...

8 CFR 235.7 - Automated inspection services.

Code of Federal Regulations, 2014 CFR

2014-01-01

...—(i) Port Passenger Accelerated Service System (PORTPASS). A system in which certain ports-of-entry... application for entry by the alien program participants on the date PORTPASS is used. United States citizens... Service. Non-United States citizens must meet all applicable documentary and entry eligibility...

VizieR Online Data Catalog: Chromospherically Active Binaries (Strassmeier+ 1993)

NASA Astrophysics Data System (ADS)

Strassmeier, K. G.; Hall, D. S.; Fekel, F. C.

1996-08-01

Stars always appear in order of increasing right-ascension for the epoch 2000.0. For the current version of the catalog, the literature was searched through December 31, 1991 although a few later references are included. Additionally, some entries are cited with "private communication", which make this catalog also a first-hand source. A number in parentheses behind an entry always corresponds to a reference given in the bibliography. See the 1988 publication for specific requirements and restrictions in compiling these catalogs. See the source reference for more details about this catalog. The following binary systems, which were listed in the first edition of the catalog, were not included in the present edition due to insufficient evidence for chromospheric activity: eta And 26 Aql 4 UMi nu2 Sgr tau Sgr the following stars are chromospherically active but are components in a "wide" binary and were not included. HD 25893 HD 79211 Forty three new binary systems have been included in the present edition. (12 data files).

Thermal Protection System Mass Estimating Relationships For Blunt-Body, Earth Entry Spacecraft

NASA Technical Reports Server (NTRS)

Sepka, Steven A.; Samareh, Jamshid A.

2015-01-01

Mass estimating relationships (MERs) are developed to predict the amount of thermal protection system (TPS) necessary for safe Earth entry for blunt-body spacecraft using simple correlations that are non-ITAR and closely match estimates from NASA's highfidelity ablation modeling tool, the Fully Implicit Ablation and Thermal Analysis Program (FIAT). These MERs provide a first order estimate for rapid feasibility studies. There are 840 different trajectories considered in this study, and each TPS MER has a peak heating limit. MERs for the vehicle forebody include the ablators Phenolic Impregnated Carbon Ablator (PICA) and Carbon Phenolic atop Advanced Carbon-Carbon. For the aftbody, the materials are Silicone Impregnated Reusable Ceramic Ablator (SIRCA), Acusil II, SLA- 561V, and LI-900. The MERs are accurate to within 14% (at one standard deviation) of FIAT prediction, and the most any MER can under predict FIAT TPS thickness is 18.7%. This work focuses on the development of these MERs, the resulting equations, model limitations, and model accuracy.

Spatial and temporal variation in evacuee risk perception throughout the evacuation and return-entry process.

PubMed

Siebeneck, Laura K; Cova, Thomas J

2012-09-01

Developing effective evacuation and return-entry plans requires understanding the spatial and temporal dimensions of risk perception experienced by evacuees throughout a disaster event. Using data gathered from the 2008 Cedar Rapids, Iowa Flood, this article explores how risk perception and location influence evacuee behavior during the evacuation and return-entry process. Three themes are discussed: (1) the spatial and temporal characteristics of risk perception throughout the evacuation and return-entry process, (2) the relationship between risk perception and household compliance with return-entry orders, and (3) the role social influences have on the timing of the return by households. The results indicate that geographic location and spatial variation of risk influenced household risk perception and compliance with return-entry plans. In addition, sociodemographic characteristics influenced the timing and characteristics of the return groups. The findings of this study advance knowledge of evacuee behavior throughout a disaster and can inform strategies used by emergency managers throughout the evacuation and return-entry process. © 2012 Society for Risk Analysis.

Computer order entry systems in the emergency department significantly reduce the time to medication delivery for high acuity patients.

PubMed

Syed, Shahbaz; Wang, Dongmei; Goulard, Debbie; Rich, Tom; Innes, Grant; Lang, Eddy

2013-07-05

Computerized physician order entry (CPOE) systems are designed to increase safety and improve quality of care; however, their impact on efficiency in the ED has not yet been validated. This study examined the impact of CPOE on process times for medication delivery, laboratory utilization and diagnostic imaging in the early, late and control phases of a regional ED-CPOE implementation. Three tertiary care hospitals serving a population in excess of 1 million inhabitants that initiated the same CPOE system during the same 3-week time window. Patients were stratified into three groupings: Control, Early CPOE and Late CPOE (n = 200 patients per group/hospital site). Eligible patients consisted of a stratified (40% CTAS 2 and 60% CTAS 3) random sample of all patients seen 30 days preceding CPOE implementation (Control), 30 days immediately after CPOE implementation (Early CPOE) and 5-6 months after CPOE implementation (Late CPOE). Primary outcomes were time to (TT) from physician assignment (MD-sign) up to MD-order completion. An ANOVA and t-test were employed for statistical analysis. In comparison with control, TT 1st MD-Ordered Medication decreased in both the Early and Late CPOE groups (102.6 min control, 62.8 Early and 65.7 late, p < 0.001). TT 1st MD-ordered laboratory results increased in both the Early and Late CPOE groups compared to Control (76.4, 85.3 and 73.8 min, respectively, p < 0.001). TT 1st X-Ray also significantly increased in both the Early and Late CPOE groups (80.4, 84.8 min, respectively, compared to 68.1, p < 0.001). Given that CT and ultrasound imaging inherently takes increased time, these imaging studies were not included, and only X-ray was examined. There was no statistical difference found between TT discharge and consult request. Regional implementation of CPOE afforded important efficiencies in time to medication delivery for high acuity ED patients. Increased times observed for laboratory and radiology results may reflect system issues outside of the emergency department and as a result of potential confounding may not be a reflection of CPOE impact.

Aviation and programmatic analyses; Volume 1, Task 1: Aviation data base development and application. [for NASA OAST programs

NASA Technical Reports Server (NTRS)

1977-01-01

A method was developed for using the NASA aviation data base and computer programs in conjunction with the GE management analysis and projection service to perform simple and complex economic analysis for planning, forecasting, and evaluating OAST programs. Capabilities of the system are discussed along with procedures for making basic data tabulations, updates and entries. The system is applied in an agricultural aviation study in order to assess its value for actual utility in the OAST working environment.

Mars Science Laboratory Entry, Descent and Landing System Overview

NASA Technical Reports Server (NTRS)

Steltzner, Adam D.; San Martin, A. Miguel; Rivellini, Tomasso P.; Chen, Allen

2013-01-01

The Mars Science Laboratory project recently places the Curiosity rove on the surface of Mars. With the success of the landing system, the performance envelope of entry, descent and landing capabilities has been extended over the previous state of the art. This paper will present an overview to the MSL entry, descent and landing system design and preliminary flight performance results.

Generic aerocapture atmospheric entry study, volume 1

NASA Technical Reports Server (NTRS)

1980-01-01

An atmospheric entry study to fine a generic aerocapture vehicle capable of missions to Mars, Saturn, and Uranus is reported. A single external geometry was developed through atmospheric entry simulations. Aerocapture is a system design concept which uses an aerodynamically controlled atmospheric entry to provide the necessary velocity depletion to capture payloads into planetary orbit. Design concepts are presented which provide the control accuracy required while giving thermal protection for the mission payload. The system design concepts consist of the following elements: (1) an extendable biconic aerodynamic configuration with lift to drag ratio between 1.0 and 2.0; (2) roll control system concepts to control aerodynamic lift and disturbance torques; (3) aeroshell design concepts capable of meeting dynamic pressure loads during aerocapture; and (4) entry thermal protection system design concepts to meet thermodynamic loads during aerocapture.

Conformal Ablative Thermal Protection System for Planetary and Human Exploration Missions: Overview of the Technology Maturation Efforts Funded by NASA's Game Changing Development Program

NASA Technical Reports Server (NTRS)

Beck, Robin A.; Arnold, James O.; Gasch, Matthew J.; Stackpoole, Margaret M.; Fan, Wendy; Szalai, Christine E.; Wercinski, Paul F.; Venkatapathy, Ethiraj

2012-01-01

The Office of Chief Technologist (OCT), NASA has identified the need for research and technology development in part from NASA's Strategic Goal 3.3 of the NASA Strategic Plan to develop and demonstrate the critical technologies that will make NASA's exploration, science, and discovery missions more affordable and more capable. Furthermore, the Game Changing Development Program (GCDP) is a primary avenue to achieve the Agency's 2011 strategic goal to "Create the innovative new space technologies for our exploration, science, and economic future." In addition, recently released "NASA space Technology Roadmaps and Priorities," by the National Research Council (NRC) of the National Academy of Sciences stresses the need for NASA to invest in the very near term in specific EDL technologies. The report points out the following challenges (Page 2-38 of the pre-publication copy released on February 1, 2012): Mass to Surface: Develop the ability to deliver more payload to the destination. NASA's future missions will require ever-greater mass delivery capability in order to place scientifically significant instrument packages on distant bodies of interest, to facilitate sample returns from bodies of interest, and to enable human exploration of planets such as Mars. As the maximum mass that can be delivered to an entry interface is fixed for a given launch system and trajectory design, the mass delivered to the surface will require reduction in spacecraft structural mass; more efficient, lighter thermal protection systems; more efficient lighter propulsion systems; and lighter, more efficient deceleration systems. Surface Access: Increase the ability to land at a variety of planetary locales and at a variety of times. Access to specific sites can be achieved via landing at a specific location (s) or transit from a single designated landing location, but it is currently infeasible to transit long distances and through extremely rugged terrain, requiring landing close to the site of interest. The entry environment is not always guaranteed with a direct entry, and improving the entry system's robustness to a variety of environmental conditions could aid in reaching more varied landing sites."

27. View of entry door to vestibule to MWOC entry ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

27. View of entry door to vestibule to MWOC entry door in transmitter building no. 102 (note coded key pad to left and intercom phone on left) and door to the central systems monitor room (CSMR) to right (out of sight). - Clear Air Force Station, Ballistic Missile Early Warning System Site II, One mile west of mile marker 293.5 on Parks Highway, 5 miles southwest of Anderson, Anderson, Denali Borough, AK

Mars Science Laboratory (MSL) Entry, Descent, and Landing Instrumentation (MEDLI): Complete Flight Data Set

NASA Technical Reports Server (NTRS)

Cheatwood, F. McNeil; Bose, Deepak; Karlgaard, Christopher D.; Kuhl, Christopher A.; Santos, Jose A.; Wright, Michael J.

2014-01-01

The Mars Science Laboratory (MSL) entry vehicle (EV) successfully entered the Mars atmosphere and landed the Curiosity rover safely on the surface of the planet in Gale crater on August 6, 2012. MSL carried the MSL Entry, Descent, and Landing (EDL) Instrumentation (MEDLI). MEDLI delivered the first in-depth understanding of the Mars entry environments and the response of the entry vehicle to those environments. MEDLI was comprised of three major subsystems: the Mars Entry Atmospheric Data System (MEADS), the MEDLI Integrated Sensor Plugs (MISP), and the Sensor Support Electronics (SSE). Ultimately, the entire MEDLI sensor suite consisting of both MEADS and MISP provided measurements that were used for trajectory reconstruction and engineering validation of aerodynamic, atmospheric, and thermal protection system (TPS) models in addition to Earth-based systems testing procedures. This report contains in-depth hardware descriptions, performance evaluation, and data information of the three MEDLI subsystems.

Motivationally Significant Stimuli Show Visual Prior Entry: Evidence for Attentional Capture

ERIC Educational Resources Information Center

West, Greg L.; Anderson, Adam A. K.; Pratt, Jay

2009-01-01

Previous studies that have found attentional capture effects for stimuli of motivational significance do not directly measure initial attentional deployment, leaving it unclear to what extent these items produce attentional capture. Visual prior entry, as measured by temporal order judgments (TOJs), rests on the premise that allocated attention…

75 FR 80870 - Self-Regulatory Organizations; Chicago Stock Exchange, Inc.; Notice of Filing and Order Granting...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

... Proposed Rule Change To Eliminate the Validated Cross Trade Entry Functionality December 16, 2010. Pursuant... eliminate the Validated Cross Trade Entry Functionality for Exchange-registered Institutional Brokers. The... Brokers (``Institutional Brokers'') by eliminating the ability of an Institutional Broker to execute...

19 CFR 141.68 - Time of entry.

Code of Federal Regulations, 2014 CFR

2014-04-01

... (pursuant to § 24.25 of this chapter) have been successfully received by CBP via the Automated Broker... from warehouse for consumption. The time of entry of merchandise withdrawn from warehouse for... the order of the warehouse proprietor) is when: (1) CBP Form 7501 is executed in proper form and filed...

19 CFR 141.68 - Time of entry.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (pursuant to § 24.25 of this chapter) have been successfully received by CBP via the Automated Broker... from warehouse for consumption. The time of entry of merchandise withdrawn from warehouse for... the order of the warehouse proprietor) is when: (1) CBP Form 7501 is executed in proper form and filed...

19 CFR 141.68 - Time of entry.

Code of Federal Regulations, 2012 CFR

2012-04-01

... (pursuant to § 24.25 of this chapter) have been successfully received by CBP via the Automated Broker... from warehouse for consumption. The time of entry of merchandise withdrawn from warehouse for... the order of the warehouse proprietor) is when: (1) CBP Form 7501 is executed in proper form and filed...

19 CFR 141.68 - Time of entry.

Code of Federal Regulations, 2011 CFR

2011-04-01

... (pursuant to § 24.25 of this chapter) have been successfully received by CBP via the Automated Broker... from warehouse for consumption. The time of entry of merchandise withdrawn from warehouse for... the order of the warehouse proprietor) is when: (1) CBP Form 7501 is executed in proper form and filed...

19 CFR 141.68 - Time of entry.

Code of Federal Regulations, 2013 CFR

2013-04-01

... (pursuant to § 24.25 of this chapter) have been successfully received by CBP via the Automated Broker... from warehouse for consumption. The time of entry of merchandise withdrawn from warehouse for... the order of the warehouse proprietor) is when: (1) CBP Form 7501 is executed in proper form and filed...

The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis

PubMed Central

2014-01-01

Background The Health Information Technology for Economic and Clinical Health (HITECH) Act subsidizes implementation by hospitals of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries caused by medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, and effects on medication errors have been variable. The objectives of this analysis were to assess the effectiveness of CPOE at reducing pADEs in hospital-related settings, and examine reasons for heterogeneous effects on medication errors. Methods Articles were identified using MEDLINE, Cochrane Library, Econlit, web-based databases, and bibliographies of previous systematic reviews (September 2013). Eligible studies compared CPOE with paper-order entry in acute care hospitals, and examined diverse pADEs or medication errors. Studies on children or with limited event-detection methods were excluded. Two investigators extracted data on events and factors potentially associated with effectiveness. We used random effects models to pool data. Results Sixteen studies addressing medication errors met pooling criteria; six also addressed pADEs. Thirteen studies used pre-post designs. Compared with paper-order entry, CPOE was associated with half as many pADEs (pooled risk ratio (RR) = 0.47, 95% CI 0.31 to 0.71) and medication errors (RR = 0.46, 95% CI 0.35 to 0.60). Regarding reasons for heterogeneous effects on medication errors, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta-regression. Differences between commercial versus homegrown systems, presence and sophistication of clinical decision support, hospital-wide versus limited implementation, and US versus non-US studies were not significant, nor was timing of publication. Higher baseline rates of medication errors predicted greater reductions (P < 0.001). Other context and implementation variables were seldom reported. Conclusions In hospital-related settings, implementing CPOE is associated with a greater than 50% decline in pADEs, although the studies used weak designs. Decreases in medication errors are similar and robust to variations in important aspects of intervention design and context. This suggests that CPOE implementation, as subsidized under the HITECH Act, may benefit public health. More detailed reporting of the context and process of implementation could shed light on factors associated with greater effectiveness. PMID:24894078

Ada Quality and Style: Guidelines for Professional Programmers

DTIC Science & Technology

1991-01-01

occured because entry queues are serviced in FIFO order, not by priority. There is another situation referred to as a race condition. A program like the...the value of ’COUNT. A task can be removed from an entry queue due to execution of an abort statement as well as expiration of a timed entry call. The...is not defined by the language and may vary from time sliced to preemptive priority. Some implementations (e.g., VAX Ada) provide several choices

Quality Assessment of Process Measures in Antimicrobial Stewardship: Concordance of Valacyclovir Indication and Automatic Prospective Approval in Computerized Provider Order Entry

PubMed Central

Lee, Tiffany; McCoy, Christopher; Mahoney, Monica V

2017-01-01

Abstract Background The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) recommend computerized decision support at the time of prescribing as an antimicrobial stewardship (AST) tool. Providing antimicrobial indications during prescribing can optimize infection-specific therapy through appropriate antimicrobial selection, dosing, and frequency. The Leapfrog group identifies this as a quality measure for their report card system. At Beth Israel Deaconess Medical Center (BIDMC), indication-based dosing has been incorporated in the computerized provider order entry (CPOE) system since 2006. At BIDMC, valacyclovir is only approved for the treatment of varicella zoster (VZV) infection or prophylaxis of solid organ transplant (SOT) patients at low risk for cytomegalovirus. These indications bypass the need for AST approval. Accuracy validation of the selected indications has not been formally performed. Methods A retrospective chart review was performed in patients prescribed valacyclovir during an 8-month period in 2016. Electronic medical records, laboratory reports, and pharmacy records were reviewed to identify the suspected/confirmed infection. The primary outcome was the concordance rate of selected CPOE valacyclovir indication compared with suspected/confirmed infection at the time of ordering. The secondary outcome was the proportion of valacyclovir use per institutional protocol. Results Overall, 117 patients were included, with a median age of 57.9 years, 51 (43.6%) were male, and 4 (3.4%) were located in an intensive care unit. Fifty-nine orders (50.4%) selected VZV as the indication, followed by 21 orders (17.9%) for SOT prophylaxis. Of orders with any CPOE indication, only 59/101 (58.4%) were concordant with suspected/confirmed infection. Of the valacyclovir orders with a VZV indication, 37 (62.7%) were concordant. Of the orders with SOT prophylaxis indications, 5 (23.8%) were concordant. Furthermore, only 46 orders (39.3%) were per BIDMC-protocol. Conclusion Concordance of CPOE indication selection and suspected/confirmed infection for valacyclovir was low. Using CPOE to grant automatic prospective approval must be monitored and audited for accuracy if employed as an AST tool. Disclosures All authors: No reported disclosures.

41 CFR 101-30.304 - Application of item entry control.

Code of Federal Regulations, 2012 CFR

2012-07-01

... entry control. 101-30.304 Section 101-30.304 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 30-FEDERAL CATALOG SYSTEM 30.3-Cataloging Items of Supply § 101-30.304 Application of item entry control. In addition...

33 CFR 161.18 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... call. H HOTEL Date, time and point of entry system Entry time expressed as in (B) and into the entry... KILO Date, time and point of exit from system Exit time expressed as in (B) and exit position expressed....; for a dredge or floating plant: configuration of pipeline, mooring configuration, number of assist...

Mars Entry Atmospheric Data System Trajectory Reconstruction Algorithms and Flight Results

NASA Technical Reports Server (NTRS)

Karlgaard, Christopher D.; Kutty, Prasad; Schoenenberger, Mark; Shidner, Jeremy; Munk, Michelle

2013-01-01

The Mars Entry Atmospheric Data System is a part of the Mars Science Laboratory, Entry, Descent, and Landing Instrumentation project. These sensors are a system of seven pressure transducers linked to ports on the entry vehicle forebody to record the pressure distribution during atmospheric entry. These measured surface pressures are used to generate estimates of atmospheric quantities based on modeled surface pressure distributions. Specifically, angle of attack, angle of sideslip, dynamic pressure, Mach number, and freestream atmospheric properties are reconstructed from the measured pressures. Such data allows for the aerodynamics to become decoupled from the assumed atmospheric properties, allowing for enhanced trajectory reconstruction and performance analysis as well as an aerodynamic reconstruction, which has not been possible in past Mars entry reconstructions. This paper provides details of the data processing algorithms that are utilized for this purpose. The data processing algorithms include two approaches that have commonly been utilized in past planetary entry trajectory reconstruction, and a new approach for this application that makes use of the pressure measurements. The paper describes assessments of data quality and preprocessing, and results of the flight data reduction from atmospheric entry, which occurred on August 5th, 2012.

Stability and Drag Reduction in a Boundary Layer with Microbubbles.

DTIC Science & Technology

1988-02-01

order accurate. .’ Since the numerical methods are not the object of this % dissertation, we decline from including the finite difference equations...previous appendix must be the special case of zero pressure gradient. Some entries of the matrices of the block tridiagonal system will be different ...of the wall mean velocity gradient was observed to be associated with the migration of the bubbles away from the boundary layer. The time scale of the

76 FR 18062 - U.S. Securities; Sale and Issue of Marketable Book-Entry Treasury Bills, Notes, and Bonds; Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

...; Sale and Issue of Marketable Book-Entry Treasury Bills, Notes, and Bonds; Book-Entry Treasury Bonds... longer be opened and transfers of securities from other book-entry systems will no longer be [email protected] . SUPPLEMENTARY INFORMATION: Legacy Treasury Direct [supreg] is a book- entry, non...

Qualitative analysis of vendor discussions on the procurement of Computerised Physician Order Entry and Clinical Decision Support systems in hospitals

PubMed Central

Cresswell, Kathrin M; Lee, Lisa; Slee, Ann; Coleman, Jamie; Bates, David W; Sheikh, Aziz

2015-01-01

Objectives We studied vendor perspectives about potentially transferable lessons for implementing organisations and national strategies surrounding the procurement of Computerised Physician Order Entry (CPOE)/Clinical Decision Support (CDS) systems in English hospitals. Setting Data were collected from digitally audio-recorded discussions from a series of CPOE/CDS vendor round-table discussions held in September 2014 in the UK. Participants Nine participants, representing 6 key vendors operating in the UK, attended. The discussions were transcribed verbatim and thematically analysed. Results Vendors reported a range of challenges surrounding the procurement and contracting processes of CPOE/CDS systems, including hospitals’ inability to adequately assess their own needs and then select a suitable product, rushed procurement and implementation processes that resulted in difficulties in meaningfully engaging with vendors, as well as challenges relating to contracting leading to ambiguities in implementation roles. Consequently, relationships between system vendors and hospitals were often strained, the vendors attributing this to a lack of hospital management's appreciation of the complexities associated with implementation efforts. Future anticipated challenges included issues surrounding the standardisation of data to enable their aggregation across systems for effective secondary uses, and implementation of data exchange with providers outside the hospital. Conclusions Our results indicate that there are significant issues surrounding capacity to procure and optimise CPOE/CDS systems among UK hospitals. There is an urgent need to encourage more synergistic and collaborative working between providers and vendors and for a more centralised support for National Health Service hospitals, which draws on a wider body of experience, including a formalised procurement framework with value-based product specifications. PMID:26503385

Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

PubMed

Hoffman, James M; Baker, Donald K; Howard, Scott C; Laver, Joseph H; Shenep, Jerry L

2011-02-01

Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.

Using System Architecture, Review Entry Criteria, and Standard Work Package Data to Enable Rapid Development of Integrated Master Schedules

DTIC Science & Technology

2016-03-01

ENTRY CRITERIA, AND STANDARD WORK PACKAGE DATA TO ENABLE RAPID DEVELOPMENT OF INTEGRATED MASTER SCHEDULES by Burton W. Porter Jr. March 2016...2. REPORT DATE March 2016 3. REPORT TYPE AND DATES COVERED Master’s Thesis 4. TITLE AND SUBTITLE USING SYSTEM ARCHITECTURE, REVIEW ENTRY ... ENTRY CRITERIA, AND STANDARD WORK PACKAGE DATA TO ENABLE RAPID DEVELOPMENT OF INTEGRATED MASTER SCHEDULES Burton W. Porter Jr. Civilian

Deciphering Interplay between Salmonella Invasion Effectors

PubMed Central

Koronakis, Vassilis

2008-01-01

Bacterial pathogens have evolved a specialized type III secretion system (T3SS) to translocate virulence effector proteins directly into eukaryotic target cells. Salmonellae deploy effectors that trigger localized actin reorganization to force their own entry into non-phagocytic host cells. Six effectors (SipC, SipA, SopE/2, SopB, SptP) can individually manipulate actin dynamics at the plasma membrane, which acts as a ‘signaling hub’ during Salmonella invasion. The extent of crosstalk between these spatially coincident effectors remains unknown. Here we describe trans and cis binary entry effector interplay (BENEFIT) screens that systematically examine functional associations between effectors following their delivery into the host cell. The results reveal extensive ordered synergistic and antagonistic relationships and their relative potency, and illuminate an unexpectedly sophisticated signaling network evolved through longstanding pathogen–host interaction. PMID:18389058

Assessing and comparing the usability of Chinese EHRs used in two Peking University hospitals to EHRs used in the US: A method of RUA.

PubMed

Xu, Lufei; Wen, Dong; Zhang, Xingting; Lei, Jianbo

2016-05-01

The objective of this study was to investigate the usability level of Chinese hospital Electronic Health Records (EHRs) by assessing the completion times of EHRs for seven "meaningful use (MU)" relevant tasks conducted at two Chinese tertiary hospitals and comparing the results to those of relevant research conducted in US EHRs. Using Rapid Usability Assessment (RUA) developed by the National Center for Cognitive Informatics and Decision Making (NCCD), the usability of EHRs from two Peking University hospitals was assessed using a three-step Keystroke Level Model (KLM) in a laboratory environment. (1) The total EHR task completion time for 7 MU relevant test tasks showed no significant differences between the two Chinese EHRs and their US counterparts, in which the time for thinking was relatively large and comprised 35.6% of the total time. The time for the electronic physician order was the largest. (2) For specific tasks, the mean completion times of the 2 hospital EHR systems spent on recording, modifying and searching (RMS) the medication orders were similar to those for the RMS radioactive tests; the mean time spent on the RMS laboratory test orders were much less. (3) There were 85 usability problems identified in the 2 hospital EHR systems. In Chinese EHRs, a substantial amount of time is required to complete tasks relevant to MU targets and many preventable usability problems can be discovered. The task completion time of the 2 Chinese EHR systems was a little shorter than in the 5 reported US EHR systems, while the differences in smoking status and CPOE tasks were obvious; one main reason for these differences was the use of structured data entry. The efficiency of Chinese and US EHRs was not significantly different. The key to improving the efficiency of both systems lies in expediting the Computerized physician order entry (CPOE) task. Many usability problems can be identified using heuristic assessments and improved by corresponding actions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Re-refinement from deposited X-ray data can deliver improved models for most PDB entries.

PubMed

Joosten, Robbie P; Womack, Thomas; Vriend, Gert; Bricogne, Gérard

2009-02-01

The deposition of X-ray data along with the customary structural models defining PDB entries makes it possible to apply large-scale re-refinement protocols to these entries, thus giving users the benefit of improvements in X-ray methods that have occurred since the structure was deposited. Automated gradient refinement is an effective method to achieve this goal, but real-space intervention is most often required in order to adequately address problems detected by structure-validation software. In order to improve the existing protocol, automated re-refinement was combined with structure validation and difference-density peak analysis to produce a catalogue of problems in PDB entries that are amenable to automatic correction. It is shown that re-refinement can be effective in producing improvements, which are often associated with the systematic use of the TLS parameterization of B factors, even for relatively new and high-resolution PDB entries, while the accompanying manual or semi-manual map analysis and fitting steps show good prospects for eventual automation. It is proposed that the potential for simultaneous improvements in methods and in re-refinement results be further encouraged by broadening the scope of depositions to include refinement metadata and ultimately primary rather than reduced X-ray data.

SHERPA Electromechanical Test Bed

NASA Technical Reports Server (NTRS)

Wason, John D.

2005-01-01

SHERPA (Strap-on High-altitude Entry Reconnaissance and Precision Aeromaneuver system) is a concept for low-cost-high-accuracy Martian reentry guidance for small scout-class missions with a capsule diameter of approximately 1 meter. This system uses moving masses to change the center of gravity of the capsule in order to control the lift generated by the controlled imbalance. This project involved designing a small proof-of-concept demonstration system that can be used to test the concept through bench-top testing, hardware-in-the-loop testing, and eventually through a drop test from a helicopter. This project has focused on the Mechatronic design aspects of the system including the mechanical, electrical, computer, and low-level control of the concept demonstration system.

The PEN&PAD data entry system: from prototype to practical system.

PubMed Central

Kirby, J.; Rector, A. L.

1996-01-01

This paper describes some of the issues addressed in the transition of the PEN&PAD from prototype clinical workstation to practical data entry system for use by general practitioners in the UK. Background and motivation of the PEN&PAD and GALEN projects are presented before the operation of the PEN&PAD user interface is described. A number of issues which have arisen in the development of the PEN&PAD Data Entry System are discussed. PMID:8947757

Adaptable Holders for Arc-Jet Screening Candidate Thermal Protection System Repair Materials

NASA Technical Reports Server (NTRS)

Riccio, Joe; Milhoan, Jim D.

2010-01-01

Reusable holders have been devised for evaluating high-temperature, plasma-resistant re-entry materials, especially fabrics. Typical material samples tested support thermal-protection-system damage repair requiring evaluation prior to re-entry into terrestrial atmosphere. These tests allow evaluation of each material to withstand the most severe predicted re-entry conditions.

Report of the Defense Science Board Task Force on Future Strategic Strike Skills

DTIC Science & Technology

2006-03-01

25 Figure 11: Re - entry Systems – Critical Skills...SKILLS___________________________________________________25 Figure 9: Guidance – Critical Skills Figure 10: Re - entry Systems – Critical Skills ICBMS/BASING...ability to survive intercontinental ballistic missile re - entry and then to operate effectively thereafter, is another area where current skills are

40 CFR 142.34 - Entry and inspection of public water systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 23 2014-07-01 2014-07-01 false Entry and inspection of public water systems. 142.34 Section 142.34 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS IMPLEMENTATION Federal Enforcement § 142.34 Entry and inspection of public...

Stakeholder identification of advanced technology opportunities at international ports of entry

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

Parker, S.K.; Icerman, L.

As part of the Advanced Technologies for International and Intermodal Ports of Entry (ATIPE) Project, a diverse group of stakeholders was engaged to help identify problems experienced at inland international border crossings, particularly those at the US-Mexican border. The fundamental issue at international ports of entry is reducing transit time through the required documentation and inspection processes. Examples of other issues or problems, typically manifested as time delays at border crossings, repeatedly mentioned by stakeholders include: (1) lack of document standardization; (2) failure to standardize inspection processes; (3) inadequate information and communications systems; (4) manual fee and tariff collection; (5)more » inconsistency of processes and procedures; and (6) suboptimal cooperation among governmental agencies. Most of these issues can be addressed to some extent by the development of advanced technologies with the objective of allowing ports of entry to become more efficient while being more effective. Three categories of technologies were unambiguously of high priority to port of entry stakeholders: (1) automated documentation; (2) systems integration; and (3) vehicle and cargo tracking. Together, these technologies represent many of the technical components necessary for pre-clearance of freight approaching international ports of entry. Integration of vehicle and cargo tracking systems with port of entry information and communications systems, as well as existing industry legacy systems, should further enable border crossings to be accomplished consistently with optimal processing times.« less

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

PubMed

Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

2017-05-01

To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

Trajectory and Aeroheating Environment Development and Sensitivity Analysis for Capsule-shaped Vehicles

NASA Technical Reports Server (NTRS)

Robinson, Jeffrey S.; Wurster, Kathryn E.

2006-01-01

Recently, NASA's Exploration Systems Research and Technology Project funded several tasks that endeavored to develop and evaluate various thermal protection systems and high temperature material concepts for potential use on the crew exploration vehicle. In support of these tasks, NASA Langley's Vehicle Analysis Branch generated trajectory information and associated aeroheating environments for more than 60 unique entry cases. Using the Apollo Command Module as the baseline entry system because of its relevance to the favored crew exploration vehicle design, trajectories for a range of lunar and Mars return, direct and aerocapture Earth-entry scenarios were developed. For direct entry, a matrix of cases was created that reflects reasonably expected minimum and maximum values of vehicle ballistic coefficient, inertial velocity at entry interface, and inertial flight path angle at entry interface. For aerocapture, trajectories were generated for a range of values of initial velocity and ballistic coefficient that, when combined with proper initial flight path angles, resulted in achieving a low Earth orbit either by employing a full lift vector up or full lift vector down attitude. For each trajectory generated, aeroheating environments were generated which were intended to bound the thermal protection system requirements for likely crew exploration vehicle concepts. The trades examined clearly pointed to a range of missions / concepts that will require ablative systems as well as a range for which reusable systems may be feasible. In addition, the results clearly indicated those entry conditions and modes suitable for manned flight, considering vehicle deceleration levels experienced during entry. This paper presents an overview of the analysis performed, including the assumptions, methods, and general approach used, as well as a summary of the trajectory and aerothermal environment information that was generated.

Journal of Human Services Abstracts. Volume 3, Number 3.

ERIC Educational Resources Information Center

Department of Health, Education, and Welfare, Washington, DC. Project Share.

This index, containing 450 abstracts on human services, is published quarterly to make available a broad range of documents to those responsible for the planning, management, and delivery of human services. The entries are arranged alphabetically by title and indexed by subject matter. Each entry includes the title, order number, source, price,…

9 CFR 93.424 - Import permits and applications for inspection of ruminants.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the veterinary inspector at the port of entry an application, in writing, for inspection, so that the veterinary inspector and customs representatives may make mutually satisfactory arrangements for the orderly... as required in § 93.427(d) shall be presented to the veterinary inspector at the port of entry when...

9 CFR 93.424 - Import permits and applications for inspection of ruminants.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the veterinary inspector at the port of entry an application, in writing, for inspection, so that the veterinary inspector and customs representatives may make mutually satisfactory arrangements for the orderly... as required in § 93.427(d) shall be presented to the veterinary inspector at the port of entry when...

Technologies for aerobraking

NASA Technical Reports Server (NTRS)

Cooper, David M.; Arnold, James O.

1991-01-01

Aerobraking is one of the largest contributors to making both lunar and Mars missions affordable. The use of aerobraking/aeroassist over all propulsive approaches saves as much as 60 percent of the initial mass required in low earth orbit (LEO); thus, the number and size of earth to orbit launch vehicles is reduced. Lunar transfer vehicles (LTV), which will be used to transport personnel and materials from LEO to lunar outpost, will aerobrake into earth's atmosphere at approximately 11 km/sec on return from the lunar surface. Current plans for both manned and robotic missions to Mars use aerocapture during arrival at Mars and at return to Earth. At Mars, the entry velocities will range from about 6 to 9.5 km/sec, and at Earth the return velocity will be about 12.5 to 14 km/sec. These entry velocities depend on trajectories, flight dates, and mission scenarios and bound the range of velocities required for the current studies. In order to successfully design aerobrakes to withstand the aerodynamic forces and heating associated with these entry velocities, as well as to make them efficient, several critical technologies must be developed. These are vehicle concepts and configurations, aerothermodynamics, thermal protection system materials, and guidance, navigation, and control systems. The status of each of these technologies are described, and what must be accomplished in each area to meet the requirements of the Space Exploration Initiative is outlined.

Entry at Venus

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj; Smith, Brandon

2016-01-01

This is lecture to be given at the IPPW 2016, as part of the 2 day course on Short Course on Destination Venus: Science, Technology and Mission Architectures. The attached presentation material is intended to be introduction to entry aspects of Venus in-situ robotic missions. The presentation introduces the audience to the aerodynamic and aerothermodynamic aspects as well as the loads, both aero and thermal, generated during entry. The course touches upon the system design aspects such as TPS design and both high and low ballistic coefficient entry system concepts that allow the science payload to be protected from the extreme entry environment and yet meet the mission objectives.

The Medical Gopher—A Microcomputer System to Help Find, Organize and Decide About Patient Data

PubMed Central

McDonald, Clement J.; Tierney, William M.

1986-01-01

We have developed a microcomputer-based medical workstation that does some of physicians' “gopher” work of fetching, organizing, reviewing and recording. For two years physicians have used the first version of this system to order all diagnostic tests in a general medicine clinic. They are about to use a newer version to write prescriptions and office visit notes and to find general medical and patient-specific information. Users can enter data into this system by “pointing” with a “mouse” to menu items displayed on a video terminal. In the course of a computer activity, a physician can obtain information about drugs, tests and different diagnoses, as well as about the patient. The microcomputer workstations are linked to each other and to a central hospital information system through a high-speed network link. Our physicians have accepted the initial order-entry system, and early experience suggests they prefer this faster and more sophisticated system. PMID:3811348

NASA CEV Reference Entry GN&C System and Analysis

NASA Technical Reports Server (NTRS)

Munday, S.; Madsen, C.; Broome, J.; Gay, R.; Tigges, M.; Strahan, A.

2007-01-01

As part of its overall objectives, the Orion spacecraft will be required to perform entry and Earth landing functions for Low Earth Orbit (LEO) and Lunar missions. Both of these entry scenarios will begin with separation of the Service Module (SM), making them unique from other Orion mission phases in that only the Command Module (CM) portion of the Crew Exploration Vehicle (CEV) will be involved, requiring a CM specific Guidance, Navigation and Control (GN&C) system. Also common to these mission scenarios will be the need for GN&C to safely return crew (or cargo) to earth within the dynamic thermal and structural constraints of entry and within acceptable accelerations on the crew, utilizing the limited aerodynamic performance of the CM capsule. The lunar return mission could additionally require an initial atmospheric entry designed to support a precision skip and second entry, all to maximize downrange performance and ensure landing in the United States. This paper describes the Entry GN&C reference design, developed by the NASA-led team, that supports these entry scenarios and that was used to validate the Orion System requirements. Description of the reference design will include an overview of the GN&C functions, avionics, and effectors and will relate these to the specific design drivers of the entry scenarios, as well as the desire for commonality in vehicle systems to support the different missions. The discussion will also include the requirement for an Emergency Entry capability beyond that of the nominal performance of the multi-string GNC system, intended to return the crew to the earth in a survivable but unguided manner. Finally, various analyses will be discussed, including those completed to support validation efforts of the current CEV requirements, along with those on-going and planned with the intention to further refine the requirements and to support design development work in conjunction with the prime contractor. Some of these ongoing analyses will include work to size effectors (jets) and fuel budgets, to refine skip entry concepts, to characterize navigation performance and uncertainties, to provide for SM disposal offshore and to identify requirements to support target site selection.

Ablation and Chemical Alteration of Cosmic Dust Particles during Entry into the Earth’s Atmosphere

NASA Astrophysics Data System (ADS)

Rudraswami, N. G.; Shyam Prasad, M.; Dey, S.; Plane, J. M. C.; Feng, W.; Carrillo-Sánchez, J. D.; Fernandes, D.

2016-12-01

Most dust-sized cosmic particles undergo ablation and chemical alteration during atmospheric entry, which alters their original properties. A comprehensive understanding of this process is essential in order to decipher their pre-entry characteristics. The purpose of the study is to illustrate the process of vaporization of different elements for various entry parameters. The numerical results for particles of various sizes and various zenith angles are treated in order to understand the changes in chemical composition that the particles undergo as they enter the atmosphere. Particles with large sizes (> few hundred μm) and high entry velocities (>16 km s‑1) experience less time at peak temperatures compared to those that have lower velocities. Model calculations suggest that particles can survive with an entry velocity of 11 km s‑1 and zenith angles (ZA) of 30°–90°, which accounts for ∼66% of the region where particles retain their identities. Our results suggest that the changes in chemical composition of MgO, SiO2, and FeO are not significant for an entry velocity of 11 km s‑1 and sizes <300 μm, but the changes in these compositions become significant beyond this size, where FeO is lost to a major extent. However, at 16 km s‑1 the changes in MgO, SiO2, and FeO are very intense, which is also reflected in Mg/Si, Fe/Si, Ca/Si, and Al/Si ratios, even for particles with a size of 100 μm. Beyond 400 μm particle sizes at 16 km s‑1, most of the major elements are vaporized, leaving the refractory elements, Al and Ca, suspended in the troposphere.

Remote Monitoring Systems for Chronic Patients on Home Hemodialysis: Field Test of a Copresence-Enhanced Design

PubMed Central

Liu, Na; Jung, Younhyun; Arisy, Adani; Nicdao, Mary Ann; Mikaheal, Mary; Baldacchino, Tanya; Khadra, Mohamed; Sud, Kamal

2017-01-01

Background Patients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the “presence” of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals. Objective This study presents an HHD system design for hemodialysis patients with features to enhance patient’s perceived “copresence” with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients. Methods A field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data. Results Patients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with “Very Happy” as the emotional status, 2167 entries with a “Happy” status, 56 entries with a “Neutral” status, 18 entries with an “Unhappy” status, and 24 entries with a “Very unhappy” status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients’ change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was able to improve patients’ feelings of being connected with their health care professionals and thus enhance their self-care on HHD. The health care professionals felt better assured with patients’ status with the use of the system and reported improved productivity and satisfaction with the copresence enhancement mechanism. The survey on the system usability indicated a high level of satisfaction among patients and nurses. Conclusions The copresence enhancement design complements the conventional use of a digitized HHD logbook and will further benefit the design of future telehealth systems. PMID:28851680

Multidimensional FEM-FCT schemes for arbitrary time stepping

NASA Astrophysics Data System (ADS)

Kuzmin, D.; Möller, M.; Turek, S.

2003-05-01

The flux-corrected-transport paradigm is generalized to finite-element schemes based on arbitrary time stepping. A conservative flux decomposition procedure is proposed for both convective and diffusive terms. Mathematical properties of positivity-preserving schemes are reviewed. A nonoscillatory low-order method is constructed by elimination of negative off-diagonal entries of the discrete transport operator. The linearization of source terms and extension to hyperbolic systems are discussed. Zalesak's multidimensional limiter is employed to switch between linear discretizations of high and low order. A rigorous proof of positivity is provided. The treatment of non-linearities and iterative solution of linear systems are addressed. The performance of the new algorithm is illustrated by numerical examples for the shock tube problem in one dimension and scalar transport equations in two dimensions.

The relative effects of entry parameters on thermal protection system weight. [space shuttle orbiters

NASA Technical Reports Server (NTRS)

Hirasaki, P. N.

1971-01-01

Shielding a spacecraft from the severe thermal environment of an atmospheric entry requires a sophisticated thermal protection system (TPS). Thermal computer program models were developed for two such TPS designs proposed for the space shuttle orbiter. The multilayer systems, a reusable surface insulation TPS, and a re-radiative metallic skin TPS, were sized for a cross-section of trajectories in the entry corridor. This analysis indicates the relative influence of the entry parameters on the weight of each TPS concept. The results are summarized graphically. The trajectory variables considered were down-range, cross-range, orbit inclination, entry interface velocity and flight path angle, maximum heating rate level, angle of attack, and ballistic coefficient. Variations in cross-range and flight path angle over the ranges considered had virtually no effect on the required entry TPS weight. The TPS weight was significantly more sensitive to variations in angle of attack than to dispersions in the other trajectory considered.

Rapid Nipah virus entry into the central nervous system of hamsters via the olfactory route

PubMed Central

Munster, Vincent J.; Prescott, Joseph B.; Bushmaker, Trenton; Long, Dan; Rosenke, Rebecca; Thomas, Tina; Scott, Dana; Fischer, Elizabeth R.; Feldmann, Heinz; de Wit, Emmie

2012-01-01

Encephalitis is a hallmark of Nipah virus (NiV) infection in humans. The exact route of entry of NiV into the central nervous system (CNS) is unknown. Here, we performed a spatio-temporal analysis of NiV entry into the CNS of hamsters. NiV initially predominantly targeted the olfactory epithelium in the nasal turbinates. From there, NiV infected neurons were visible extending through the cribriform plate into the olfactory bulb, providing direct evidence of rapid CNS entry. Subsequently, NiV disseminated to the olfactory tubercle and throughout the ventral cortex. Transmission electron microscopy on brain tissue showed extravasation of plasma cells, neuronal degeneration and nucleocapsid inclusions in affected tissue and axons, providing further evidence for axonal transport of NiV. NiV entry into the CNS coincided with the occurrence of respiratory disease, suggesting that the initial entry of NiV into the CNS occurs simultaneously with, rather than as a result of, systemic virus replication. PMID:23071900

Interruption as a test of the user-computer interface

NASA Technical Reports Server (NTRS)

Kreifeldt, J. G.; Mccarthy, M. E.

1981-01-01

In order to study the effects different logic systems might have on interrupted operation, an algebraic calculator and a reverse polish notation calculator were compared when trained users were interrupted during problem entry. The RPN calculator showed markedly superior resistance to interruption effects compared to the AN calculator although no significant differences were found when the users were not interrupted. Causes and possible remedies for interruption effects are speculated. It is proposed that because interruption is such a common occurrence, it be incorporated into comparative evaluation tests of different logic system and control/display system and that interruption resistance be adopted as a specific design criteria for such design.

46 CFR Section 1 - What this order does.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 8 2014-10-01 2014-10-01 false What this order does. Section 1 Section 1 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY GENERAL AGENT'S RESPONSIBILITY IN CONNECTION WITH FOREIGN REPAIR CUSTOM'S ENTRIES Section 1 What this order does. This order...

46 CFR Section 1 - What this order does.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 8 2013-10-01 2013-10-01 false What this order does. Section 1 Section 1 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY GENERAL AGENT'S RESPONSIBILITY IN CONNECTION WITH FOREIGN REPAIR CUSTOM'S ENTRIES Section 1 What this order does. This order...

46 CFR Section 1 - What this order does.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false What this order does. Section 1 Section 1 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION A-NATIONAL SHIPPING AUTHORITY GENERAL AGENT'S RESPONSIBILITY IN CONNECTION WITH FOREIGN REPAIR CUSTOM'S ENTRIES Section 1 What this order does. This order...

Return on Investment Point of Service Computerized Provider Charge Entry

PubMed Central

Kiepek, Wendy; FitzHenry, Fern; Shultz, Edward K

2003-01-01

Provider charge entry systems offer many benefits to users and organizations. At Vanderbilt University Medical Center, a web-based provider charge entry system promises to deliver benefits in reducing days in accounts receivable, reducing labor required for claims and edit processing, and implementing business rules that deliver both strategic and financial benefits. PMID:14728396

Development of an infection screening system for entry inspection at airport quarantine stations using ear temperature, heart and respiration rates.

PubMed

Sun, Guanghao; Abe, Nobujiro; Sugiyama, Youhei; Nguyen, Quang Vinh; Nozaki, Kohei; Nakayama, Yosuke; Takei, Osamu; Hakozaki, Yukiya; Abe, Shigeto; Matsui, Takemi

2013-01-01

After the outbreak of severe acute respiratory syndrome (SARS) in 2003, many international airport quarantine stations conducted fever-based screening to identify infected passengers using infrared thermography for preventing global pandemics. Due to environmental factors affecting measurement of facial skin temperature with thermography, some previous studies revealed the limits of authenticity in detecting infectious symptoms. In order to implement more strict entry screening in the epidemic seasons of emerging infectious diseases, we developed an infection screening system for airport quarantines using multi-parameter vital signs. This system can automatically detect infected individuals within several tens of seconds by a neural-network-based discriminant function using measured vital signs, i.e., heart rate obtained by a reflective photo sensor, respiration rate determined by a 10-GHz non-contact respiration radar, and the ear temperature monitored by a thermography. In this paper, to reduce the environmental effects on thermography measurement, we adopted the ear temperature as a new screening indicator instead of facial skin. We tested the system on 13 influenza patients and 33 normal subjects. The sensitivity of the infection screening system in detecting influenza were 92.3%, which was higher than the sensitivity reported in our previous paper (88.0%) with average facial skin temperature.

31 CFR 354.1 - Definitions of terms.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., DEPARTMENT OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING BOOK-ENTRY SECURITIES OF THE... the claimant for another Person to hold, transfer, or deal with the Security. (b) Book-entry Sallie Mae Security means a Sallie Mae Security issued or maintained in the Book-entry System. (c) Book-entry...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Conversions to book-entry. 337.6... FEDERAL HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Conversions to book-entry. 337.6... HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Conversions to book-entry. 337.6... HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Conversions to book-entry. 337.6... HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

31 CFR 337.6 - Conversions to book-entry.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Conversions to book-entry. 337.6... HOUSING ADMINISTRATION DEBENTURES Certificated Debentures § 337.6 Conversions to book-entry. Upon implementation of the book-entry debenture system, to be announced in advance by separate public notice, all new...

Multi-ray-based system matrix generation for 3D PET reconstruction

NASA Astrophysics Data System (ADS)

Moehrs, Sascha; Defrise, Michel; Belcari, Nicola; DelGuerra, Alberto; Bartoli, Antonietta; Fabbri, Serena; Zanetti, Gianluigi

2008-12-01

Iterative image reconstruction algorithms for positron emission tomography (PET) require a sophisticated system matrix (model) of the scanner. Our aim is to set up such a model offline for the YAP-(S)PET II small animal imaging tomograph in order to use it subsequently with standard ML-EM (maximum-likelihood expectation maximization) and OSEM (ordered subset expectation maximization) for fully three-dimensional image reconstruction. In general, the system model can be obtained analytically, via measurements or via Monte Carlo simulations. In this paper, we present the multi-ray method, which can be considered as a hybrid method to set up the system model offline. It incorporates accurate analytical (geometric) considerations as well as crystal depth and crystal scatter effects. At the same time, it has the potential to model seamlessly other physical aspects such as the positron range. The proposed method is based on multiple rays which are traced from/to the detector crystals through the image volume. Such a ray-tracing approach itself is not new; however, we derive a novel mathematical formulation of the approach and investigate the positioning of the integration (ray-end) points. First, we study single system matrix entries and show that the positioning and weighting of the ray-end points according to Gaussian integration give better results compared to equally spaced integration points (trapezoidal integration), especially if only a small number of integration points (rays) are used. Additionally, we show that, for a given variance of the single matrix entries, the number of rays (events) required to calculate the whole matrix is a factor of 20 larger when using a pure Monte-Carlo-based method. Finally, we analyse the quality of the model by reconstructing phantom data from the YAP-(S)PET II scanner.

The evolution of the market for commercial computerized physician order entry and computerized decision support systems for prescribing.

PubMed

Mozaffar, Hajar; Williams, Robin; Cresswell, Kathrin; Morrison, Zoe; Bates, David W; Sheikh, Aziz

2016-03-01

To understand the evolving market of commercial off-the-shelf Computerized Physician Order Entry (CPOE) and Computerized Decision Support (CDS) applications and its effects on their uptake and implementation in English hospitals. Although CPOE and CDS vendors have been quick to enter the English market, uptake has been slow and uneven. To investigate this, the authors undertook qualitative ethnography of vendors and adopters of hospital CPOE/CDS systems in England. The authors collected data from semi-structured interviews with 11 individuals from 4 vendors, including the 2 most entrenched suppliers, and 6 adopter hospitals, and 21 h of ethnographic observation of 2 user groups, and 1 vendor event. The research and analysis was informed by insights from studies of the evolution of technology fields and the emergence of generic COTS enterprise solutions. Four key themes emerged: (1) adoption of systems that had been developed outside of England, (2) vendors' configuration and customization strategies, (3) localized adopter practices vs generic systems, and (4) unrealistic adopter demands. Evidence for our over-arching finding concerning the current immaturity of the market was derived from vendors' strategies, adopters' reactions to the technology, and policy makers' incomplete insights. The CPOE/CDS market in England is still in an emergent phase. The rapid entrance of diverse products, triggered by federal policy initiatives, has resulted in premature adoption of systems that do not yet adequately meet the needs of hospitals. Vendors and adopters lacked understanding of how to design and implement generic solutions to meet diverse user needs. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Aerospace medicine and biology: A continuing bibliography with indexes, supplement 97

NASA Technical Reports Server (NTRS)

1972-01-01

Subject coverage concentrates on the biological, physiological, psychological, and environmental effects to which man is subjected during and following simulated or actual flight in the earth's atmosphere or in interplanetary space. References describing similar effects on biological organisms of lower order are also included. Such related topics as sanitary problems, pharmacology, toxicology, safety and survival, life support systems, exobiology, and personnel factors receive appropriate attention. Each entry consists of a standard citation accompanied by its abstract.

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 94)

NASA Technical Reports Server (NTRS)

1971-01-01

Subject coverage concentrates on the biological, physiological, psychological, and environmental effects to which man is subjected during and following simulated or actual flight in the earth's atmosphere or in interplanetary space. References describing similar effects on biological organisms of lower order are also included. Such related topics as sanitary problems, pharmacology, toxicology, safety and survival, life support systems, exobiology, and personnel factors receive appropriate attention. Each entry consists of a standard citation accompanied by its abstract.

Aerospace medicine and biology: A continuing bibliography with indexes, supplement 96

NASA Technical Reports Server (NTRS)

1971-01-01

Subject coverage concentrates on the biological, physiological, psychological, and environmental effects to which man is subjected during and following simulated or actual flight in the earth's atmosphere or in interplanetary space. References describing similar effects on biological organisms of lower order are also included. Such related topics as sanitary problems, pharmacology, toxicology, safety and survival, life support systems, exobiology, and personnel factors receive appropriate attention. Each entry consists of a standard citation accompanied by its abstract.

Aerospace medicine and biology: A continuing bibliography with indexes, supplement

NASA Technical Reports Server (NTRS)

1972-01-01

Subject coverage concentrates on the biological, physiological, psychological, and environmental effects to which man is subjected during and following simulated or actual flight in the earth's atmosphere or in interplanetary space. References describing similar effects on biological organisms of lower order are also included. Such related topics as sanitary problems, pharmacology, toxicology, safety and survival, life support systems, exobiology, and personnel factors receive appropriate attention. Each entry consists of a standard citation accompanied by its abstract.

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 100)

NASA Technical Reports Server (NTRS)

1972-01-01

Subject coverage concentrates on the biological, physiological, psychological, and environmental effects to which man is subjected during and following simulated or actual flight in the earth's atmosphere or in interplanetary space. Reference describing similar effects on biological organisms of lower order are also included. Such related topics as sanitary problems, pharmacology, toxicology, safety and survival, life support systems, exobiology, and personnel factors receive appropriate attention. Each entry consists of a standard citation accompanied by its abstract.

Using the nursing process to implement a Y2K computer application.

PubMed

Hobbs, C F; Hardinge, T T

2000-01-01

Because of the coming year 2000, the need was assessed to upgrade the order entry system at many hospitals. At Somerset Medical Center, a training team divided the transition into phases and used a modified version of the nursing process to implement the new program. The entire process required fewer than 6 months and was relatively problem-free. This successful transition was aided by the nursing process, training team, and innovative educational techniques.

Mars Entry Atmospheric Data System Modeling, Calibration, and Error Analysis

NASA Technical Reports Server (NTRS)

Karlgaard, Christopher D.; VanNorman, John; Siemers, Paul M.; Schoenenberger, Mark; Munk, Michelle M.

2014-01-01

The Mars Science Laboratory (MSL) Entry, Descent, and Landing Instrumentation (MEDLI)/Mars Entry Atmospheric Data System (MEADS) project installed seven pressure ports through the MSL Phenolic Impregnated Carbon Ablator (PICA) heatshield to measure heatshield surface pressures during entry. These measured surface pressures are used to generate estimates of atmospheric quantities based on modeled surface pressure distributions. In particular, the quantities to be estimated from the MEADS pressure measurements include the dynamic pressure, angle of attack, and angle of sideslip. This report describes the calibration of the pressure transducers utilized to reconstruct the atmospheric data and associated uncertainty models, pressure modeling and uncertainty analysis, and system performance results. The results indicate that the MEADS pressure measurement system hardware meets the project requirements.

Managed care penetration and other factors affecting computerized physician order entry in the ambulatory setting.

PubMed

Menachemi, Nir; Ford, Eric W; Chukmaitov, Askar; Brooks, Robert G

2006-12-01

To estimate the current uses level of ambulatory computerized physician order entry (A-CPOE) among physicians and to examine the relationship of managed care penetration as well as other market and practice characteristics to use of A-CPOE by physicians. This study uses both primary and secondary data sources. The primary data source was a large-scale survey of physicians' use of information technologies in Florida. Secondary data on managed care penetration were obtained from the Florida Agency for Health Care Administration, and other market-level data were extracted from the area resource file. A hierarchical logistic regression model was used to examine the correlation of county-level and practice-level characteristics with physicians' self-reported use of A-CPOE systems. Overall, 1360 physicians (32.4%) indicated use of an A-CPOE system. Findings suggest that 1% more managed care penetration was associated with 2.1% lower use of A-CPOE (P = .003). Additionally, practice size, multispecialty affiliation, and primary care practice were significantly and positively correlated with the use of A-CPOE. Physician age was negatively associated with A-CPOE use. Managed care organizations may experience significant financial savings from A-CPOE use by physicians; however, managed care penetration in a community negatively affects A-CPOE use among physicians in their practices. Further study regarding the causal nature of this association is warranted.

7 CFR 1216.60 - Reports.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AND ORDERS; MISCELLANEOUS COMMODITIES), DEPARTMENT OF AGRICULTURE PEANUT PROMOTION, RESEARCH, AND INFORMATION ORDER Peanut Promotion, Research, and Information Order Reports, Books, and Records § 1216.60... following: (1) Number of pounds of peanuts produced or handled; (2) Price paid to producers (entry in value...

Dynamic Oligomerization of Integrase Orchestrates HIV Nuclear Entry.

PubMed

Borrenberghs, Doortje; Dirix, Lieve; De Wit, Flore; Rocha, Susana; Blokken, Jolien; De Houwer, Stéphanie; Gijsbers, Rik; Christ, Frauke; Hofkens, Johan; Hendrix, Jelle; Debyser, Zeger

2016-11-10

Nuclear entry is a selective, dynamic process granting the HIV-1 pre-integration complex (PIC) access to the chromatin. Classical analysis of nuclear entry of heterogeneous viral particles only yields averaged information. We now have employed single-virus fluorescence methods to follow the fate of single viral pre-integration complexes (PICs) during infection by visualizing HIV-1 integrase (IN). Nuclear entry is associated with a reduction in the number of IN molecules in the complexes while the interaction with LEDGF/p75 enhances IN oligomerization in the nucleus. Addition of LEDGINs, small molecule inhibitors of the IN-LEDGF/p75 interaction, during virus production, prematurely stabilizes a higher-order IN multimeric state, resulting in stable IN multimers resistant to a reduction in IN content and defective for nuclear entry. This suggests that a stringent size restriction determines nuclear pore entry. Taken together, this work demonstrates the power of single-virus imaging providing crucial insights in HIV replication and enabling mechanism-of-action studies.

36 CFR 261.50 - Orders.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in Areas Designated by Order § 261.50 Orders. (a) The Chief, each Regional Forester, each Experiment... issue orders which close or restrict the use of described areas within the area over which he has jurisdiction. An order may close an area to entry or may restrict the use of an area by applying any or all of...

Data entry errors and design for model-based tight glycemic control in critical care.

PubMed

Ward, Logan; Steel, James; Le Compte, Aaron; Evans, Alicia; Tan, Chia-Siong; Penning, Sophie; Shaw, Geoffrey M; Desaive, Thomas; Chase, J Geoffrey

2012-01-01

Tight glycemic control (TGC) has shown benefits but has been difficult to achieve consistently. Model-based methods and computerized protocols offer the opportunity to improve TGC quality but require human data entry, particularly of blood glucose (BG) values, which can be significantly prone to error. This study presents the design and optimization of data entry methods to minimize error for a computerized and model-based TGC method prior to pilot clinical trials. To minimize data entry error, two tests were carried out to optimize a method with errors less than the 5%-plus reported in other studies. Four initial methods were tested on 40 subjects in random order, and the best two were tested more rigorously on 34 subjects. The tests measured entry speed and accuracy. Errors were reported as corrected and uncorrected errors, with the sum comprising a total error rate. The first set of tests used randomly selected values, while the second set used the same values for all subjects to allow comparisons across users and direct assessment of the magnitude of errors. These research tests were approved by the University of Canterbury Ethics Committee. The final data entry method tested reduced errors to less than 1-2%, a 60-80% reduction from reported values. The magnitude of errors was clinically significant and was typically by 10.0 mmol/liter or an order of magnitude but only for extreme values of BG < 2.0 mmol/liter or BG > 15.0-20.0 mmol/liter, both of which could be easily corrected with automated checking of extreme values for safety. The data entry method selected significantly reduced data entry errors in the limited design tests presented, and is in use on a clinical pilot TGC study. The overall approach and testing methods are easily performed and generalizable to other applications and protocols. © 2012 Diabetes Technology Society.

Computer-supported weight-based drug infusion concentrations in the neonatal intensive care unit.

PubMed

Giannone, Gay

2005-01-01

This article addresses the development of a computerized provider order entry (CPOE)-embedded solution for weight-based neonatal drug infusion developed during the transition from a legacy CPOE system to a customized application of a neonatal CPOE product during a hospital-wide information system transition. The importance of accurate fluid management in the neonate is reviewed. The process of tailoring the system that eventually resulted in the successful development of a computer application enabling weight-based medication infusion calculation for neonates within the CPOE information system is explored. In addition, the article provides guidelines on how to customize a vendor solution for hospitals with neonatal intensive care unit.

Weighted re-randomization tests for minimization with unbalanced allocation.

PubMed

Han, Baoguang; Yu, Menggang; McEntegart, Damian

2013-01-01

Re-randomization test has been considered as a robust alternative to the traditional population model-based methods for analyzing randomized clinical trials. This is especially so when the clinical trials are randomized according to minimization, which is a popular covariate-adaptive randomization method for ensuring balance among prognostic factors. Among various re-randomization tests, fixed-entry-order re-randomization is advocated as an effective strategy when a temporal trend is suspected. Yet when the minimization is applied to trials with unequal allocation, fixed-entry-order re-randomization test is biased and thus compromised in power. We find that the bias is due to non-uniform re-allocation probabilities incurred by the re-randomization in this case. We therefore propose a weighted fixed-entry-order re-randomization test to overcome the bias. The performance of the new test was investigated in simulation studies that mimic the settings of a real clinical trial. The weighted re-randomization test was found to work well in the scenarios investigated including the presence of a strong temporal trend. Copyright © 2013 John Wiley & Sons, Ltd.

19 CFR Appendix to 19 Cfr Part 0 - Treasury Department Order No. 100-16

Code of Federal Regulations, 2010 CFR

2010-04-01

... completion of entry or substance of entry summary including duty assessment and collection, classification... the Committee on Ways and Means and the Chairman and Ranking Member of the Committee on Finance every... Ranking Member of the Committee on Finance every six months. The Secretary of the Treasury shall list any...

78 FR 3913 - Public Land Order No. 7807: Withdrawal of Public Lands for the Camp Michael Monsoor Mountain...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-17

..., location, and entry under the general land laws, including the United States mining laws, for a period of... Training Facility. This withdrawal also transfers administrative jurisdiction of the lands to the... entry under the general land laws, including the United States mining laws, but not from leasing under...

A discussion of higher order software concepts as they apply to functional requirements and specifications. [space shuttles and guidance

NASA Technical Reports Server (NTRS)

Hamilton, M.

1973-01-01

The entry guidance software functional requirements (requirements design phase), its architectural requirements (specifications design phase), and the entry guidance software verified code are discussed. It was found that the proper integration of designs at both the requirements and specifications levels are of high priority consideration.

Chinese-English 2,000 Selected Chinese Common Sayings (Yale Romanization).

ERIC Educational Resources Information Center

Wu, C.K.; Wu, K.S.

Compiled here for the first time in Yale romanization are 2,000 common Chinese sayings, idioms, proverbs, and other figures of speech. The entries are arranged in two series: once in alphabetic order according to the Yale romanization and then again by the stroke-count of the Chinese characters. The romanized entries are accompanied by several…

76 FR 78886 - Certain Welded Carbon Steel Standard Pipe and Tube From Turkey: Intent To Rescind Countervailing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-20

... Standard Pipe and Tube From Turkey: Intent To Rescind Countervailing Duty Administrative Review, in Part... certain welded carbon steel pipe and tube from Turkey. See Antidumping or Countervailing Duty Order... Certain Welded Carbon Steel Standard Pipe from Turkey,'' (October 27, 2011). A Type 3 entry is an entry of...

Midwives and the Computerization of Perinatal Data Entry: The Theory of Beneficial Engagement.

PubMed

Craswell, Alison; Moxham, Lorna; Broadbent, Marc

2016-10-01

Theory building in nursing and midwifery both to explain and inform practice is important to advance these professions via provision of a theoretical foundation. This research explored the process of perinatal data entry undertaken by midwives to explore the impact of the movement from paper to computer collection of data. Use of grounded theory methodology enabled theory building, leading to a theoretical understanding of the phenomenon and development of the Theory of Beneficial Engagement grounded in the data. Methods involved in-depth semistructured interviews with 15 users of perinatal data systems. Participants were recruited from 12 different healthcare locations and were utilizing three different electronic systems for data entry. The research question that guided the study focused on examining the influences of using the computer for perinatal data entry. Findings indicated that qualities particular to some midwives denoted engagement with perinatal data entry, suggesting a strong desire to enter complete, timely, and accurate data. The Theory of Beneficial Engagement provides a model of user engagement with systems for perinatal data entry consistent with other theories of engagement. The theory developed describes this phenomenon in a simple, elegant manner that can be applied to other areas where mandatory data entry is undertaken.

Sensorimotor Adaptation Following Exposure to Ambiguous Inertial Motion Cues

NASA Technical Reports Server (NTRS)

Wood, S. J.; Clement, G. R.; Rupert, A. H.; Reschke, M. F.; Harm, D. L.; Guedry, F. E.

2007-01-01

The central nervous system must resolve the ambiguity of inertial motion sensory cues in order to derive accurate spatial orientation awareness. Adaptive changes in how inertial cues from the otolith system are integrated with other sensory information lead to perceptual and postural disturbances upon return to Earth s gravity. The primary goals of this ground-based research investigation are to explore physiological mechanisms and operational implications of tilt-translation disturbances during and following re-entry, and to evaluate a tactile prosthesis as a countermeasure for improving control of whole-body orientation during tilt and translation motion.

Genesis Sample Return Capsule Overview

NASA Technical Reports Server (NTRS)

Willcockson, Bill

2005-01-01

I. Simple Entry Capsule Concept: a) Spin-Stabilized/No Active Control Systems; b) Ballistic Entry for 11.04 km/sec Velocity; c) No Heatshield Separation During Entry; d) Parachute Deploy via g-Switch + Timer. II. Stardust Design Inheritance a) Forebody Shape; b) Seal Concepts; c) Parachute Deploy Control; d) Utah Landing Site (UTTR). III. TPS Systems a) Heatshield - Carbon-Carbon - First Planetary Entry; b) Backshell - SLA-561V - Flight Heritage from Pathfinder, MER; d) Forebody Structural Penetrations Aerothermal and TPS Design Process has the Same Methodology as Used for Pathfinder, MER Flight Vehicles.

Predictive Modeling for NASA Entry, Descent and Landing Missions

NASA Technical Reports Server (NTRS)

Wright, Michael

2016-01-01

Entry, Descent and Landing (EDL) Modeling and Simulation (MS) is an enabling capability for complex NASA entry missions such as MSL and Orion. MS is used in every mission phase to define mission concepts, select appropriate architectures, design EDL systems, quantify margin and risk, ensure correct system operation, and analyze data returned from the entry. In an environment where it is impossible to fully test EDL concepts on the ground prior to use, accurate MS capability is required to extrapolate ground test results to expected flight performance.

Low Cost Entry, Descent, and Landing (EDL) Instrumentation for Planetary Missions

NASA Technical Reports Server (NTRS)

Hwang, H. H.; Munk, M. M.; Dillman, R. A.; Mahzari, M.; Swanson, G. T.; White, T. R.

2016-01-01

Missions that involve traversing through a planetary atmosphere are unique opportunities that require elements of entry, descent, and landing (EDL). Many aspects of the EDL sequence are qualified using analysis and simulation due to the inability to conduct appropriate ground tests, however validating flight data are often lacking, especially for missions not involving Earth re-entry. NASA has made strategic decisions to collect EDL flight data in order to improve future mission designs. For example, MEDLI1 and EFT-1 gathered hypersonic pressure and in-depth temperature data in the thermal protection system (TPS). However, the ability to collect EDL flight data from the smaller competed missions, such as Discovery and New Frontiers, has been limited in part due to the Principal Investigator-managed cost-caps (PIMCC). The recent NASA decision to consider EDL instrumentation earlier in the mission design cycle led to the inclusion of a requirement in the Discovery 2014 Announcement of Opportunity which requires all missions that involve EDL to include an Engineering Science Investigation (ESI).2 The ESI would involve sensors for aerothermal environment and TPS; atmosphere, aerodynamics, and flight dynamics; atmospheric decelerator; and/or vehicle structure.3 The ESI activity would be funded outside of the PIMCC.

Port-of-entry advanced sorting system (PASS) operational test

DOT National Transportation Integrated Search

1998-12-01

In 1992 the Oregon Department of Transportation undertook an operational test of the Port-of-Entry Advanced Sorting System (PASS), which uses a two-way communication automatic vehicle identification system, integrated with weigh-in-motion, automatic ...

Low temperature simulation of subliming boundary layer flow in Jupiter atmosphere

NASA Technical Reports Server (NTRS)

Chen, C. J.

1976-01-01

A low-temperature approximate simulation for the sublimation of a graphite heat shield under Jovian entry conditions is studied. A set of algebraic equations is derived to approximate the governing equation and boundary conditions, based on order-of-magnitude analysis. Characteristic quantities such as the wall temperature and the subliming velocity are predicted. Similarity parameters that are needed to simulate the most dominant phenomena of the Jovian entry flow are also given. An approximate simulation of the sublimation of the graphite heat shield is performed with an air-dry-ice model. The simulation with the air-dry-ice model may be carried out experimentally at a lower temperature of 3000 to 6000 K instead of the entry temperature of 14,000 K. The rate of graphite sublimation predicted by the present algebraic approximation agrees to the order of magnitude with extrapolated data. The limitations of the simulation method and its utility are discussed.

Multi-Mission System Analysis for Planetary Entry (M-SAPE) Version 1

NASA Technical Reports Server (NTRS)

Samareh, Jamshid; Glaab, Louis; Winski, Richard G.; Maddock, Robert W.; Emmett, Anjie L.; Munk, Michelle M.; Agrawal, Parul; Sepka, Steve; Aliaga, Jose; Zarchi, Kerry;

30 CFR 75.326 - Mean entry air velocity.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Mean entry air velocity. 75.326 Section 75.326... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.326 Mean entry air velocity. In exhausting face ventilation systems, the mean entry air velocity shall be at least 60 feet per minute...

30 CFR 75.326 - Mean entry air velocity.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Mean entry air velocity. 75.326 Section 75.326... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Ventilation § 75.326 Mean entry air velocity. In exhausting face ventilation systems, the mean entry air velocity shall be at least 60 feet per minute...

Development Challenges of Game-Changing Entry System Technologies From Concept to Mission Infusion

NASA Technical Reports Server (NTRS)

Venkatapathy, Ethiraj; Beck, Robin; Ellerby, Don; Feldman, Jay; Gage, Peter; Munk, Michelle; Wercinski, Paul

2016-01-01

Realization within the US and NASA that future exploration both Human and Robotic will require innovative new technologies led to the creation of the Space Technology Mission Directorate and investment in game changing technologies with high pay-off. Some of these investments will see success and others, due to many of the constraints, will not attain their goal. The co-authors of this proposed presentation have been involved from concept to mission infusion aspects of entry technologies that are game changing. The four example technologies used to describe the challenges experienced along the pathways to success are at different levels of maturity. They are Conformal, 3-D MAT, HEEET and ADEPT. The four examples in many ways capture broad aspects of the challenges of maturation and illustrate what led some to be exceptionally successful and how others had to be altered in order remain viable game changing technologies.

Influence of radiant energy exchange on the determination of convective heat transfer rates to Orbiter leeside surfaces during entry

NASA Technical Reports Server (NTRS)

Throckmorton, D. A.

1982-01-01

Temperatures measured at the aerodynamic surface of the Orbiter's thermal protection system (TPS), and calorimeter measurements, are used to determine heating rates to the TPS surface during atmospheric entry. On the Orbiter leeside, where convective heating rates are low, it is possible that a significant portion of the total energy input may result from solar radiation, and for the wing, cross radiation from the hot (relatively) Orbiter fuselage. In order to account for the potential impact of these sources, values of solar- and cross-radiation heat transfer are computed, based upon vehicle trajectory and attitude information and measured surface temperatures. Leeside heat-transfer data from the STS-2 mission are presented, and the significance of solar radiation and fuselage-to-wing cross-radiation contributions to total energy input to Orbiter leeside surfaces is assessed.

Optimization of orbital assignment and specification of service areas in satellite communications

NASA Technical Reports Server (NTRS)

Wang, Cou-Way; Levis, Curt A.; Buyukdura, O. Merih

1987-01-01

The mathematical nature of the orbital and frequency assignment problem for communications satellites is explored, and it is shown that choosing the correct permutations of the orbit locations and frequency assignments is an important step in arriving at values which satisfy the signal-quality requirements. Two methods are proposed to achieve better spectrum/orbit utilization. The first, called the delta S concept, leads to orbital assignment solutions via either mixed-integer or restricted basis entry linear programming techniques; the method guarantees good single-entry carrier-to-interference ratio results. In the second, a basis for specifying service areas is proposed for the Fixed Satellite Service. It is suggested that service areas should be specified according to the communications-demand density in conjunction with the delta S concept in order to enable the system planner to specify more satellites and provide more communications supply.

Performance of two-lobe hole-entry hybrid journal bearing system under the combined influence of textured surface and couple stress lubricant

NASA Astrophysics Data System (ADS)

Khatri, Chandra B.; Sharma, Satish C.

2018-02-01

Textured surface in journal bearings is becoming an important area of investigation during the last few years. Surface textures have the shapes of micro-dimple with a small diameter and depth having order of magnitude of bearing clearance. This paper presents the influence of couple stress lubricant on the circular and non-circular hole-entry hybrid journal bearing system and reports the comparative study between the textured and non-textured circular/non-circular hybrid journal bearing system. The governing Reynolds equation has been modified for the couple stress lubricant flow in the clearance of bearing and journal. The FEM technique has been applied to solve the modified Reynolds equation together with restrictor flow equation. The numerically simulated results indicate that the influence of couple stress lubricant is significantly more in textured journal bearing than that of non-textured journal bearing. Further, it has been observed that the textured two-lobe (δ = 1.1) hybrid journal bearing lubricated with couple stress lubricant provides larger values of fluid film stiffness coefficients and stability threshold speed against other bearings studied in the present paper.

Human Mars Lander Design for NASA's Evolvable Mars Campaign

NASA Technical Reports Server (NTRS)

Polsgrove, Tara; Chapman, Jack; Sutherlin, Steve; Taylor, Brian; Fabisinski, Leo; Collins, Tim; Cianciolo Dwyer, Alicia; Samareh, Jamshid; Robertson, Ed; Studak, Bill;

How to maintain blood supply during computer network breakdown: a manual backup system.

PubMed

Zeiler, T; Slonka, J; Bürgi, H R; Kretschmer, V

2000-12-01

Electronic data management systems using computer network systems and client/server architecture are increasingly used in laboratories and transfusion services. Severe problems arise if there is no network access to the database server and critical functions are not available. We describe a manual backup system (MBS) developed to maintain the delivery of blood products to patients in a hospital transfusion service in case of a computer network breakdown. All data are kept on a central SQL database connected to peripheral workstations in a local area network (LAN). Request entry from wards is performed via machine-readable request forms containing self-adhesive specimen labels with barcodes for test tubes. Data entry occurs on-line by bidirectional automated systems or off-line manually. One of the workstations in the laboratory contains a second SQL database which is frequently and incrementally updated. This workstation is run as a stand-alone, read-only database if the central SQL database is not available. In case of a network breakdown, the time-graded MBS is launched. Patient data, requesting ward and ordered tests/requests, are photocopied through a template from the request forms on special MBS worksheets serving as laboratory journal for manual processing and result report (a copy is left in the laboratory). As soon as the network is running again the data from the off-line period are entered into the primary SQL server. The MBS was successfully used at several occasions. The documentation of a 90-min breakdown period is presented in detail. Additional work resulted from the copy work and the belated manual data entry after restoration of the system. There was no delay in issue of blood products or result reporting. The backup system described has been proven to be simple, quick and safe to maintain urgent blood supply and distribution of laboratory results in case of unexpected network breakdown.

Re-refinement from deposited X-ray data can deliver improved models for most PDB entries

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

Joosten, Robbie P.; Womack, Thomas; Vriend, Gert, E-mail: vriend@cmbi.ru.nl

2009-02-01

An evaluation of validation and real-space intervention possibilities for improving existing automated (re-)refinement methods. The deposition of X-ray data along with the customary structural models defining PDB entries makes it possible to apply large-scale re-refinement protocols to these entries, thus giving users the benefit of improvements in X-ray methods that have occurred since the structure was deposited. Automated gradient refinement is an effective method to achieve this goal, but real-space intervention is most often required in order to adequately address problems detected by structure-validation software. In order to improve the existing protocol, automated re-refinement was combined with structure validation andmore » difference-density peak analysis to produce a catalogue of problems in PDB entries that are amenable to automatic correction. It is shown that re-refinement can be effective in producing improvements, which are often associated with the systematic use of the TLS parameterization of B factors, even for relatively new and high-resolution PDB entries, while the accompanying manual or semi-manual map analysis and fitting steps show good prospects for eventual automation. It is proposed that the potential for simultaneous improvements in methods and in re-refinement results be further encouraged by broadening the scope of depositions to include refinement metadata and ultimately primary rather than reduced X-ray data.« less

Correlations for Boundary-Layer Transition on Mars Science Laboratory Entry Vehicle Due to Heat-Shield Cavities

NASA Technical Reports Server (NTRS)

Hollis, Brian R.; Liechty, Derek S.

2008-01-01

The influence of cavities (for attachment bolts) on the heat-shield of the proposed Mars Science Laboratory entry vehicle has been investigated experimentally and computationally in order to develop a criterion for assessing whether the boundary layer becomes turbulent downstream of the cavity. Wind tunnel tests were conducted on the 70-deg sphere-cone vehicle geometry with various cavity sizes and locations in order to assess their influence on convective heating and boundary layer transition. Heat-transfer coefficients and boundary-layer states (laminar, transitional, or turbulent) were determined using global phosphor thermography.

The ubiquitin-proteasome system is essential for the productive entry of Japanese encephalitis virus.

PubMed

Wang, Shaobo; Liu, Haibin; Zu, Xiangyang; Liu, Yang; Chen, Liman; Zhu, Xueqin; Zhang, Leike; Zhou, Zheng; Xiao, Gengfu; Wang, Wei

2016-11-01

The host-virus interaction during the cellular entry of Japanese encephalitis virus (JEV) is poorly characterized. The ubiquitin-proteasome system (UPS), the major intracellular proteolytic pathway, mediates diverse cellular processes, including endocytosis and signal transduction, which may be involved in the entry of virus. Here, we showed that the proteasome inhibitors, MG132 and lactacystin, impaired the productive entry of JEV by effectively interfering with viral intracellular trafficking at the stage between crossing cell membrane and the initial translation of the viral genome after uncoating. Using confocal microscopy, it was demonstrated that a proportion of the internalized virions were misdirected to lysosomes following treatment with MG132, resulting in non-productive entry. In addition, using specific siRNAs targeting ubiquitin, we verified that protein ubiquitination was involved in the entry of JEV. Overall, our study demonstrated the UPS is essential for the productive entry of JEV and might represent a potential antiviral target for JEV infection. Copyright © 2016 Elsevier Inc. All rights reserved.

Method and system for entering data within a flight plan entry field

NASA Technical Reports Server (NTRS)

Gibbs, Michael J. (Inventor); Van Omen, Debi (Inventor); Adams, Michael B. (Inventor); Chase, Karl L. (Inventor); Lewis, Daniel E. (Inventor); McCrobie, Daniel E. (Inventor)

2005-01-01

The present invention provides systems, apparatus and methods for entering data into a flight plan entry field which facilitates the display and editing of aircraft flight-plan data. In one embodiment, the present invention provides a method for entering multiple waypoint and procedure identifiers at once within a single a flight plan entry field. In another embodiment, the present invention provides for the partial entry of any waypoint or procedure identifiers, and thereafter relating the identifiers with an aircraft's flight management system to anticipate the complete text entry for display. In yet another embodiment, the present invention discloses a method to automatically provide the aircraft operator with selectable prioritized arrival and approach routing identifiers by a single manual selection. In another embodiment, the present invention is a method for providing the aircraft operator with selectable alternate patterns to a new runway.

Aerocapture Inflatable Decelerator for Planetary Entry

NASA Technical Reports Server (NTRS)

Reza, Sajjad; Hund, Richard; Kustas, Frank; Willcockson, William; Songer, Jarvis; Brown, Glen

2007-01-01

Forward Attached Inflatable Decelerators, more commonly known as inflatable aeroshells, provide an effective, cost efficient means of decelerating spacecrafts by using atmospheric drag for aerocapture or planetary entry instead of conventional liquid propulsion deceleration systems. Entry into planetary atmospheres results in significant heating and aerodynamic pressures which stress aeroshell systems to their useful limits. Incorporation of lightweight inflatable decelerator surfaces with increased surface-area footprints provides the opportunity to reduce heat flux and induced temperatures, while increasing the payload mass fraction. Furthermore, inflatable aeroshell decelerators provide the needed deceleration at considerably higher altitudes and Mach numbers when compared with conventional rigid aeroshell entry systems. Inflatable aeroshells also provide for stowage in a compact space, with subsequent deployment of a large-area, lightweight heatshield to survive entry heating. Use of a deployable heatshield decelerator enables an increase in the spacecraft payload mass fraction and may eliminate the need for a spacecraft backshell.

SCOPE in Cataloguing.

ERIC Educational Resources Information Center

Tom, Ellen; Reed, Sue

This report describes the Systematic Computerized Processing in Cataloguing system (SCOPE), an automated system for the catalog department of a university library. The system produces spine labels, pocket labels, book cards for the circulation system, catalog cards including shelf list, main entry, subject and added entry cards, statistics, an…

Port-of-entry Advanced Sorting System (PASS) operational test : final report

DOT National Transportation Integrated Search

1998-12-01

In 1992 the Oregon Department of Transportation undertook an operational test of the Port-of-Entry Advanced Sorting System (PASS), which uses a two-way communication automatic vehicle identification system, integrated with weigh-in-motion, automatic ...

Post-Flight Analysis of the Guidance, Navigation, and Control Performance During Orion Exploration Flight Test 1

NASA Technical Reports Server (NTRS)

Barth, Andrew; Mamich, Harvey; Hoelscher, Brian

2015-01-01

The first test flight of the Orion Multi-Purpose Crew Vehicle presented additional challenges for guidance, navigation and control as compared to a typical re-entry from the International Space Station or other Low Earth Orbit. An elevated re-entry velocity and steeper flight path angle were chosen to achieve aero-thermal flight test objectives. New IMU's, a GPS receiver, and baro altimeters were flight qualified to provide the redundant navigation needed for human space flight. The guidance and control systems must manage the vehicle lift vector in order to deliver the vehicle to a precision, coastal, water landing, while operating within aerodynamic load, reaction control system, and propellant constraints. Extensive pre-flight six degree-of-freedom analysis was performed that showed mission success for the nominal mission as well as in the presence of sensor and effector failures. Post-flight reconstruction analysis of the test flight is presented in this paper to show whether that all performance metrics were met and establish how well the pre-flight analysis predicted the in-flight performance.

Systematic Review of Medical Informatics-Supported Medication Decision Making.

PubMed

Melton, Brittany L

2017-01-01

This systematic review sought to assess the applications and implications of current medical informatics-based decision support systems related to medication prescribing and use. Studies published between January 2006 and July 2016 which were indexed in PubMed and written in English were reviewed, and 39 studies were ultimately included. Most of the studies looked at computerized provider order entry or clinical decision support systems. Most studies examined decision support systems as a means of reducing errors or risk, particularly associated with medication prescribing, whereas a few studies evaluated the impact medical informatics-based decision support systems have on workflow or operations efficiency. Most studies identified benefits associated with decision support systems, but some indicate there is room for improvement.

Remote Monitoring Systems for Chronic Patients on Home Hemodialysis: Field Test of a Copresence-Enhanced Design.

PubMed

Liu, Na; Kim, Jinman; Jung, Younhyun; Arisy, Adani; Nicdao, Mary Ann; Mikaheal, Mary; Baldacchino, Tanya; Khadra, Mohamed; Sud, Kamal

2017-08-29

Patients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the "presence" of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals. This study presents an HHD system design for hemodialysis patients with features to enhance patient's perceived "copresence" with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients. A field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data. Patients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with "Very Happy" as the emotional status, 2167 entries with a "Happy" status, 56 entries with a "Neutral" status, 18 entries with an "Unhappy" status, and 24 entries with a "Very unhappy" status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients' change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was able to improve patients' feelings of being connected with their health care professionals and thus enhance their self-care on HHD. The health care professionals felt better assured with patients' status with the use of the system and reported improved productivity and satisfaction with the copresence enhancement mechanism. The survey on the system usability indicated a high level of satisfaction among patients and nurses. The copresence enhancement design complements the conventional use of a digitized HHD logbook and will further benefit the design of future telehealth systems. ©Na Liu, Jinman Kim, Younhyun Jung, Adani Arisy, Mary Ann Nicdao, Mary Mikaheal, Tanya Baldacchino, Mohamed Khadra, Kamal Sud. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 29.08.2017.

Radiology reporting: a closed-loop cycle from order entry to results communication.

PubMed

Weiss, David L; Kim, Woojin; Branstetter, Barton F; Prevedello, Luciano M

2014-12-01

With the increasing prevalence of PACS over the past decade, face-to-face image review among health care providers has become a rarity. This change has resulted in increasing dependence on fast and accurate communication in radiology. Turnaround time expectations are now conveyed in minutes rather than hours or even days. Ideal modern radiology communication is a closed-loop cycle with multiple interoperable applications contributing to the final product. The cycle starts with physician order entry, now often performed through the electronic medical record, with clinical decision support to ensure that the most effective imaging study is ordered. Radiology reports are now almost all in electronic format. The majority are produced using speech recognition systems. Optimization of this software use can alleviate some, if not all, of the inherent user inefficiencies in this type of reporting. Integrated third-party software applications that provide data mining capability are extremely helpful in both academic and clinical settings. The closed-loop ends with automated communication of imaging results. Software products for this purpose should facilitate use of levels of alert, automated escalation to providers, and recording of audit trails of reports received. The multiple components of reporting should be completely interoperable with each other, as well as with the PACS, the RIS, and the electronic medical record. This integration will maximize radiologist efficiency and minimize the possibility of communication error. Copyright © 2014. Published by Elsevier Inc.

Mars Science Laboratory Entry, Descent and Landing System Development Challenges and Preliminary Flight Performance

NASA Technical Reports Server (NTRS)

Steltzner, Adam D.; San Martin, A. Miguel; Rivellini, Tommaso P.

2013-01-01

The Mars Science Laboratory project recently landed the Curiosity rover on the surface of Mars. With the success of the landing system, the performance envelope of entry, descent, and landing capabilities has been extended over the previous state of the art. This paper will present an overview of the MSL entry, descent, and landing system, a discussion of a subset of its development challenges, and include a discussion of preliminary results of the flight reconstruction effort.

Overview of the MEDLI Project

NASA Technical Reports Server (NTRS)

Gazarik, Michael J.; Hwang, Helen; Little, Alan; Cheatwood, Neil; Wright, Michael; Herath, Jeff

2007-01-01

The Mars Science Laboratory Entry, Descent, and Landing Instrumentation (MEDLI) Project's objectives are to measure aerothermal environments, sub-surface heatshield material response, vehicle orientation, and atmospheric density for the atmospheric entry and descent phases of the Mars Science Laboratory (MSL) entry vehicle. The flight science objectives of MEDLI directly address the largest uncertainties in the ability to design and validate a robust Mars entry system, including aerothermal, aerodynamic and atmosphere models, and thermal protection system (TPS) design. The instrumentation suite will be installed in the heatshield of the MSL entry vehicle. The acquired data will support future Mars entry and aerocapture missions by providing measured atmospheric data to validate Mars atmosphere models and clarify the design margins for future Mars missions. MEDLI thermocouple and recession sensor data will significantly improve the understanding of aeroheating and TPS performance uncertainties for future missions. MEDLI pressure data will permit more accurate trajectory reconstruction, as well as separation of aerodynamic and atmospheric uncertainties in the hypersonic and supersonic regimes. This paper provides an overview of the project including the instrumentation design, system architecture, and expected measurement response.

Overview of the MEDLI Project

NASA Technical Reports Server (NTRS)

Gazarik, Michael J.; Little, Alan; Cheatwood, F. Neil; Wright, Michael J.; Herath, Jeff A.; Martinez, Edward R.; Munk, Michelle; Novak, Frank J.; Wright, Henry S.

2008-01-01

The Mars Science Laboratory Entry, Descent, and Landing Instrumentation (MEDLI) Project s objectives are to measure aerothermal environments, sub-surface heatshield material response, vehicle orientation, and atmospheric density for the atmospheric entry and descent phases of the Mars Science Laboratory (MSL) entry vehicle. The flight science objectives of MEDLI directly address the largest uncertainties in the ability to design and validate a robust Mars entry system, including aerothermal, aerodynamic and atmosphere models, and thermal protection system (TPS) design. The instrumentation suite will be installed in the heatshield of the MSL entry vehicle. The acquired data will support future Mars entry and aerocapture missions by providing measured atmospheric data to validate Mars atmosphere models and clarify the design margins for future Mars missions. MEDLI thermocouple and recession sensor data will significantly improve the understanding of aeroheating and TPS performance uncertainties for future missions. MEDLI pressure data will permit more accurate trajectory reconstruction, as well as separation of aerodynamic and atmospheric uncertainties in the hypersonic and supersonic regimes. This paper provides an overview of the project including the instrumentation design, system architecture, and expected measurement response.

A combination HIV reporter virus system for measuring post-entry event efficiency and viral outcome in primary CD4+ T cell subsets.

PubMed

Tilton, Carisa A; Tabler, Caroline O; Lucera, Mark B; Marek, Samantha L; Haqqani, Aiman A; Tilton, John C

2014-01-01

Fusion between the viral membrane of human immunodeficiency virus (HIV) and the host cell marks the end of the HIV entry process and the beginning of a series of post-entry events including uncoating, reverse transcription, integration, and viral gene expression. The efficiency of post-entry events can be modulated by cellular factors including viral restriction factors and can lead to several distinct outcomes: productive, latent, or abortive infection. Understanding host and viral proteins impacting post-entry event efficiency and viral outcome is critical for strategies to reduce HIV infectivity and to optimize transduction of HIV-based gene therapy vectors. Here, we report a combination reporter virus system measuring both membrane fusion and viral promoter-driven gene expression. This system enables precise determination of unstimulated primary CD4+ T cell subsets targeted by HIV, the efficiency of post-entry viral events, and viral outcome and is compatible with high-throughput screening and cell-sorting methods. Copyright © 2013 Elsevier B.V. All rights reserved.

Protecting Astronaut Health at First Entry into Vehicles Visiting the international Space Station: Insights from Whole-Module Offgas Testing

NASA Technical Reports Server (NTRS)

Meyers, Valerie

2014-01-01

NASA has accumulated considerable experience in offgas testing of whole modules prior to their docking with the International Space Station (ISS). Since 1998, the Space Toxicology Office has performed offgas testing of the Lab module, both MPLM modules, US Airlock, Node 1, Node 2, Node 3, ATV1, HTV1, and three commercial vehicles. The goal of these tests is twofold: first, to protect the crew from adverse health effects of accumulated volatile pollutants when they first enter the module on orbit, and secondly, to determine the additional pollutant load that the ISS air revitalization systems must handle. In order to predict the amount of accumulated pollutants, the module is sealed for at least 1/5th the worst-case time interval that could occur between the last clean air purge and final hatch closure on the ground and the crew's first entry on orbit. This time can range from a few days to a few months. Typically, triplicate samples are taken at pre-planned times throughout the test. Samples are then analyzed by gas chromatography and mass spectrometry, and the rate of accumulation of pollutants is then extrapolated over time. The analytical values are indexed against 7-day spacecraft maximum allowable concentrations (SMACs) to provide a prediction of the total toxicity value (T-value) at the time of first entry. This T-value and the toxicological effects of specific pollutants that contribute most to the overall toxicity are then used to guide first entry operations. Finally, results are compared to first entry samples collected on orbit to determine the predictive ability of the ground-based offgas test.

The Influence of China's Entry into the WTO on Its Education System

ERIC Educational Resources Information Center

Ding, Xiaohao; Yue, Changjun; Sun, Yuze

2009-01-01

The entry of China in the World Trade Organization (WTO) in 2001 holds a number of promises for educational services. The purpose of this article is to explore both the direct and the indirect influence of China's entry into WTO on its education system. The direct influence mainly refers to the increase in the demand for education overseas and in…

Reducing Wrong Patient Selection Errors: Exploring the Design Space of User Interface Techniques

PubMed Central

Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

2014-01-01

Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients’ identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed. PMID:25954415

Reducing wrong patient selection errors: exploring the design space of user interface techniques.

PubMed

Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

2014-01-01

Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients' identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed.

Managing drugs safely.

PubMed

van den Anker, John N

2005-02-01

There is hard data to show that newborn infants are more likely than adults to experience adverse reactions to drugs. Paradoxically, drug-related legislation to ensure safe and effective drug use in humans neglected neonates until 2002, when the Best Pharmaceuticals Act for Children was signed into law in the USA. The situation for neonates should now catch up with that for adults and neonates will be prescribed more licensed drugs in the near future. If we are to be able to analyze the underlying system errors to improve the safe use of drugs in the studied patient population, reporting of adverse drug events and reactions needs to happen in a blame free environment. In addition, computerized physician order entry will certainly further improve the current situation by preventing errors in ordering, transcribing, verifying, and transmitting medication orders.

31 CFR 315.3 - Converting definitive savings bonds to book-entry bonds in New Treasury Direct.

Code of Federal Regulations, 2011 CFR

2011-07-01

... book-entry bonds in New Treasury Direct. 315.3 Section 315.3 Money and Finance: Treasury Regulations.... SAVINGS NOTES General Information § 315.3 Converting definitive savings bonds to book-entry bonds in New... book-entry bonds through New Treasury Direct, an online system for holding Treasury securities. The Web...

31 CFR 315.3 - Converting definitive savings bonds to book-entry bonds in New Treasury Direct.

Code of Federal Regulations, 2010 CFR

2010-07-01

... to book-entry bonds in New Treasury Direct. 315.3 Section 315.3 Money and Finance: Treasury.... SAVINGS NOTES General Information § 315.3 Converting definitive savings bonds to book-entry bonds in New... book-entry bonds through New Treasury Direct, an online system for holding Treasury securities. The Web...

Entry Vehicle Control System Design for the Mars Smart Lander

NASA Technical Reports Server (NTRS)

Calhoun, Philip C.; Queen, Eric M.

2002-01-01

The NASA Langley Research Center, in cooperation with the Jet Propulsion Laboratory, participated in a preliminary design study of the Entry, Descent and Landing phase for the Mars Smart Lander Project. This concept utilizes advances in Guidance, Navigation and Control technology to significantly reduce uncertainty in the vehicle landed location on the Mars surface. A candidate entry vehicle controller based on the Reaction Control System controller for the Apollo Lunar Excursion Module digital autopilot is proposed for use in the entry vehicle attitude control. A slight modification to the phase plane controller is used to reduce jet-firing chattering while maintaining good control response for the Martian entry probe application. The controller performance is demonstrated in a six-degree-of-freedom simulation with representative aerodynamics.

A cumulative index to a continuing bibliography on aerospace medicine and biology, January 1972

NASA Technical Reports Server (NTRS)

1972-01-01

Subject coverage concentrates on the biological, physiological, psychological, and environmental effects to which man is subjected during and following simulated or actual flight in the earth's atmosphere or in interplanetary space. References describing similar effects on biological organisms of lower order are also included. Such related topics as sanitary problems, pharmacology, toxicology, safety and survival, life support systems, exobiology, and personnel factors receive appropriate attention. Each entry consists of a standard citation accompanied by its abstract.

Aerodynamic and performance characterization of supersonic retropropulsion for application to planetary entry and descent

NASA Astrophysics Data System (ADS)

Korzun, Ashley M.

The entry, descent, and landing (EDL) systems for the United States' six successful landings on Mars and the 2011 Mars Science Laboratory (MSL) have all relied heavily on extensions of technology developed for the Viking missions of the mid 1970s. Incremental improvements to these technologies, namely rigid 70-deg sphere-cone aeroshells, supersonic disk-gap-band parachutes, and subsonic propulsive terminal descent, have increased payload mass capability to 950 kg (MSL). However, MSL is believed to be near the upper limit for landed mass using a Viking-derived EDL system. To achieve NASA's long-term exploration goals at Mars, technologies are needed that enable more than an order of magnitude increase in landed mass (10s of metric tons), several orders of magnitude increase in landing accuracy (10s or 100s of meters), and landings at higher surface elevations (0+ km). Supersonic deceleration has been identified as a critical deficiency in extending Viking-heritage technologies to high-mass, high-ballistic coefficient systems. As the development and qualification of significantly larger supersonic parachutes is not a viable path forward to increase landed mass capability to 10+ metric tons, alternative approaches must be developed. Supersonic retropropulsion (SRP), or the use of retropropulsive thrust while an entry vehicle is traveling at supersonic conditions, is one such alternative approach. The concept originated in the 1960s, though only recently has interest in SRP resurfaced. While its presence in the historical literature lends some degree of credibility to the concept of using retropropulsion at supersonic conditions, the overall immaturity of supersonic retropropulsion requires additional evaluation of its potential as a decelerator technology for high-mass Mars entry systems, as well as its comparison with alternative decelerators. The supersonic retropropulsion flowfield is typically a complex interaction between highly under-expanded jet flow and the shock layer of a blunt body in supersonic flow. Although numerous wind tunnel tests of relevance to SRP have been conducted, the scope of the work is limited in the freestream conditions and composition, retropropulsion conditions and composition, and configurations and geometries explored. The SRP aerodynamic - propulsive interaction alters the aerodynamic characteristics of the vehicle, and models must be developed that accurately represent the impact of SRP on system mass and performance. Work within this thesis has defined and advanced the state of the art for supersonic retropropulsion. This has been achieved through the application of systems analysis, computational analysis, and analytical methods. The contributions of this thesis include a detailed performance analysis and exploration of the design space specific to supersonic retropropulsion, establishment of the relationship between vehicle performance and the aerodynamic - propulsive interaction, and an assessment of the required fidelity and computational cost in simulating supersonic retropropulsion flowfields, with emphasis on the effort required to develop aerodynamic databases for conceptual design.

Characterisation of re-entrant circuit (or rotational activity) in vitro using the HL1-6 myocyte cell line.

PubMed

Houston, Charles; Tzortzis, Konstantinos N; Roney, Caroline; Saglietto, Andrea; Pitcher, David S; Cantwell, Chris D; Chowdhury, Rasheda A; Ng, Fu Siong; Peters, Nicholas S; Dupont, Emmanuel

2018-06-01

Fibrillation is the most common arrhythmia observed in clinical practice. Understanding of the mechanisms underlying its initiation and maintenance remains incomplete. Functional re-entries are potential drivers of the arrhythmia. Two main concepts are still debated, the "leading circle" and the "spiral wave or rotor" theories. The homogeneous subclone of the HL1 atrial-derived cardiomyocyte cell line, HL1-6, spontaneously exhibits re-entry on a microscopic scale due to its slow conduction velocity and the presence of triggers, making it possible to examine re-entry at the cellular level. We therefore investigated the re-entry cores in cell monolayers through the use of fluorescence optical mapping at high spatiotemporal resolution in order to obtain insights into the mechanisms of re-entry. Re-entries in HL1-6 myocytes required at least two triggers and a minimum colony area to initiate (3.5 to 6.4 mm 2 ). After electrical activity was completely stopped and re-started by varying the extracellular K + concentration, re-entries never returned to the same location while 35% of triggers re-appeared at the same position. A conduction delay algorithm also allows visualisation of the core of the re-entries. This work has revealed that the core of re-entries is conduction blocks constituted by lines and/or groups of cells rather than the round area assumed by the other concepts of functional re-entry. This highlights the importance of experimentation at the microscopic level in the study of re-entry mechanisms. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Parametric Thermal Soak Model for Earth Entry Vehicles

NASA Technical Reports Server (NTRS)

Agrawal, Parul; Samareh, Jamshid; Doan, Quy D.

2013-01-01

The analysis and design of an Earth Entry Vehicle (EEV) is multidisciplinary in nature, requiring the application many disciplines. An integrated tool called Multi Mission System Analysis for Planetary Entry Descent and Landing or M-SAPE is being developed as part of Entry Vehicle Technology project under In-Space Technology program. Integration of a multidisciplinary problem is a challenging task. Automation of the execution process and data transfer among disciplines can be accomplished to provide significant benefits. Thermal soak analysis and temperature predictions of various interior components of entry vehicle, including the impact foam and payload container are part of the solution that M-SAPE will offer to spacecraft designers. The present paper focuses on the thermal soak analysis of an entry vehicle design based on the Mars Sample Return entry vehicle geometry and discusses a technical approach to develop parametric models for thermal soak analysis that will be integrated into M-SAPE. One of the main objectives is to be able to identify the important parameters and to develop correlation coefficients so that, for a given trajectory, can estimate the peak payload temperature based on relevant trajectory parameters and vehicle geometry. The models are being developed for two primary thermal protection (TPS) materials: 1) carbon phenolic that was used for Galileo and Pioneer Venus probes and, 2) Phenolic Impregnated Carbon Ablator (PICA), TPS material for Mars Science Lab mission. Several representative trajectories were selected from a very large trade space to include in the thermal analysis in order to develop an effective parametric thermal soak model. The selected trajectories covered a wide range of heatload and heatflux combinations. Non-linear, fully transient, thermal finite element simulations were performed for the selected trajectories to generate the temperature histories at the interior of the vehicle. Figure 1 shows the finite element model that was used for the simulations. The results indicate that it takes several hours for the thermal energy to soak into the interior of the vehicle and achieve maximum payload temperatures. In addition, a strong correlation between the heatload and peak payload container temperature is observed that will help establishing the parametric thermal soak model.

A usability study of CPOE's medication administration functions: impact on physician-nurse cooperation.

PubMed

Beuscart-Zéphir, Marie Catherine; Pelayo, Sylvia; Degoulet, Patrice; Anceaux, Françoise; Guerlinger, Sandra; Meaux, Jean-Jacques

2004-01-01

Implementation of CPOE systems in Healthcare Institutions has proven efficient in reducing medication errors but it also induces hidden side-effects on Doctor-Nurse cooperation. We propose a usability engineering approach to this problem. An extensive activity analysis of the medication ordering and administration process was performed in several departments of 3 different hospitals. Two of these hospitals are still using paper-based orders, while the 3rd one is in the roll-out phase of medication functions of its CPOE system. We performed a usability assessment of this CPOE system. The usability assessment uncovered usability problems for the entry of medication administration time scheduling by the physician and revealed that the information can be ambiguous for the nurse. The comparison of cooperation models in both situation shows that users tend to adopt a distributed decision making paradigm in the paper-based situation, while the CPOE system supports a centralized decision making process. This analysis can support recommendation for the re-engineering of the Human-Computer Interface.

VizieR Online Data Catalog: CCDM (Components of Double and Multiple stars) (Dommanget+ 1994)

NASA Astrophysics Data System (ADS)

Dommanget, J.; Nys, O.

1996-11-01

The introduction to this catalogue has been the subject of a publication in the "Communications de l'Observatoire Royal de Belgique" (Serie A, number 115). Detailed are: its origins, its aims, its realization, the search of identifiers, the compilation of astrometric data and the related problems as well as the fundamental ties between the CCDM and the HIPPARCOS INPUT CATALOGUE (HIC). It also contains a complete bibliography of the referred papers. The contents of the general catalogue (63,463 systems) is also described as well as the conditions of its availability to the astronomical community and the projects underway for the next edition. For all these items, the user is invited to refer to this publication because hereafter only the format and the contents of the catalogue follow. To identify the systems and their components, we adopted the clever numbering process of the authors of the INDEX consisting in combining the right ascension and declination, respectively limited to 0.1 minute of time and to 1 minute of arc. In order to distinguish the CCDM numbers from the INDEX numbers - in addition to their different equinox: 2000 for the CCDM and 1900 for the INDEX - we adopted the signs + and - instead of the letters N and S for separating the coordinates. Consequently, in the INDEX and in the CCDM, one entry is devoted to a same system but the contrary to the INDEX, where a sub-entry is assigned to each group of two components, whatever the multiplicity of the system may be, the CCDM allows one sub-entry and thus one record per component. The present edition contains only the 34,031 systems (table below, part I) for which an accurate position has been found for at least one component. The catalogue extends thus much over the sample of the somewhat 14,000 systems finally retained for the HIPPARCOS INPUT CATALOGUE and assembled in its Annex 1. (1 data file).

Computer retrieval of bibliographies using an editing program

USGS Publications Warehouse

Brethauer, G.E.; Brokaw, V.L.

1979-01-01

A simple program permits use of the text .editor 'qedx,' part of many computer systems, to input bibliographic entries and to retrieve specific entries which contain keywords of interest. Multiple keywords may be used sequentially to find specific entries.

INVESTIGATION OF DRY-WEATHER POLLUTANT ENTRIES INTO STORM-DRAINAGE SYSTEMS

EPA Science Inventory

This article describes the results of a series of research tasks to develop a procedure to investigate non-stormwater (dry-weather) entries into storm drainage systems. Dry-weather flows discharging from storm drainage systems can contribute significant pollutant loadings to rece...

Research and development for Onboard Navigation (ONAV) ground based expert/trainer system: ONAV entry knowledge requirements specification update

NASA Technical Reports Server (NTRS)

Bochsler, Daniel C.

1988-01-01

A revised version of expert knowledge for the onboard navigation (ONAV) entry system is given. Included is some brief background information together with information describing the knowledge that the system does contain.

Secretary | Center for Cancer Research

Cancer.gov

The Basic Science Program (BSP) pursues independent, multidisciplinary research programs in basic or applied molecular biology, immunology, retrovirology, cancer biology, or human genetics. Research efforts and support are an integral part of the Center for Cancer Research (CCR) at the Frederick national Laboratory for Cancer Research (FNLCR). The BSP Office provides procurement and logistical assistance in support of the research activities of the Center for Cancer Research.KEY ROLES/RESPONSIBILITIES The Secretary III will: Provide heavy-volume procurement support to a large customer base of laboratory staff, both Leidos Biomed and CCR (gov’t), using blanket orders, purchase requisitions, credit card, and online warehouse system Data entry into appropriate financial system component (CostPoint, Cor360), status checks on orders, maintenance of orders log, reconciliation of credit card transactions, maintenance of electronic filing systems Providing logistical support for the facilitation of travel packages (both pre-travel and post travel) for Leidos Biomed employees, as well as the coordination of seminar speakers and subsequent reimbursements Composing and answering emails/correspondence Communicating with all levels of personnel, both verbally and in writing, to gather and clearly convey information

77 FR 67062 - Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-08

... DEPARTMENT OF THE TREASURY Fiscal Service Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book-Entry System AGENCY: Bureau of the Public Debt, Fiscal... fee schedule applicable to transfers of U.S. Treasury book-entry securities maintained on the National...

75 FR 67807 - Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-03

... DEPARTMENT OF THE TREASURY Fiscal Service Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book-Entry System Authority: 31 CFR 357.45. AGENCY: Bureau of the...) is announcing a new fee schedule applicable to transfers of U.S. Treasury book-entry securities...

76 FR 68523 - Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-04

... DEPARTMENT OF THE TREASURY Fiscal Service Fee Schedule for the Transfer of U.S. Treasury Book-Entry Securities Held on the National Book-Entry System AGENCY: Bureau of the Public Debt, Fiscal... fee schedule applicable to transfers of U.S. Treasury book-entry securities maintained on the National...

Using an Evidence-Based Approach to EMR Implementation to Optimize Outcomes and Avoid Unintended Consequences

PubMed Central

Longhurst, Christopher A.; Palma, Jonathan P.; Grisim, Lisa M.; Widen, Eric; Chan, Melanie; Sharek, Paul J.

2013-01-01

Implementation of an electronic medical record (EMR) with computerized physician order entry (CPOE) can provide an important foundation for preventing harm and improving outcomes. Incentivized by the recent economic stimulus initiative, healthcare systems are implementing vendor-based EMR systems at an unprecedented rate. Accumulating evidence suggests that local implementation decisions, rather than the specific EMR product or technology selected, are the primary drivers of the quality improvement performance of these systems. However, limited attention has been paid to effective approaches to EMR implementation. In this case report, we outline the evidence-based approach we used to make EMR implementation decisions in a pragmatic structure intended for replication at other sites. PMID:24771994

Comprehensive analysis of a Radiology Operations Management computer system.

PubMed

Arenson, R L; London, J W

1979-11-01

The Radiology Operations Management computer system at the Hospital of the University of Pennsylvania is discussed. The scheduling and file room modules are based on the system at Massachusetts General Hospital. Patient delays are indicated by the patient tracking module. A reporting module allows CRT/keyboard entry by transcriptionists, entry of standard reports by radiologists using bar code labels, and entry by radiologists using a specialty designed diagnostic reporting terminal. Time-flow analyses demonstrate a significant improvement in scheduling, patient waiting, retrieval of radiographs, and report delivery. Recovery of previously lost billing contributes to the proved cost effectiveness of this system.

Temporal and other factors that influence the time doctors take to prescribe using an electronic prescribing system

PubMed Central

Coleman, Jamie J; Hodson, James; Thomas, Sarah K; Brooks, Hannah L; Ferner, Robin E

2015-01-01

Background A computerized physician order entry (CPOE) system with embedded clinical decision support can reduce medication errors in hospitals, but might increase the time taken to generate orders. Aims We aimed to quantify the effects of temporal (month, day of week, hour of shift) and other factors (grade of doctor, prior experience with the system, alert characteristics, and shift type) on the time taken to generate a prescription order. Setting A large university teaching hospital using a locally developed CPOE system with an extensive audit database. Design We retrospectively analyzed prescription orders from the audit database between August 2011 and July 2012. Results The geometric mean time taken to generate a prescription order within the CPOE system was 11.75 s (95% CI 11.72 to 11.78). Time to prescribe was most affected by the display of high-level (24.59 s (24.43 to 24.76); p<0.001) or previously unseen (18.87 s (18.78 to 18.96); p<0.001) alerts. Prescribers took significantly less time at weekends (11.29 s (11.23 to 11.35)) than on weekdays (11.88 s (11.84 to 11.91); p<0.001), in the first (11.25 s (11.16 to 11.34); p<0.001) and final (11.56 s (11.47 to 11.66); p<0.001) hour of their shifts, and after the first month of using the system. Conclusions The display of alerts, prescribing experience, system familiarity, and environment all affect the time taken to generate a prescription order. Our study reinforces the need for appropriate alerts to be presented to individuals at an appropriate place in the workflow, in order to improve prescribing efficiency. PMID:25074989

Mechanization of Library Procedures in the Medium-sized Medical Library: IX. Holding Statements in PHILSOM: a Study of their Activity *

PubMed Central

Beckwith, Helen K.

1970-01-01

A study was made of the serial holding statements in PHILSOM over a six-month period, in order to determine the desirability of printing the complete serial holding statements monthly. Attention was given to the frequency of internal and update changes in both active and dead entries. The results indicate that while sufficient activity is observed in active serial entries to warrant their monthly updating, dead serial entries remain constant over this period. This indicates that a large group of PHILSOM entries can be easily identified and isolated, facilitating division and independent updating of the resultant lists. The desirability of such a division, however, must also take into consideration the user's ease in handling such a segmented listing. Images PMID:5439902

Rate of electronic health record adoption in South Korea: A nation-wide survey.

PubMed

Kim, Young-Gun; Jung, Kyoungwon; Park, Young-Taek; Shin, Dahye; Cho, Soo Yeon; Yoon, Dukyong; Park, Rae Woong

2017-05-01

The adoption rate of electronic health record (EHR) systems in South Korea has continuously increased. However, in contrast to the situation in the United States (US), where there has been a national effort to improve and standardize EHR interoperability, no consensus has been established in South Korea. The goal of this study was to determine the current status of EHR adoption in South Korean hospitals compared to that in the US. All general and tertiary teaching hospitals in South Korea were surveyed regarding their EHR status in 2015 with the same questionnaire as used previously. The survey form estimated the level of adoption of EHR systems according to 24 core functions in four categories (clinical documentation, result view, computerized provider order entry, and decision supports). The adoption level was classified into comprehensive and basic EHR systems according to their functionalities. EHRs and computerized physician order entry systems were used in 58.1% and 86.0% of South Korean hospitals, respectively. Decision support systems and problem list documentation were the functions most frequently missing from comprehensive and basic EHR systems. The main barriers cited to adoption of EHR systems were the cost of purchasing (48%) and the ongoing cost of maintenance (11%). The EHR adoption rate in Korean hospitals (37.2%) was higher than that in US hospitals in 2010 (15.1%), but this trend was reversed in 2015 (58.1% vs. 75.2%). The evidence suggests that these trends were influenced by the level of financial and political support provided to US hospitals after the HITECH Act was passed in 2009. The EHR adoption rate in Korea has increased, albeit more slowly than in the US. It is logical to suggest that increased funding and support tied to the HITECH Act in the US partly explains the difference in the adoption rates of EHRs in both countries. Copyright © 2017 Elsevier B.V. All rights reserved.

Computerized physician order entry system combined with on-ward pharmacist: analysis of pharmacists' interventions.

PubMed

Bedouch, Pierrick; Tessier, Alexandre; Baudrant, Magalie; Labarere, José; Foroni, Luc; Calop, Jean; Bosson, Jean-Luc; Allenet, Benoît

2012-08-01

To analyse pharmacists' interventions in a setting where a computerized physician order entry system (CPOE) is in use and a pharmacist works on the ward. A prospective cohort study was conducted in seven wards of a French teaching hospital using CPOE along with the presence of a full-time on-ward pharmacy resident. We documented the characteristics of pharmacists' interventions communicated to physicians during the medication order validation process whenever a drug-related problem was identified. Independent predictors of the physician's acceptance of the pharmacist's intervention were assessed using multiple logistic regression analysis. The 448 pharmacists' interventions concerned: non-conformity to guidelines or contraindications (22%), too high doses (19%), drug interactions (15%) and improper administration (15%). The interventions consisted of changes in drug choice (41%), dose adjustment (23%), drug monitoring (19%) and optimization of administration (17%). Interventions were communicated via the CPOE in 57% of cases and 43% orally. The rate of physicians' acceptance was 79.2%. In multivariate analysis, acceptance was significantly associated with the physician's status [higher for residents vs. seniors: OR = 7.23, CI 95 (2.37-22.10), P < 0.01], method of communication [higher for oral vs. computer communication: OR = 12.5, CI 95 (4.16-37.57), P < 0.01] and type of recommendation [higher for drug monitoring vs. drug choice recommendations: OR = 10.32, CI 95 (3.20-33.29), P < 0.01]. When a clinical pharmacist is present on a ward in which a CPOE is in use, the pharmacists' interventions are well accepted by physicians. Specific predictors of the acceptance by physicians emerge, but further research as to the impact of CPOE on pharmacist-physician communication is needed. © 2011 Blackwell Publishing Ltd.

Changing an automated drug inventory control system to a data base design.

PubMed

Bradish, R A

1982-09-01

A pharmacy department's change from indexed sequential access files to a data base management system (DBMS) for purposes of automated inventory control is described. The DBMS has three main functional areas: (1) inventory ordering and accountability, (2) charging of interdepartmental and intradepartmental orders, and (3) data manipulation with report design for management control. There are seven files directly related to the inventory ordering and accountability area. Each record can be accessed directly or through another file. Information on the quantity of a drug on hand, drug(s) supplied by a specific vendor, status of a purchase order, or calculation of an estimated order quantity can be retrieved quickly. In the drug master file, two records contain a reorder point and safety-stock level that are determined by searching the entries in the order history file and vendor master file. The intradepartmental and interdepartmental orders section contains five files assigned to record and store information on drug distribution. All items removed from the stockroom and distributed are recorded, and reports can be generated for itemized bills, total cost by area, and as formatted files for the accounts payable department. The design, development, and implementation of the DBMS took approximately a year using a part-time pharmacist and minimal outside help, while the previous system required constant expensive help of a programmer/analyst. The DBMS has given the pharmacy department a flexible inventory management system with increased drug control, decreased operating expenses, increased use of department personnel, and the ability to develop and enhance other systems.

Planetary/DOD entry technology flight experiments. Volume 2: Planetary entry flight experiments

NASA Technical Reports Server (NTRS)

Christensen, H. E.; Krieger, R. J.; Mcneilly, W. R.; Vetter, H. C.

1976-01-01

The technical feasibility of launching a high speed, earth entry vehicle from the space shuttle to advance technology for the exploration of the outer planets' atmospheres was established. Disciplines of thermodynamics, orbital mechanics, aerodynamics propulsion, structures, design, electronics and system integration focused on the goal of producing outer planet environments on a probe shaped vehicle during an earth entry. Major aspects of analysis and vehicle design studied include: planetary environments, earth entry environment capability, mission maneuvers, capabilities of shuttle upper stages, a comparison of earth entry planetary environments, experiment design and vehicle design.

48 CFR 552.270-9 - Inspection-Right of Entry.

Code of Federal Regulations, 2010 CFR

2010-10-01

... for asbestos fibers; (2) Inspecting the heating, ventilation and air conditioning system, maintenance... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Inspection-Right of Entry. 552.270-9 Section 552.270-9 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION...

[Information technology for the management of health care data: the EPIweb project].

PubMed

Vittorini, Pierpaolo; Necozione, Stefano; di Orio, Ferdinando

2005-01-01

In the US, the Center for Disease Control and Prevention has produced has increased the permeability of the computer science technologies, in order to achieve a better and more efficient management of health care data. In this context, the present paper proposes a discussion regarding a web-based information system, called EPIweb. This system allows researchers to select the centers for the data entry, collect and elaborate health care data, produce technical reports and discuss results. Such a system aims to be easy-to-use, totally configurable and particularly suitable for the management of multicenter studies. The paper shows the EPIweb features, proposes a sample system run, and concludes with a discussion regarding both the advantages and the possible improvements and extensions.

8. LONG VIEW OF CONCRETE FORBAY/SANDBOX FROM ENTRY POINT OF ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. LONG VIEW OF CONCRETE FORBAY/SANDBOX FROM ENTRY POINT OF WATER CONVEYANCE SYSTEM. VIEW TO WEST. - Tule River Hydroelectric Project, Water Conveyance System, Middle Fork Tule River, Springville, Tulare County, CA

78 FR 35607 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-13

..., Camp H.M. Smith, HI 96861-4028.'' * * * * * Categories of records in the system: Delete entry and.... Box 64028, Camp H.M. Smith, HI 96861-4028.'' Notification procedure: Delete entry and replace with...

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

Rudraswami, N. G.; Prasad, M. Shyam; Dey, S.

Most dust-sized cosmic particles undergo ablation and chemical alteration during atmospheric entry, which alters their original properties. A comprehensive understanding of this process is essential in order to decipher their pre-entry characteristics. The purpose of the study is to illustrate the process of vaporization of different elements for various entry parameters. The numerical results for particles of various sizes and various zenith angles are treated in order to understand the changes in chemical composition that the particles undergo as they enter the atmosphere. Particles with large sizes (> few hundred μ m) and high entry velocities (>16 km s{sup −1})more » experience less time at peak temperatures compared to those that have lower velocities. Model calculations suggest that particles can survive with an entry velocity of 11 km s{sup −1} and zenith angles (ZA) of 30°–90°, which accounts for ∼66% of the region where particles retain their identities. Our results suggest that the changes in chemical composition of MgO, SiO{sub 2}, and FeO are not significant for an entry velocity of 11 km s{sup −1} and sizes <300 μ m, but the changes in these compositions become significant beyond this size, where FeO is lost to a major extent. However, at 16 km s{sup −1} the changes in MgO, SiO{sub 2}, and FeO are very intense, which is also reflected in Mg/Si, Fe/Si, Ca/Si, and Al/Si ratios, even for particles with a size of 100 μ m. Beyond 400 μ m particle sizes at 16 km s{sup −1}, most of the major elements are vaporized, leaving the refractory elements, Al and Ca, suspended in the troposphere.« less

17 CFR 201.510 - Temporary cease-and-desist orders: Application process.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Temporary cease-and-desist orders: Application process. 201.510 Section 201.510 Commodity and Securities Exchanges SECURITIES AND... § 201.510 Temporary cease-and-desist orders: Application process. (a) Procedure. A request for entry of...

17 CFR 201.510 - Temporary cease-and-desist orders: Application process.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 17 Commodity and Securities Exchanges 2 2012-04-01 2012-04-01 false Temporary cease-and-desist orders: Application process. 201.510 Section 201.510 Commodity and Securities Exchanges SECURITIES AND... § 201.510 Temporary cease-and-desist orders: Application process. (a) Procedure. A request for entry of...

17 CFR 201.510 - Temporary cease-and-desist orders: Application process.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 17 Commodity and Securities Exchanges 2 2013-04-01 2013-04-01 false Temporary cease-and-desist orders: Application process. 201.510 Section 201.510 Commodity and Securities Exchanges SECURITIES AND... § 201.510 Temporary cease-and-desist orders: Application process. (a) Procedure. A request for entry of...

A detailed description of the implementation of inpatient insulin orders with a commercial electronic health record system.

PubMed

Neinstein, Aaron; MacMaster, Heidemarie Windham; Sullivan, Mary M; Rushakoff, Robert

2014-07-01

In the setting of Meaningful Use laws and professional society guidelines, hospitals are rapidly implementing electronic glycemic management order sets. There are a number of best practices established in the literature for glycemic management protocols and programs. We believe that this is the first published account of the detailed steps to be taken to design, implement, and optimize glycemic management protocols in a commercial computerized provider order entry (CPOE) system. Prior to CPOE implementation, our hospital already had a mature glycemic management program. To transition to CPOE, we underwent the following 4 steps: (1) preparation and requirements gathering, (2) design and build, (3) implementation and dissemination, and (4) optimization. These steps required more than 2 years of coordinated work between physicians, nurses, pharmacists, and programmers. With the move to CPOE, our complex glycemic management order sets were successfully implemented without any significant interruptions in care. With feedback from users, we have continued to refine the order sets, and this remains an ongoing process. Successful implementation of glycemic management protocols in CPOE is dependent on broad stakeholder input and buy-in. When using a commercial CPOE system, there may be limitations of the system, necessitating workarounds. There should be an upfront plan to apply resources for continuous process improvement and optimization after implementation. © 2014 Diabetes Technology Society.

Structures and Mechanisms Design Concepts for Adaptive Deployable Entry Placement Technology

NASA Technical Reports Server (NTRS)

Yount, Bryan C.; Arnold, James O.; Gage, Peter J.; Mockelman, Jeffrey; Venkatapathy, Ethiraj

2012-01-01

System studies have shown that large deployable aerodynamic decelerators such as the Adaptive Deployable Entry and Placement Technology (ADEPT) concept can revolutionize future robotic and human exploration missions involving atmospheric entry, descent and landing by significantly reducing the maximum heating rate, total heat load, and deceleration loads experienced by the spacecraft during entry [1-3]. ADEPT and the Hypersonic Inflatable Aerodynamic Decelerator (HIAD) [4] share the approach of stowing the entry system in the shroud of the launch vehicle and deploying it to a much larger diameter prior to entry. The ADEPT concept provides a low ballistic coefficient for planetary entry by employing an umbrella-like deployable structure consisting of ribs, struts and a fabric cover that form an aerodynamic decelerator capable of undergoing hypersonic flight. The ADEPT "skin" is a 3-D woven carbon cloth that serves as a thermal protection system (TPS) and as a structural surface that transfers aerodynamic forces to the underlying ribs [5]. This paper focuses on design activities associated with integrating ADEPT components (cloth, ribs, struts and mechanisms) into a system that can function across all configurations and environments of a typical mission concept: stowed during launch, in-space deployment, entry, descent, parachute deployment and separation from the landing payload. The baseline structures and mechanisms were selected via trade studies conducted during the summer and fall of 2012. They are now being incorporated into the design of a ground test article (GTA) that will be fabricated in 2013. It will be used to evaluate retention of the stowed configuration in a launch environment, mechanism operation for release, deployment and locking, and static strength of the deployed decelerator. Of particular interest are the carbon cloth interfaces, underlying hot structure, (Advanced Carbon- Carbon ribs) and other structural components (nose cap, struts, and main body) designed to withstand the pressure and extremely high heating experienced during planetary entry.

Learning analytics: Dataset for empirical evaluation of entry requirements into engineering undergraduate programs in a Nigerian university.

PubMed

Odukoya, Jonathan A; Popoola, Segun I; Atayero, Aderemi A; Omole, David O; Badejo, Joke A; John, Temitope M; Olowo, Olalekan O

2018-04-01

In Nigerian universities, enrolment into any engineering undergraduate program requires that the minimum entry criteria established by the National Universities Commission (NUC) must be satisfied. Candidates seeking admission to study engineering discipline must have reached a predetermined entry age and met the cut-off marks set for Senior School Certificate Examination (SSCE), Unified Tertiary Matriculation Examination (UTME), and the post-UTME screening. However, limited effort has been made to show that these entry requirements eventually guarantee successful academic performance in engineering programs because the data required for such validation are not readily available. In this data article, a comprehensive dataset for empirical evaluation of entry requirements into engineering undergraduate programs in a Nigerian university is presented and carefully analyzed. A total sample of 1445 undergraduates that were admitted between 2005 and 2009 to study Chemical Engineering (CHE), Civil Engineering (CVE), Computer Engineering (CEN), Electrical and Electronics Engineering (EEE), Information and Communication Engineering (ICE), Mechanical Engineering (MEE), and Petroleum Engineering (PET) at Covenant University, Nigeria were randomly selected. Entry age, SSCE aggregate, UTME score, Covenant University Scholastic Aptitude Screening (CUSAS) score, and the Cumulative Grade Point Average (CGPA) of the undergraduates were obtained from the Student Records and Academic Affairs unit. In order to facilitate evidence-based evaluation, the robust dataset is made publicly available in a Microsoft Excel spreadsheet file. On yearly basis, first-order descriptive statistics of the dataset are presented in tables. Box plot representations, frequency distribution plots, and scatter plots of the dataset are provided to enrich its value. Furthermore, correlation and linear regression analyses are performed to understand the relationship between the entry requirements and the corresponding academic performance in engineering programs. The data provided in this article will help Nigerian universities, the NUC, engineering regulatory bodies, and relevant stakeholders to objectively evaluate and subsequently improve the quality of engineering education in the country.

Technology Investments in the NASA Entry Systems Modeling Project

NASA Technical Reports Server (NTRS)

Barnhardt, Michael; Wright, Michael; Hughes, Monica

2017-01-01

The Entry Systems Modeling (ESM) technology development project, initiated in 2012 under NASAs Game Changing Development (GCD) Program, is engaged in maturation of fundamental research developing aerosciences, materials, and integrated systems products for entry, descent, and landing(EDL)technologies [1]. To date, the ESM project has published over 200 papers in these areas, comprising the bulk of NASAs research program for EDL modeling. This presentation will provide an overview of the projects successes and challenges, and an assessment of future investments in EDL modeling and simulation relevant to NASAs mission

76 FR 60566 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Approving Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-29

.... Description of the Proposal The purpose of the proposal is to amend two subsections of Exchange Rule 1080 to allow entry of day limit orders for the proprietary accounts of SQTs and RSQTs. Current Rule 1080 (Phlx....\\4\\ Rule 1080 states that it governs the orders, execution reports and administrative order messages...

75 FR 20850 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-21

... in the efforts to make system changes. Grantees will complete systems web-based data entry on goals... grantee and key staff-partner interview 249 2 1.60 797 guide EBHV grantee systems web-based data entry... prevent child maltreatment. An evaluation study will address four domains: (1) Systems change to develop...

RADON MITIGATION IN SCHOOLS: HVAC SYSTEMS IN SCHOOLS TEND TO HAVE A GREATER IMPACT ON RADON LEVELS THAN HVAC SYSTEMS IN HOMES

EPA Science Inventory

The first part of this two-part paper discusses radon entry into schools, radon mitigation approaches for schools, and school characteristics (e.g., heating, ventilation, and air conditioing -- HVAC-- system design and operationg) that influence radon entry and mitigation system ...

Mars Entry Atmospheric Data System Modelling and Algorithm Development

NASA Technical Reports Server (NTRS)

Karlgaard, Christopher D.; Beck, Roger E.; OKeefe, Stephen A.; Siemers, Paul; White, Brady; Engelund, Walter C.; Munk, Michelle M.

2009-01-01

The Mars Entry Atmospheric Data System (MEADS) is being developed as part of the Mars Science Laboratory (MSL), Entry, Descent, and Landing Instrumentation (MEDLI) project. The MEADS project involves installing an array of seven pressure transducers linked to ports on the MSL forebody to record the surface pressure distribution during atmospheric entry. These measured surface pressures are used to generate estimates of atmospheric quantities based on modeled surface pressure distributions. In particular, the quantities to be estimated from the MEADS pressure measurements include the total pressure, dynamic pressure, Mach number, angle of attack, and angle of sideslip. Secondary objectives are to estimate atmospheric winds by coupling the pressure measurements with the on-board Inertial Measurement Unit (IMU) data. This paper provides details of the algorithm development, MEADS system performance based on calibration, and uncertainty analysis for the aerodynamic and atmospheric quantities of interest. The work presented here is part of the MEDLI performance pre-flight validation and will culminate with processing flight data after Mars entry in 2012.

Preliminary assessment of the Mars Science Laboratory entry, descent, and landing simulation

NASA Astrophysics Data System (ADS)

Way, David W.

On August 5, 2012, the Mars Science Laboratory rover, Curiosity, successfully landed inside Gale Crater. This landing was the seventh successful landing and fourth rover to be delivered to Mars. Weighing nearly one metric ton, Curiosity is the largest and most complex rover ever sent to investigate another planet. Safely landing such a large payload required an innovative Entry, Descent, and Landing system, which included the first guided entry at Mars, the largest supersonic parachute ever flown at Mars, and the novel Sky Crane landing system. A complete, end-to-end, six degree-of-freedom, multi-body computer simulation of the Mars Science Laboratory Entry, Descent, and Landing sequence was developed at the NASA Langley Research Center. In-flight data gathered during the successful landing is compared to pre-flight statistical distributions, predicted by the simulation. These comparisons provide insight into both the accuracy of the simulation and the overall performance of the Entry, Descent, and Landing system.

Conformal Ablative Thermal Protection System for Planetary and Human Exploration Missions

NASA Technical Reports Server (NTRS)

Beck, R.; Arnold, J.; Gasch, M.; Stackpole, M.; Wercinski, R.; Venkatapathy, E.; Fan, W.; Thornton, J; Szalai, C.

2012-01-01

The Office of Chief Technologist (OCT), NASA has identified the need for research and technology development in part from NASAs Strategic Goal 3.3 of the NASA Strategic Plan to develop and demonstrate the critical technologies that will make NASAs exploration, science, and discovery missions more affordable and more capable. Furthermore, the Game Changing Development Program (GCDP) is a primary avenue to achieve the Agencys 2011 strategic goal to Create the innovative new space technologies for our exploration, science, and economic future. In addition, recently released NASA Space Technology Roadmaps and Priorities, by the National Research Council (NRC) of the National Academy of Sciences stresses the need for NASA to invest in the very near term in specific EDL technologies. The report points out the following challenges (Page 2-38 of the pre-publication copy released on February 1, 2012): Mass to Surface: Develop the ability to deliver more payload to the destination. NASA's future missions will require ever-greater mass delivery capability in order to place scientifically significant instrument packages on distant bodies of interest, to facilitate sample returns from bodies of interest, and to enable human exploration of planets such as Mars. As the maximum mass that can be delivered to an entry interface is fixed for a given launch system and trajectory design, the mass delivered to the surface will require reductions in spacecraft structural mass more efficient, lighter thermal protection systems more efficient lighter propulsion systems and lighter, more efficient deceleration systems. Surface Access: Increase the ability to land at a variety of planetary locales and at a variety of times. Access to specific sites can be achieved via landing at a specific location(s) or transit from a single designated landing location, but it is currently infeasible to transit long distances and through extremely rugged terrain, requiring landing close to the site of interest. The entry environment is not always guaranteed with a direct entry, and improving the entry systems robustness to a variety of environmental conditions could aid in reaching more varied landing sites. The National Research Council (NRC) Space Technology Roadmaps and Priorities report highlights six challenges and they are: 1) Mass to Surface, 2) Surface Access, 3) Precision Landing, 4) Surface Hazard Detection and Avoidance, 5) Safety and Mission Assurance, and 6) Affordability. In order for NASA to meet these challenges, the report recommends immediate focus on Rigid and Flexible Thermal Protection Systems. Rigid TPS systems such as Avcoat or SLA are honeycomb based and PICA is in the form of tiles. The honeycomb systems is manufactured using techniques that require filling of each (3/8 cell) by hand and within a limited amount of time once the ablative compound is mixed, all of the cells have to be filled and the entire heat-shield has to be cured. The tile systems such as PICA pose a different challenge as the mechanical strength characteristic and the manufacturing limitations require large number of small tiles with gap-fillers between the tiles. Recent investments in flexible ablative systems have given rise to the potential for conformal ablative TPS> A conformal TPS over a rigid aeroshell has the potential to solve a number of challenges faced by traditional rigid TPS materials.

8. INTERIOR OF FRONT SCREENEDIN PORCH SHOWING PORCH ENTRY DOOR ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. INTERIOR OF FRONT SCREENED-IN PORCH SHOWING PORCH ENTRY DOOR AT PHOTO CENTER AND FRONT ENTRY DOOR TO LIVING ROOM AT PHOTO LEFT. VIEW TO NORTHWEST. - Bishop Creek Hydroelectric System, Plant 4, Worker Cottage, Bishop Creek, Bishop, Inyo County, CA

40 CFR 141.100 - Criteria and procedures for public water systems using point-of-entry devices.

Code of Federal Regulations, 2011 CFR

2011-07-01

... include physical measurements and observations such as total flow treated and mechanical condition of the... engineering design review of the point-of-entry devices. (2) The design and application of the point-of-entry...

40 CFR 141.100 - Criteria and procedures for public water systems using point-of-entry devices.

Code of Federal Regulations, 2013 CFR

2013-07-01

... include physical measurements and observations such as total flow treated and mechanical condition of the... engineering design review of the point-of-entry devices. (2) The design and application of the point-of-entry...

40 CFR 141.100 - Criteria and procedures for public water systems using point-of-entry devices.

Code of Federal Regulations, 2012 CFR

2012-07-01

... include physical measurements and observations such as total flow treated and mechanical condition of the... engineering design review of the point-of-entry devices. (2) The design and application of the point-of-entry...

Apollo experience report: Guidance and control systems: Command and service module entry monitor subsystem

NASA Technical Reports Server (NTRS)

Reina, B., Jr.; Patterson, H. G.

1975-01-01

The conceptual aspects of the command and service module entry monitor subsystem, together with an interpretation of the displays and their associated relationship to entry trajectory control, are presented. The entry monitor subsystem is described, and the problems encountered during the developmental phase and the first five manned Apollo flights are discussed in conjunction with the design improvements implemented.

An Assessment of Health Care Information and Management Systems Society and Leapfrog Data on Computerized Provider Order Entry

PubMed Central

Diana, Mark L; Kazley, Abby Swanson; Menachemi, Nir

2011-01-01

Objective To assess the internal consistency and agreement between the Health Care Information and Management Systems Society (HIMSS) and the Leapfrog computerized provider order entry (CPOE) data. Data Sources Secondary hospital data collected by HIMSS Analytics, the Leapfrog Group, and the American Hospital Association from 2005 to 2007. Study Design Dichotomous measures of full CPOE status were created for the HIMSS and Leapfrog datasets in each year. We assessed internal consistency by calculating the percent of full adopters in a given year that report full CPOE status in subsequent years. We assessed the level of agreement between the two datasets by calculating the κ statistic and McNemar's test. We examined responsiveness by assessing the change in full CPOE status rates, over time, reported by HIMSS and Leapfrog data, respectively. Principal Findings Findings indicate minimal agreement between the two datasets regarding positive hospital CPOE status, but adequate agreement within a given dataset from year to year. Relative to each other, the HIMSS data tend to overestimate increases in full CPOE status over time, while the Leapfrog data may underestimate year over year increases in national CPOE status. Conclusions Both Leapfrog and HIMSS data have strengths and weaknesses. Those interested in studying outcomes associated with CPOE use or adoption should be aware of the strengths and limitations of the Leapfrog and HIMSS datasets. Future development of a standard definition of CPOE status in hospitals will allow for a more comprehensive validation of these data. PMID:21449956

Enablers and barriers to using two-way information technology in the management of adults with diabetes: A descriptive systematic review.

PubMed

Macdonald, Emma M; Perrin, Byron M; Kingsley, Michael Ic

2017-01-01

Background This systematic review aimed to explore the enablers and barriers faced by adults with diabetes using two-way information communication technologies to support diabetes self-management. Methods Relevant literature was obtained from five databases using search strategies combining four major constructs: adults with diabetes, biomedical technology, communication technology and patient utilisation. Results Of 8430 unique articles identified, 48 were included for review. Risk of bias was assessed using either the Newcastle-Ottowa or Cochrane risk of bias assessment tools. Seventy-one percent of studies were of cohort design with the majority of studies assessed at high or unclear risk of bias. Consistently identified barriers included poorly designed interfaces requiring manual data entry and systems that lacked functionalities valued by patients. Commonly cited enablers included access to reliable technology, highly automated data entry and transmission, graphical display of data with immediate feedback, and supportive health care professionals and family members. Conclusions People with diabetes face a number of potentially modifiable barriers in using technology to support their diabetes management. In order to address these barriers, end users should be consulted in the design process and consideration given to theories of technology adoption to inform design and implementation. Systems should be designed to solve clinical or behavioural problems that are identified by patients as priorities. Technology should be as automated, streamlined, mobile, low cost and integrated as possible in order to limit the burden of usage for the patient and maximise clinical usefulness.