43 CFR 11.37 - Must the authorized official confirm exposure before implementing the Assessment Plan?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Secretary of the Interior NATURAL RESOURCE DAMAGE ASSESSMENTS Assessment Plan Phase § 11.37 Must the... methodologies in the Assessment Plan, the authorized official must confirm that at least one of the natural resources identified as potentially injured in the preassessment screen has in fact been exposed to the...

Tank 241-AY-101 Privatization Push Mode Core Sampling and Analysis Plan

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

TEMPLETON, A.M.

2000-01-12

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AY-101. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AY-101 required to satisfy Data Quality Objectives For RPP Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO) (Nguyen 1999a), Data Quality Objectives For TWRS Privatization Phase I : Confirm Tank T Is An Appropriate Feed Source For Low-Activity Waste Feed Batch X (LAW DQO) (Nguyen 1999b), Low Activitymore » Waste and High-Level Waste Feed Data Quality Objectives (L and H DQO) (Patello et al. 1999), and Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO) (Bloom 1996). Special instructions regarding support to the LAW and HLW DQOs are provided by Baldwin (1999). Push mode core samples will be obtained from risers 15G and 150 to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples; composite the liquids and solids; perform chemical analyses on composite and segment samples; archive half-segment samples; and provide subsamples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AY-101 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plans and are not within the scope of this SAP.« less

Tank 241-AY-101 Privatization Push Mode Core Sampling and Analysis Plan

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

TEMPLETON, A.M.

2000-05-19

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AY-101. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AY-101 required to satisfy ''Data Quality Objectives For RPP Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO)' (Nguyen 1999a), ''Data Quality Objectives For TWRS Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For Low-Activity Waste Feed Butch X (LAW DQO) (Nguyen 1999b)'', ''Low Activity Wastemore » and High-Level Waste Feed Data Quality Objectives (L&H DQO)'' (Patello et al. 1999), and ''Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO)'' (Bloom 1996). Special instructions regarding support to the LAW and HLW DQOs are provided by Baldwin (1999). Push mode core samples will be obtained from risers 15G and 150 to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples; composite the liquids and solids; perform chemical analyses on composite and segment samples; archive half-segment samples; and provide sub-samples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AY-101 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plans and are not within the scope of this SAP.« less

Extended performance solar electric propulsion thrust system study. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Poeschel, R. L.; Hawthorne, E. I.

1977-01-01

Several thrust system design concepts were evaluated and compared using the specifications of the most advanced 30 cm engineering model thruster as the technology base. The extensions in thruster performance required for the Halley's comet mission were defined and alternative thrust system concepts were designed. Confirmation testing and analysis of thruster and power-processing components were performed, and the feasibility of satisfying extended performance requirements was verified. A baseline design was selected from the alternatives considered, and the design analysis and documentation were refined. A program development plan was formulated that outlines the work structure considered necessary for developing, qualifying, and fabricating the flight hardware for the baseline thrust system within the time frame of a project to rendezvous with Halley's comet. An assessment was made of the costs and risks associated with a baseline thrust system as provided to the mission project under this plan. Critical procurements and interfaces were identified and defined. Results are presented.

Anticipating market demand: tracking enrollee satisfaction and health over time.

PubMed

Allen, H

1998-12-01

To assess guidelines, set by the National Committee for Quality Assurance, for the Health Plan Employer Data and Information Set (HEDIS) 1999 CAHPS 2.0H Survey (formerly the HEDIS 1999 Consumer Survey) in the light of user's needs to monitor health plan performance over time, monitor sick enrollees, and prioritize determinants (drivers) of enrollee experience. A two-wave, cross-sectional/longitudinal panel design, consisting of national surveys mailed to employees of three major USA corporations in 1993 and 1995. Samples included employees selected to represent 23 major managed care and indemnity plans in five regions of the USA. In 1993, 14 587 employees responded and in 1995 9018 employees responded (response rates: 51 and 52%). The longitudinal panel sample included 5729 employees who completed both surveys and stayed in the same plan for both years. STUDY MEASURES: The main 1993 and 1995 surveys consisted of 154 and 116 items, respectively. Panel survey content assessed care delivery, plan administration, functional status, well being, and chronic disease. CAHPS 2.0H's point-in-time, cross-sectional design was unable to detect selection bias and led to an inaccurate view of change in performance. CAHPS 2.0H's use of aggregate samples masked key differences between healthy and sick enrollees; e.g. the sick became less satisfied over time. The association-based, statistical techniques that many survey users will employ to prioritize the 'drivers' of enrollee experience in the absence of CAHPS 2.0H guidelines yielded a less efficient account of change than the multi-method/multi-trait approach developed for this project. Consumer experience of plan performance is best understood when the separate contributions of longitudinal membership and movement in and out of plans are clarified, changes in health are identified, changes for sick and healthy enrollees are compared, and plan performance on satisfaction criteria is probed to give confirmation and detail. Changes to the CAHPS 2.0H approach in HEDIS 1999 will facilitate user application of these principles.

Planning study for Merkel cell carcinoma based on the relapse pattern.

PubMed

Hoeller, Ulrike; Schubert, Tina; Mueller, Thomas; Budach, Volker; Ghadjar, Pirus; Brenner, Winfried; Kuschke, Wolf

2017-04-01

To develop a technique for radiation (RT) of in-transit path ways (IT) in Merkel cell carcinoma. In the planning study, IT were ink-marked on the skin during sentinel lymphscintigraphy and wire-marked in planning-CT. Pre- and post-operative planning-CTs were acquired. The clinical target volume (CTV) included tumor bed plus safety margin, IT and draining nodes, the planning volume (PTV) the CTV plus 0.5-1cm margin. VMAT plans with 2-3 arcs were analyzed. A planning study was performed for five pts. including two pts. with primary tumor (PT) in head and neck, 1 pt. each with PT of elbow, forearm and upper leg respectively. Plans showed satisfactory PTV coverage: D mean 100%±0%, D 98% 92.4%±2.24%, homogeneity index (HI) 0.095±0.01, conformation number (CN) 0.84±0.01 and conformality index (CI) 0.95±0.01. The planning study confirms feasibility of highly conformal irradiation of IT pathways based on individualized target delineation. Currently, patients referred for non-metastatic MCC are encouraged to enroll in a prospective clinical study that evaluates the feasibility of radiation of IT pathways. Copyright © 2017 Elsevier B.V. All rights reserved.

MO-FG-303-06: Evaluation of the Performance of Very High-Energy Electron (VHEE) Beams in Radiotherapy: Five Clinical Cases

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

Palma, B; Bazalova-Carter, M; Qu, B

Purpose: To evaluate the performance of 100–120 MeV very-high energy electron (VHEE) scanning pencil beams to radiotherapy by means of Monte Carlo (MC) simulations. Methods: We selected five clinical cases with target sizes of 1.2 cm{sup 3} to 990.4 cm{sup 3}. We calculated VHEE treatment plans using the MC EGSnrc code implemented in a MATLAB-based graphical user interface developed by our group. We generated phase space data for beam energies: 100 and 120 MeV and pencil beam spot sizes of 1, 3, and 5 mm at FWHM. The number of equidistant beams considered in this work was 16 or 32.more » Dose was calculated and then imported into a research version of RayStation where treatment plan optimization was performed. We compared the VHEE plans with the clinically delivered volumetric modulated arc therapy (VMAT) plan to evaluate VHEE plans performance. Results: VHEE plans provided the same PTV coverage and dose homogeneity than VMAT plans for all the cases. In average, the mean dose to organs at risk (OARs) was 24% lower for the VHEE plans. The structures that benefited the most from using VHEE were: large bowel for the esophagus case, chest wall for the liver case, brainstem for the acoustic case, carina for the lung case, and genitalia for the anal case, with 23.7–34.6% lower dose. VHEE dose distributions were more conformal than VMAT solution as confirmed by conformity indices CI100 and CI50. Integral dose to the body was in average 19.6% (9.2%–36.5%) lower for the VHEE plans. Conclusion: We have shown that VHEE plans resulted in similar or superior dose distributions compared to clinical VMAT plans for five different cases and a wide range of target volumes, including a case with a small target (1.2 cm{sup 3}), which represents a challenge for VMAT planning and might require the use of more complex non-coplanar VMAT plans. B Palma: None. M Bazalova: None. B Hardemark: Employee, RaySearch Laboratories AB. E Hynning: Employee, RaySearch Laboratories AB. B Qu: None. B Loo Jr.: Research support, RaySearch, Varian. P Maxim: Research support, RaySearch, Varian.« less

Fast Transformation of Temporal Plans for Efficient Execution

NASA Technical Reports Server (NTRS)

Tsamardinos, Ioannis; Muscettola, Nicola; Morris, Paul

1998-01-01

Temporal plans permit significant flexibility in specifying the occurrence time of events. Plan execution can make good use of that flexibility. However, the advantage of execution flexibility is counterbalanced by the cost during execution of propagating the time of occurrence of events throughout the flexible plan. To minimize execution latency, this propagation needs to be very efficient. Previous work showed that every temporal plan can be reformulated as a dispatchable plan, i.e., one for which propagation to immediate neighbors is sufficient. A simple algorithm was given that finds a dispatchable plan with a minimum number of edges in cubic time and quadratic space. In this paper, we focus on the efficiency of the reformulation process, and improve on that result. A new algorithm is presented that uses linear space and has time complexity equivalent to Johnson s algorithm for all-pairs shortest-path problems. Experimental evidence confirms the practical effectiveness of the new algorithm. For example, on a large commercial application, the performance is improved by at least two orders of magnitude. We further show that the dispatchable plan, already minimal in the total number of edges, can also be made minimal in the maximum number of edges incoming or outgoing at any node.

A framework to assess management performance in district health systems: a qualitative and quantitative case study in Iran.

PubMed

Tabrizi, Jafar Sadegh; Gholipour, Kamal; Iezadi, Shabnam; Farahbakhsh, Mostafa; Ghiasi, Akbar

2018-01-01

The aim was to design a district health management performance framework for Iran's healthcare system. The mixed-method study was conducted between September 2015 and May 2016 in Tabriz, Iran. In this study, the indicators of district health management performance were obtained by analyzing the 45 semi-structured surveys of experts in the public health system. Content validity of performance indicators which were generated in qualitative part were reviewed and confirmed based on content validity index (CVI). Also content validity ratio (CVR) was calculated using data acquired from a survey of 21 experts in quantitative part. The result of this study indicated that, initially, 81 indicators were considered in framework of district health management performance and, at the end, 53 indicators were validated and confirmed. These indicators were classified in 11 categories which include: human resources and organizational creativity, management and leadership, rules and ethics, planning and evaluation, district managing, health resources management and economics, community participation, quality improvement, research in health system, health information management, epidemiology and situation analysis. The designed framework model can be used to assess the district health management and facilitates performance improvement at the district level.

Extended performance solar electric propulsion thrust system study. Volume 3: Tradeoff studies of alternate thrust system configurations

NASA Technical Reports Server (NTRS)

Hawthorne, E. I.

1977-01-01

Several thrust system design concepts were evaluated and compared using the specifications of the most advanced 30 cm engineering model thruster as the technology base. Emphasis was placed on relatively high power missions. The extensions in thruster performance required for the Halley's comet mission were defined and alternative thrust system concepts were designed in sufficient detail for comparing mass, efficiency, reliability, structure, and thermal characteristics. Confirmation testing and analysis of thruster and power-processing components were performed. A baseline design was selected from the alternatives considered, and the design analysis and documentation were refined. A program development plan was formulated that outlines the work structure considered necessary for developing, qualifying, and fabricating the flight hardware for the baseline thrust system within the time frame of a project to rendezvous with Halley's comet. An assessment was made of the costs and risks associated with a baseline thrust system as provided to the mission project under this plan. Critical procurements and interfaces were identified and defined.

Assessments of managed care organizations in the Greater Baton Rouge area by physicians and physicians' office managers.

PubMed

Cassidy, W M; Dyson, T; Grenier, C E

2001-03-01

Health care quality assessment under managed care organizations is usually derived from two sources: (1) consumer satisfaction surveys, and (2) The Health Plan Employer Data Information Set reports. There is little published data regarding physicians' critiques. This study surveyed physicians and office managers as to the quality of healthcare under 10 managed care organizations in the Greater Baton Rouge area. Performance indicators in the physician questionnaire focused on personal satisfaction, perception of patient satisfaction, and mental health coverage. The office managers' checklist included payment and certification issues, telephone time spent gaining certification, level of knowledge among plan enrollees of their benefits, appeal process, and adequacy of reimbursement. Means were calculated for each performance indicator and managed care organizations were ranked. Tukey-Kramer's post-hoc multiple comparisons test was used to confirm rank order validity. Significant differences were found among companies. Significant rank-order agreement by both physicians and office managers was evident. The usefulness of such surveys and performing them annually is discussed.

Role of working memory, inhibition, and fluid intelligence in the performance of the Tower of London task.

PubMed

D'Antuono, Giovanni; La Torre, Francesca Romana; Marin, Dario; Antonucci, Gabriella; Piccardi, Laura; Guariglia, Cecilia

2017-01-01

We investigated the relationship between verbal and visuo-spatial measures of working memory, inhibition, fluid intelligence and the performance on the Tower of London (ToL) task in a large sample of 830 healthy participants aged between 18 and 71 years. We found that fluid intelligence and visuo-spatial working memory accounted for a significant variance in the ToL task, while performances on verbal working memory and on the Stroop Test were not predictive for performance on the ToL. The present results confirm that fluid intelligence has a fundamental role on planning tests, but also show that visuo-spatial working memory plays a crucial role in ToL performance.

Telemedicine Consultations in Oral and Maxillofacial Surgery: A Follow-Up Study.

PubMed

Wood, Eric W; Strauss, Robert A; Janus, Charles; Carrico, Caroline K

2016-02-01

The purpose of this study was to follow up on the previous study in evaluating the efficiency and reliability of telemedicine consultations for preoperative assessment of patients. A retrospective study of 335 patients over a 6-year period was performed to evaluate success rates of telemedicine consultations in adequately assessing patients for surgical treatment under anesthesia. Success or failure of the telemedicine consultation was measured by the ability to triage patients appropriately for the hospital operating room versus the clinic, to provide an accurate diagnosis and treatment plan, and to provide a sufficient medical and physical assessment for planned anesthesia. Data gathered from the average distance traveled and data from a previous telemedicine study performed by the National Institute of Justice were used to estimate the cost savings of using telemedicine consultations over the 6-year period. Practitioners performing the consultation were successful 92.2% of the time in using the data collected to make a diagnosis and treatment plan. Patients were triaged correctly 99.6% of the time for the clinic or hospital operating room. Most patients (98.0%) were given sufficient medical and physical assessment and were able to undergo surgery with anesthesia as planned at the clinic appointment immediately after telemedicine consultation. Most patients (95.9%) were given an accurate diagnosis and treatment plan. The estimated amount saved by providing consultation by telemedicine and eliminating in-office consultation was substantial at $134,640. This study confirms the findings from previous studies that telemedicine consultations are as reliable as those performed by traditional methods. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Theory of Planned Behavior in the Classroom: An Examination of the Instructor Confirmation-Interaction Model

ERIC Educational Resources Information Center

Burns, Michael E.; Houser, Marian L.; Farris, Kristen LeBlanc

2018-01-01

The current study utilizes the theory of planned behavior (Ajzen "Organizational Behavior and Human Decision Processes," 50, 179-211 Ajzen 1991) to examine an instructor confirmation-interaction model in the instructional communication context to discover a means by which instructors might cultivate positive student attitudes and…

Self-Efficacy and Planning as Predictors of Physical Activity in the Context of Workplace Health Promotion.

PubMed

Keller, Jan; Gellert, Paul; Knoll, Nina; Schneider, Michael; Ernsting, Anna

2016-11-01

Fostering self-efficacy and planning in individuals can support the uptake and maintenance of regular physical activity. This study examined self-efficacy and planning as mechanisms of an online-delivered workplace health promotion intervention to enhance employees' physical activity. A special focus lay on reciprocal interrelations among self-efficacy and planning over time, as previous work predominantly accounted for only one predictive direction at a time. Data from N = 1,063 employees of a pharmaceutical company who reported an intention to increase their physical activity levels were assessed at three measurement points up to 12 weeks following the intervention. Cross-lagged panel analyses were performed to examine effects of self-efficacy and planning on physical activity as well as reciprocal interrelations between self-efficacy and planning. Findings indicated an increase in self-efficacy, planning, and physical activity following the intervention. Planning was consistently linked to subsequent physical activity, whereas self-efficacy was not associated. Also, reciprocal interrelations among self-efficacy and planning were found across both measurement lags. Planning was confirmed as a predictor of physical activity, whereas self-efficacy was not. However, cross-lagged interrelations indicated reciprocal reactivation among self-efficacy and planning over time, suggesting beneficial effects of including strategies that foster both volitional constructs in interventions. © 2016 The International Association of Applied Psychology.

Back to the future: autobiographical planning and the functionality of mind-wandering.

PubMed

Baird, Benjamin; Smallwood, Jonathan; Schooler, Jonathan W

2011-12-01

Given that as much as half of human thought arises in a stimulus independent fashion, it would seem unlikely that such thoughts would play no functional role in our lives. However, evidence linking the mind-wandering state to performance decrement has led to the notion that mind-wandering primarily represents a form of cognitive failure. Based on previous work showing a prospective bias to mind-wandering, the current study explores the hypothesis that one potential function of spontaneous thought is to plan and anticipate personally relevant future goals, a process referred to as autobiographical planning. The results confirm that the content of mind-wandering is predominantly future-focused, demonstrate that individuals with high working memory capacity are more likely to engage in prospective mind-wandering, and show that prospective mind-wandering frequently involves autobiographical planning. Together this evidence suggests that mind-wandering can enable prospective cognitive operations that are likely to be useful to the individual as they navigate through their daily lives. Copyright © 2011 Elsevier Inc. All rights reserved.

Planning abilities of children aged 4 years and 9 months to 8 ½ years: Effects of age, fluid intelligence and school type on performance in the Tower of London test

PubMed Central

Malloy-Diniz, Leandro Fernandes; Cardoso-Martins, Cláudia; Nassif, Elaine Pacheco; Levy, Angela Maria; Leite, Wellington Borges; Fuentes, Daniel

2008-01-01

The present study investigated the relationship between age and one type of environmental factor, namely, type of school (i.e., private vs. public), and the development of mental planning ability, as measured by the Tower of London (TOL) test. Methods Participants comprised 197 public and 174 private school students, ranging in age from 4 years and 9 months to 8 years and 6 months. Besides the TOL test, students were administered Raven's Colored Matrices. Results Results confirmed the findings of previous studies that both age and school type are important predictors of mental planning. Furthermore, results also suggest that the relationship between type of school and mental planning ability cannot be accounted for by differences in students' fluid intelligence. Conclusion In the present study, the TOL test continued to differentiate public from private school students, even after we controlled for the effect of differences on the Raven test. PMID:29213536

An integrated orthognathic surgery system for virtual planning and image-guided transfer without intermediate splint.

PubMed

Kim, Dae-Seung; Woo, Sang-Yoon; Yang, Hoon Joo; Huh, Kyung-Hoe; Lee, Sam-Sun; Heo, Min-Suk; Choi, Soon-Chul; Hwang, Soon Jung; Yi, Won-Jin

2014-12-01

Accurate surgical planning and transfer of the planning in orthognathic surgery are very important in achieving a successful surgical outcome with appropriate improvement. Conventionally, the paper surgery is performed based on a 2D cephalometric radiograph, and the results are expressed using cast models and an articulator. We developed an integrated orthognathic surgery system with 3D virtual planning and image-guided transfer. The maxillary surgery of orthognathic patients was planned virtually, and the planning results were transferred to the cast model by image guidance. During virtual planning, the displacement of the reference points was confirmed by the displacement from conventional paper surgery at each procedure. The results of virtual surgery were transferred to the physical cast models directly through image guidance. The root mean square (RMS) difference between virtual surgery and conventional model surgery was 0.75 ± 0.51 mm for 12 patients. The RMS difference between virtual surgery and image-guidance results was 0.78 ± 0.52 mm, which showed no significant difference from the difference of conventional model surgery. The image-guided orthognathic surgery system integrated with virtual planning will replace physical model surgical planning and enable transfer of the virtual planning directly without the need for an intermediate splint. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

University students' cognitive performance under temperature cycles induced by direct load control events.

PubMed

Zhang, F; de Dear, R

2017-01-01

As one of the most common strategies for managing peak electricity demand, direct load control (DLC) of air-conditioners involves cycling the compressors on and off at predetermined intervals. In university lecture theaters, the implementation of DLC induces temperature cycles which might compromise university students' learning performance. In these experiments, university students' learning performance, represented by four cognitive skills of memory, concentration, reasoning, and planning, was closely monitored under DLC-induced temperature cycles and control conditions simulated in a climate chamber. In Experiment 1 with a cooling set point temperature of 22°C, subjects' cognitive performance was relatively stable or even slightly promoted by the mild heat intensity and short heat exposure resulting from temperature cycles; in Experiment 2 with a cooling set point of 24°C, subjects' reasoning and planning performance observed a trend of decline at the higher heat intensity and longer heat exposure. Results confirm that simpler cognitive tasks are less susceptible to temperature effects than more complex tasks; the effect of thermal variations on cognitive performance follows an extended-U relationship with performance being relatively stable across a range of temperatures. DLC appears to be feasible in university lecture theaters if DLC algorithms are implemented judiciously. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

General surgery graduates may be ill prepared to enter rural or community surgical practice.

PubMed

Gillman, Lawrence M; Vergis, Ashley

2013-06-01

Rural/community surgery presents unique challenges to general surgeons. Not only are they required to perform "classic" general surgery procedures, but they are also often expected to be competent in other surgical disciplines. Final-year Canadian-trained residents in general surgery were asked to complete the survey. The survey explored chief residents' career plans for the following year and whether or not they would independently perform various procedures, some general surgical, and others now considered within the domain of the subspecialties. Sixty-four residents (71%) completed the survey. Twenty percent planned to undertake a rural surgical practice, 17% an urban community practice, and 55% had confirmed fellowships. Most residents (>90%) expressed comfort with basic general surgical procedures. However, residents were less comfortable with subspecialty procedures that are still performed by general surgeons in many rural practices. More than half of graduating general surgery residents are choosing subspecialty fellowship training over proceeding directly to practice. Those choosing a rural or community practice are likely to feel ill prepared to replace existing surgeons. Copyright © 2013 Elsevier Inc. All rights reserved.

Three-dimensional virtual planning in orthognathic surgery enhances the accuracy of soft tissue prediction.

PubMed

Van Hemelen, Geert; Van Genechten, Maarten; Renier, Lieven; Desmedt, Maria; Verbruggen, Elric; Nadjmi, Nasser

2015-07-01

Throughout the history of computing, shortening the gap between the physical and digital world behind the screen has always been strived for. Recent advances in three-dimensional (3D) virtual surgery programs have reduced this gap significantly. Although 3D assisted surgery is now widely available for orthognathic surgery, one might still argue whether a 3D virtual planning approach is a better alternative to a conventional two-dimensional (2D) planning technique. The purpose of this study was to compare the accuracy of a traditional 2D technique and a 3D computer-aided prediction method. A double blind randomised prospective study was performed to compare the prediction accuracy of a traditional 2D planning technique versus a 3D computer-aided planning approach. The accuracy of the hard and soft tissue profile predictions using both planning methods was investigated. There was a statistically significant difference between 2D and 3D soft tissue planning (p < 0.05). The statistically significant difference found between 2D and 3D planning and the actual soft tissue outcome was not confirmed by a statistically significant difference between methods. The 3D planning approach provides more accurate soft tissue planning. However, the 2D orthognathic planning is comparable to 3D planning when it comes to hard tissue planning. This study provides relevant results for choosing between 3D and 2D planning in clinical practice. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Bladder radiotherapy treatment: A retrospective comparison of 3-dimensional conformal radiotherapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy plans

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

Pasciuti, Katia, E-mail: k.pasciuti@virgilio.it; Kuthpady, Shrinivas; Anderson, Anne

To examine tumor's and organ's response when different radiotherapy plan techniques are used. Ten patients with confirmed bladder tumors were first treated using 3-dimensional conformal radiotherapy (3DCRT) and subsequently the original plans were re-optimized using the intensity-modulated radiation treatment (IMRT) and volumetric-modulated arc therapy (VMAT)-techniques. Targets coverage in terms of conformity and homogeneity index, TCP, and organs' dose limits, including integral dose analysis were evaluated. In addition, MUs and treatment delivery times were compared. Better minimum target coverage (1.3%) was observed in VMAT plans when compared to 3DCRT and IMRT ones confirmed by a statistically significant conformity index (CI) results.more » Large differences were observed among techniques in integral dose results of the femoral heads. Even if no statistically significant differences were reported in rectum and tissue, a large amount of energy deposition was observed in 3DCRT plans. In any case, VMAT plans provided better organs and tissue sparing confirmed also by the normal tissue complication probability (NTCP) analysis as well as a better tumor control probability (TCP) result. Our analysis showed better overall results in planning using VMAT techniques. Furthermore, a total time reduction in treatment observed among techniques including gantry and collimator rotation could encourage using the more recent one, reducing target movements and patient discomfort.« less

Iodine supplementation during pregnancy and lactation. Position statement of the working group on disorders related to iodine deficiency and thyroid dysfunction of the Spanish Society of Endocrinology and Nutrition.

PubMed

Donnay, Sergio; Arena, Jose; Lucas, Anna; Velasco, Inés; Ares, Susana

2014-01-01

Severe and mild iodine deficiency during pregnancy and lactation affects thyroid function of the mother and neonate as well as the infant's neuropsychological development. Studies performed in Spain confirm that most women are iodine deficient during pregnancy and lactation. Pregnant and breast feeding women and women planning to become pregnant should take iodine supplements. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

CLOSURE REPORT FOR CORRECTIVE ACTION UNIT 528: POLYCHLORINATED BIPHENYLS CONTAMINATION NEVADA TEST SITE, NEVADA

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

BECHTEL NEVADA

2006-09-01

This Closure Report (CR) describes the closure activities performed at CAU 528, Polychlorinated Biphenyls Contamination, as presented in the Nevada Division of Environmental Protection (NDEP)-approved Corrective Action Plan (CAP) (US. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSAINSO], 2005). The approved closure alternative was closure in place with administrative controls. This CR provides a summary of the completed closure activities, documentation of waste disposal, and analytical data to confirm that the remediation goals were met.

The increased concentration of health plan markets can benefit consumers through lower hospital prices.

PubMed

Melnick, Glenn A; Shen, Yu-Chu; Wu, Vivian Yaling

2011-09-01

The long-term trend of consolidation among US health plans has raised providers' concerns that the concentration of health plan markets can depress their prices. Although our study confirmed that, it also revealed a more complex picture. First, we found that 64 percent of hospitals operate in markets where health plans are not very concentrated, and only 7 percent are in markets that are dominated by a few health plans. Second, we found that in most markets, hospital market concentration exceeds health plan concentration. Third, our study confirmed earlier studies showing that greater hospital market concentration leads to higher hospital prices. Fourth, we found that hospital prices in the most concentrated health plan markets are approximately 12 percent lower than in more competitive health plan markets. Overall, our results show that more concentrated health plan markets can counteract the price-increasing effects of concentrated hospital markets, and that-contrary to conventional wisdom-increased health plan concentration benefits consumers through lower hospital prices as long as health plan markets remain competitive. Our findings also suggest that consumers would benefit from policies that maintained competition in hospital markets or that would restore competition to hospital markets that are uncompetitive.

Robot body self-modeling algorithm: a collision-free motion planning approach for humanoids.

PubMed

Leylavi Shoushtari, Ali

2016-01-01

Motion planning for humanoid robots is one of the critical issues due to the high redundancy and theoretical and technical considerations e.g. stability, motion feasibility and collision avoidance. The strategies which central nervous system employs to plan, signal and control the human movements are a source of inspiration to deal with the mentioned problems. Self-modeling is a concept inspired by body self-awareness in human. In this research it is integrated in an optimal motion planning framework in order to detect and avoid collision of the manipulated object with the humanoid body during performing a dynamic task. Twelve parametric functions are designed as self-models to determine the boundary of humanoid's body. Later, the boundaries which mathematically defined by the self-models are employed to calculate the safe region for box to avoid the collision with the robot. Four different objective functions are employed in motion simulation to validate the robustness of algorithm under different dynamics. The results also confirm the collision avoidance, reality and stability of the predicted motion.

Planning of visually guided reach-to-grasp movements: inference from reaction time and contingent negative variation (CNV).

PubMed

Zaepffel, Manuel; Brochier, Thomas

2012-01-01

We performed electroencephalogram (EEG) recording in a precuing task to investigate the planning processes of reach-to-grasp movements in human. In this reaction time (RT) task, subjects had to reach, grasp, and pull an object as fast as possible after a visual GO signal. We manipulated two parameters: the hand shape for grasping (precision grip or side grip) and the force required to pull the object (high or low). Three seconds before the GO onset, a cue provided advance information about force, grip, both parameters, or no information at all. EEG data show that reach-to-grasp movements generate differences in the topographic distribution of the late Contingent Negative Variation (ICNV) amplitude between the 4 precuing conditions. Along with RT data, it confirms that two distinct functional networks are involved with different time courses in the planning of grip and force. Finally, we outline the composite nature of the lCNV that might reflect both high- and low-level planning processes. Copyright © 2011 Society for Psychophysiological Research.

First flux surface measurements on W7-X

NASA Astrophysics Data System (ADS)

Pedersen, Thomas Sunn; Otte, Matthias; Biedermann, Christoph; Bozhenkov, Sergey; Braeuer, Torsten; Lazerson, Samuel; W7-X Team

2015-11-01

Wendelstein 7-X is rapidly approaching first plasma operation. The full operational B-field of 2.5 T has been reached using the 70 superconducting coils. The first flux surface measurements have recently been successfully performed. This talk will describe the W7-X flux surface measurement system, and show and analyze the first results from this diagnostic, which, at the time of writing this abstract, can be summarized as follows: Confirmation of the existence of nested, closed flux surfaces, first measurements of iota, and detection of the expected internal 5/6 island chain of the OP1.1 configuration. The data obtained so far agree with expectations, and provide a first confirmation of the accuracy of the coil geometry and assembly, as well as diagnostic installation. They also confirm that, with respect to the magnetic topology, plasma operation can start. Plans for, and potentially first results of, measurements of any remnant field errors, will be reported separately at this meeting.

[Prenatal genetic counseling and instruction for deaf families by genetic test].

PubMed

Han, Ming-yu; Huang, Sha-sha; Wang, Guo-jian; Yuan, Yong-yi; Kang, Dong-yang; Zhang, Xin; Dai, Pu

2011-11-01

Analyzed the molecular pathogenesis of probands by means of genetic test and assisted the local Family Planning Institute by providing prenatal genetic counseling and instruction for deaf families who eager to have more baby. Total of forty-three deaf families were recruited by two institutes for family planning from Guangzhou and Weifang. Forty-two families had one deaf child with normal hearing parents. One family was that parents and their child were all deaf. Genetic testing of GJB2, SLC26A4 and mitochondrial DNA (mtDNA) 12SrRNA were firstly performed in probands and their parents, following medical history, physical examination, auditory test and CT scan of temporal bone were completed. And then the genetic information and instruction were provided to each deaf family. Fifteen of these 43 families had positive results of genetic test. In fifteen families, one family was confirmed that the parents and their child all carried homozygous GJB2 mutations and the recurrence risk was 100%. Twelve families were confirmed that the probands carried homozygous/compound GJB2 or SLC26A4 mutations while their parents were GJB2 or SLC26A4 carriers, and the recurrence risk was 25%. One family was confirmed that the proband, diagnosed with enlarged vestibular aqueduct syndrome (EVAS) by CT scan, carried heterozygous SLC26A4 mutation from the mother, and the recurrence risk was still 25% based on the hereditary pattern of EVAS although another SLC26A4 mutation from the father was not found. One family was confirmed that the proband carried a heterozygous GJB2 mutation from the mother and the possibility to be GJB2 carrier for offsprings was 50%. The rest 28 families were that all probands and their parents did not carry GJB2, SLC26A4 and mtDNA 12SrRNA pathological mutation. Genetic testing can provide more accurate and useful prenatal genetic counseling and instruction to deaf families. Meanwhile, it is an ideal way to develop a cooperative relationship with the institute for family planning.

Inspired Planning

ERIC Educational Resources Information Center

Erickson, Paul W.

2009-01-01

Long-range facility planning is a comprehensive process for preparing education institutions for the future and confirm that facilities meet current needs. A long-range facilities plan (LRFP) evaluates how facilities support programs and the educational needs of students, staff and the community. Each school district or college has unique needs…

Technical Note: Partial body irradiation of mice using a customized PMMA apparatus and a clinical 3D planning/LINAC radiotherapy system

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

Karagounis, Ilias V.; Koukourakis, Michael I., E-mail: targ@her.forthnet.gr, E-mail: mkoukour@med.duth.gr; Abatzoglou, Ioannis M., E-mail: abadzoglou@yahoo.gr

Purpose: In vivo radiobiology experiments involving partial body irradiation (PBI) of mice are of major importance because they allow for the evaluation of individual organ tolerance; overcoming current limitations of experiments using lower dose, whole body irradiation. In the current study, the authors characterize and validate an effective and efficient apparatus for multiple animal PBI, directed to the head, thorax, or abdomen of mice. Methods: The apparatus is made of polymethylmethacrylate and consists of a rectangular parallelepiped prism (40 cm × 16 cm × 8 cm), in which five holes were drilled to accomodate standard 60 ml syringes, each housingmore » an unanesthetized, fully immobilized mouse. Following CT-scanning and radiotherapy treatment planning, radiation fields were designed to irradiate the head, thorax, or abdomen of the animal. Thermoluminescent dosimeters (TLDs) were used to confirm the treatment planning dosimetry for primary beam and scattered radiation. Results: Mice are efficiently placed into 60 ml syringes and immobilized, without the use of anesthetics. Although partial rotational movement around the longitudinal axis and a minor 2 mm forward/backward movement are permitted, this does not compromise the irradiation of the chosen body area. TLDs confirmed the dose values predicted by the treatment planning dosimetry, both for primary beam and scattered radiation. Conclusions: The customized PMMA apparatus described and validated is cost-effective, convenient to use, and efficient in performing PBI without the use of anesthesia. The developed apparatus permits the isolated irradiation of the mouse head, thorax, and abdomen. Importantly, the apparatus allows the delivery of PBI to five mice, simultaneously, representing an efficient way to effectively expose a large number of animals to PBI through multiple daily fractions, simulating clinical radiotherapy treatment schedules.« less

Technical Note: Partial body irradiation of mice using a customized PMMA apparatus and a clinical 3D planning/LINAC radiotherapy system.

PubMed

Karagounis, Ilias V; Abatzoglou, Ioannis M; Koukourakis, Michael I

2016-05-01

In vivo radiobiology experiments involving partial body irradiation (PBI) of mice are of major importance because they allow for the evaluation of individual organ tolerance; overcoming current limitations of experiments using lower dose, whole body irradiation. In the current study, the authors characterize and validate an effective and efficient apparatus for multiple animal PBI, directed to the head, thorax, or abdomen of mice. The apparatus is made of polymethylmethacrylate and consists of a rectangular parallelepiped prism (40 cm × 16 cm × 8 cm), in which five holes were drilled to accomodate standard 60 ml syringes, each housing an unanesthetized, fully immobilized mouse. Following CT-scanning and radiotherapy treatment planning, radiation fields were designed to irradiate the head, thorax, or abdomen of the animal. Thermoluminescent dosimeters (TLDs) were used to confirm the treatment planning dosimetry for primary beam and scattered radiation. Mice are efficiently placed into 60 ml syringes and immobilized, without the use of anesthetics. Although partial rotational movement around the longitudinal axis and a minor 2 mm forward/backward movement are permitted, this does not compromise the irradiation of the chosen body area. TLDs confirmed the dose values predicted by the treatment planning dosimetry, both for primary beam and scattered radiation. The customized PMMA apparatus described and validated is cost-effective, convenient to use, and efficient in performing PBI without the use of anesthesia. The developed apparatus permits the isolated irradiation of the mouse head, thorax, and abdomen. Importantly, the apparatus allows the delivery of PBI to five mice, simultaneously, representing an efficient way to effectively expose a large number of animals to PBI through multiple daily fractions, simulating clinical radiotherapy treatment schedules.

Automatic Segmentation of the Eye in 3D Magnetic Resonance Imaging: A Novel Statistical Shape Model for Treatment Planning of Retinoblastoma

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

Ciller, Carlos, E-mail: carlos.cillerruiz@unil.ch; Ophthalmic Technology Group, ARTORG Center of the University of Bern, Bern; Centre d’Imagerie BioMédicale, University of Lausanne, Lausanne

Purpose: Proper delineation of ocular anatomy in 3-dimensional (3D) imaging is a big challenge, particularly when developing treatment plans for ocular diseases. Magnetic resonance imaging (MRI) is presently used in clinical practice for diagnosis confirmation and treatment planning for treatment of retinoblastoma in infants, where it serves as a source of information, complementary to the fundus or ultrasonographic imaging. Here we present a framework to fully automatically segment the eye anatomy for MRI based on 3D active shape models (ASM), and we validate the results and present a proof of concept to automatically segment pathological eyes. Methods and Materials: Manualmore » and automatic segmentation were performed in 24 images of healthy children's eyes (3.29 ± 2.15 years of age). Imaging was performed using a 3-T MRI scanner. The ASM consists of the lens, the vitreous humor, the sclera, and the cornea. The model was fitted by first automatically detecting the position of the eye center, the lens, and the optic nerve, and then aligning the model and fitting it to the patient. We validated our segmentation method by using a leave-one-out cross-validation. The segmentation results were evaluated by measuring the overlap, using the Dice similarity coefficient (DSC) and the mean distance error. Results: We obtained a DSC of 94.90 ± 2.12% for the sclera and the cornea, 94.72 ± 1.89% for the vitreous humor, and 85.16 ± 4.91% for the lens. The mean distance error was 0.26 ± 0.09 mm. The entire process took 14 seconds on average per eye. Conclusion: We provide a reliable and accurate tool that enables clinicians to automatically segment the sclera, the cornea, the vitreous humor, and the lens, using MRI. We additionally present a proof of concept for fully automatically segmenting eye pathology. This tool reduces the time needed for eye shape delineation and thus can help clinicians when planning eye treatment and confirming the extent of the tumor.« less

Automatic Segmentation of the Eye in 3D Magnetic Resonance Imaging: A Novel Statistical Shape Model for Treatment Planning of Retinoblastoma.

PubMed

Ciller, Carlos; De Zanet, Sandro I; Rüegsegger, Michael B; Pica, Alessia; Sznitman, Raphael; Thiran, Jean-Philippe; Maeder, Philippe; Munier, Francis L; Kowal, Jens H; Cuadra, Meritxell Bach

2015-07-15

Proper delineation of ocular anatomy in 3-dimensional (3D) imaging is a big challenge, particularly when developing treatment plans for ocular diseases. Magnetic resonance imaging (MRI) is presently used in clinical practice for diagnosis confirmation and treatment planning for treatment of retinoblastoma in infants, where it serves as a source of information, complementary to the fundus or ultrasonographic imaging. Here we present a framework to fully automatically segment the eye anatomy for MRI based on 3D active shape models (ASM), and we validate the results and present a proof of concept to automatically segment pathological eyes. Manual and automatic segmentation were performed in 24 images of healthy children's eyes (3.29 ± 2.15 years of age). Imaging was performed using a 3-T MRI scanner. The ASM consists of the lens, the vitreous humor, the sclera, and the cornea. The model was fitted by first automatically detecting the position of the eye center, the lens, and the optic nerve, and then aligning the model and fitting it to the patient. We validated our segmentation method by using a leave-one-out cross-validation. The segmentation results were evaluated by measuring the overlap, using the Dice similarity coefficient (DSC) and the mean distance error. We obtained a DSC of 94.90 ± 2.12% for the sclera and the cornea, 94.72 ± 1.89% for the vitreous humor, and 85.16 ± 4.91% for the lens. The mean distance error was 0.26 ± 0.09 mm. The entire process took 14 seconds on average per eye. We provide a reliable and accurate tool that enables clinicians to automatically segment the sclera, the cornea, the vitreous humor, and the lens, using MRI. We additionally present a proof of concept for fully automatically segmenting eye pathology. This tool reduces the time needed for eye shape delineation and thus can help clinicians when planning eye treatment and confirming the extent of the tumor. Copyright © 2015 Elsevier Inc. All rights reserved.

Neuropsychological Performance in Polyconsumer Men Under Treatment. Influence of Age of Onset of Substance Use

PubMed Central

Capella, Maria del Mar; Benaiges, Irina; Adan, Ana

2015-01-01

Neurocognition is a key factor in the development and maintenance of Substance Use Disorders (SUD). However, there are still several aspects that need to be studied in this area. In this study, we elucidate the influence of age of onset of substance use (OSU) on the clinical course and neuropsychological performance of substance use disorder (SUD) patients, as well as to explore the influence of years of education, duration of drug use and premorbid intelligence quotient (IQ) on the cognitive results obtained. An exhaustive neuropsychological battery was used to assess different cognitive domains in 80 male polyconsumers, 41 with earlier OSU (16 years or before: OSU ≤ 16) and 39 with later OSU (17 years or later: OSU ≥ 17). The patients were under treatment with at least 4 months of abstinence confirmed by urinalysis. The OSU ≤ 16 group presented a worse clinical state, as well as a lower premorbid IQ and worse performance in processing speed, visual perception and planning skills. The duration of drug use may account for the differences in planning and processing speed. In this work we discuss the premorbid or acquired nature of the cognitive deficits found. PMID:26155725

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

Lee, S; Ellis, R; Traughber, B

Purpose: Treating gynecological cancers with interstitial high-dose-rate (HDR) brachytherapy requires precise reconstruction of catheter positions to obtain accurate dosimetric plans. In this study, we investigated the degree of reproducibility of dosimetric plans for Syed HDR brachytherapy. Methods: We randomly selected five patients having cervix-vaginal cancer who were recently treated in our clinic with interstitial HDR brachytherapy with a prescription dose of 25–30 Gy in five fractions. Interstitial needles/catheters were placed under fluoroscopic guidance and intra-operative 3T MRI scan was performed to confirm the desired catheter placement for adequate target volume coverage. A CT scan was performed and fused with themore » MRI for delineating high-risk CTV (HR-CTV), intermediate-risk CTV (IR-CTV) and OARs. HDR treatment plans were generated using Oncentra planning software. A single plan was used for all five fractions of treatment for each patient. For this study, we took the original clinical plan and removed all the reconstructed catheters from the plan keeping the original contours unchanged. Then, we manually reconstructed all the catheters and entered the same dwell time from the first original clinical plan. The dosimetric parameters studied were: D90 for HR-CTV and IR-CV, and D2cc for bladder, rectum, sigmoid and bowel. Results: The mean of absolute differences in dosimetric coverage (D90) were (range): 1.3% (1.0–2.0%) and 2.0% (0.9–3.6%) for HR-CTV and IR-CTV, respectively. In case of OARs, the mean of absolute variations in D2cc were (range): 4.7% (0.7–8.9%) for bladder, 1.60% (0.3–3.2%) for rectum, 1.6% (0–3.9%) for sigmoid, and 1.8% (0–5.1%) for bowel. Conclusion: Overall, the reproducibility of interstitial HDR plans was within clinically acceptable limit. Observed maximum variation in D2cc for bladder. If number of catchers and dwell points were relatively low or any one catheter was heavily loaded, then reproducibility of the plan was more sensitive to the accuracy of catheter reconstruction.« less

The potential of polymer gel dosimeters for 3D MR-IGRT quality assurance

NASA Astrophysics Data System (ADS)

Roed, Y.; Ding, Y.; Wen, Z.; Wang, J.; Pinsky, L.; Ibbott, G.

2017-05-01

Advances in radiotherapy technology have enabled more accurate delivery of radiation doses to anatomically complex tumor volumes, while sparing surrounding tissues. The most recent advanced treatment modality combines a radiation delivery system (either Cobalt-60 therapy heads or linear accelerator) with a diagnostic magnetic resonance (MR) scanner to perform MR-image guided radiotherapy (MR-IGRT). For a radiation treatment plan to be delivered successfully with MR-IGRT the compliance with previously established criteria to validate the passing of such plans has to be confirmed. Due to the added strong magnetic field a new set of quality assurance standards has to be developed. Ideal detectors are MR-compatible, can capture complex dose distributions and can be read out with MRI. Polymer gels were investigated as potential three dimensional MR-IGRT quality assurance detectors.

An Online Scheduling Algorithm with Advance Reservation for Large-Scale Data Transfers

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

Balman, Mehmet; Kosar, Tevfik

Scientific applications and experimental facilities generate massive data sets that need to be transferred to remote collaborating sites for sharing, processing, and long term storage. In order to support increasingly data-intensive science, next generation research networks have been deployed to provide high-speed on-demand data access between collaborating institutions. In this paper, we present a practical model for online data scheduling in which data movement operations are scheduled in advance for end-to-end high performance transfers. In our model, data scheduler interacts with reservation managers and data transfer nodes in order to reserve available bandwidth to guarantee completion of jobs that aremore » accepted and confirmed to satisfy preferred time constraint given by the user. Our methodology improves current systems by allowing researchers and higher level meta-schedulers to use data placement as a service where theycan plan ahead and reserve the scheduler time in advance for their data movement operations. We have implemented our algorithm and examined possible techniques for incorporation into current reservation frameworks. Performance measurements confirm that the proposed algorithm is efficient and scalable.« less

Benchmarking of a treatment planning system for spot scanning proton therapy: Comparison and analysis of robustness to setup errors of photon IMRT and proton SFUD treatment plans of base of skull meningioma

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

Harding, R., E-mail: ruth.harding2@wales.nhs.uk; Trnková, P.; Lomax, A. J.

Purpose: Base of skull meningioma can be treated with both intensity modulated radiation therapy (IMRT) and spot scanned proton therapy (PT). One of the main benefits of PT is better sparing of organs at risk, but due to the physical and dosimetric characteristics of protons, spot scanned PT can be more sensitive to the uncertainties encountered in the treatment process compared with photon treatment. Therefore, robustness analysis should be part of a comprehensive comparison between these two treatment methods in order to quantify and understand the sensitivity of the treatment techniques to uncertainties. The aim of this work was tomore » benchmark a spot scanning treatment planning system for planning of base of skull meningioma and to compare the created plans and analyze their robustness to setup errors against the IMRT technique. Methods: Plans were produced for three base of skull meningioma cases: IMRT planned with a commercial TPS [Monaco (Elekta AB, Sweden)]; single field uniform dose (SFUD) spot scanning PT produced with an in-house TPS (PSI-plan); and SFUD spot scanning PT plan created with a commercial TPS [XiO (Elekta AB, Sweden)]. A tool for evaluating robustness to random setup errors was created and, for each plan, both a dosimetric evaluation and a robustness analysis to setup errors were performed. Results: It was possible to create clinically acceptable treatment plans for spot scanning proton therapy of meningioma with a commercially available TPS. However, since each treatment planning system uses different methods, this comparison showed different dosimetric results as well as different sensitivities to setup uncertainties. The results confirmed the necessity of an analysis tool for assessing plan robustness to provide a fair comparison of photon and proton plans. Conclusions: Robustness analysis is a critical part of plan evaluation when comparing IMRT plans with spot scanned proton therapy plans.« less

Implementation rates of uro-oncology multidisciplinary meeting decisions.

PubMed

Kinnear, Ned; Smith, Riley; Hennessey, Derek B; Bolton, Damien; Sengupta, Shomik

2017-11-01

To assess implementation rates of the consensus plans made at the uro-oncology multidisciplinary meeting (MDM) of an Australian tertiary centre, and analyse obstacles to implementation. A retrospective review was performed of all patients discussed at the uro-oncology MDM at our institution between 1 January and 30 June 2015. Rates of referral for MDM discussion after a new histological diagnosis of malignancy, categorised by tumour type, were assessed. Patient records were interrogated to confirm MDM plan implementation, with the outcomes examined being completion of MDM plan within 3 months and factors preventing implementation. During the enrolment period, from 291 uro-oncological procedures, 240 yielded malignant histology of which 160 (67%) were discussed at the MDM. Overall, 202 patients, including 32 females, were discussed at the uro-oncology MDM. MDM consensus plans were implemented in 184 (91.1%) patients. Reasons for deviation from the MDM plan included delay in care, patient deterioration or comorbidities, patient preference, consultant decision, loss to follow-up, and change in patient scenario due to additional new information. The MDM is increasingly important in the care of uro-oncology patients, with about two-thirds of new diagnoses currently captured. There appear to be few barriers to the implementation of consensus plans, with nearly all patients undergoing the recommended management. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Irradiation performance of HTGR recycle fissile fuel

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

Homan, F.J.; Long, E.L. Jr.

1976-08-01

The irradiation performance of candidate HTGR recycle fissile fuel under accelerated testing conditions is reviewed. Failure modes for coated-particle fuels are described, and the performance of candidate recycle fissile fuels is discussed in terms of these failure modes. The bases on which UO/sub 2/ and (Th,U)O/sub 2/ were rejected as candidate recycle fissile fuels are outlined, along with the bases on which the weak-acid resin (WAR)-derived fissile fuel was selected as the reference recycle kernel. Comparisons are made relative to the irradiation behavior of WAR-derived fuels of varying stoichiometry and conclusions are drawn about the optimum stoichiometry and the rangemore » of acceptable values. Plans for future testing in support of specification development, confirmation of the results of accelerated testing by real-time experiments, and improvement in fuel performance and reliability are described.« less

The performance of H2O, R134a, SES36, ethanol, and HFE7100 two-phase closed thermosyphons for varying operating parameters and geometry

NASA Astrophysics Data System (ADS)

Andrzejczyk, Rafał; Muszyński, Tomasz

2017-09-01

In this study, the influences of different parameters at performance two-phase closed thermosiphon (TPCT) was presented. It has been confirmed that the working fluid, as well as operating parameters and fill ratio, are very important factors in the performance of TPCT. The article shows characteristics of gravitational tube geometries, as well as the technical characteristic of the most important system components, i.e., the evaporator/condenser. The experiment's plan and the results of it for the two-phase thermosiphon for both evaluated geometries with varying thermal and fluid flow parameters are presented. Experiments were performed for the most perspective working fluids, namely: water, R134a, SES36, ethanol and HFE7100. Obtained research proves the possibility to use TPCT for heat recovery from the industrial waste water.

Am I On the Mark? Technology Planning for the E-Rate.

ERIC Educational Resources Information Center

Kimball, Chip; Sibely, Peter H. R.

1998-01-01

Discusses technology use plans (TUPs) that schools need for E-rate discounts that are available through the Federal Telecommunications Act. A Technology Plan Analysis Rubric is included that is used to evaluate whether a TUP has the elements considered essential as described in educational research and confirmed by practicing technology…

The utility of magnetic resonance imaging in the diagnosis and management of pediatric benign ovarian lesions.

PubMed

Emil, Sherif; Youssef, Fouad; Arbash, Ghaidaa; Baird, Robert; Laberge, Jean-Martin; Puligandla, Pramod; Albuquerque, Pedro

2018-01-31

The utility of magnetic resonance imaging (MRI) in the diagnosis and management of pediatric ovarian lesions has not been well defined. A retrospective review of all girls who underwent MRI evaluation of ovarian masses during the period 2009-2015 was performed. The accuracy of MRI was evaluated by comparing results with surgical findings, pathology reports, and subsequent imaging. The influence of the MRI on the treatment plan was specifically explored. Eighteen girls, 12-17years of age, underwent 27 MRIs, subsequent to ultrasound identification of ovarian lesions. Of 9 neoplastic lesions diagnosed on MRI, 8 (89%) were confirmed by surgical and pathological findings. Of 18 functional lesions, 17 (94.4%) were confirmed pathologically or by resolution on subsequent imaging. Twenty MRI exams (74%) directly influenced the treatment plan, by leading to appropriate operative intervention in 9 and appropriate observation in 11. The extent of ovarian resection was guided by MRI findings in 8 of 9 (89%) neoplastic lesions. For characterizing lesions as neoplastic, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI were 89%, 94%, 94%, 89%, and 93% respectively. MRI can differentiate functional from neoplastic pediatric ovarian masses, and guide ovarian resection in appropriate cases. II. Copyright © 2018. Published by Elsevier Inc.

Applicability of action planning and coping planning to dental flossing among Norwegian adults: a confirmatory factor analysis approach.

PubMed

Astrøm, Anne Nordrehaug

2008-06-01

Using a prospective design and a representative sample of 25-yr-old Norwegians, this study hypothesized that action planning and coping planning will add to the prediction of flossing at 4 wk of follow-up over and above the effect of intention and previous flossing. This study tested the validity of a proposed 3-factor structure of the measurement model of intention, action planning, and coping planning and for its invariance across gender. A survey was conducted in three Norwegian counties, and 1,509 out of 8,000 randomly selected individuals completed questionnaires assessing the constructs of action planning and coping planning related to daily flossing. A random subsample of 500 participants was followed up at 4 wk with a telephone interview to assess flossing. Confirmatory factor analysis (CFA) confirmed the proposed 3-factor model after respecification. Although the chi-square test was statistically significant [chi(2) = 58.501, degrees of freedom (d.f.) = 17), complementary fit indices were satisfactory [goodness-of-fit index (GFI) = 0.99, root mean squared error of approximation (RMSEA) = 0.04]. Multigroup CFA provided evidence of complete invariance of the measurement model across gender. After controlling for previous flossing, intention (beta = 0.08) and action planning (beta = 0.11) emerged as independent predictors of subsequent flossing, accounting for 2.3% of its variance. Factorial validity of intention, action planning and coping planning, and the validity of action planning in predicting flossing prospectively, was confirmed by the present study.

SU-E-T-250: New IMRT Sequencing Strategy: Towards Intra-Fraction Plan Adaptation for the MR-Linac

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

Kontaxis, C; Bol, G; Lagendijk, J

2014-06-01

Purpose: To develop a new sequencer for IMRT planning that during treatment makes the inclusion of external factors possible and by doing so accounts for intra-fraction anatomy changes. Given a real-time imaging modality that will provide the updated patient anatomy during delivery, this sequencer is able to take these changes into account during the calculation of subsequent segments. Methods: Pencil beams are generated for each beam angle of the treatment and a fluence optimization is performed. The pencil beams, together with the patient anatomy and the above optimal fluence form the input of our algorithm. During each iteration the followingmore » steps are performed: A fluence optimization is done and each beam's fluence is then split to discrete intensity levels. Deliverable segments are calculated for each one of these. Each segment's area multiplied by its intensity describes its efficiency. The most efficient segment among all beams is then chosen to deliver a part of the calculated fluence and the dose that will be delivered by this segment is calculated. This delivered dose is then subtracted from the remaining dose. This loop is repeated until 90% of the dose has been delivered and a final segment weight optimization is performed to reach full convergence. Results: This algorithm was tested in several prostate cases yielding results that meet all clinical constraints. Quality assurance was performed on Delta4 and film phantoms for one of these prostate cases and received clinical acceptance after passing both gamma analyses with the 3%/3mm criteria. Conclusion: A new sequencing algorithm was developed to facilitate the needs of intensity modulated treatment. The first results on static anatomy confirm that it can calculate clinical plans equivalent to those of the commercially available planning systems. We are now working towards 100% dose convergence which will allow us to handle anatomy deformations. This work is financially supported by Elekta AB, Stockholm, Sweden.« less

Dosimetric Comparison of Helical Tomotherapy and Dynamic Conformal Arc Therapy in Stereotactic Radiosurgery for Vestibular Schwannomas

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

Lee, Tsair-Fwu, E-mail: tflee@cc.kuas.edu.t; Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Chao, Pei-Ju

2011-04-01

The dosimetric results of stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) performed using dynamic conformal arc therapy (DCAT) with the Novalis system and helical TomoTherapy (HT) were compared using plan quality indices. The HT plans were created for 10 consecutive patients with VS previously treated with SRS using the Novalis system. The dosimetric indices used to compare the techniques included the conformity index (CI) and homogeneity index (HI) for the planned target volume (PTV), the comprehensive quality index (CQI) for nine organs at risk (OARs), gradient score index (GSI) for the dose drop-off outside the PTV, and plan quality indexmore » (PQI), which was verified using the plan quality discerning power (PQDP) to incorporate 3 plan indices, to evaluate the rival plans. The PTV ranged from 0.27-19.99 cm{sup 3} (median 3.39 cm{sup 3}), with minimum required PTV prescribed doses of 10-16 Gy (median 12 Gy). Both systems satisfied the minimum required PTV prescription doses. HT conformed better to the PTV (CI: 1.51 {+-} 0.23 vs. 1.94 {+-} 0.34; p < 0.01), but had a worse drop-off outside the PTV (GSI: 40.3 {+-} 10.9 vs. 64.9 {+-} 13.6; p < 0.01) compared with DCAT. No significant difference in PTV homogeneity was observed (HI: 1.08 {+-} 0.03 vs. 1.09 {+-} 0.02; p = 0.20). HT had a significantly lower maximum dose in 4 OARs and significant lower mean dose in 1 OAR; by contrast, DCAT had a significantly lower maximum dose in 1 OAR and significant lower mean dose in 2 OARs, with the CQI of the 9 OARs = 0.92 {+-} 0.45. Plan analysis using PQI (HT 0.37 {+-} 0.12 vs. DCAT 0.65 {+-} 0.08; p < 0.01), and verified using the PQDP, confirmed the dosimetric advantage of HT. However, the HT system had a longer beam-on time (33.2 {+-} 7.4 vs. 4.6 {+-} 0.9 min; p < 0.01) and consumed more monitor units (16772 {+-} 3803 vs. 1776 {+-} 356.3; p < 0.01). HT had a better dose conformity and similar dose homogeneity but worse dose gradient than DCAT. Plan analysis confirmed the dosimetric advantage of HT, although not all indices revealed a better outcome for HT. Whether this dosimetric advantage translates into a clinical benefit deserves further investigation.« less

Dose rate evaluation of workers on the operation floor in Fukushima-Daiichi Unit 3

NASA Astrophysics Data System (ADS)

Matsushita, Kaoru; Kurosawa, Masahiko; Shirai, Keisuke; Matsuoka, Ippei; Mukaida, Naoki

2017-09-01

At Fukushima Daiichi Nuclear Power Plant Unit 3, installation of a fuel handling machine is planned to support the removal of spent fuel. The dose rates at the workplace were calculated based on the source distribution measured using a collimator in order to confirm that the dose rates on the operation floor were within a manageable range. It was confirmed that the accuracy of the source distribution was C/M = 1.0-2.4. These dose rates were then used to plan the work on the operation floor.

Intraoperative application of geometric three-dimensional mitral valve assessment package: a feasibility study.

PubMed

Mahmood, Feroze; Karthik, Swaminathan; Subramaniam, Balachundhar; Panzica, Peter J; Mitchell, John; Lerner, Adam B; Jervis, Karinne; Maslow, Andrew D

2008-04-01

To study the feasibility of using 3-dimensional (3D) echocardiography in the operating room for mitral valve repair or replacement surgery. To perform geometric analysis of the mitral valve before and after repair. Prospective observational study. Academic, tertiary care hospital. Consecutive patients scheduled for mitral valve surgery. Intraoperative reconstruction of 3D images of the mitral valve. One hundred and two patients had 3D analysis of their mitral valve. Successful image reconstruction was performed in 93 patients-8 patients had arrhythmias or a dilated mitral valve annulus resulting in significant artifacts. Time from acquisition to reconstruction and analysis was less than 5 minutes. Surgeon identification of mitral valve anatomy was 100% accurate. The study confirms the feasibility of performing intraoperative 3D reconstruction of the mitral valve. This data can be used for confirmation and communication of 2-dimensional data to the surgeons by obtaining a surgical view of the mitral valve. The incorporation of color-flow Doppler into these 3D images helps in identification of the commissural or perivalvular location of regurgitant orifice. With improvements in the processing power of the current generation of echocardiography equipment, it is possible to quickly acquire, reconstruct, and manipulate images to help with timely diagnosis and surgical planning.

Lockheed Martin approach to a Reusable Launch Vehicle (RLV)

NASA Astrophysics Data System (ADS)

Elvin, John D.

1996-03-01

This paper discusses Lockheed Martin's perspective on the development of a cost effective Reusable Launch Vehicle (RLV). Critical to a successful Single Stage To Orbit (SSTO) program are; an economic development plan sensitive to fiscal constraints; a vehicle concept satisfying present and future US launch needs; and an operations concept commensurate with a market driven program. Participation in the economic plan by government, industry, and the commercial sector is a key element of integrating our development plan and funding profile. The RLV baseline concept design, development evolution and several critical trade studies illustrate the superior performance achieved by our innovative approach to the problem of SSTO. Findings from initial aerodynamic and aerothermodynamic wind tunnel tests and trajectory analyses on this concept confirm the superior characteristics of the lifting body shape combined with the Linear Aerospike rocket engine. This Aero Ballistic Rocket (ABR) concept captures the essence of The Skunk Works approach to SSTO RLV technology integration and system engineering. These programmatic and concept development topics chronicle the key elements to implementing an innovative market driven next generation RLV.

Radiographic and ultrasonographic characteristics of ventral abdominal hernia in pigeons (Columba livia).

PubMed

Amer, Mohammed S; Hassan, Elham A; Torad, Faisal A

2018-02-20

Five female egg-laying pigeons presented with painless, reducible, ventral abdominal swellings located between the keel and the pubis, or close to the cloaca. Based on clinical, radiographic, and ultrasonographic examination, these pigeons were diagnosed with ventral abdominal hernia requiring surgical interference. Reduction was successfully performed under general anesthesia. Radiographic and ultrasonographic examinations were beneficial for confirming the diagnosis and visualizing the hernial content for surgical planning. Lateral radiographs were more helpful than ventrodorsal radiographs for identification of the hernial content and its continuation with the abdominal muscles. Ultrasonographic examination offered a non-invasive diagnostic tool that allowed for the differentiation of hernia from other abdominal swellings. In addition, it played a beneficial role in identification of the hernial content and follow up after surgical interference. In conclusion, radiographic and ultrasonographic examinations were beneficial in the diagnosis, surgical planning, and follow up after surgical interference of ventral abdominal hernia in pigeons.

Nickel-Hydrogen Cell Testing Experience, NASA/Goddard Space Flight Center

NASA Technical Reports Server (NTRS)

Rao, Gopalakrishna M.

1999-01-01

The objectives of the project were to test the Nickel-Hydrogen Cell to: (1) verify the Aerospace Cell Flight Worthiness, (2) Elucidate the Aerospace Cell Thermal Behavior, (3) Develop the Aerospace Battery Assembly Design(s) and In-orbit Battery Management plan(s) and (4) Understand the Aerospace Cell Failure Mechanism. The tests included the LEO and GEO Life cycle tests, Calorimetric Analysis, Destructive Physical analysis, and special tests. Charts show the Mission Profile Cycling Data, Stress Cycling Data. The test data complies with the mission requirements, validating the flight worthiness of batteries. The nominal stress and mission profile cycling performance test shows the charge voltage as high as 1.60V and recharge ratio greater than 1.05. It is apparent that the electrochemical signatures alone do not provide conclusive proof for Nickel precharge. The researchers recommend a gas and positive plate analyses for further confirmation.

Succession planning : determining VDOT's professional needs for the 21st century : final report.

DOT National Transportation Integrated Search

1993-01-01

This report addresses the development of a program of succession planning for the Virginia Department of Transportation (VDOT). Transportation industry findings, confirmed by VDOT demographics, indicate a greater-than- average turnover among senior t...

Scheimpflug topographical changes after Femtosecond LASIK for mixed astigmatism - theoretical aspects and case study.

PubMed

Tabacaru, Bogdana; Stanca, Horia Tudor

2017-01-01

Objective: To evaluate the corneal topographical changes after Femtosecond-LASIK surgery in eyes with mixed astigmatism. Methods: We present the analysis of the corneal Scheimpflug topographies of a patient treated with Femtosecond-LASIK technique for bilateral mixed astigmatism. Results: Three-dimensional reconstruction maps and differential anterior curvature maps were used to demonstrate the ablation profile and its stability in time. Conclusions: Visual and refractive results were very good after surgery, being topographically confirmed by the corneal reshaping which was performed as planned, the achieved ablation being stable during the one-year follow-up period.

[Crisis of the professional ethics at educational system of Bosnia and Herzegovina and its relationship].

PubMed

Ziga, Jusuf; Masić, Izet

2005-01-01

In the structure of ruining of the social values system, in post war Bosnia and Herzegovina we possess the worrying degradation of the professional morals in the educational performance: irreal examination, intervention, bribe, sexual black mail and similar. That confirmed the results of the extensive examination which recently was realized on this subject. The negative crisis effects of the professional morals in the educational system will, surely, at the social plan, more long-term reflect. Because, it is no about only in the intelectual-expert, than also about the educational component of personality forming.

Data envelopment analysis model for the appraisal and relative performance evaluation of nurses at an intensive care unit.

PubMed

Osman, Ibrahim H; Berbary, Lynn N; Sidani, Yusuf; Al-Ayoubi, Baydaa; Emrouznejad, Ali

2011-10-01

The appraisal and relative performance evaluation of nurses are very important and beneficial for both nurses and employers in an era of clinical governance, increased accountability and high standards of health care services. They enhance and consolidate the knowledge and practical skills of nurses by identification of training and career development plans as well as improvement in health care quality services, increase in job satisfaction and use of cost-effective resources. In this paper, a data envelopment analysis (DEA) model is proposed for the appraisal and relative performance evaluation of nurses. The model is validated on thirty-two nurses working at an Intensive Care Unit (ICU) at one of the most recognized hospitals in Lebanon. The DEA was able to classify nurses into efficient and inefficient ones. The set of efficient nurses was used to establish an internal best practice benchmark to project career development plans for improving the performance of other inefficient nurses. The DEA result confirmed the ranking of some nurses and highlighted injustice in other cases that were produced by the currently practiced appraisal system. Further, the DEA model is shown to be an effective talent management and motivational tool as it can provide clear managerial plans related to promoting, training and development activities from the perspective of nurses, hence increasing their satisfaction, motivation and acceptance of appraisal results. Due to such features, the model is currently being considered for implementation at ICU. Finally, the ratio of the number DEA units to the number of input/output measures is revisited with new suggested values on its upper and lower limits depending on the type of DEA models and the desired number of efficient units from a managerial perspective.

[Analysis of the Burkinabe National Health Program for the Elderly (BNPEH) 2008-2012].

PubMed

Berthé-Sanou, Lalla; Berthé, Abdramane; Drabo, Maxime; Badini-Kinda, Fatoumata; Somé, Mathias; Ouedraogo, Dieudonné; Macq, Jean

2013-01-01

As a result of ageing of the population, most countries of sub-Saharan Africa, either spontaneously and/or in response to international incentives, are starting to develop sectorial or multisectorial action plans in favour of the elderly. Are these plans relevant and consistent and do they improve the health of the elderly? This study was performed to assess the relevance, consistency and implementation of the National Health Programme for the Elderly (PNSPA) 2008-2012 in Burkina Faso. This qualitative analysis was conducted in Ouagadougou in November-December 2011 in 47 subjects including 27 elderly subjects and 20 stakeholders responsible for the design and/or implementation of the PNSPA. These respondents were selected rattionally and were individually interviewed. Content analysis was therefore performed. The PNSPA is relevant in the Burkinabe context. It takes into account the health needs of elderly people in Burkina Faso as well as the availability of resources in health centres. It presents several consistency problems. It has rarely been implemented due to lack of political support and inadequate financial resources. The Burkina Faso PNSPA has encountered more difficulties than similar plans in Senegal and Mali, which have also encountered low implementation rates. This situation confirms that the elderly in sub-Saharan Africa constitute a top priority vulnerable population but which is neglected by all actors to varying degrees.

Three-dimensional magnetic resonance imaging based on time-of-flight magnetic resonance angiography for superficial cerebral arteriovenous malformation--technical note.

PubMed

Murata, Takahiro; Horiuchi, Tetsuyoshi; Rahmah, Nunung Nur; Sakai, Keiichi; Hongo, Kazuhiro

2011-01-01

Direct surgery remains important for the treatment of superficial cerebral arteriovenous malformation (AVM). Surgical planning on the basis of careful analysis from various neuroimaging modalities can aid in resection of superficial AVM with favorable outcome. Three-dimensional (3D) magnetic resonance (MR) imaging reconstructed from time-of-flight (TOF) MR angiography was developed as an adjunctive tool for surgical planning of superficial AVM. 3-T TOF MR imaging without contrast medium was performed preoperatively in patients with superficial AVM. The images were imported into OsiriX imaging software and the 3D reconstructed MR image was produced using the volume rendering method. This 3D MR image could clearly visualize the surface angioarchitecture of the AVM with the surrounding brain on a single image, and clarified feeding arteries including draining veins and the relationship with sulci or fissures surrounding the nidus. 3D MR image of the whole AVM angioarchitecture was also displayed by skeletonization of the surrounding brain. Preoperative 3D MR image corresponded to the intraoperative view. Feeders on the brain surface were easily confirmed and obliterated during surgery, with the aid of the 3D MR images. 3D MR imaging for surgical planning of superficial AVM is simple and noninvasive to perform, enhances intraoperative orientation, and is helpful for successful resection.

An ex ante control chart for project monitoring using earned duration management observations

NASA Astrophysics Data System (ADS)

Mortaji, Seyed Taha Hossein; Noori, Siamak; Noorossana, Rassoul; Bagherpour, Morteza

2017-12-01

In the past few years, there has been an increasing interest in developing project control systems. The primary purpose of such systems is to indicate whether the actual performance is consistent with the baseline and to produce a signal in the case of non-compliance. Recently, researchers have shown an increased interest in monitoring project's performance indicators, by plotting them on the Shewhart-type control charts over time. However, these control charts are fundamentally designed for processes and ignore project-specific dynamics, which can lead to weak results and misleading interpretations. By paying close attention to the project baseline schedule and using statistical foundations, this paper proposes a new ex ante control chart which discriminates between acceptable (as-planned) and non-acceptable (not-as-planned) variations of the project's schedule performance. Such control chart enables project managers to set more realistic thresholds leading to a better decision making for taking corrective and/or preventive actions. For the sake of clarity, an illustrative example has been presented to show how the ex ante control chart is constructed in practice. Furthermore, an experimental investigation has been set up to analyze the performance of the proposed control chart. As expected, the results confirm that, when a project starts to deflect significantly from the project's baseline schedule, the ex ante control chart shows a respectable ability to detect and report right signals while avoiding false alarms.

Retrospective analysis of imaging techniques for treatment planning and monitoring of obliteration for gamma knife treatment of cerebral arteriovenous malformation.

PubMed

Amponsah, Kwame; Ellis, Thomas L; Chan, Michael D; Lovato, James F; Bourland, J Daniel; deGuzman, Allan F; Ekstrand, Kenneth E; Munley, Michael T; McMullen, Kevin P; Shaw, Edward G; Tatter, Stephen B

2012-10-01

It has been well established that Gamma Knife radiosurgery (GKS) is an effective treatment for brain arteriovenous malformations (AVMs). To evaluate complete obliteration rates for magnetic resonance imaging (MRI)-based GKS treatment planning performed with and without angiography and to conduct a preliminary assessment of the utility of using pulsed arterial spin labeling (PASL) magnetic resonance (MR) perfusion imaging to confirm complete obliteration. Forty-six patients were identified who had undergone GKS without embolization with a minimum follow-up of 2 years. One group was planned with integrated stereotactic angiography and MR (spoiled gradient recalled) images obtained on the day of GKS. A second technique avoided the risk of arteriography by using only axial MR images. Beginning in 2007, PASL MR perfusion imaging was routinely performed as a portion of the follow-up MRI to assess the restoration of normal blood flow of the nidus and surrounding area. The overall obliteration rate for the angiography/MRI group was 88.0% (29 of 33). Patients in the MRI-only group had an obliteration rate of 61.5% (8 of 13), with P=.092 with the Fisher exact test, which is not statistically significant. A Kaplan-Meier analysis was also not statistically significant (log rank test, P=.474). Four of 9 patients with incomplete obliteration on angiography also had shown residual abnormal blood flow on PASL imaging. This retrospective analysis shows that treatment planning technique used in GKS does not play a role in the eventual obliteration of treated AVMs. PASL may have potential in the evaluation of AVM obliteration.

Tank 241-AZ-102 Privatization Push Mode Core Sampling and Analysis Plan

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

RASMUSSEN, J.H.

1999-08-02

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AZ-102. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AZ-102 required to satisfy the Data Quality Objectives For TWRS Privatization Phase I: Confirm Tank TIS An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO) (Nguyen 1999a), Data Quality Objectives For TWRS Privatization Phase 1: Confirm Tank TIS An Appropriate Feed Source For Low-Activity Waste Feed Batch X (LAW DQO) (Nguyen 1999b), Low Activity Waste andmore » High Level Waste Feed Data Quality Objectives (L&H DQO) (Patello et al. 1999) and Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO) (Bloom 1996). The Tank Characterization Technical Sampling Basis document (Brown et al. 1998) indicates that these issues, except the Equipment DQO apply to tank 241-AZ-102 for this sampling event. The Equipment DQO is applied for shear strength measurements of the solids segments only. Poppiti (1999) requires additional americium-241 analyses of the sludge segments. Brown et al. (1998) also identify safety screening, regulatory issues and provision of samples to the Privatization Contractor(s) as applicable issues for this tank. However, these issues will not be addressed via this sampling event. Reynolds et al. (1999) concluded that information from previous sampling events was sufficient to satisfy the safety screening requirements for tank 241 -AZ-102. Push mode core samples will be obtained from risers 15C and 24A to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples, composite the liquids and solids, perform chemical analyses, and provide subsamples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AZ-102 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plan.« less

SU-F-J-156: The Feasibility of MR-Only IMRT Planning for Prostate Anatomy

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

Vaitheeswaran, R; Sivaramakrishnan, KR; Kumar, Prashant

Purpose: For prostate anatomy, previous investigations have shown that simulated CT (sCT) generated from MR images can be used for accurate dose computation. In this study, we demonstrate the feasibility of MR-only IMRT planning for prostate case. Methods: Regular CT (rCT) and MR images of the same patient were acquired for prostate anatomy. Regions-of-interest (ROIs) i.e. target and risk structures are delineated on the rCT. A simulated CT (sCT) is generated from the MR image using the method described by Schadewaldt N et al. Their work establishes the clinical acceptability of dose calculation results on the sCT when compared tomore » rCT. rCT and sCT are rigidly registered to ensure proper alignment between the two images. rCT and sCT are overlaid on each other and slice-wise visual inspection confirms excellent agreement between the two images. ROIs on the rCT are copied over to sCT. Philips AutoPlanning solution is used for generating treatment plans. The same treatment technique protocol (plan parameters and clinical goals) is used to generate AutoPlan-rCT and AutoPlan-sCT respectively for rCT and and sCT. DVH comparison on ROIs and slice-wise evaluation of dose is performed between AutoPlan-rCT and AutoPlan-sCT. Delivery parameters i.e. beam and corresponding segments from the AutoPlan-sCT are copied over to rCT and dose is computed to get AutoPlan-sCT-on-rCT. Results: Plan evaluation is done based on Dose Volume Histogram (DVH) of ROIs and manual slice-wise inspection of dose distribution. Both AutoPlan-rCT and AutoPlan-sCT provide a clinically acceptable plan. Also, AutoPlan-sCT-on-rCT shows excellent agreement with AutoPlan-sCT. Conclusion: The study demonstrates that it is feasible to do IMRT planning on the simulated CT image obtained from MR image for prostate anatomy. The research is supported by Philips India Ltd.« less

Alternative Fuels Data Center: Petroleum and Emission Reduction Planning

Science.gov Websites

Add Goal × Log In You need an account to save your plans. If you already have an account, log in below. Otherwise, create an account. Email address: Password: Confirm password: LOG IN Cancel Forgot

Lunar Reconnaissance Orbiter K-Band (26 GHz) Signal Analysis: Initial Study Results

NASA Astrophysics Data System (ADS)

Morabito, D. D.; Heckman, D.

2017-11-01

Lower frequency telemetry bands are becoming more limited in bandwidth due to increased competition between flight projects and other entities. Higher frequency bands offer significantly more bandwidth and hence the prospect of much higher data rates. Future or prospective flight projects considering higher frequency bands such as Ka-band (32 GHz) for deep-space and K-band (26 GHz) for near-Earth telemetry links are interested in past flight experience with available received data at these frequencies. Given that there is increased degradation due to the atmosphere at these higher frequencies, there is an effort to retrieve flight data of received signal strength to analyze performance under a variety of factors. Such factors include elevation angle, season, and atmospheric conditions. This article reports on the analysis findings of over 10 million observations of received signal strength of the Lunar Reconnaissance Orbiter (LRO) spacecraft collected between 2014 and 2017. We analyzed these data to characterize link performance over a wide range of weather conditions, season, and as a function of elevation angle. Based on this analysis, we have confirmed the safety of using a 3-dB margin for preflight planning purposes. These results suggest that a 3-dB margin with respect to adverse conditions will ensure a 98 to 99 percent data return under 95 percent weather conditions at 26 GHz (K-band), thus confirming expectations from link budget predictions. The results suggest that this margin should be applicable for all elevation angles above 10 deg. Thus, missions that have sufficient power for their desired data rates may opt to use 10 deg as their minimum elevation angle. Limitations of this study include climate variability and the fact that the observations require removal of hotbody noise in order to perform an adequate cumulative distribution function (CDF) analysis, which is planned for a future comprehensive study. Flight projects may use other link margins depending upon available information, uncertainties of non-atmospheric link parameters, and mission phase.

Compatibility Grab Sampling and Analysis Plan for FY 2000

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

SASAKI, L.M.

1999-12-29

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for grab samples obtained to address waste compatibility. It is written in accordance with requirements identified in Data Quality Objectives for Tank Farms Waste Compatibility Program (Mulkey et al. 1999) and Tank Farm Waste Transfer Compatibility Program (Fowler 1999). In addition to analyses to support Compatibility, the Waste Feed Delivery program has requested that tank samples obtained for Compatibility also be analyzed to confirm the high-level waste and/or low-activity waste envelope(s) for the tank waste (Baldwin 1999). The analytical requirements tomore » confirm waste envelopes are identified in Data Quality Objectives for TWRS Privatization Phase I: Confirm Tank T is an Appropriate Feed Source for Low-Activity Waste Feed Batch X (Nguyen 1999a) and Data Quality Objectives for RPP Privatization Phase I: Confirm Tank T is an Appropriate Feed Source for High-Level Waste Feed Batch X (Nguyen 1999b).« less

High Efficiency Low Cost CO2 Compression Using Supersonic Shock Wave Technology

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

Williams, J; Aarnio, M; Grosvenor, A

2010-12-31

Development and testing results from a supersonic compressor are presented. The compressor achieved record pressure ratio for a fully-supersonic stage and successfully demonstrated the technology potential. Several tasks were performed in compliance with the DOE award objectives. A high-pressure ratio compressor was retrofitted to improve rotordynamics behavior and successfully tested. An outside review panel confirmed test results and design approach. A computational fluid dynamics code used to analyze the Ramgen supersonic flowpath was extensively and successfully modified to improve use on high-performance computing platforms. A comprehensive R&D implementation plan was developed and used to lay the groundwork for a futuremore » full-scale compressor demonstration. Conceptual design for a CO2 demonstration compressor was developed and reviewed.« less

External ultrasonography of the neck does not add diagnostic value to integrated positron emission tomography-computed tomography (PET-CT) scanning in the diagnosis of cervical lymph node metastases in patients with esophageal carcinoma.

PubMed

Blom, R L G M; Vliegen, R F A; Schreurs, W M J; Belgers, H J; Stohr, I; Oostenbrug, L E; Sosef, M N

2012-08-01

One of the objectives of preoperative imaging in esophageal cancer patients is the detection of cervical lymph node metastases. Traditionally, external ultrasonography of the neck has been combined with computed tomography (CT) in order to improve the detection of cervical metastases. In general, integrated positron emission tomography-computed tomography (PET-CT) has been shown to be superior to CT or PET regarding staging and therefore may limit the role of external ultrasonography of the neck. The objective of this study was to determine the additional value of external ultrasonography of the neck to PET-CT. This study included all patients referred our center for treatment of esophageal carcinoma. Diagnostic staging was performed to determine treatment plan. Cervical lymph nodes were evaluated by external ultrasonography of the neck and PET-CT. In case of suspect lymph nodes on external ultrasonography or PET-CT, fine needle aspiration (FNA) was performed. Between 2008 and 2010, 170 out of 195 referred patients underwent both external ultrasonography of the neck and PET-CT. Of all patients, 84% were diagnosed with a tumor at or below the distal esophagus. In 140 of 170 patients, the cervical region was not suspect; no FNA was performed. Seven out of 170 patients had suspect nodes on both PET-CT and external ultrasonography. Five out of seven patients had cytologically confirmed malignant lymph nodes, one of seven had benign nodes, in one patient FNA was not performed; exclusion from esophagectomy was based on intra-abdominal metastases. In one out of 170 patients, PET-CT showed suspect nodes combined with a negative external ultrasonography; cytology of these nodes was benign. Twenty-two out of 170 patients had a negative PET-CT with suspect nodes on external ultrasonography. In 18 of 22 patients, cervical lymph nodes were cytologically confirmed benign; in four patients, FNA was not possible or inconclusive. At a median postoperative follow-up of 15 months, only 1% of patients developed cervical lymph node metastases. This study shows no additional value of external ultrasonography to a negative PET-CT. According to our results, it can be omitted in the primary workup. However, suspect lymph nodes on PET-CT should be confirmed by FNA to exclude false positives if it would change treatment plan. © 2011 Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

The efficacy and utilisation of preoperative multiparametric magnetic resonance imaging in robot-assisted radical prostatectomy: does it change the surgical dissection plan?

PubMed

Tavukçu, Hasan Hüseyin; Aytaç, Ömer; Balcı, Numan Cem; Kulaksızoğlu, Haluk; Atuğ, Fatih

2017-12-01

We investigated the effect of the use of multiparametric prostate magnetic resonance imaging (mp-MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robot-assisted radical prostatectomy. We prospectively evaluated 60 consecutive patients, including 30 patients who had (Group 1), and 30 patients who had not (Group 2) mp-MRI before robot-assisted radical prostatectomy. Based on the findings of mp-MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial in the mp-MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), Gleason sum scores and surgical margin positivity. There was no statistically significant difference between the two groups in terms of age, PSA, biopsy Gleason score, final pathological Gleason score and surgical margin positivity. mp-MRI changed the initial surgical plan in 18 of 30 patients (60%) in Group 1. In seventeen of these patients (56%) surgical plan was changed from non-nerve sparing to interfascial nerve sparing plan. In one patient dissection plan was changed to non-nerve sparing technique which had extraprostatic extension on final pathology. Surgical margin positivity was similar in Groups 1, and 2 (16% and 13%, respectively) although, Group 1 had higher number of high- risk patients. mp-MRI confirmed the primary tumour localisation in the final pathology in 27 of of 30 patients (90%). Preoperative mp-MRI effected the decision to perform a nerve-sparing technique in 56% of the patients in our study; moreover, changing the dissection plan from non-nerve-sparing technique to a nerve sparing technique did not increase the rate of surgical margin positivity.

Development of the performance confirmation program at YUCCA mountain, nevada

USGS Publications Warehouse

LeCain, G.D.; Barr, D.; Weaver, D.; Snell, R.; Goodin, S.W.; Hansen, F.D.

2006-01-01

The Yucca Mountain Performance Confirmation program consists of tests, monitoring activities, experiments, and analyses to evaluate the adequacy of assumptions, data, and analyses that form the basis of the conceptual and numerical models of flow and transport associated with a proposed radioactive waste repository at Yucca Mountain, Nevada. The Performance Confirmation program uses an eight-stage risk-informed, performance-based approach. Selection of the Performance Confirmation activities for inclusion in the Performance Confirmation program was done using a risk-informed performance-based decision analysis. The result of this analysis was a Performance Confirmation base portfolio that consists of 20 activities. The 20 Performance Confirmation activities include geologic, hydrologie, and construction/engineering testing. Some of the activities began during site characterization, and others will begin during construction, or post emplacement, and continue until repository closure.

ACHP | Stragetic Sustainability Performance Plans

Science.gov Websites

Sustainability Performance Plan (SSPP). Click here to access these plans. The ACHP's SSPP addresses how the Strategic Sustainability Performance Plan 2012 (PDF) ACHP Strategic Sustainability Performance Plan 2011 (PDF) ACHP Strategic Sustainability Performance Plan 2010 (PDF) Updated August 5, 2013 Return to Top

Investigations into Generalization of Constraint-Based Scheduling Theories with Applications to Space Telescope Observation Scheduling

NASA Technical Reports Server (NTRS)

Muscettola, Nicola; Smith, Steven S.

1996-01-01

This final report summarizes research performed under NASA contract NCC 2-531 toward generalization of constraint-based scheduling theories and techniques for application to space telescope observation scheduling problems. Our work into theories and techniques for solution of this class of problems has led to the development of the Heuristic Scheduling Testbed System (HSTS), a software system for integrated planning and scheduling. Within HSTS, planning and scheduling are treated as two complementary aspects of the more general process of constructing a feasible set of behaviors of a target system. We have validated the HSTS approach by applying it to the generation of observation schedules for the Hubble Space Telescope. This report summarizes the HSTS framework and its application to the Hubble Space Telescope domain. First, the HSTS software architecture is described, indicating (1) how the structure and dynamics of a system is modeled in HSTS, (2) how schedules are represented at multiple levels of abstraction, and (3) the problem solving machinery that is provided. Next, the specific scheduler developed within this software architecture for detailed management of Hubble Space Telescope operations is presented. Finally, experimental performance results are given that confirm the utility and practicality of the approach.

Transforming the Department of State: Adapting Operational Capacities and Capabilities to the Post-9/11 Reality, Evolving Interagency Responsibilities, and the Challenges of the 21st Century

DTIC Science & Technology

2006-04-14

combination of the Strategic Plan, MPPs, and BPPs goals, along with performance, and accountability plans. Three other documents are inherently important...DOS Strategic Plan, Mission Performance Plan (MPP), Bureau Performance Plan ( BPP ). NSC representation, POLADs, Embassy Country Teams, and...the world. DOS Strategic Plan, Mission Performance Plan (MPP), Bureau Performance Plan ( BPP ). NSC representation, POLADs, Exchange

The LCOGT NEO Follow-up Network

NASA Astrophysics Data System (ADS)

Lister, Tim; Greenstreet, Sarah; Gomez, Edward; Christensen, Eric J.; Larson, Stephen M.

2016-10-01

The LCOGT NEO Follow-up Network is using the telescopes of the Las Cumbres Observatory Global Telescope Network (LCOGT) and a web-based target selection, scheduling and data reduction system to confirm NEO candidates and characterize radar-targeted known NEOs. Starting in July 2014, the LCOGT NEO Follow-up Network has observed over 3,500 targets and reported more than 16,000 astrometric and photometric measurements to the Minor Planet Center (MPC).The LCOGT NEO Follow-up Network's main aims are to perform confirming follow-up of the large number of NEO candidates and to perform characterization measurements of radar targets to obtain light curves and rotation rates. The NEO candidates come from the NEO surveys such as Catalina, PanSTARRS, ATLAS, NEOWISE and others. In particular, we are targeting objects in the Southern Hemisphere, where the LCOGT NEO Follow-up Network is the largest resource for NEO observations.LCOGT has completed the first phase of the deployment with the installation and commissioning of the nine 1-meter telescopes at McDonald Observatory (Texas), Cerro Tololo (Chile), SAAO (South Africa) and Siding Spring Observatory (Australia). The telescope network has been fully operational since 2014 May, and observations are being executed remotely and robotically. Future expansion to a site at Ali Observatory, Tibet is planned for 2017-2018.We have developed web-based software called NEOexchange which automatically downloads and aggregates NEO candidates from the Minor Planet Center's NEO Confirmation Page, the Arecibo and Goldstone radar target lists and the NASA ARM list. NEOexchange allows the planning and scheduling of observations on the LCOGT Telescope Network and the tracking of the resulting blocks and generated data. We have recently extended the NEOexchange software to include automated data reduction to re-compute the astrometric solution, determine the photometric zeropoint and find moving objects and present these results to the user via the website.We will present results from the LCOGT NEO Follow-up Network and from the development of the NEOexchange software which is used to schedule, analyze and report observations taken with the LCOGT Network.

Uprated OMS Engine Status-Sea Level Testing Results

NASA Technical Reports Server (NTRS)

Bertolino, J. D.; Boyd, W. C.

1990-01-01

The current Space Shuttle Orbital Maneuvering Engine (OME) is pressure fed, utilizing storable propellants. Performance uprating of this engine, through the use of a gas generator driven turbopump to increase operating pressure, is being pursued by the NASA Johnson Space Center (JSC). Component level design, fabrication, and test activities for this engine system have been on-going since 1984. More recently, a complete engine designated the Integrated Component Test Bed (ICTB), was tested at sea level conditions by Aerojet. A description of the test hardware and results of the sea level test program are presented. These results, which include the test condition operating envelope and projected performance at altitude conditions, confirm the capability of the selected Uprated OME (UOME) configuration to meet or exceed performance and operational requirements. Engine flexibility, demonstrated through testing at two different operational mixture ratios, along with a summary of projected Space Shuttle performance enhancements using the UOME, are discussed. Planned future activities, including ICTB tests at simulated altitude conditions, and recommendations for further engine development, are also discussed.

45 CFR 156.1210 - Confirmation of HHS payment and collections reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

... reports. 156.1210 Section 156.1210 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES Qualified Health Plan Issuer Responsibilities § 156.1210 Confirmation of HHS...

Temporary organ displacement coupled with image-guided, intensity-modulated radiotherapy for paraspinal tumors

PubMed Central

2013-01-01

Background To investigate the feasibility and dosimetric improvements of a novel technique to temporarily displace critical structures in the pelvis and abdomen from tumor during high-dose radiotherapy. Methods Between 2010 and 2012, 11 patients received high-dose image-guided intensity-modulated radiotherapy with temporary organ displacement (TOD) at our institution. In all cases, imaging revealed tumor abutting critical structures. An all-purpose drainage catheter was introduced between the gross tumor volume (GTV) and critical organs at risk (OAR) and infused with normal saline (NS) containing 5-10% iohexol. Radiation planning was performed with the displaced OARs and positional reproducibility was confirmed with cone-beam CT (CBCT). Patients were treated within 36 hours of catheter placement. Radiation plans were re-optimized using pre-TOD OARs to the same prescription and dosimetrically compared with post-TOD plans. A two-tailed permutation test was performed on each dosimetric measure. Results The bowel/rectum was displaced in six patients and kidney in four patients. One patient was excluded due to poor visualization of the OAR; thus 10 patients were analyzed. A mean of 229 ml (range, 80–1000) of NS 5-10% iohexol infusion resulted in OAR mean displacement of 17.5 mm (range, 7–32). The median dose prescribed was 2400 cGy in one fraction (range, 2100–3000 in 3 fractions). The mean GTV Dmin and PTV Dmin pre- and post-bowel TOD IG-IMRT dosimetry significantly increased from 1473 cGy to 2086 cGy (p=0.015) and 714 cGy to 1214 cGy (p=0.021), respectively. TOD increased mean PTV D95 by 27.14% of prescription (p=0.014) while the PTV D05 decreased by 9.2% (p=0.011). TOD of the bowel resulted in a 39% decrease in mean bowel Dmax (p=0.008) confirmed by CBCT. TOD of the kidney significantly decreased mean kidney dose and Dmax by 25% (0.022). Conclusions TOD was well tolerated, reproducible, and facilitated dose escalation to previously radioresistant tumors abutting critical structures while minimizing dose to OARs. PMID:23800073

Stridor: an unusual presentation of juvenile nasopharyngeal angiofibroma

PubMed Central

Singh, Hitendra Prakash; Kumar, Sunil; Vashishtha, Madhukar; Agarwal, Satya Prakash

2014-01-01

Nasopharyngeal angiofibroma is a rare and benign disease, which is mainly found in adolescent male subjects. It is usually diagnosed on clinical grounds on the basis of its presenting symptoms of nasal obstruction, nasal mass and most importantly unprovoked recurrent moderate to severe epistaxis. Imaging studies are only needed to confirm the diagnosis and formulate the management plan. A case of juvenile nasopharyngeal angiofibroma is presented here, which presented to us with severe respiratory distress and stridor. Urgent tracheostomy had to be performed before definitive management could be started. Definitive treatment was excision through modified transpalatal with sublabial route, which resulted in successful outcome. PMID:24711471

Stridor: an unusual presentation of juvenile nasopharyngeal angiofibroma.

PubMed

Singh, Hitendra Prakash; Kumar, Sunil; Vashishtha, Madhukar; Agarwal, Satya Prakash

2014-04-07

Nasopharyngeal angiofibroma is a rare and benign disease, which is mainly found in adolescent male subjects. It is usually diagnosed on clinical grounds on the basis of its presenting symptoms of nasal obstruction, nasal mass and most importantly unprovoked recurrent moderate to severe epistaxis. Imaging studies are only needed to confirm the diagnosis and formulate the management plan. A case of juvenile nasopharyngeal angiofibroma is presented here, which presented to us with severe respiratory distress and stridor. Urgent tracheostomy had to be performed before definitive management could be started. Definitive treatment was excision through modified transpalatal with sublabial route, which resulted in successful outcome.

X-ray satellite

NASA Technical Reports Server (NTRS)

1985-01-01

The 3rd Quarter Status Report on DFVLR's ROSAT project confirms that with regard to technical performance and costs the project is on schedule. The valid schedule for engineering model and flight model completion on May 7, 1985 leads to a launch date on October 30, 1987. Progress in each department is compared to and explained with regard to the milestone plan. Continued problems with the gold damping of the FM-mirror system and contamination of the sterile rooms where the mirrors are stored have led to postponement of milestone 7. It is not yet completely clear to what extent all successive milestones will be affected by this factor.

Monte Carlo based, patient-specific RapidArc QA using Linac log files.

PubMed

Teke, Tony; Bergman, Alanah M; Kwa, William; Gill, Bradford; Duzenli, Cheryl; Popescu, I Antoniu

2010-01-01

A Monte Carlo (MC) based QA process to validate the dynamic beam delivery accuracy for Varian RapidArc (Varian Medical Systems, Palo Alto, CA) using Linac delivery log files (DynaLog) is presented. Using DynaLog file analysis and MC simulations, the goal of this article is to (a) confirm that adequate sampling is used in the RapidArc optimization algorithm (177 static gantry angles) and (b) to assess the physical machine performance [gantry angle and monitor unit (MU) delivery accuracy]. Ten clinically acceptable RapidArc treatment plans were generated for various tumor sites and delivered to a water-equivalent cylindrical phantom on the treatment unit. Three Monte Carlo simulations were performed to calculate dose to the CT phantom image set: (a) One using a series of static gantry angles defined by 177 control points with treatment planning system (TPS) MLC control files (planning files), (b) one using continuous gantry rotation with TPS generated MLC control files, and (c) one using continuous gantry rotation with actual Linac delivery log files. Monte Carlo simulated dose distributions are compared to both ionization chamber point measurements and with RapidArc TPS calculated doses. The 3D dose distributions were compared using a 3D gamma-factor analysis, employing a 3%/3 mm distance-to-agreement criterion. The dose difference between MC simulations, TPS, and ionization chamber point measurements was less than 2.1%. For all plans, the MC calculated 3D dose distributions agreed well with the TPS calculated doses (gamma-factor values were less than 1 for more than 95% of the points considered). Machine performance QA was supplemented with an extensive DynaLog file analysis. A DynaLog file analysis showed that leaf position errors were less than 1 mm for 94% of the time and there were no leaf errors greater than 2.5 mm. The mean standard deviation in MU and gantry angle were 0.052 MU and 0.355 degrees, respectively, for the ten cases analyzed. The accuracy and flexibility of the Monte Carlo based RapidArc QA system were demonstrated. Good machine performance and accurate dose distribution delivery of RapidArc plans were observed. The sampling used in the TPS optimization algorithm was found to be adequate.

The use of air bags for mitigating grade crossing and trespass accidents : literature review and research plan.

DOT National Transportation Integrated Search

2016-06-01

This literature review will confirm prior work in the use of locomotive airbag technologies for vehicle or pedestrian collision : mitigation, and to focus planned activities and tasks for this research. The state of the art in relevant technologies h...

77 FR 64427 - Revisions to the California State Implementation Plan, San Joaquin Valley Unified Air Pollution...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... the California State Implementation Plan, San Joaquin Valley Unified Air Pollution Control District... revisions to the San Joaquin Valley Unified Air Pollution Control District (SJVUAPCD) portion of the..., Gas, and Geothermal Resources confirmed that in the Ventura County Air Pollution Control District...

Road-map to plan and structure the preliminary site investigation program for a geological repository in Japan

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

Deguchi, Akira; Tsuchi, Hiroyuki; Kitayama, Kazumi

2007-07-01

Available in abstract form only. Full text of publication follows: A stepwise site selection process has been adopted for geological disposal of HLW in Japan. Literature surveys (LS), followed by preliminary investigations (PI) and, finally, detailed investigations (DI) in underground facilities will be carried out in the successive selection stages. In the PI stage, surface-based investigations such as borehole surveys and geophysical prospecting will be implemented with two main objectives. The first is to obtain information relating to legal requirements on siting, such as the occurrence of igneous or fault activity, and to confirm the extremely low likelihood of adversemore » impacts on the candidate site resulting from such phenomena. The second is to obtain the information required for the design and performance assessment of the engineered barrier system and the repository. In order to implement these preliminary investigations rigorously and efficiently within the constraints of a limited time period, budget and resources, PI planning before commencing investigations and on-site PI management during the investigation phase are very important issues. The planning and management of PI have to be performed by NUMO staff, but not all staff have sufficient experience in the range of disciplines involved. NUMO therefore decided to compile existing knowledge and experience in the planning and management of investigations in the form of manuals to be used to improve and maintain internal expertise. Experts with experience in overseas investigation programs were requested to prepare these manuals. This paper outlines the structure and scope of the upper level manual (road-map) and discusses NUMO's experience in applying it in 'dry-runs' to model sites. (authors)« less

Applying the theory of planned behavior to self-report dental attendance in Norwegian adults through structural equation modelling approach.

PubMed

Åstrøm, Anne N; Lie, Stein Atle; Gülcan, Ferda

2018-05-31

Understanding factors that affect dental attendance behavior helps in constructing effective oral health campaigns. A socio-cognitive model that adequately explains variance in regular dental attendance has yet to be validated among younger adults in Norway. Focusing a representative sample of younger Norwegian adults, this cross-sectional study provided an empirical test of the Theory of Planned Behavior (TPB) augmented with descriptive norm and action planning and estimated direct and indirect effects of attitudes, subjective norms, descriptive norms, perceived behavioral control and action planning on intended and self-reported regular dental attendance. Self-administered questionnaires provided by 2551, 25-35 year olds, randomly selected from the Norwegian national population registry were used to assess socio-demographic factors, dental attendance as well as the constructs of the augmented TPB model (attitudes, subjective norms, descriptive norms, intention, action planning). A two-stage process of structural equation modelling (SEM) was used to test the augmented TPB model. Confirmatory factor analysis, CFA, confirmed the proposed correlated 6-factor measurement model after re-specification. SEM revealed that attitudes, perceived behavioral control, subjective norms and descriptive norms explained intention. The corresponding standardized regression coefficients were respectively (β = 0.70), (β =0.18), (β = - 0.17) and (β =0.11) (p < 0.001). Intention (β =0.46) predicted action planning and action planning (β =0.19) predicted dental attendance behavior (p < 0.001). The model revealed indirect effects of intention and perceived behavioral control on behavior through action planning and through intention and action planning, respectively. The final model explained 64 and 41% of the total variance in intention and dental attendance behavior. The findings support the utility of the TPB, the expanded normative component and action planning in predicting younger adults' intended- and self-reported dental attendance. Interventions targeting young adults' dental attendance might usefully focus on positive consequences following this behavior accompanied with modeling and group performance.

Lot quality assurance sampling for screening communities hyperendemic for Schistosoma mansoni.

PubMed

Rabarijaona, L P; Boisier, P; Ravaoalimalala, V E; Jeanne, I; Roux, J F; Jutand, M A; Salamon, R

2003-04-01

Lot quality assurance sampling (LQAS) was evaluated for rapid low cost identification of communities where Schistosoma mansoni infection was hyperendemic in southern Madagascar. In the study area, S. mansoni infection shows very focused and heterogeneous distribution requiring multifariousness of local surveys. One sampling plan was tested in the field with schoolchildren and several others were simulated in the laboratory. Randomization and stool specimen collection were performed by voluntary teachers under direct supervision of the study staff and no significant problem occurred. As expected from Receiver Operating Characteristic (ROC) curves, all sampling plans allowed correct identification of hyperendemic communities and of most of the hypoendemic ones. Frequent misclassifications occurred for communities with intermediate prevalence and the cheapest plans had very low specificity. The study confirmed that LQAS would be a valuable tool for large scale screening in a country with scarce financial and staff resources. Involving teachers, appeared to be quite feasible and should not lower the reliability of surveys. We recommend that the national schistosomiasis control programme systematically uses LQAS for identification of communities, provided that sample sizes are adapted to the specific epidemiological patterns of S. mansoni infection in the main regions.

A safe and accurate method to perform esthetic mandibular contouring surgery for Far Eastern Asians.

PubMed

Hsieh, A M-C; Huon, L-K; Jiang, H-R; Liu, S Y-C

2017-05-01

A tapered mandibular contour is popular with Far Eastern Asians. This study describes a safe and accurate method of using preoperative virtual surgical planning (VSP) and an intraoperative ostectomy guide to maximize the esthetic outcomes of mandibular symmetry and tapering while mitigating injury to the inferior alveolar nerve (IAN). Twelve subjects with chief complaints of a wide and square lower face underwent this protocol from January to June 2015. VSP was used to confirm symmetry and preserve the IAN while maximizing the surgeon's ability to taper the lower face via mandibular inferior border ostectomy. The accuracy of this method was confirmed by superimposition of the perioperative computed tomography scans in all subjects. No subjects complained of prolonged paresthesia after 3 months. A safe and accurate protocol for achieving an esthetic lower face in indicated Far Eastern individuals is described. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Conceptual Study on Hypersonic Turbojet Experimental Vehicle (HYTEX)

NASA Astrophysics Data System (ADS)

Taguchi, Hideyuki; Murakami, Akira; Sato, Tetsuya; Tsuchiya, Takeshi

Pre-cooled turbojet engines have been investigated aiming at realization of reusable space transportation systems and hypersonic airplanes. Evaluation methods of these engine performances have been established based on ground tests. There are some plans on the demonstration of hypersonic propulsion systems. JAXA focused on hypersonic propulsion systems as a key technology of hypersonic transport airplane. Demonstrations of Mach 5 class hypersonic technologies are stated as a development target at 2025 in the long term vision. In this study, systems analyses of hypersonic turbojet experiment (HYTEX) with Mach 5 flight capability is performed. Aerodynamic coefficients are obtained by CFD analyses and wind tunnel tests. Small Pre-cooled turbojet is fabricated and tested using liquid hydrogen as fuel. As a result, characteristics of the baseline vehicle shape is clarified, . and effects of pre-cooling are confirmed at the firing test.

Topping cycle for coal-fueled electric power plants using the ceramic helical expander

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

Myers, B.; Landingham, R.; Mohr, P.

Ceramic helical expanders are advocated as the work output element in a 2500/sup 0/F direct coal-fired Brayton topping cycle for central power station application. When combined with a standard steam electric power plant cycle, such a cycle could result in an overall thermal conversion efficiency in excess of 50 percent. The performance, coal tolerance, and system-development-time advantages of the ceramic helical expander approach are enumerated. A perspective on the choice of design and materials is provided. A preliminary consideration of physical properties, economic questions, and service experience has led us to a preference for the silicon nitride and silicon carbidemore » family of materials. A program to confirm the performance and coal tolerance aspects of a ceramic helical expander system is planned.« less

Gastrojejunostomy without partial gastrectomy to manage duodenal stenosis in a dog.

PubMed

Nel, Johannes J; du Plessis, Cornelius J; Coetzee, Gert L

2015-12-09

A nine-year-old female Rottweiler with a history of repeated gastrointestinal ulcerations and three previous surgical interventions related to gastrointestinal ulceration presented with symptoms of anorexia and intermittent vomiting. Benign gastric outflow obstruction was diagnosed in the proximal duodenal area. The initial surgical plan was to perform a pylorectomy with gastroduodenostomy (Billroth I procedure), but owing to substantial scar tissue and adhesions in the area a palliative gastrojejunostomy was performed. This procedure provided a bypass for the gastric contents into the proximal jejunum via the new stoma, yet still allowed bile and pancreatic secretions to flow normally via the patent duodenum. The gastrojejunostomy technique was successful in the surgical management of this case, which involved proximal duodenal stricture in the absence of neoplasia. Regular telephonic followup over the next 12 months confirmed that the patient was doing well.

A new adaptive videogame for training attention and executive functions: design principles and initial validation.

PubMed

Montani, Veronica; De Filippo De Grazia, Michele; Zorzi, Marco

2014-01-01

A growing body of evidence suggests that action videogames could enhance a variety of cognitive skills and more specifically attention skills. The aim of this study was to develop a novel adaptive videogame to support the rehabilitation of the most common consequences of traumatic brain injury (TBI), that is the impairment of attention and executive functions. TBI patients can be affected by psychomotor slowness and by difficulties in dealing with distraction, maintain a cognitive set for a long time, processing different simultaneously presented stimuli, and planning purposeful behavior. Accordingly, we designed a videogame that was specifically conceived to activate those functions. Playing involves visuospatial planning and selective attention, active maintenance of the cognitive set representing the goal, and error monitoring. Moreover, different game trials require to alternate between two tasks (i.e., task switching) or to perform the two tasks simultaneously (i.e., divided attention/dual-tasking). The videogame is controlled by a multidimensional adaptive algorithm that calibrates task difficulty on-line based on a model of user performance that is updated on a trial-by-trial basis. We report simulations of user performance designed to test the adaptive game as well as a validation study with healthy participants engaged in a training protocol. The results confirmed the involvement of the cognitive abilities that the game is supposed to enhance and suggested that training improved attentional control during play.

A new adaptive videogame for training attention and executive functions: design principles and initial validation

PubMed Central

Montani, Veronica; De Filippo De Grazia, Michele; Zorzi, Marco

2014-01-01

A growing body of evidence suggests that action videogames could enhance a variety of cognitive skills and more specifically attention skills. The aim of this study was to develop a novel adaptive videogame to support the rehabilitation of the most common consequences of traumatic brain injury (TBI), that is the impairment of attention and executive functions. TBI patients can be affected by psychomotor slowness and by difficulties in dealing with distraction, maintain a cognitive set for a long time, processing different simultaneously presented stimuli, and planning purposeful behavior. Accordingly, we designed a videogame that was specifically conceived to activate those functions. Playing involves visuospatial planning and selective attention, active maintenance of the cognitive set representing the goal, and error monitoring. Moreover, different game trials require to alternate between two tasks (i.e., task switching) or to perform the two tasks simultaneously (i.e., divided attention/dual-tasking). The videogame is controlled by a multidimensional adaptive algorithm that calibrates task difficulty on-line based on a model of user performance that is updated on a trial-by-trial basis. We report simulations of user performance designed to test the adaptive game as well as a validation study with healthy participants engaged in a training protocol. The results confirmed the involvement of the cognitive abilities that the game is supposed to enhance and suggested that training improved attentional control during play. PMID:24860529

75 FR 57200 - National Poultry Improvement Plan and Auxiliary Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-20

... (ELISA) test to confirm the positive results of other serological tests. We are proposing to remove the ELISA test from this list. The ELISA test is a screening assay and should not be used to confirm... status is negative for Mycoplasma. We would amend this paragraph to include the ELISA and the official...

Knapp confirmed as NSF Director

NASA Astrophysics Data System (ADS)

Edward A. Knapp was confirmed by the Senate in a voice vote on April 15 as the director of the National Science Foundation (NSF). The Senate vote followed a confirmation hearing by the Senate Labor and Human Resources Committee. Knapp, who was nominated by President Reagan to head the foundation in November, had been assistant director for NSF's mathematical and physical sciences (MPS) directorate since July 1982.Allegations that he has been politicizing NSF have beleaguered Knapp since he asked for resignations or firm commitments to leave from three NSF top administrators in December (two of these administrators had been planning to leave, though no resignation dates had been set). Knapp assured the Senate committee during the April 13 confirmation hearings that he made the decision to ask for the resignations and that, although he had discussed his plan with Office of Science and Technology Policy officials, they did not request that certain people be removed in exchange for particular increases in the NSF budget. Knapp consistently has defended himself against the allegations by saying that he wants his own team at the agency.

Feasibility assessment of the interactive use of a Monte Carlo algorithm in treatment planning for intraoperative electron radiation therapy

NASA Astrophysics Data System (ADS)

Guerra, Pedro; Udías, José M.; Herranz, Elena; Santos-Miranda, Juan Antonio; Herraiz, Joaquín L.; Valdivieso, Manlio F.; Rodríguez, Raúl; Calama, Juan A.; Pascau, Javier; Calvo, Felipe A.; Illana, Carlos; Ledesma-Carbayo, María J.; Santos, Andrés

2014-12-01

This work analysed the feasibility of using a fast, customized Monte Carlo (MC) method to perform accurate computation of dose distributions during pre- and intraplanning of intraoperative electron radiation therapy (IOERT) procedures. The MC method that was implemented, which has been integrated into a specific innovative simulation and planning tool, is able to simulate the fate of thousands of particles per second, and it was the aim of this work to determine the level of interactivity that could be achieved. The planning workflow enabled calibration of the imaging and treatment equipment, as well as manipulation of the surgical frame and insertion of the protection shields around the organs at risk and other beam modifiers. In this way, the multidisciplinary team involved in IOERT has all the tools necessary to perform complex MC dosage simulations adapted to their equipment in an efficient and transparent way. To assess the accuracy and reliability of this MC technique, dose distributions for a monoenergetic source were compared with those obtained using a general-purpose software package used widely in medical physics applications. Once accuracy of the underlying simulator was confirmed, a clinical accelerator was modelled and experimental measurements in water were conducted. A comparison was made with the output from the simulator to identify the conditions under which accurate dose estimations could be obtained in less than 3 min, which is the threshold imposed to allow for interactive use of the tool in treatment planning. Finally, a clinically relevant scenario, namely early-stage breast cancer treatment, was simulated with pre- and intraoperative volumes to verify that it was feasible to use the MC tool intraoperatively and to adjust dose delivery based on the simulation output, without compromising accuracy. The workflow provided a satisfactory model of the treatment head and the imaging system, enabling proper configuration of the treatment planning system and providing good accuracy in the dosage simulation.

Independent verification survey report for exposure units Z2-24, Z2-31, Z2-32, AND Z2-36 in zone 2 of the East Tennessee technology park Oak Ridge, Tennessee

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

King, David A.

The U.S. Department of Energy (DOE) Oak Ridge Office of Environmental Management selected Oak Ridge Associated Universities (ORAU), through the Oak Ridge Institute for Science and Education (ORISE) contract, to perform independent verification (IV) at Zone 2 of the East Tennessee Technology Park (ETTP) in Oak Ridge, Tennessee. ORAU has concluded IV surveys, per the project-specific plan (PSP) (ORAU 2013a) covering exposure units (EUs) Z2-24, -31, -32, and -36. The objective of this effort was to verify the target EUs comply with requirements in the Zone 2 Record of Decision (ROD) (DOE 2005), as implemented by using the dynamic verificationmore » strategy presented in the dynamic work plan (DWP) (BJC 2007); and confirm commitments in the DWP were adequately implemented, as verified via IV surveys and soil sampling.« less

The influence of viewing an entertainment-education program on cornea donation intention: a test of the theory of planned behavior.

PubMed

Bae, Hyuhn-Suhck; Kang, Seok

2008-01-01

This study was designed to examine the role of issue involvement and the 3 components of the theory of planned behavior in predicting intentions to sign a cornea donor card. This study also compares viewers and nonviewers of an entertainment-education program in terms of issue involvement and the theory of planned behavior. The breakdown of effects for the latent constructs confirms that issue involvement is an important intermediary in the persuasion process. Issue involvement is a common causal antecedent of attitude, subjective norm, and perceived behavioral control, the last 2 of which, in turn, predict intentions, whereas attitude does not. The revised path model confirms that involvement directly influences intentions. In the comparison of viewers with nonviewers, viewers exhibit a significantly higher degree of involvement, attitude toward cornea donation, subjective norm, perceived behavioral control, and intention to sign a cornea donor card. The overall findings of this study suggest that adding issue involvement in the theory of planned behavior enhances the explanatory power of the theory in predicting intentions.

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

Jermoumi, M; Cao, D; Housley, D

Purpose: In this study, we evaluated the performance of an Elekta linac in the delivery of gated radiotherapy. We examined whether the use of either a short gating window or a long beam hold impacts the accuracy of the delivery Methods: The performance of an Elekta linac in the delivery of gated radiotherapy was assessed using a 20cmX 20cm open field with the radiation delivered using a range of beam-on and beam-off time periods. Two SBRT plans were used to examine the accuracy of gated beam delivery for clinical treatment plans. For the SBRT cases, tests were performed for bothmore » free-breathing based gating and for gated delivery with a simulated breath-hold. A MatriXX 2D ion chamber array was used for data collection, and the gating accuracy was evaluated using gamma score. Results: For the 20cmX20cm open field, the gated beam delivery agreed closely with the non-gated delivery results. Discrepancies in the agreement, however, began to appear with a 5-to-1 ratio of the beam-off to beam-on. For these tight gating windows, each beam-on segment delivered a small number of monitor units. This finding was confirmed with dose distribution analysis from the delivery of the two VMAT plans where the gamma score(±1%,2%/1mm) showed passing rates in the range of 95% to 100% for gating windows of 25%, 38%, 50%, 63%, 75%, and 83%. Using a simulated sinusoidal breathing signal with a 4 second period, the gamma score of freebreathing gating and breath-hold gating deliveries were measured in the range of 95.7% to 100%. Conclusion: The results demonstrate that Elekta linacs can be used to accurately deliver respiratory gated treatments for both free-breathing and breath-hold patients. The accuracy of beams delivered in a gated delivery mode at low small MU proved higher than similar deliveries performed in a non-gated (manually interrupted) fashion.« less

[The study of establishment of the " Chinese provincial Blindness prevention technical guidance group performance evaluation system"].

PubMed

Lu, L N; He, X G; Zhu, J F; Xu, X; Zhang, R; Hu, X; Zou, H D

2016-11-11

Objective: To establish an assessment system, including indexes and scoring methods, that can be used for performance evaluation of the provincial blindness prevention technical guidance group properly and effectively . Methods: The indexes and scoring methods were set based on the core content of The " National Plan of Prevention and Treatment of Blindness (2012-2015)" , the specific requirement and target of the World Health Organization (WHO) "For the General Eye Health: Global plan of Action (2014-2019)" , and the current situation of the China's provinces and autonomous regions. These indexes should be of effectiveness, feasibility, comparability, guidance and advancing. Formed by a literature review of candidate indicators, the framework of the system is built by qualitative assessment. With the Delphi method, the system was further revised and improved. Empirical pilot study was then used to prove the feasibility, followed by the final qualitative analysis that establish the " Chinese provincial Blindness prevention technical guidance group performance evaluation system" . Results: Through the literature review and qualitative assessment, a six dimensional system framework was built, including 6 first-level indicators, 16 second-level indicators, and 29 third-level indicators through Delphi method evaluation. With the variation coefficient method, the coeffiences of the first-level index weight were calculated as: Organization and management 0.15, Development and implementation of blindness prevention plans 0.15, Implementation of blindness prevention projects 0.14, Training 0.17, Health education 0.18, and Cooperation and exchanges 0.21. The specific scoring method for this system is confirmed as: data and files check, field interview, and record interview, sampling investigation. Empirical pilot study was conducted in the Jilin, Guizhou and Gansu provinces, and the self-assessment results from local experts were consistent with the scores from the systems. Conclusion: This system established is appropriate at current time, and it can effectively evaluate the performance of the Chinese provincial Blindness prevention technical guidance group. (Chin J Ophthalmol, 2016, 52:814-824) .

Comparative analysis of operational forecasts versus actual weather conditions in airline flight planning: Summary report

NASA Technical Reports Server (NTRS)

Keitz, J. F.

1982-01-01

The impact of more timely and accurate weather data on airline flight planning with the emphasis on fuel savings is studied. This summary report discusses the results of each of the four major tasks of the study. Task 1 compared airline flight plans based on operational forecasts to plans based on the verifying analyses and found that average fuel savings of 1.2 to 2.5 percent are possible with improved forecasts. Task 2 consisted of similar comparisons but used a model developed for the FAA by SRI International that simulated the impact of ATc diversions on the flight plans. While parts of Task 2 confirm the Task I findings, inconsistency with other data and the known impact of ATC suggests that other Task 2 findings are the result of errors in the model. Task 3 compares segment weather data from operational flight plans with the weather actually observed by the aircraft and finds the average error could result in fuel burn penalties (or savings) of up to 3.6 percent for the average 8747 flight. In Task 4 an in-depth analysis of the weather forecast for the 33 days included in the study finds that significant errors exist on 15 days. Wind speeds in the area of maximum winds are underestimated by 20 to 50 kts., a finding confirmed in the other three tasks.

Yes, there was a moon race

NASA Technical Reports Server (NTRS)

Oberg, James E.

1990-01-01

Examination of newly disclosed evidence confirms that the Soviets were indeed striving to reach the moon before the U.S. in 1969. It is noted that a Soviet unmanned lunar probe crashed on the moon's surface only hours before the U.S. Apollo landing. Now confirmed openly are moon-exploration schedules that were competitive with Apollo plans, the names and histories of Soviet lunar boosters and landers, identities of the lunar cosmonauts; and even photos of manned lunar craft are available. Additional details on the troubled moon-probe program are presented: technical problems, continuous changes in goals, schedules, and planning, vehicle and personnel disasters, transfer of authority between ministries, and political power struggles in the scientific community.

Completed suicide in an autopsy-confirmed case of early onset Alzheimer's disease.

PubMed

Hartzell, Jennifer Wiener; Geary, Richard; Gyure, Kymberly; Chivukula, Venkata Ravi; Haut, Marc W

2018-04-01

We report a case of a 57-year-old male with clinically diagnosed and autopsy-confirmed early onset Alzheimer's disease who completed suicide by gunshot wound to the chest. This case has several unique aspects that have not been discussed in previous case reports of completed suicide in Alzheimer's disease. In particular, our patient's death was highly planned with successful compensation for his cognitive deficits. After all firearms had been removed from the home as a safety precaution, he obtained a new weapon, hid it and left himself cues to find and use it. The case is discussed in the context of literature differentiating the neural circuitry propagating impulsive versus planned suicidal acts.

10 CFR 60.137 - General requirements for performance confirmation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... IN GEOLOGIC REPOSITORIES Technical Criteria Performance Confirmation Requirements § 60.137 General requirements for performance confirmation. The geologic repository operations area shall be designed so as to...

Elucidation of the molecular mechanisms underlying adverse reactions associated with a kinase inhibitor using systems toxicology

PubMed Central

Amemiya, Takahiro; Honma, Masashi; Kariya, Yoshiaki; Ghosh, Samik; Kitano, Hiroaki; Kurachi, Yoshihisa; Fujita, Ken-ichi; Sasaki, Yasutsuna; Homma, Yukio; Abernethy, Darrel R; Kume, Haruki; Suzuki, Hiroshi

2015-01-01

Background/Objectives: Targeted kinase inhibitors are an important class of agents in anticancer therapeutics, but their limited tolerability hampers their clinical performance. Identification of the molecular mechanisms underlying the development of adverse reactions will be helpful in establishing a rational method for the management of clinically adverse reactions. Here, we selected sunitinib as a model and demonstrated that the molecular mechanisms underlying the adverse reactions associated with kinase inhibitors can efficiently be identified using a systems toxicological approach. Methods: First, toxicological target candidates were short-listed by comparing the human kinase occupancy profiles of sunitinib and sorafenib, and the molecular mechanisms underlying adverse reactions were predicted by sequential simulations using publicly available mathematical models. Next, to evaluate the probability of these predictions, a clinical observation study was conducted in six patients treated with sunitinib. Finally, mouse experiments were performed for detailed confirmation of the hypothesized molecular mechanisms and to evaluate the efficacy of a proposed countermeasure against adverse reactions to sunitinib. Results: In silico simulations indicated the possibility that sunitinib-mediated off-target inhibition of phosphorylase kinase leads to the generation of oxidative stress in various tissues. Clinical observations of patients and mouse experiments confirmed the validity of this prediction. The simulation further suggested that concomitant use of an antioxidant may prevent sunitinib-mediated adverse reactions, which was confirmed in mouse experiments. Conclusions: A systems toxicological approach successfully predicted the molecular mechanisms underlying clinically adverse reactions associated with sunitinib and was used to plan a rational method for the management of these adverse reactions. PMID:28725458

48 CFR 1252.216-72 - Performance evaluation plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Performance evaluation....216-72 Performance evaluation plan. As prescribed in (TAR) 48 CFR 1216.406(b), insert the following clause: Performance Evaluation Plan (OCT 1994) (a) A Performance Evaluation Plan shall be unilaterally...

DOT Performance Plan FY 1999

DOT National Transportation Integrated Search

1999-01-01

The Department of Transportation Performance Plan is a companion piece to the DOT Strategic Plan and to the DOT Fiscal Year 1999 Budget Request. The Performance Plan defines those performance indicators and goals that will be used to mark progress to...

Closure Report for Corrective Action Unit 340: NTS Pesticide Release Sites Nevada Test Site, Nevada

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

C. M. Obi

The purpose of this report is to provide documentation of the completed corrective action and to provide data confirming the corrective action. The corrective action was performed in accordance with the approved Corrective Action Plan (CAP) (U.S. Department of Energy [DOE], 1999) and consisted of clean closure by excavation and disposal. The Area 15 Quonset Hut 15-11 was formerly used for storage of farm supplies including pesticides, herbicides, and fertilizers. The Area 23 Quonset Hut 800 was formerly used to clean pesticide and herbicide equipment. Steam-cleaning rinsate and sink drainage occasionally overflowed a sump into adjoining drainage ditches. One ditchmore » flows south and is referred to as the quonset hut ditch. The other ditch flows southeast and is referred to as the inner drainage ditch. The Area 23 Skid Huts were formerly used for storing and mixing pesticide and herbicide solutions. Excess solutions were released directly to the ground near the skid huts. The skid huts were moved to a nearby location prior to the site characterization performed in 1998 and reported in the Corrective Action Decision Document (CADD) (DOE, 1998). The vicinity and site plans of the Area 23 sites are shown in Figures 2 and 3, respectively.« less

Data Validation Package: April 2016 Groundwater Sampling at the Falls City, Texas, Disposal Site

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

Jasso, Tashina; Widdop, Michael

Nine groundwater samples were collected at the Falls City, Texas, Disposal Site as specified in the March 2008 Long-Term Surveillance Plan for the US Department of Energy Falls City Uranium Mill Tailings Disposal Site, Falls City, Texas (DOE-LM/1602-2008). Sampling and analyses were conducted as specified in the Sampling and Analysis Plan for US Department of Energy Office of Legacy Management Sites (LMS/PRO/S04351, continually updated). The wells sampled included the cell performance monitoring wells (0709, 0858, 0880, 0906, and 0921) and the groundwater monitoring wells (0862, 0886, 0891, 0924, and 0963). A duplicate sample was collected from location 0891. Water levelsmore » were measured at each sampled well. Historically, cell performance monitoring wells 0908 and 0916 have not produced water and were confirmed as dry during this sampling event. These wells are completed above the saturated interval in the formation. Notable observations for time-concentration graphs in this report include: (1) uranium concentrations in well 0891 continue to increase; (2) the uranium concentration in well 0880 is higher than the 2015 value and lower than the 2014 value, and it remains within the range of historical values; and (3) uranium concentrations in the other sampled wells are below 2 mg/L and consistent with previous results.« less

Strategic planning by independent community pharmacies.

PubMed

Harrison, Donald L

2005-01-01

(1) To assess the degree and level of use of the strategic planning process (none, partly, fully) by independent community pharmacy owners/managers and (2) to evaluate the relationships between independent community pharmacy owners/managers' level of strategic planning and indicators of pharmacy performance; including new and refill prescriptions filled, gross margin, rated patient care performance, rated dispensing performance, rated non-pharmacy performance, and rated financial performance. Cross-sectional study. United States. Nationwide random sample of 1,250 owners/managers of independent community pharmacies. Mailed survey. Quality of strategic planning conducted; pharmacy performance measures. Only 141 of 527 (26.8%) usable responses indicated use of some (77 pharmacies, 54.6%) or all (64 pharmacies, 45.4%) of the seven steps typical of strategic planning. Significant associations were observed between the level of strategic planning use and all pharmacy performance variables assessed, including indicators such as greater numbers of new and refill prescriptions dispensed, gross margins, patient care performance, dispensing performance, non-pharmacy performance, and financial performance. Greater ratings of pharmacy performance were significantly associated with the level of strategic planning use. Respondents who fully used strategic planning had significantly higher indicators than partial users; respondents who partly used the process had significantly higher ratings than respondents who did not conduct strategic planning.

The current status and future prospects of computer-assisted hip surgery.

PubMed

Inaba, Yutaka; Kobayashi, Naomi; Ike, Hiroyuki; Kubota, So; Saito, Tomoyuki

2016-03-01

The advances in computer assistance technology have allowed detailed three-dimensional preoperative planning and simulation of preoperative plans. The use of a navigation system as an intraoperative assistance tool allows more accurate execution of the preoperative plan, compared to manual operation without assistance of the navigation system. In total hip arthroplasty using CT-based navigation, three-dimensional preoperative planning with computer software allows the surgeon to determine the optimal angle of implant placement at which implant impingement is unlikely to occur in the range of hip joint motion necessary for daily activities of living, and to determine the amount of three-dimensional correction for leg length and offset. With the use of computer navigation for intraoperative assistance, the preoperative plan can be precisely executed. In hip osteotomy using CT-based navigation, the navigation allows three-dimensional preoperative planning, intraoperative confirmation of osteotomy sites, safe performance of osteotomy even under poor visual conditions, and a reduction in exposure doses from intraoperative fluoroscopy. Positions of the tips of chisels can be displayed on the computer monitor during surgery in real time, and staff other than the operator can also be aware of the progress of surgery. Thus, computer navigation also has an educational value. On the other hand, its limitations include the need for placement of trackers, increased radiation exposure from preoperative CT scans, and prolonged operative time. Moreover, because the position of a bone fragment cannot be traced after osteotomy, methods to find its precise position after its movement need to be developed. Despite the need to develop methods for the postoperative evaluation of accuracy for osteotomy, further application and development of these systems are expected in the future. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

EPRI/DOE High Burnup Fuel Sister Pin Test Plan Simplification and Visualization

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

Saltzstein, Sylvia J.; Sorenson, Ken B.; Hanson, Brady

The EPRI/DOE High Burnup Confirmatory Data Project (herein called the "Demo") is a multi-year, multi-entity confirmation demonstration test with the purpose of providing quantitative and qualitative data to show how high-burnup fuel ages in dry storage over a ten-year period. The Demo involves obtaining 32 assemblies of high-burnup PWR fuel of four common cladding alloys from the North Anna Nuclear Power Plant, drying them according to standard plant procedures, and then storing them in an NRC-licensed TN-3 2B cask on the North Anna dry storage pad for ten years. After the ten-year storage time, the cask will be opened andmore » the rods will be examined for signs of aging. Twenty-five rods from assemblies of similar claddings, in-reactor placement, and burnup histories (herein called "sister rods") have been shipped from the North Anna Nuclear Power Plant and are currently being nondestructively tested at Oak Ridge National Laboratory. After the non-destructive testing has been completed for each of the twenty-five rods, destructive analysis will be performed at ORNL, PNNL, and ANL to obtain mechanical data. Opinions gathered from the expert interviews, ORNL and PNNL Sister Rod Test Plans, and numerous meetings has resulted in the Simplified Test Plan described in this document. Some of the opinions and discussions leading to the simplified test plan are included here. Detailed descriptions and background are in the ORNL and PNNL plans in the appendices . After the testing described in this simplified test plan h as been completed , the community will review all the collected data and determine if additional testing is needed.« less

SU-E-J-74: Dosimetric Advantages of Adaptive Radiotherapy for Head and Neck Cancer Are Confirmed with Weekly CBCT Images

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

Shang, Q; Li, Z; Qu, H

2015-06-15

Purpose: Our previous study showed that weekly dose monitoring using cone-beam CT (CBCT) images can guide the timing and need for adaptive re-planning during the treatment of head and neck (HN) cancer. Here we aim to confirm the dosimetric improvement of adaptive radiotherapy (ART) using weekly CBCTs. Methods: We randomly selected seven HN patients treated with ART due to noticeable anatomic changes. Twenty weekly images acquired during the second treatment course were included. These CBCTs were aligned with both the initial and re-planning simulation CTs according to the clinical shifts. Daily doses were re-calculated for both the initial and adaptivemore » plans. Contours of the tumor and organs-at-risk (OARs) were manually delineated by a physician on the re-planning CT and then were transferred to the CBCTs for plan evaluation. Contour modifications were made based on the daily anatomic changes observed on CBCTs. All patients were treated with 70Gy to the primary tumor and 56Gy to the elective lymph nodes. Results: Volumetric changes of the tumor (range — 43.9%∼+15.9%) were observed. The average D99 to the primary tumor was (70.1±2.0)Gy (range 62.2∼72.5Gy) for the adaptive plan and (66.0±5.5)Gy (range 50.9∼70.7Gy) for the initial plan(p<<0.01). The average D99 to the elective neck was (56.3±1.3)Gy (range 52.8∼59.2Gy) for the adaptive plan and (52.4±7.0)Gy (range 37.7∼58.6Gy) for the initial plan(p=0.01). The parotid decreased in volume during the treatment course (range 7.3%∼42.2%). The average D-mean to the spared parotid decreased by 15.3% (p=0.002) for the adaptive plan when compared to the original. With ART, 4 out of 7 patients experienced better sparing of the spinal cord (D-max reduced by 2.5%∼10.2%) and the oral cavity (D-mean reduced by 3.5%∼20.1%). Conclusion: Weekly CBCT dosimetry confirms that ART is an effective method to accommodate on-treatment anatomic changes. In select patients, tumor coverage and OAR sparing may be improved with ART. Research is funded by Siemens.« less

Suspected placenta accreta and cesarean hysterectomy: observational cohort utilizing an intraoperative decision strategy.

PubMed

Weiniger, Carolyn F; Kabiri, Doron; Ginosar, Yehuda; Ezra, Yossef; Shachar, BatZion; Lyell, Deirdre J

2016-03-01

Planned cesarean hysterectomy (CH) is recommended to minimize morbidity for suspected placenta accreta (PA), yet this ends fertility. We examined CH frequency and post-operative morbidities for suspected PA cases when an intra-operative decision strategy to perform CH was used. Suspected PA cases were pre-operatively identified in one tertiary care center. Women were assessed intra-operatively, prior to uterine incision, for immediate CH or for attempted placental separation. We compared outcomes among women with versus without PA (surgical and/or pathologic diagnosis), and examined outcomes following immediate CH versus attempted placental separation. Our cohort, from 2002 to 2012, comprised 99 women with suspected PA; 54 (54.5%) had PA diagnosed by surgery/pathology, and 45 (45.5%) did not. Among women diagnoses surgically or pathologically with PA, CH was performed for 46/54 (85%); 8 women with suspected PA had successful placental separation. 27 of the 46 CH were performed immediately following uterine wall examination and 19 were performed following attempted placental separation. We received histological confirmation of the clinical placenta accreta diagnosis for 24/46 (52.2%) cases, and in 22/46 (47.8%) cases the histology did not confirm the clinical diagnosis. Surgery duration, packed cell transfusion requirement and postoperative outcomes were similar among women with PA regardless of immediate CH versus attempted placental separation, except for a higher cystotomy rates following attempted placental separation. Emergency deliveries were performed at significantly earlier gestational ages. Among women with suspected PA, an intra-operative CH decision allows some women to avoid CH. Consideration of attempted placental separation did not increase blood transfusion or post-operative complications, but was associated with a higher rate of cystotomy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

TU-FG-201-03: Automatic Pre-Delivery Verification Using Statistical Analysis of Consistencies in Treatment Plan Parameters by the Treatment Site and Modality

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

Liu, S; Wu, Y; Chang, X

Purpose: A novel computer software system, namely APDV (Automatic Pre-Delivery Verification), has been developed for verifying patient treatment plan parameters right prior to treatment deliveries in order to automatically detect and prevent catastrophic errors. Methods: APDV is designed to continuously monitor new DICOM plan files on the TMS computer at the treatment console. When new plans to be delivered are detected, APDV checks the consistencies of plan parameters and high-level plan statistics using underlying rules and statistical properties based on given treatment site, technique and modality. These rules were quantitatively derived by retrospectively analyzing all the EBRT treatment plans ofmore » the past 8 years at authors’ institution. Therapists and physicists will be notified with a warning message displayed on the TMS computer if any critical errors are detected, and check results, confirmation, together with dismissal actions will be saved into database for further review. Results: APDV was implemented as a stand-alone program using C# to ensure required real time performance. Mean values and standard deviations were quantitatively derived for various plan parameters including MLC usage, MU/cGy radio, beam SSD, beam weighting, and the beam gantry angles (only for lateral targets) per treatment site, technique and modality. 2D-based rules of combined MU/cGy ratio and averaged SSD values were also derived using joint probabilities of confidence error ellipses. The statistics of these major treatment plan parameters quantitatively evaluate the consistency of any treatment plans which facilitates automatic APDV checking procedures. Conclusion: APDV could be useful in detecting and preventing catastrophic errors immediately before treatment deliveries. Future plan including automatic patient identify and patient setup checks after patient daily images are acquired by the machine and become available on the TMS computer. This project is supported by the Agency for Healthcare Research and Quality (AHRQ) under award 1R01HS0222888. The senior author received research grants from ViewRay Inc. and Varian Medical System.« less

Telemedicine in South Africa: success or failure?

PubMed

Gulube, S M; Wynchank, S

2001-01-01

A national telemedicine system for South Africa was planned in 1998. In the first phase, starting in 1999, 28 pilot sites were established in six provinces. The initial applications were teleradiology, tele-ultrasound for antenatal services, telepathology and tele-ophthalmology. Telemedicine equipment was connected by ISDN at 256 kbit/s. From January to September 2000, 2663 radiographic studies were performed at the three Northwest Province teleradiology transmission sites, of which 264 studies (10%) were selected for specialist radiologist reporting by teleradiology. From June to August 2000, nine antenatal care tele-ultrasound consultations were performed in the Northern Cape Province and four transfers were avoided through the use of telemedicine. One area of concern is the relatively low usage of the telemedicine system, which raises questions about its cost-effectiveness. The experience of telemedicine in South Africa confirmed, as others have found, that common problems relate to the technical and organizational challenges of introducing telemedicine.

School asthma screening and case management: attendance and learning outcomes.

PubMed

Moricca, Michelle L; Grasska, Merry A; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C; Galant, Stanley P

2013-04-01

Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided to link these students to medical care and assure asthma action plans at school. In the 40 children with confirmed diagnosis who received CM, academic performance on standardized testing postintervention was similar to the 76 children who were low risk for asthma. Average days absent due to illness in the CM group were reduced from 5.8 to 3.7 days in the postintervention school year. School nurse screening, CM, and collaboration with a medical provider resulted in early identification, referral, and subsequent treatment of students at risk for asthma and may have contributed to reduced illness absences.

SU-E-T-504: Usefulness of CT-MR Fusion in Radiotherapy Planning for Prostate Cancer Patient with Bilateral Hip Replacements

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

He, R.; Giri, Shankar; VA Medical Center at Jackson, Mississippi

2014-06-01

Purpose: Target localization of prostate for Intensity Modulated Radiation Therapy (IMRT) in patients with bilateral hip replacements is difficult due to artifacts in Computed Tomography (CT) images generated from the prostheses high Z materials. In this study, Magnetic Resonance (MR) images fused with CT images are tested as a solution. Methods: CT images of 2.5 mm slice thickness were acquired on a GE Lightspeed scanner with a flat-topped couch for a prostate cancer patient with bilateral hip replacements. T2 weighted images of 5 mm separation were acquired on a MR Scanner. After the MR-CT registration on a radiotherapy treatment planningmore » system (Eclipse, Varian), the target volumes were defined by the radiation oncologists on MR images and then transferred to CT images for planning and dose calculation. The CT Hounsfield Units (HU) was reassigned to zero (as water) for artifacts. The Varian flat panel treatment couch was modeled for dose calculation accuracy with heterogeneity correction. A Volume Matrix Arc Therapy (VMAT) and a seven-field IMRT plans were generated, each avoiding any beam transversing the prostheses; the two plans were compared. The superior VMAT plan was used for treating the patient. In-vivo dosimetry was performed using MOSFET (Best Canada) placed in a surgical tube inserted into the patient rectum during therapy. The measured dose was compared with planned dose for MOSFET location. Results: The registration of MR-CT images and the agreement of target volumes were confirmed by three physicians. VMAT plan was deemed superior to IMRT based on dose to critical nearby structures and overall conformality of target dosing. In-vivo measured dose compared with calculated dose was -4.5% which was likely due to attenuation of the surgical tube surrounding MOSFET. Conclusion: When artifacts are present on planning CT due to bilateral hip prostheses, MR-CT image fusion is a feasible solution for target delineation.« less

SU-F-T-574: MLC Based SRS Beam Commissioning - Minimum Target Size Investigation

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

Zakikhani, R; Able, C

2016-06-15

Purpose: To implement a MLC accelerator based SRS program using small fields down to 1 cm × 1 cm and to determine the smallest target size safe for clinical treatment. Methods: Computerized beam scanning was performed in water using a diode detector and a linac-head attached transmission ion chamber to characterize the small field dosimetric aspects of a 6 MV photon beam (Trilogy-Varian Medical Systems, Inc.). The output factors, PDD and profiles of field sizes 1, 2, 3, 4, and 10 cm{sup 2} were measured and utilized to create a new treatment planning system (TPS) model (AAA ver 11021). Staticmore » MLC SRS treatment plans were created and delivered to a homogeneous phantom (Cube 20, CIRS, Inc.) for a 1.0 cm and 1.5 cm “PTV” target. A 12 field DMLC plan was created for a 2.1 cm target. Radiochromic film (EBT3, Ashland Inc.) was used to measure the planar dose in the axial, coronal and sagittal planes. A micro ion chamber (0.007 cc) was used to measure the dose at isocenter for each treatment delivery. Results: The new TPS model was validated by using a tolerance criteria of 2% dose and 2 mm distance to agreement. For fields ≤ 3 cm{sup 2}, the max PDD, Profile and OF difference was 0.9%, 2%/2mm and 1.4% respectively. The measured radiochromic film planar dose distributions had gamma scores of 95.3% or higher using a 3%/2mm criteria. Ion chamber measurements for all 3 test plans effectively met our goal of delivering the dose accurately to within 5% when compared to the expected dose reported by the TPS (1 cm plan Δ= −5.2%, 1.5 cm plan Δ= −2.0%, 2 cm plan Δ= 1.5%). Conclusion: End to end testing confirmed that MLC defined SRS for target sizes ≥ 1.0 cm can be safely planned and delivered.« less

7 CFR 1781.15 - Planning and performing development.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Planning and performing development. 1781.15 Section..., DEPARTMENT OF AGRICULTURE (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS) LOANS AND ADVANCES § 1781.15 Planning and performing development. Planning and performing development...

7 CFR 1781.15 - Planning and performing development.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 12 2011-01-01 2011-01-01 false Planning and performing development. 1781.15 Section..., DEPARTMENT OF AGRICULTURE (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS) LOANS AND ADVANCES § 1781.15 Planning and performing development. Planning and performing development...

Confirmation of gastric tube bedside placement with the sky blue method.

PubMed

Imamura, Takashi; Maeda, Hajime; Kinoshita, Hidetoshi; Shibukawa, Yasuko; Suda, Kiyomi; Fukuda, Yutaka; Goto, Aya; Nagasawa, Katsutoshi

2014-02-01

The purpose was to review our experiences and determine if applying the sky blue method is reliable in confirming gastric tube (GT) placement in neonates. The study population consisted of 44 infants (55 placements) who were admitted to the Takeda General Hospital between April 2012 and March 2013 and who required GT exchange. The sky blue method using indigo carmine (IC) was indicated for planned tube exchange only. Diluted IC was injected into the gastric space via the old GT just before the tube exchange. The tube was exchanged using a standard method. Then, we checked whether the diluted IC could be collected through the new GT or not. The reasons for GT placement were a gestational age of < 35 weeks in 31 (56.4%), poor sucking or swallowing disorders in 17 (30.4%), and respiratory disorders in 7 (12.7%) of the 55 placements. GT placement using the sky blue method was considered successful in 52 placements (94.4%), with the remaining 3 placements (5.6%) considered to be failures due to the inability to obtain IC from the gastric space. No adverse events were observed during the tube exchange period. Based on the results, the sky blue method can be considered to be reliable method for the confirmation of GT placement. These results also suggest that the number of radiologic evaluations performed to confirm correct replacement of the GT in infants can be reduced in the future.

Extreme Tetralogy of Fallot With Polycythemia in a Ferret (Mustela putorius furo).

PubMed

Dias, Sara; Planellas, Marta; Canturri, Albert; Martorell, Jaume

2017-06-01

A 5-month-old, intact male ferret (Mustela putorius furo) was presented with apathy, tachypnea and exercise intolerance. On initial physical examination, tachypnea and cyanosis were the two primary clinical signs detected. The complete blood count also revealed a severe polycythemia, with lymphopenia, neutrophilia and eosinophilia. Further diagnostic imaging tests were performed. The thoracic radiographs revealed cardiomegaly and a diffuse alveolar pulmonary pattern. Consequently, an echocardiography was performed and showed an interventricular septal defect, pulmonic artery occlusion, overriding of the aorta and right ventricle hypertrophy. All abnormalities were compatible with a tetralogy of Fallot (TOF). As a treatment plan, a phlebotomy was performed and the ferret was posteriorly maintained with oxygen and fluid therapy. The following day, the hematocrit decreased 11% and the respiratory distress improved. Four days later, the ferret got clinically worse and was euthanized. A necropsy was performed and confirmed the presence of an extreme TOF with a diffused interstitial pneumonia secondary to Pneumocystis carinii. To the author's knowledge, this is the first report of an extreme tetralogy of Fallot with polycythemia in a ferret. Copyright © 2017 Elsevier Inc. All rights reserved.

Building thermography as a tool in energy audits and building commissioning procedure

NASA Astrophysics Data System (ADS)

Kauppinen, Timo

2007-04-01

A Building Commissioning-project (ToVa) was launched in Finland in the year 2003. A comprehensive commissioning procedure, including the building process and operation stage was developed in the project. This procedure will confirm the precise documentation of client's goals, definition of planning goals and the performance of the building. It is rather usual, that within 1-2 years after introduction the users complain about the defects or performance malfunctions of the building. Thermography is one important manual tool in verifying the thermal performance of the building envelope. In this paper the results of one pilot building (a school) will be presented. In surveying the condition and energy efficiency of buildings, various auxiliary means are needed. We can compare the consumption data of the target building with other, same type of buildings by benchmarking. Energy audit helps to localize and determine the energy saving potential. The most general and also most effective auxiliary means in monitoring the thermal performance of building envelopes is an infrared camera. In this presentation some examples of the use of thermography in energy audits are presented.

Effects of modafinil on non-verbal cognition, task enjoyment and creative thinking in healthy volunteers

PubMed Central

Müller, U.; Rowe, J.B.; Rittman, T.; Lewis, C.; Robbins, T.W.; Sahakian, B.J.

2013-01-01

Background Modafinil, a putative cognitive enhancing drug, has previously been shown to improve performance of healthy volunteers as well as patients with attention deficit disorder and schizophrenia, mainly in tests of executive functions. The aim of this study was to investigate the effects of modafinil on non-verbal cognitive functions in healthy volunteers, with a particular focus on variations of cognitive load, measures of motivational factors and the effects on creative problem-solving. Methods A double-blind placebo-controlled parallel design study evaluated the effect of 200 mg of modafinil (N = 32) or placebo (N = 32) in non-sleep deprived healthy volunteers. Non-verbal tests of divergent and convergent thinking were used to measure creativity. A new measure of task motivation was used, together with more levels of difficulty on neuropsychological tests from the CANTAB battery. Results Improvements under modafinil were seen on spatial working memory, planning and decision making at the most difficult levels, as well as visual pattern recognition memory following delay. Subjective ratings of enjoyment of task performance were significantly greater under modafinil compared with placebo, but mood ratings overall were not affected. The effects of modafinil on creativity were inconsistent and did not reach statistical significance. Conclusions Modafinil reliably enhanced task enjoyment and performance on several cognitive tests of planning and working memory, but did not improve paired associates learning. The findings confirm that modafinil can enhance aspects of highly demanding cognitive performance in non-sleep deprived individuals. This article is part of a Special Issue entitled ‘Cognitive Enhancers’. PMID:22820554

Effects of modafinil on non-verbal cognition, task enjoyment and creative thinking in healthy volunteers.

PubMed

Müller, U; Rowe, J B; Rittman, T; Lewis, C; Robbins, T W; Sahakian, B J

2013-01-01

Modafinil, a putative cognitive enhancing drug, has previously been shown to improve performance of healthy volunteers as well as patients with attention deficit disorder and schizophrenia, mainly in tests of executive functions. The aim of this study was to investigate the effects of modafinil on non-verbal cognitive functions in healthy volunteers, with a particular focus on variations of cognitive load, measures of motivational factors and the effects on creative problem-solving. A double-blind placebo-controlled parallel design study evaluated the effect of 200 mg of modafinil (N = 32) or placebo (N = 32) in non-sleep deprived healthy volunteers. Non-verbal tests of divergent and convergent thinking were used to measure creativity. A new measure of task motivation was used, together with more levels of difficulty on neuropsychological tests from the CANTAB battery. Improvements under modafinil were seen on spatial working memory, planning and decision making at the most difficult levels, as well as visual pattern recognition memory following delay. Subjective ratings of enjoyment of task performance were significantly greater under modafinil compared with placebo, but mood ratings overall were not affected. The effects of modafinil on creativity were inconsistent and did not reach statistical significance. Modafinil reliably enhanced task enjoyment and performance on several cognitive tests of planning and working memory, but did not improve paired associates learning. The findings confirm that modafinil can enhance aspects of highly demanding cognitive performance in non-sleep deprived individuals. This article is part of a Special Issue entitled 'Cognitive Enhancers'. Copyright © 2012 Elsevier Ltd. All rights reserved.

Agility performance in high-level junior basketball players: the predictive value of anthropometrics and power qualities.

PubMed

Sisic, Nedim; Jelicic, Mario; Pehar, Miran; Spasic, Miodrag; Sekulic, Damir

2016-01-01

In basketball, anthropometric status is an important factor when identifying and selecting talents, while agility is one of the most vital motor performances. The aim of this investigation was to evaluate the influence of anthropometric variables and power capacities on different preplanned agility performances. The participants were 92 high-level, junior-age basketball players (16-17 years of age; 187.6±8.72 cm in body height, 78.40±12.26 kg in body mass), randomly divided into a validation and cross-validation subsample. The predictors set consisted of 16 anthropometric variables, three tests of power-capacities (Sargent-jump, broad-jump and medicine-ball-throw) as predictors. The criteria were three tests of agility: a T-Shape-Test; a Zig-Zag-Test, and a test of running with a 180-degree turn (T180). Forward stepwise multiple regressions were calculated for validation subsamples and then cross-validated. Cross validation included correlations between observed and predicted scores, dependent samples t-test between predicted and observed scores; and Bland Altman graphics. Analysis of the variance identified centres being advanced in most of the anthropometric indices, and medicine-ball-throw (all at P<0.05); with no significant between-position-differences for other studied motor performances. Multiple regression models originally calculated for the validation subsample were then cross-validated, and confirmed for Zig-zag-Test (R of 0.71 and 0.72 for the validation and cross-validation subsample, respectively). Anthropometrics were not strongly related to agility performance, but leg length is found to be negatively associated with performance in basketball-specific agility. Power capacities are confirmed to be an important factor in agility. The results highlighted the importance of sport-specific tests when studying pre-planned agility performance in basketball. The improvement in power capacities will probably result in an improvement in agility in basketball athletes, while anthropometric indices should be used in order to identify those athletes who can achieve superior agility performance.

48 CFR 2452.216-73 - Performance evaluation plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Performance evaluation plan... 2452.216-73 Performance evaluation plan. As prescribed in 2416.406(e)(3), insert the following clause in all award fee contracts: Performance Evaluation Plan (AUG 1987) (a) The Government shall...

48 CFR 3052.216-72 - Performance evaluation plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Performance evaluation... CONTRACT CLAUSES Text of Provisions and Clauses 3052.216-72 Performance evaluation plan. As prescribed in... Evaluation Plan (DEC 2003) (a) A Performance Evaluation Plan shall be unilaterally established by the...

National Highway Traffic Safety Administration FY 1995 Performance Plan

DOT National Transportation Integrated Search

1994-09-01

The NHTSA Fiscal Year 1995 performance plan for the Government Performance and Results Act of 1993 (GPRA) is the second in the three year pilot phase of the Act. This plan differs from the FY 1994 plan in two respects: 1) it uses a different "perform...

Using logic models to enhance the methodological quality of primary health-care interventions: guidance from an intervention to promote nutrition care by general practitioners and practice nurses.

PubMed

Ball, Lauren; Ball, Dianne; Leveritt, Michael; Ray, Sumantra; Collins, Clare; Patterson, Elizabeth; Ambrosini, Gina; Lee, Patricia; Chaboyer, Wendy

2017-04-01

The methodological designs underpinning many primary health-care interventions are not rigorous. Logic models can be used to support intervention planning, implementation and evaluation in the primary health-care setting. Logic models provide a systematic and visual way of facilitating shared understanding of the rationale for the intervention, the planned activities, expected outcomes, evaluation strategy and required resources. This article provides guidance for primary health-care practitioners and researchers on the use of logic models for enhancing methodological rigour of interventions. The article outlines the recommended steps in developing a logic model using the 'NutriCare' intervention as an example. The 'NutriCare' intervention is based in the Australian primary health-care setting and promotes nutrition care by general practitioners and practice nurses. The recommended approach involves canvassing the views of all stakeholders who have valuable and informed opinions about the planned project. The following four targeted, iterative steps are recommended: (1) confirm situation, intervention aim and target population; (2) document expected outcomes and outputs of the intervention; (3) identify and describe assumptions, external factors and inputs; and (4) confirm intervention components. Over a period of 2 months, three primary health-care researchers and one health-services consultant led the collaborative development of the 'NutriCare' logic model. Primary health-care practitioners and researchers are encouraged to develop a logic model when planning interventions to maximise the methodological rigour of studies, confirm that data required to answer the question are captured and ensure that the intervention meets the project goals.

The Use of Magnetic Resonance Imaging in Planning a Pedicled Perforator Flap for Pressure Sores in the Gluteal Region.

PubMed

Park, Sun-June; Lee, Kyeong-Tae; Jeon, Byung-Joon; Woo, Kyong-Je

2018-04-01

Pedicled perforator flaps (PPFs) have been widely used to treat pressure sores in the gluteal region. Selection of a reliable perforator is crucial for successful surgical treatment of pressure sores using PPFs. In this study, we evaluate the role of magnetic resonance imaging (MRI) in planning PPF reconstruction of pressure sores in the gluteal region. A retrospective chart review was performed in patients who had undergone these PPF reconstructions and who had received preoperative MRI. Preoperatively, the extent of infection and necrotic tissue was evaluated using MRI, and a reliable perforator was identified, considering the perforator location in relation to the defect, perforator size, and perforator courses. Intraoperatively, the targeted perforator was marked on the skin at the locations measured on the MRI images, and the marked location was confirmed using intraoperative handheld Doppler. Superior gluteal artery, inferior gluteal artery, or parasacral perforators were used for the PPFs. Surgical outcomes were evaluated. A total of 12 PPFs were performed in 12 patients. Superior gluteal artery perforator flaps were performed in 7 patients, inferior gluteal artery perforator flaps were performed in 3 patients, and parasacral perforator flaps were performed in 2 patients. We could identify a reliable perforator on MRI, and it was found at the predicted locations in all cases. There was only one case of partial flap necrosis. There was no recurrence of the pressure sores during the mean follow-up period of 6.7 months (range = 3-15 months). In selected patients with gluteal pressure sores, MRI is a suitable means for not only providing information about disease extent and comorbidities but also for evaluating perforators for PPF reconstructions.

7 CFR 761.10 - Planning and performing construction and other development.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Planning and performing construction and other... Provisions § 761.10 Planning and performing construction and other development. (a) Purpose. This section describes Agency policies regarding the planning and performing of construction and other development work...

Cultural Resource Protection Plan for the Remote-Handled Low-Level Waste Disposal Facility at the Idaho National Laboratory

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

Pace, Brenda Ringe; Gilbert, Hollie Kae

2015-05-01

This plan addresses cultural resource protection procedures to be implemented during construction of the Remote Handled Low Level Waste project at the Idaho National Laboratory. The plan proposes pre-construction review of proposed ground disturbing activities to confirm avoidance of cultural resources. Depending on the final project footprint, cultural resource protection strategies might also include additional survey, protective fencing, cultural resource mapping and relocation of surface artifacts, collection of surface artifacts for permanent curation, confirmation of undisturbed historic canal segments outside the area of potential effects for construction, and/or archaeological test excavations to assess potential subsurface cultural deposits at known culturalmore » resource locations. Additionally, all initial ground disturbing activities will be monitored for subsurface cultural resource finds, cultural resource sensitivity training will be conducted for all construction field personnel, and a stop work procedure will be implemented to guide assessment and protection of any unanticipated discoveries after initial monitoring of ground disturbance.« less

Dutch healthcare reform: did it result in performance improvement of health plans? A comparison of consumer experiences over time.

PubMed

Hendriks, Michelle; Spreeuwenberg, Peter; Rademakers, Jany; Delnoij, Diana M J

2009-09-17

Many countries have introduced elements of managed competition in their healthcare system with the aim to accomplish more efficient and demand-driven health care. Simultaneously, generating and reporting of comparative healthcare information has become an important quality-improvement instrument. We examined whether the introduction of managed competition in the Dutch healthcare system along with public reporting of quality information was associated with performance improvement in health plans. Experiences of consumers with their health plan were measured in four consecutive years (2005-2008) using the CQI(R) health plan instrument 'Experiences with Healthcare and Health Insurer'. Data were available of 13,819 respondents (response = 45%) of 30 health plans in 2005, of 8,266 respondents (response = 39%) of 32 health plans in 2006, of 8,088 respondents (response = 34%) of 32 health plans in 2007, and of 7,183 respondents (response = 31%) of 32 health plans in 2008. We performed multilevel regression analyses with three levels: respondent, health plan and year of measurement. Per year and per quality aspect, we estimated health plan means while adjusting for consumers' age, education and self-reported health status. We tested for linear and quadratic time effects using chi-squares. The overall performance of health plans increased significantly from 2005 to 2008 on four quality aspects. For three other aspects, we found that the overall performance first declined and then increased from 2006 to 2008, but the performance in 2008 was not better than in 2005. The overall performance of health plans did not improve more often for quality aspects that were identified as important areas of improvement in the first year of measurement. On six out of seven aspects, the performance of health plans that scored below average in 2005 increased more than the performance of health plans that scored average and/or above average in that year. We found mixed results concerning the effects of managed competition on the performance of health plans. To determine whether managed competition in the healthcare system leads to quality improvement in health plans, it is important to examine whether and for what reasons health plans initiate improvement efforts.

Using discrete-event simulation in strategic capacity planning for an outpatient physical therapy service.

PubMed

Rau, Chi-Lun; Tsai, Pei-Fang Jennifer; Liang, Sheau-Farn Max; Tan, Jhih-Cian; Syu, Hong-Cheng; Jheng, Yue-Ling; Ciou, Ting-Syuan; Jaw, Fu-Shan

2013-12-01

This study uses a simulation model as a tool for strategic capacity planning for an outpatient physical therapy clinic in Taipei, Taiwan. The clinic provides a wide range of physical treatments, with 6 full-time therapists in each session. We constructed a discrete-event simulation model to study the dynamics of patient mixes with realistic treatment plans, and to estimate the practical capacity of the physical therapy room. The changes in time-related and space-related performance measurements were used to evaluate the impact of various strategies on the capacity of the clinic. The simulation results confirmed that the clinic is extremely patient-oriented, with a bottleneck occurring at the traction units for Intermittent Pelvic Traction (IPT), with usage at 58.9 %. Sensitivity analysis showed that attending to more patients would significantly increase the number of patients staying for overtime sessions. We found that pooling the therapists produced beneficial results. The average waiting time per patient could be reduced by 45 % when we pooled 2 therapists. We found that treating up to 12 new patients per session had no significantly negative impact on returning patients. Moreover, we found that the average waiting time for new patients decreased if they were given priority over returning patients when called by the therapists.

Analysis of the characteristics of competitive badminton

PubMed Central

Cabello, M; Gonzalez-Badillo, J

2003-01-01

Objective: To describe the characteristics of badminton in order to determine the energy requirements, temporal structure, and movements in the game that indicate performance level. To use the findings to plan training with greater precision. Methods: Eleven badminton players (mean (SD) age 21.8 (3.26) years) with international experience from four different countries (France, Italy, Spain, and Portugal) were studied. Two of the Spanish players were monitored in several matches, giving a total of 14 samples, all during the 1999 Spanish International Tournament. Blood lactate concentration was measured with a reflective photometer. Maximum and average heart rates were recorded with a heart rate monitor. Temporal structure and actions during the matches were determined from video recordings. All variables were measured during and after the game and later analysed using a descriptive study. Results: The results confirmed the high demands of the sport, with a maximum heart rate of 190.5 beats/min and an average of 173.5 beats/min during matches over 28 minutes long and performance intervals of 6.4 seconds and rest time of 12.9 seconds between exchanges. Conclusions: The results suggest that badminton is characterised by repetitive efforts of alactic nature and great intensity which are continuously performed throughout the match. An awareness of these characteristics, together with data on the correlations between certain actions such as unforced errors and winning shots and the final result of the match, will aid in more appropriate planning and monitoring of specific training. PMID:12547746

The performance of the K6 scale in a large school sample: A follow-up study evaluating measurement invariance on the Idaho Youth Prevention Survey.

PubMed

Peiper, Nicholas; Lee, Alexander; Lindsay, Stephanie; Drashner, Nathan; Wing, Janeena

2016-06-01

Since 2013, Idaho has been building capacity and infrastructure through the Strategic Prevention Framework State Incentive Grant to prevent substance abuse and related problems, namely psychiatric morbidity. As this federal initiative requires states to engage in data-driven strategic planning at the state and community levels, clinically validated instruments are particularly valuable in the context of school surveys that have limited space and require timely administration. Thus, the K6 scale was included on the 2014 Idaho Youth Prevention Survey as a measure of nonspecific psychological distress. To verify the unidimensional structure of the K6, principal axis and confirmatory factor analyses were performed in a school-based sample of Idaho students (n = 12,150). A series of multigroup confirmatory factor analyses were then performed to evaluate measurement invariance across gender, age, and race. Overall, the prevalence of serious psychological distress in the past 30 days was 17.2% in Idaho. Factor analyses confirmed the 1-factor solution of the K6. Four levels of measurement invariance were demonstrated across gender, age, and race. Together, these results further illustrate the construct validity of the K6 for use in adolescent populations. Other states are encouraged to include the K6 on their school surveys to facilitate policy planning and resource allocation as well as generate cross-state comparisons. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Report on the oversight assessment of the operational readiness review of the Replacement Tritium Facility at Savannah River Site

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

Lee, B.T.

1993-03-01

This report presents the results of an oversight assessment (OA) conducted by the US Department of Energy's (DOE) Office of Environment, Safety and Health (EH) of operational readiness review (ORR) activities for the Replacement Tritium Facility (RTF) located at Savannah River Site (SRS). The EH OA of this facility took place concurrently with an ORR conducted by the DOE Office of Defense Programs (DP). The DP ORR was conducted from January 19 through February 5, 1993. The EH OA was performed in accordance with the protocol and procedures specified in EH Program for Oversight Assessment of Operational Readiness Evaluations formore » Startups and Restarts,'' dated September 15, 1992. The EH OA Team evaluated the DP ORR to determine whether it was thorough and demonstrated sufficient inquisitiveness to verify that the implementation of programs and procedures adequately ensures the protection of worker safety and health. The EH OA Team performed its evaluation of the DP ORR in the following technical areas: occupational safety, industrial hygiene, and respiratory protection; fire protection; and chemical safety. In the areas of fire protection and chemical safety, the EH OA Team conducted independent vertical-slice reviews to confirm DP ORR results. Within each technical area, the EH OA Team reviewed the DP ORR Plan, including the Criteria Review and Approach Documents (CRADs); the qualifications of individual DP ORR team members; the performance of planned DP ORR activities; and the results of the DP ORR.« less

Report on the oversight assessment of the operational readiness review of the Replacement Tritium Facility at Savannah River Site

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

Lee, B.T.

1993-03-01

This report presents the results of an oversight assessment (OA) conducted by the US Department of Energy`s (DOE) Office of Environment, Safety and Health (EH) of operational readiness review (ORR) activities for the Replacement Tritium Facility (RTF) located at Savannah River Site (SRS). The EH OA of this facility took place concurrently with an ORR conducted by the DOE Office of Defense Programs (DP). The DP ORR was conducted from January 19 through February 5, 1993. The EH OA was performed in accordance with the protocol and procedures specified in ``EH Program for Oversight Assessment of Operational Readiness Evaluations formore » Startups and Restarts,`` dated September 15, 1992. The EH OA Team evaluated the DP ORR to determine whether it was thorough and demonstrated sufficient inquisitiveness to verify that the implementation of programs and procedures adequately ensures the protection of worker safety and health. The EH OA Team performed its evaluation of the DP ORR in the following technical areas: occupational safety, industrial hygiene, and respiratory protection; fire protection; and chemical safety. In the areas of fire protection and chemical safety, the EH OA Team conducted independent vertical-slice reviews to confirm DP ORR results. Within each technical area, the EH OA Team reviewed the DP ORR Plan, including the Criteria Review and Approach Documents (CRADs); the qualifications of individual DP ORR team members; the performance of planned DP ORR activities; and the results of the DP ORR.« less

The LCO Follow-up and Characterization Network and AgentNEO Citizen Science Project

NASA Astrophysics Data System (ADS)

Lister, Tim; Greenstreet, Sarah; Gomez, Edward; Christensen, Eric J.; Larson, Stephen M.

2017-10-01

The LCO NEO Follow-up Network is using the telescopes of the Las Cumbres Observatory (LCO) and a web-based target selection, scheduling and data reduction system to confirm NEO candidates and characterize radar-targeted known NEOs. Starting in July 2014, the LCO NEO Follow-up Network has observed over 4,500 targets and reported more than 25,000 astrometric and photometric measurements to the Minor Planet Center.The LCO NEO Follow-up Network's main aims are to perform confirming follow-up of the large number of NEO candidates and to perform characterization measurements of radar targets to obtain light curves and rotation rates. The NEO candidates come from the NEO surveys such as Catalina, PanSTARRS, ATLAS, NEOWISE and others. In particular, we are targeting objects in the Southern Hemisphere, where the LCO NEO Follow-up Network is the largest resource for NEO observations.The first phase of the LCO Network comprises nine 1-meter and seven 0.4-meter telescopes at site at McDonald Observatory (Texas), Cerro Tololo (Chile), SAAO (South Africa) and Siding Spring Observatory (Australia). The network has been fully operational since 2014 May, and observations are being executed remotely and robotically. Additional 0.4-meter telescopes will be deployed in 2017 and 2x1-meter telescopes for a site at Ali Observatory, Tibet are planned for 2018-2019.We have developed web-based software called NEOexchange which automatically downloads and aggregates NEO candidates from the Minor Planet Center's NEO Confirmation Page, the Arecibo and Goldstone radar target lists and the NASA lists. NEOexchange allows the planning and scheduling of observations on the LCO Telescope Network and the tracking of the resulting blocks and generated data. We have extended the NEOexchange software to include automated scheduling and moving object detection, with the results presented to the user via the website.We will present results from the LCO NEO Follow-up Network and from the development of the NEOexchange software which is used to schedule, analyze and report observations taken with the LCO Network. In addition, we describe a Citizen Science project, AgentNEO, which uses LCO data to allow the public to find and learn about asteroids.

Life-Satisfaction, Values and Goal Achievement: The Case of Planned versus by Chance Searches on the Internet

ERIC Educational Resources Information Center

Casas, Ferran; Gonzalez, Monica; Figuer, Cristina; Coenders, Germa

2004-01-01

The relation between life domains satisfaction and overall life satisfaction, values, internal/external perceived control and the option of planning or by chance searching information on the Internet has been explored in a sample of Spanish adolescents aged 12 to 16 (N=968). Age and sex differences have been examined. Results clearly confirm a…

Transportation planning performance measures : appendices.

DOT National Transportation Integrated Search

2005-10-01

The article is the appendices for Transportation Planning Performance Measures. : Oregon transportation plans, including the statewide Oregon Transportation Plan, and current regional transportation plans for the Portland, Salem, Eugene, and Medford ...

When daily planning improves employee performance: The importance of planning type, engagement, and interruptions.

PubMed

Parke, Michael R; Weinhardt, Justin M; Brodsky, Andrew; Tangirala, Subrahmaniam; DeVoe, Sanford E

2018-03-01

Does planning for a particular workday help employees perform better than on other days they fail to plan? We investigate this question by identifying 2 distinct types of daily work planning to explain why and when planning improves employees' daily performance. The first type is time management planning (TMP)-creating task lists, prioritizing tasks, and determining how and when to perform them. We propose that TMP enhances employees' performance by increasing their work engagement, but that these positive effects are weakened when employees face many interruptions in their day. The second type is contingent planning (CP) in which employees anticipate possible interruptions in their work and plan for them. We propose that CP helps employees stay engaged and perform well despite frequent interruptions. We investigate these hypotheses using a 2-week experience-sampling study. Our findings indicate that TMP's positive effects are conditioned upon the amount of interruptions, but CP has positive effects that are not influenced by the level of interruptions. Through this study, we help inform workers of the different planning methods they can use to increase their daily motivation and performance in dynamic work environments. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Special event planning for the emergency manager.

PubMed

Gaynor, Peter T

2009-11-01

In the domain of emergency management and homeland security there is a lack of a formal planning process at the local level when it comes to special event planning. The unique nature of special event planning demands an understanding of the planning process for both traditional and non-traditional planning partners. This understanding will make certain that local governments apply due diligence when planning for the safety of the public. This paper offers a practical roadmap for planning at the local level. It will address those 'special events' that are beyond routine local events but not of a sufficient scale to be granted National Special Security Event status. Due to the infrequency of 'special events' in most communities, it is imperative that deliberate planning takes place. Upon conclusion, the reader will be able to construct a planning process tailored to the needs of their community, guide both traditional and non-traditional planning partners through the planning process, determine priorities, explore alternatives, plan for contingencies, conduct a confirmation brief, facilitate operations and assemble an after-action report and improvement plan.

Performance-based planning and programming guidebook.

DOT National Transportation Integrated Search

2013-09-01

"Performance-based planning and programming (PBPP) refers to the application of performance management principles within the planning and programming processes of transportation agencies to achieve desired performance outcomes for the multimodal tran...

Low Activity Waste Pretreatment System Bench-Scale Testing: Supporting Integrated Testing and Facility Safety Analyses - 17171

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

Schonewill, Philip P.; Russell, Renee L.; Daniel, Richard C.

The Low Activity Waste Pretreatment System (LAWPS) is being designed to enable the direct feed of waste to the Hanford Tank Waste Treatment and Immobilization Plant (WTP) Low Activity Waste (LAW) facility to be immobilized. Prior to construction of the LAWPS, pilot-scale integrated testing of the key unit operations (crossflow filtration, ion exchange using spherical resorcinol-formaldehyde (sRF) resin) will be conducted by a team led by Washington River Protection Solutions (WRPS) to increase the technology maturation level of the facility’s critical technology elements. As a part of this effort, Pacific Northwest National Laboratory (PNNL) has conducted a series of bench-scalemore » (or engineering-scale) tests to perform two major objectives: (1) support pilot-scale integrated testing of the LAWPS by supplying information or performance data in advance of operating the pilot-scale facility; and (2) collect data needed to establish or confirm assumptions/approaches planned for implementation in the LAWPS safety basis. The first objective was focused in two technical areas: developing simulants that are representative of expected waste feed and can be produced at larger scales, and using these simulants in a bench-scale crossflow filter to establish expected solid-liquid separation performance. The crossflow filter was also used to observe the efficacy (with respect to filter production rate) of selected operational strategies. The second objective also included two technical areas: measuring the effect of sRF resin on hydrogen generation rate under irradiation, and demonstrating that the planned hydrogen management approach is effective and robust. The hydrogen management strategy involves fluidization of the sRF resin bed in the ion exchange columns and recirculating the liquid, a scenario that is planned for testing at full column height. The full height tests at PNNL also supported full-scale IX column testing conducted as part of the technology maturation plan. The experimental approaches used at PNNL in these four technical areas are summarized and selected key preliminary results are provided.« less

14 CFR 136.13 - Helicopter performance plan and operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Helicopter performance plan and operations... Helicopter performance plan and operations. (a) Each operator must complete a performance plan before each helicopter commercial air tour, or flight operated under 14 CFR 91.146 or 91.147. The pilot in command must...

14 CFR 136.13 - Helicopter performance plan and operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Helicopter performance plan and operations... Helicopter performance plan and operations. (a) Each operator must complete a performance plan before each helicopter commercial air tour, or flight operated under 14 CFR 91.146 or 91.147. The pilot in command must...

14 CFR 136.13 - Helicopter performance plan and operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Helicopter performance plan and operations... Helicopter performance plan and operations. (a) Each operator must complete a performance plan before each helicopter commercial air tour, or flight operated under 14 CFR 91.146 or 91.147. The pilot in command must...

34 CFR 300.601 - State performance plans and data collection.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true State performance plans and data collection. 300.601... Monitoring, Technical Assistance, and Enforcement § 300.601 State performance plans and data collection. (a) General. Not later than December 3, 2005, each State must have in place a performance plan that evaluates...

The Relationship between Health Plan Performance Measures and Physician Network Overlap: Implications for Measuring Plan Quality

PubMed Central

Maeng, Daniel D; Scanlon, Dennis P; Chernew, Michael E; Gronniger, Tim; Wodchis, Walter P; McLaughlin, Catherine G

2010-01-01

Objective To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics. Data Source We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas. Study Design We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures. Principal Findings The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality. Conclusions Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance. PMID:20403064

PSOLA: A Heuristic Land-Use Allocation Model Using Patch-Level Operations and Knowledge-Informed Rules.

PubMed

Liu, Yaolin; Peng, Jinjin; Jiao, Limin; Liu, Yanfang

2016-01-01

Optimizing land-use allocation is important to regional sustainable development, as it promotes the social equality of public services, increases the economic benefits of land-use activities, and reduces the ecological risk of land-use planning. Most land-use optimization models allocate land-use using cell-level operations that fragment land-use patches. These models do not cooperate well with land-use planning knowledge, leading to irrational land-use patterns. This study focuses on building a heuristic land-use allocation model (PSOLA) using particle swarm optimization. The model allocates land-use with patch-level operations to avoid fragmentation. The patch-level operations include a patch-edge operator, a patch-size operator, and a patch-compactness operator that constrain the size and shape of land-use patches. The model is also integrated with knowledge-informed rules to provide auxiliary knowledge of land-use planning during optimization. The knowledge-informed rules consist of suitability, accessibility, land use policy, and stakeholders' preference. To validate the PSOLA model, a case study was performed in Gaoqiao Town in Zhejiang Province, China. The results demonstrate that the PSOLA model outperforms a basic PSO (Particle Swarm Optimization) in the terms of the social, economic, ecological, and overall benefits by 3.60%, 7.10%, 1.53% and 4.06%, respectively, which confirms the effectiveness of our improvements. Furthermore, the model has an open architecture, enabling its extension as a generic tool to support decision making in land-use planning.

PSOLA: A Heuristic Land-Use Allocation Model Using Patch-Level Operations and Knowledge-Informed Rules

PubMed Central

Liu, Yaolin; Peng, Jinjin; Jiao, Limin; Liu, Yanfang

2016-01-01

Optimizing land-use allocation is important to regional sustainable development, as it promotes the social equality of public services, increases the economic benefits of land-use activities, and reduces the ecological risk of land-use planning. Most land-use optimization models allocate land-use using cell-level operations that fragment land-use patches. These models do not cooperate well with land-use planning knowledge, leading to irrational land-use patterns. This study focuses on building a heuristic land-use allocation model (PSOLA) using particle swarm optimization. The model allocates land-use with patch-level operations to avoid fragmentation. The patch-level operations include a patch-edge operator, a patch-size operator, and a patch-compactness operator that constrain the size and shape of land-use patches. The model is also integrated with knowledge-informed rules to provide auxiliary knowledge of land-use planning during optimization. The knowledge-informed rules consist of suitability, accessibility, land use policy, and stakeholders’ preference. To validate the PSOLA model, a case study was performed in Gaoqiao Town in Zhejiang Province, China. The results demonstrate that the PSOLA model outperforms a basic PSO (Particle Swarm Optimization) in the terms of the social, economic, ecological, and overall benefits by 3.60%, 7.10%, 1.53% and 4.06%, respectively, which confirms the effectiveness of our improvements. Furthermore, the model has an open architecture, enabling its extension as a generic tool to support decision making in land-use planning. PMID:27322619

Toward a web-based real-time radiation treatment planning system in a cloud computing environment.

PubMed

Na, Yong Hum; Suh, Tae-Suk; Kapp, Daniel S; Xing, Lei

2013-09-21

To exploit the potential dosimetric advantages of intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), an in-depth approach is required to provide efficient computing methods. This needs to incorporate clinically related organ specific constraints, Monte Carlo (MC) dose calculations, and large-scale plan optimization. This paper describes our first steps toward a web-based real-time radiation treatment planning system in a cloud computing environment (CCE). The Amazon Elastic Compute Cloud (EC2) with a master node (named m2.xlarge containing 17.1 GB of memory, two virtual cores with 3.25 EC2 Compute Units each, 420 GB of instance storage, 64-bit platform) is used as the backbone of cloud computing for dose calculation and plan optimization. The master node is able to scale the workers on an 'on-demand' basis. MC dose calculation is employed to generate accurate beamlet dose kernels by parallel tasks. The intensity modulation optimization uses total-variation regularization (TVR) and generates piecewise constant fluence maps for each initial beam direction in a distributed manner over the CCE. The optimized fluence maps are segmented into deliverable apertures. The shape of each aperture is iteratively rectified to be a sequence of arcs using the manufacture's constraints. The output plan file from the EC2 is sent to the simple storage service. Three de-identified clinical cancer treatment plans have been studied for evaluating the performance of the new planning platform with 6 MV flattening filter free beams (40 × 40 cm(2)) from the Varian TrueBeam(TM) STx linear accelerator. A CCE leads to speed-ups of up to 14-fold for both dose kernel calculations and plan optimizations in the head and neck, lung, and prostate cancer cases considered in this study. The proposed system relies on a CCE that is able to provide an infrastructure for parallel and distributed computing. The resultant plans from the cloud computing are identical to PC-based IMRT and VMAT plans, confirming the reliability of the cloud computing platform. This cloud computing infrastructure has been established for a radiation treatment planning. It substantially improves the speed of inverse planning and makes future on-treatment adaptive re-planning possible.

Toward a web-based real-time radiation treatment planning system in a cloud computing environment

NASA Astrophysics Data System (ADS)

Hum Na, Yong; Suh, Tae-Suk; Kapp, Daniel S.; Xing, Lei

2013-09-01

To exploit the potential dosimetric advantages of intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), an in-depth approach is required to provide efficient computing methods. This needs to incorporate clinically related organ specific constraints, Monte Carlo (MC) dose calculations, and large-scale plan optimization. This paper describes our first steps toward a web-based real-time radiation treatment planning system in a cloud computing environment (CCE). The Amazon Elastic Compute Cloud (EC2) with a master node (named m2.xlarge containing 17.1 GB of memory, two virtual cores with 3.25 EC2 Compute Units each, 420 GB of instance storage, 64-bit platform) is used as the backbone of cloud computing for dose calculation and plan optimization. The master node is able to scale the workers on an ‘on-demand’ basis. MC dose calculation is employed to generate accurate beamlet dose kernels by parallel tasks. The intensity modulation optimization uses total-variation regularization (TVR) and generates piecewise constant fluence maps for each initial beam direction in a distributed manner over the CCE. The optimized fluence maps are segmented into deliverable apertures. The shape of each aperture is iteratively rectified to be a sequence of arcs using the manufacture’s constraints. The output plan file from the EC2 is sent to the simple storage service. Three de-identified clinical cancer treatment plans have been studied for evaluating the performance of the new planning platform with 6 MV flattening filter free beams (40 × 40 cm2) from the Varian TrueBeamTM STx linear accelerator. A CCE leads to speed-ups of up to 14-fold for both dose kernel calculations and plan optimizations in the head and neck, lung, and prostate cancer cases considered in this study. The proposed system relies on a CCE that is able to provide an infrastructure for parallel and distributed computing. The resultant plans from the cloud computing are identical to PC-based IMRT and VMAT plans, confirming the reliability of the cloud computing platform. This cloud computing infrastructure has been established for a radiation treatment planning. It substantially improves the speed of inverse planning and makes future on-treatment adaptive re-planning possible.

User manual and spreadsheet tool for implementing performance planning for rural planning organizations.

DOT National Transportation Integrated Search

2017-03-01

The performance-planning tool developed as part of this project is intended for use with the guidebook for establishing and using rural performance based transportation system assessment, monitoring, planning, and programming to support the rural pla...

Strategic planning processes and hospital financial performance.

PubMed

Kaissi, Amer A; Begun, James W

2008-01-01

Many common management practices in healthcare organizations, including the practice of strategic planning, have not been subject to widespread assessment through empirical research. If management practice is to be evidence-based, evaluations of such common practices need to be undertaken. The purpose of this research is to provide evidence on the extent of strategic planning practices and the association between hospital strategic planning processes and financial performance. In 2006, we surveyed a sample of 138 chief executive officers (CEOs) of hospitals in the state of Texas about strategic planning in their organizations and collected financial information on the hospitals for 2003. Among the sample hospitals, 87 percent reported having a strategic plan, and most reported that they followed a variety of common practices recommended for strategic planning-having a comprehensive plan, involving physicians, involving the board, and implementing the plan. About one-half of the hospitals assigned responsibility for the plan to the CEO. We tested the association between these planning characteristics in 2006 and two measures of financial performance for 2003. Three dimensions of the strategic planning process--having a strategic plan, assigning the CEO responsibility for the plan, and involving the board--are positively associated with earlier financial performance. Further longitudinal studies are needed to evaluate the cause-and-effect relationship between planning and performance.

Internal Fixation of Complicated Acetabular Fractures Directed by Preoperative Surgery with 3D Printing Models.

PubMed

Liu, Zhao-Jie; Jia, Jian; Zhang, Yin-Guang; Tian, Wei; Jin, Xin; Hu, Yong-Cheng

2017-05-01

The purpose of this article is to evaluate the efficacy and feasibility of preoperative surgery with 3D printing-assisted internal fixation of complicated acetabular fractures. A retrospective case review was performed for the above surgical procedure. A 23-year-old man was confirmed by radiological examination to have fractures of multiple ribs, with hemopneumothorax and communicated fractures of the left acetabulum. According to the Letounel and Judet classification, T-shaped fracture involving posterior wall was diagnosed. A 3D printing pelvic model was established using CT digital imaging and communications in medicine (DICOM) data preoperatively, with which surgical procedures were simulated in preoperative surgery to confirm the sequence of the reduction and fixation as well as the position and length of the implants. Open reduction with internal fixation (ORIF) of the acetabular fracture using modified ilioinguinal and Kocher-Langenbeck approaches was performed 25 days after injury. Plates that had been pre-bent in the preoperative surgery were positioned and screws were tightened in the directions determined in the preoperative planning following satisfactory reduction. The duration of the operation was 170 min and blood loss was 900 mL. Postoperative X-rays showed that anatomical reduction of the acetabulum was achieved and the hip joint was congruous. The position and length of the implants were not different when compared with those in preoperative surgery on 3D printing models. We believe that preoperative surgery using 3D printing models is beneficial for confirming the reduction and fixation sequence, determining the reduction quality, shortening the operative time, minimizing preoperative difficulties, and predicting the prognosis for complicated fractures of acetabulam. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy.

PubMed

Rong, Yi; Yadav, Poonam; Welsh, James S; Fahner, Tasha; Paliwal, Bhudatt

2012-01-01

The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3-50.4 Gy with daily fraction size of 1.7-2.0 Gy. Total dose to the scar PTV was prescribed to 58.0-60.2 Gy at 2.0-2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7-1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments. Published by Elsevier Inc.

Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy

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

Rong Yi, E-mail: rong@humonc.wisc.edu; University of Wisconsin Riverview Cancer Center, Wisconsin Rapids, WI; Yadav, Poonam

2012-10-01

The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3-50.4 Gy with daily fraction size of 1.7-2.0 Gy. Total dose to the scar PTV was prescribed to 58.0-60.2 Gy at 2.0-2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTVmore » received 1.7-1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments.« less

Potential risk of alpha-glucosidase inhibitor administration in prostate cancer external radiotherapy by exceptional rectal gas production: a case report.

PubMed

Nishimura, Takuya; Yamazaki, Hideya; Iwama, Kazuki; Oota, Yoshitaka; Aibe, Norihiro; Nakamura, Satoaki; Yoshida, Ken; Okabe, Haruumi; Yamada, Kei

2014-05-05

Radiotherapy is a standard treatment for prostate cancer, and image-guided radiotherapy is increasingly being used to aid precision of dose delivery to targeted tissues. However, precision during radiotherapy cannot be maintained when unexpected intrafraction organ motion occurs. We report our experience of internal organ motion caused by persistent gas production in a patient taking an alpha-glucosidase inhibitor. A 68-year-old Japanese man with prostate cancer visited our institution for treatment with helical tomotherapy. He suffered from diabetes mellitus and took an alpha-glucosidase inhibitor. Routine treatment planning computed tomography showed a large volume of rectal gas; an enema was given to void the rectum. Subsequent treatment planning computed tomography again showed a large volume of gas. After exercise (walking) to remove the intestinal gas, a third scan was performed as a test scan without tight fixation, which showed a sufficiently empty rectum for planning. However, after only a few minutes, treatment planning computed tomography again showed extreme accumulation of gas. Therefore, we postponed treatment planning computed tomography and consulted his doctor to suspend the alpha-glucosidase inhibitor, which was the expected cause of his persistent gas. Four days after the alpha-glucosidase inhibitor regimen was suspended, we took a fourth treatment planning computed tomography and made a treatment plan without gas accumulation. Thereafter, the absence of rectal gas accumulation was confirmed using daily megavolt computed tomography before treatment, and the patient received 37 fractions of intensity-modified radiotherapy at 74 Gy without rectal gas complications. In this case study, the alpha-glucosidase inhibitor induced the accumulation of intestinal gas, which may have caused unexpected organ motion, untoward reactions, and insufficient doses to clinical targets. We suggest that patients who are taking an alpha-glucosidase inhibitor for diabetes should discontinue use of that particular medicine prior to beginning radiotherapy.

Cost sharing and HEDIS performance.

PubMed

Chernew, Michael; Gibson, Teresa B

2008-12-01

Physicians, health plans, and health systems are increasingly evaluated and rewarded based on Health Plan Effectiveness Data and Information Set (HEDIS) and HEDIS-like performance measures. Concurrently, employers and health plans continue to try to control expenditures by increasing out-of-pocket costs for patients. The authors use fixed-effect logit models to assess how rising copayment rates for physician office visits and prescription drugs affect performance on HEDIS measures. Findings suggest that the increase in copayment rates lowers performance scores, demonstrating the connection between financial aspects of plan design and quality performance, and highlighting the potential weakness of holding plans and providers responsible for performance when payers and benefit plan managers also influence performance. Yet the effects are not consistent across all domains and, in many cases, are relatively modest in magnitude. This may reflect the HEDIS definitions and suggests that more sensitive measures may capture the impact of benefit design changes on performance.

U.S. and International Responses to the Global Spread of Avian Flu: Issues for Congress

DTIC Science & Technology

2006-05-01

Agriculture Organization . . . . . . . . . . . . . . . . . . 13 The World Organization for Animal Health . . . . . . . . . . . . . . . . . . . . . . . . 14 The...Influenza Plan. [http://www.hhs.gov/pandemicflu/plan/]. 4 The World Organization for Animal Health (OIE) has confirmed H5N1 among birds in the...countries, including Germany. On April 14, 2006, the World Organization for Animal Health (OIE) and the United Nations Food and Agricultural

Comprehensive rehabilitation using dental implants in generalized aggressive periodontitis

PubMed Central

Ramesh, Asha; Ravi, Sheethalan; Kaarthikeyan, Gurumoorthy

2017-01-01

Generalized aggressive periodontitis (GAP) is a debilitating form of the disease and it results in deteriorating effects on the esthetic and functional aspects of the oral cavity. This case report describes the comprehensive rehabilitation of GAP patient using dental implants. The treatment planning involved thorough scaling and root planning (SRP) with oral hygiene instructions. The patient was motivated to adhere to a strict oral hygiene regimen following which periodontal flap surgery employing guided tissue regeneration and bone grafts was performed. Bacterial culture for anaerobic microorganisms was done using a gas pack pre- and postperiodontal treatment to confirm the effectiveness of the periodontal treatment regimen and also to proceed with dental implant placement. The rigorous maintenance program ensured the stability of the periodontium following which immediate placement of dental implants in the maxillary and mandibular anterior region was done. The fixed metal-ceramic prosthesis was fabricated in a step-by-step process and the patient was recalled on a periodic basis over a 3-year follow-up duration. This case is a testimonial to the postperiodontal treatment long-term stability with excellent patient cooperation and strict maintenance protocol. PMID:29398863

An evaluation of client satisfaction with training programs and technical assistance provided by Florida's Coordinated School Health Program Office.

PubMed

Weiler, R M; Pigg, R M

2000-11-01

Client or customer satisfaction surveys assess the perceived quality of programs, products, services, and employee performance. Such assessments prove beneficial for evaluation and planning purposes. This survey examined the satisfaction of clients using the programs, services, and technical assistance provided through the Coordinated School Health Program Office (CSHPO) in the Florida Department of Education. Using the 42-item Client Satisfaction Survey, data were collected in summer 1999 from 300 of 574 clients (52.3%) who attended training sessions or sought technical assistance from CSHPO during 1996-1999. More than two-thirds (67.2%) of clients rated the training program as "very good" or "excellent" at increasing their understanding about the concept of a coordinated school health program. Overall, 69.7% of clients rated the training programs they attended as "very good" or "excellent." Resource materials and staff effectiveness rated positively as well. Findings confirmed client satisfaction with CSHPO's training programs, technical assistance, and staff. Information obtained through the client satisfaction survey can be used by CSHPO to assist in future program planning and resource allocations.

An ischemic stroke patient with free floating thrombus in carotid artery, successfully treated by open carotid thrombectomy: a first case report in Nepal.

PubMed

Shrestha, Prabin; Adhikari, Rupendra; Tamrakar, Samantha; Pant, Basanta; Koirala, Bhagwan; Yamaguchi, Satoshi; Kurisu, Kaoru

2012-12-01

Free floating thrombus in the carotid artery is a well-known phenomenon, though relatively rare. We present a case in which we performed open surgery and achieved successful retrieval of the thrombus. A 40 year-old male patient presented with ischemic stroke and mild left hemiparesis. Computerized tomography and magnetic resonance imaging showed infarction in the right parieto-occipital area. Carotid Doppler study showed carotid stenosis on the right side. Further investigation with CT angiography of the neck vessels confirmed significant carotid artery occlusion with a free-floating thrombus in the internal carotid artery. Carotid endarterectomy was planned under EEG monitoring. The right carotid artery was exposed with a vertical incision along the medial margin of the sternocleido-mastoid muscle. The carotid artery was opened and, as expected, showed a soft, mobile thrombus. Thus thrombectomy was planned. A 2 Fr fogarty catheter was introduced distal to the thrombus, the balloon was inflated and pulled back gently, which removed the thrombus completely. There was no postoperative complication and the patient is fine at 1 year follow-up.

Lithium formate EPR dosimetry for verifications of planned dose distributions prior to intensity-modulated radiation therapy.

PubMed

Gustafsson, H; Lund, E; Olsson, S

2008-09-07

The objective of the present investigation was to evaluate lithium formate electron paramagnetic resonance (EPR) dosimetry for measurement of dose distributions in phantoms prior to intensity-modulated radiation therapy (IMRT). Lithium formate monohydrate tablets were carefully prepared, and blind tests were performed in clinically relevant situations in order to determine the precision and accuracy of the method. Further experiments confirmed that within the accuracy of the current method, the dosimeter response was independent of beam energies and dose rates used for IMRT treatments. The method was applied to IMRT treatment plans, and the dose determinations were compared to ionization chamber measurements. The experiments showed that absorbed doses above 3 Gy could be measured with an uncertainty of less than 2.5% of the dose (coverage factor kappa = 1.96). Measurement time was about 15 min using a well-calibrated dosimeter batch. The conclusion drawn from the investigation was that lithium formate EPR dosimetry is a promising new tool for absorbed dose measurements in external beam radiation therapy, especially for doses above 3 Gy.

Lithium formate EPR dosimetry for verifications of planned dose distributions prior to intensity-modulated radiation therapy

NASA Astrophysics Data System (ADS)

Gustafsson, H.; Lund, E.; Olsson, S.

2008-09-01

The objective of the present investigation was to evaluate lithium formate electron paramagnetic resonance (EPR) dosimetry for measurement of dose distributions in phantoms prior to intensity-modulated radiation therapy (IMRT). Lithium formate monohydrate tablets were carefully prepared, and blind tests were performed in clinically relevant situations in order to determine the precision and accuracy of the method. Further experiments confirmed that within the accuracy of the current method, the dosimeter response was independent of beam energies and dose rates used for IMRT treatments. The method was applied to IMRT treatment plans, and the dose determinations were compared to ionization chamber measurements. The experiments showed that absorbed doses above 3 Gy could be measured with an uncertainty of less than 2.5% of the dose (coverage factor k = 1.96). Measurement time was about 15 min using a well-calibrated dosimeter batch. The conclusion drawn from the investigation was that lithium formate EPR dosimetry is a promising new tool for absorbed dose measurements in external beam radiation therapy, especially for doses above 3 Gy.

High Pressure Structure and Electrical Resistance Measurements on Cadmium Sulfide Nanoparticles

NASA Astrophysics Data System (ADS)

Montgomery, J. M.; Stemshorn, A. K.; Stanishevsky, A.; Vohra, Y. K.; Weir, S. T.

2010-03-01

Room-temperature four-probe electrical resistance and synchrotron x-ray diffraction measurements have been performed on dried and aqueous suspensions of CdS nanoparticles (25 nm in diameter) to 35 GPa. Nanoparticles used in these experiments were synthesized using the reaction between a cadmium salt and thiourea under hydrothermal conditions without using any surfactants. While the x-ray structure data confirms the irreversible wurtzite -> rocksalt transition seen at 2.5 GPa in bulk CdS, the corresponding resistance drop was not observed in the measured range, indicating that the nanoparticle boundaries may prevent electronic communication between particles. Further studies on dry and aqueous 10 nm nano-spheres and 9 nm diameter nano-rods are planned, and the results of these experiments will be presented.

5 CFR 430.305 - Planning and communicating performance.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... 430.305 Section 430.305 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.305 Planning and communicating... strategic planning initiatives. Critical elements and performance requirements for each senior executive...

5 CFR 430.305 - Planning and communicating performance.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... 430.305 Section 430.305 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Managing Senior Executive Performance § 430.305 Planning and communicating... strategic planning initiatives. Critical elements and performance requirements for each senior executive...

TH-EF-BRB-06: Implementation of a Modulated-Arc Total Body Irradiation (TBI) Technique Using the RayStation Treatment Planning System

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

Phillips, J; Cheung, J; Held, M

2016-06-15

Purpose: To develop a clinical workflow for delivering a modulated-arc total body irradiation (TBI) with RayStation scripting. This technique uses arc fields with the patient lying at floor level on a padded table and is validated through measurements taken on a custom-made TBI phantom. Methods: Treatment planning was performed for a retrospective cohort of eight patients with a diverse range of heights and body types. Each was replanned using an open-field dual arc method, with the patient in supine and prone positions on the floor of the vault. All plans were optimized using Raystation Planning 4.7.2.5 (RaySearch Laboratories, Stockholm, Sweden),more » with 200 cGy prescribed to the 95% of the body contour − 5mm. This results in an open-field beam that sweeps craniocaudally across the length of the patient. The technique is validated with measurements at 10 cm intervals in a custom-milled, 5 cm thick acrylic phantom. A centrally located CC13 ion chamber and a Mobile MOSFET (Best Medical Canada, Ottawa, ON) detector array were used to measure dose. Supine and prone arcs for each patient were consecutively delivered, and the aggregate dose at each point was compared to the planned dose calculated in the phantom. Results: The ion chamber measurements differed from the planned dose by an average of .5%, with a standard deviation of 2.1%. All measured data for the MOSFETS were within 10% of the corresponding planned dose except for two outlying points. The standard deviation of dose differences across the entire cohort was 4.0%. Most significant discrepancies occurred either in inhomogeneous regions with large gradients, or at inferior points where beam angle was steepest. Conclusion: We have confirmed that the planned dose is well matched to our measurements within 10% for this method of planning and delivery. We are currently incorporating this technique into our clinical workflow. This work is supported by RaySearch.« less

Credentialing of radiotherapy centres in Australasia for TROG 09.02 (Chisel), a Phase III clinical trial on stereotactic ablative body radiotherapy of early stage lung cancer.

PubMed

Kron, Tomas; Chesson, Brent; Hardcastle, Nicholas; Crain, Melissa; Clements, Natalie; Burns, Mark; Ball, David

2018-05-01

A randomised clinical trial comparing stereotactic ablative body radiotherapy (SABR) with conventional radiotherapy for early stage lung cancer has been conducted in Australia and New Zealand under the auspices of the TransTasman Radiation Oncology Group (NCT01014130). We report on the technical credentialing program as prerequisite for centres joining the trial. Participating centres were asked to develop treatment plans for two test cases to assess their ability to create plans according to protocol. Dose delivery in the presence of inhomogeneity and motion was assessed during a site visit using a phantom with moving inserts. Site visits for the trial were conducted in 16 Australian and 3 New Zealand radiotherapy facilities. The tests with low density inhomogeneities confirmed shortcomings of the AAA algorithm for dose calculation. Dose was assessed for a typical treatment delivery including at least one non-coplanar beam in a stationary and moving phantom. This end-to-end test confirmed that all participating centres were able to deliver stereotactic ablative body radiotherapy with the required accuracy while the planning study demonstrated that they were able to produce acceptable plans for both test cases. The credentialing process documented that participating centres were able to deliver dose as required in the trial protocol. It also gave an opportunity to provide education about the trial and discuss technical issues such as four-dimensional CT, small field dosimetry and patient immobilisation with staff in participating centres. Advances in knowledge: Credentialing is an important quality assurance tool for radiotherapy trials using advanced technology. In addition to confirming technical competence, it provides an opportunity for education and discussion about the trial.

42 CFR 457.710 - State plan requirements: Strategic objectives and performance goals.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) ALLOTMENTS AND GRANTS TO STATES Strategic Planning, Reporting, and Evaluation § 457.710 State plan requirements: Strategic objectives and performance goals. (a) Plan description. A State plan must include a... 42 Public Health 4 2011-10-01 2011-10-01 false State plan requirements: Strategic objectives and...

42 CFR 457.710 - State plan requirements: Strategic objectives and performance goals.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... The State's strategic objectives, performance goals and performance measures must include a common... 42 Public Health 4 2010-10-01 2010-10-01 false State plan requirements: Strategic objectives and...) ALLOTMENTS AND GRANTS TO STATES Strategic Planning, Reporting, and Evaluation § 457.710 State plan...

Sci-Sat AM: Radiation Dosimetry and Practical Therapy Solutions - 12: Suitability of plan class specific reference fields for estimating dosimeter correction factors for small clinical CyberKnife fields

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

Vandervoort, Eric; Christiansen, Eric; Belec, Jaso

Purpose: The purpose of this work is to investigate the utility of plan class specific reference (PCSR) fields for predicting dosimeter response within isocentric and non-isocentric composite clinical fields using the smallest fields employed by the CyberKnife radiosurgery system. Methods: Monte Carlo dosimeter response correction factors (CFs) were calculated for a plastic scintillator and microchamber dosimeter in 21 clinical fields and 9 candidate plan-class PCSR fields which employ the 5, 7.5 and 10 mm diameter collimators. Measurements were performed in 5 PCSR fields to confirm the predicted relative response of detectors in the same field. Results: Ratios of corrected measuredmore » dose in the PCSR fields agree to within 1% of unity. Calculated CFs for isocentric fields agree within 1.5% of those for PCSR fields. Large and variable microchamber CFs are required for non-isocentric fields, with differences as high as 5% between different clinical fields in the same plan class and 4% within the same field depending on the point of measurement. Non-isocentric PCSR fields constructed to have relatively homogenous dose over a region larger than the detector have very different ion chamber CFs from clinical fields. The plastic scintillator detector has much more consistent response within each plan class but still require 3–4% corrections in some fields. Conclusions: While the PCSR field concept is useful for small isocentric fields, this approach may not be appropriate for non-isocentric clinical fields which exhibit large and variable ion chamber CFs which differ significantly from CFs for homogenous field PCSRs.« less

Analyzing mobile WiMAX base station deployment under different frequency planning strategies

NASA Astrophysics Data System (ADS)

Salman, M. K.; Ahmad, R. B.; Ali, Ziad G.; Aldhaibani, Jaafar A.; Fayadh, Rashid A.

2015-05-01

The frequency spectrum is a precious resource and scarce in the communication markets. Therefore, different techniques are adopted to utilize the available spectrum in deploying WiMAX base stations (BS) in cellular networks. In this paper several types of frequency planning techniques are illustrated, and a comprehensive comparative study between conventional frequency reuse of 1 (FR of 1) and fractional frequency reuse (FFR) is presented. These techniques are widely used in network deployment, because they employ universal frequency (using all the available bandwidth) in their base station installation/configuration within network system. This paper presents a network model of 19 base stations in order to be employed in the comparison of the aforesaid frequency planning techniques. Users are randomly distributed within base stations, users' resource mapping and their burst profile selection are based on the measured signal to interference plus-noise ratio (SINR). Simulation results reveal that the FFR has advantages over the conventional FR of 1 in various metrics. 98 % of downlink resources (slots) are exploited when FFR is applied, whilst it is 81 % at FR of 1. Data rate of FFR has been increased to 10.6 Mbps, while it is 7.98 Mbps at FR of 1. The spectral efficiency is better enhanced (1.072 bps/Hz) at FR of 1 than FFR (0.808 bps/Hz), since FR of 1 exploits all the Bandwidth. The subcarrier efficiency shows how many data bits that can be carried by subcarriers under different frequency planning techniques, the system can carry more data bits under FFR (2.40 bit/subcarrier) than FR of 1 (1.998 bit/subcarrier). This study confirms that FFR can perform better than conventional frequency planning (FR of 1) which made it a strong candidate for WiMAX BS deployment in cellular networks.

Next Generation Nuclear Plant Methods Research and Development Technical Program Plan -- PLN-2498

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

Richard R. Schultz; Abderrafi M. Ougouag; David W. Nigg

2008-09-01

One of the great challenges of designing and licensing the Very High Temperature Reactor (VHTR) is to confirm that the intended VHTR analysis tools can be used confidently to make decisions and to assure all that the reactor systems are safe and meet the performance objectives of the Generation IV Program. The research and development (R&D) projects defined in the Next Generation Nuclear Plant (NGNP) Design Methods Development and Validation Program will ensure that the tools used to perform the required calculations and analyses can be trusted. The Methods R&D tasks are designed to ensure that the calculational envelope ofmore » the tools used to analyze the VHTR reactor systems encompasses, or is larger than, the operational and transient envelope of the VHTR itself. The Methods R&D focuses on the development of tools to assess the neutronic and thermal fluid behavior of the plant. The fuel behavior and fission product transport models are discussed in the Advanced Gas Reactor (AGR) program plan. Various stress analysis and mechanical design tools will also need to be developed and validated and will ultimately also be included in the Methods R&D Program Plan. The calculational envelope of the neutronics and thermal-fluids software tools intended to be used on the NGNP is defined by the scenarios and phenomena that these tools can calculate with confidence. The software tools can only be used confidently when the results they produce have been shown to be in reasonable agreement with first-principle results, thought-problems, and data that describe the “highly ranked” phenomena inherent in all operational conditions and important accident scenarios for the VHTR.« less

Next Generation Nuclear Plant Methods Technical Program Plan

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

Richard R. Schultz; Abderrafi M. Ougouag; David W. Nigg

2010-12-01

One of the great challenges of designing and licensing the Very High Temperature Reactor (VHTR) is to confirm that the intended VHTR analysis tools can be used confidently to make decisions and to assure all that the reactor systems are safe and meet the performance objectives of the Generation IV Program. The research and development (R&D) projects defined in the Next Generation Nuclear Plant (NGNP) Design Methods Development and Validation Program will ensure that the tools used to perform the required calculations and analyses can be trusted. The Methods R&D tasks are designed to ensure that the calculational envelope ofmore » the tools used to analyze the VHTR reactor systems encompasses, or is larger than, the operational and transient envelope of the VHTR itself. The Methods R&D focuses on the development of tools to assess the neutronic and thermal fluid behavior of the plant. The fuel behavior and fission product transport models are discussed in the Advanced Gas Reactor (AGR) program plan. Various stress analysis and mechanical design tools will also need to be developed and validated and will ultimately also be included in the Methods R&D Program Plan. The calculational envelope of the neutronics and thermal-fluids software tools intended to be used on the NGNP is defined by the scenarios and phenomena that these tools can calculate with confidence. The software tools can only be used confidently when the results they produce have been shown to be in reasonable agreement with first-principle results, thought-problems, and data that describe the “highly ranked” phenomena inherent in all operational conditions and important accident scenarios for the VHTR.« less

Next Generation Nuclear Plant Methods Technical Program Plan -- PLN-2498

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

Richard R. Schultz; Abderrafi M. Ougouag; David W. Nigg

2010-09-01

One of the great challenges of designing and licensing the Very High Temperature Reactor (VHTR) is to confirm that the intended VHTR analysis tools can be used confidently to make decisions and to assure all that the reactor systems are safe and meet the performance objectives of the Generation IV Program. The research and development (R&D) projects defined in the Next Generation Nuclear Plant (NGNP) Design Methods Development and Validation Program will ensure that the tools used to perform the required calculations and analyses can be trusted. The Methods R&D tasks are designed to ensure that the calculational envelope ofmore » the tools used to analyze the VHTR reactor systems encompasses, or is larger than, the operational and transient envelope of the VHTR itself. The Methods R&D focuses on the development of tools to assess the neutronic and thermal fluid behavior of the plant. The fuel behavior and fission product transport models are discussed in the Advanced Gas Reactor (AGR) program plan. Various stress analysis and mechanical design tools will also need to be developed and validated and will ultimately also be included in the Methods R&D Program Plan. The calculational envelope of the neutronics and thermal-fluids software tools intended to be used on the NGNP is defined by the scenarios and phenomena that these tools can calculate with confidence. The software tools can only be used confidently when the results they produce have been shown to be in reasonable agreement with first-principle results, thought-problems, and data that describe the “highly ranked” phenomena inherent in all operational conditions and important accident scenarios for the VHTR.« less

Reduced use of occult bacteremia blood screens by emergency medicine physicians using immunization registry for children presenting with fever without a source.

PubMed

Zeretzke, Cristina M; McIntosh, Mark S; Kalynych, Colleen J; Wylie, Todd; Lott, Michelle; Wood, David

2012-07-01

This study examined whether utilization of the Florida State Health Online Tracking System (SHOTS) immunization registry to determine Haemophilus influenzae type B and heptavalent pneumococcal conjugate (PCV7) vaccine status impacts the protocolized decision to perform a screening blood draw for occult bacteremia (OB) in young children. A convenience sample of children 6 to 24 months of age presenting to the pediatric emergency department with fever of greater than 39°C without a source was enrolled. Physicians were trained to use the SHOTS immunization registry and reviewed the emergency department's fever protocol. A "preregistry" workup plan was documented for each patient based on clinical history, immunization status before accessing SHOTS, and physical examination. A "postregistry" workup plan was then documented based on the SHOTS record. Demographic and registry data were recorded. Preregistry workup plans indicated OB screening blood draws for 100% (n = 91; 95% confidence interval [CI], 96-100) of patients with unconfirmed immunization status. Of those 91 children, 58% (n = 53; 95% CI, 55-61) were documented in SHOTS as having received their primary conjugate vaccine series at ages 2, 4, and 6 months. Registry access reduced the percentage of screening blood draws from 100% (n = 91) to 42% (n = 38; 95% CI, 37-53; P < 0.001). The state immunization registry is an adjunctive tool to caregiver recall, which can be used by emergency medicine practitioners to confirm completion of the primary conjugate vaccine series before making the decision to perform blood screens for OB in children aged 6 to 24 months who present with fever without a source.

Visually Exploring Transportation Schedules.

PubMed

Palomo, Cesar; Guo, Zhan; Silva, Cláudio T; Freire, Juliana

2016-01-01

Public transportation schedules are designed by agencies to optimize service quality under multiple constraints. However, real service usually deviates from the plan. Therefore, transportation analysts need to identify, compare and explain both eventual and systemic performance issues that must be addressed so that better timetables can be created. The purely statistical tools commonly used by analysts pose many difficulties due to the large number of attributes at trip- and station-level for planned and real service. Also challenging is the need for models at multiple scales to search for patterns at different times and stations, since analysts do not know exactly where or when relevant patterns might emerge and need to compute statistical summaries for multiple attributes at different granularities. To aid in this analysis, we worked in close collaboration with a transportation expert to design TR-EX, a visual exploration tool developed to identify, inspect and compare spatio-temporal patterns for planned and real transportation service. TR-EX combines two new visual encodings inspired by Marey's Train Schedule: Trips Explorer for trip-level analysis of frequency, deviation and speed; and Stops Explorer for station-level study of delay, wait time, reliability and performance deficiencies such as bunching. To tackle overplotting and to provide a robust representation for a large numbers of trips and stops at multiple scales, the system supports variable kernel bandwidths to achieve the level of detail required by users for different tasks. We justify our design decisions based on specific analysis needs of transportation analysts. We provide anecdotal evidence of the efficacy of TR-EX through a series of case studies that explore NYC subway service, which illustrate how TR-EX can be used to confirm hypotheses and derive new insights through visual exploration.

Clinical Application of an Open-Source 3D Volume Rendering Software to Neurosurgical Approaches.

PubMed

Fernandes de Oliveira Santos, Bruno; Silva da Costa, Marcos Devanir; Centeno, Ricardo Silva; Cavalheiro, Sergio; Antônio de Paiva Neto, Manoel; Lawton, Michael T; Chaddad-Neto, Feres

2018-02-01

Preoperative recognition of the anatomic individualities of each patient can help to achieve more precise and less invasive approaches. It also may help to anticipate potential complications and intraoperative difficulties. Here we describe the use, accuracy, and precision of a free tool for planning microsurgical approaches using 3-dimensional (3D) reconstructions from magnetic resonance imaging (MRI). We used the 3D volume rendering tool of a free open-source software program for 3D reconstruction of images of surgical sites obtained by MRI volumetric acquisition. We recorded anatomic reference points, such as the sulcus and gyrus, and vascularization patterns for intraoperative localization of lesions. Lesion locations were confirmed during surgery by intraoperative ultrasound and/or electrocorticography and later by postoperative MRI. Between August 2015 and September 2016, a total of 23 surgeries were performed using this technique for 9 low-grade gliomas, 7 high-grade gliomas, 4 cortical dysplasias, and 3 arteriovenous malformations. The technique helped delineate lesions with an overall accuracy of 2.6 ± 1.0 mm. 3D reconstructions were successfully performed in all patients, and images showed sulcus, gyrus, and venous patterns corresponding to the intraoperative images. All lesion areas were confirmed both intraoperatively and at the postoperative evaluation. With the technique described herein, it was possible to successfully perform 3D reconstruction of the cortical surface. This reconstruction tool may serve as an adjunct to neuronavigation systems or may be used alone when such a system is unavailable. Copyright © 2017 Elsevier Inc. All rights reserved.

Plan-graph Based Heuristics for Conformant Probabilistic Planning

NASA Technical Reports Server (NTRS)

Ramakrishnan, Salesh; Pollack, Martha E.; Smith, David E.

2004-01-01

In this paper, we introduce plan-graph based heuristics to solve a variation of the conformant probabilistic planning (CPP) problem. In many real-world problems, it is the case that the sensors are unreliable or take too many resources to provide knowledge about the environment. These domains are better modeled as conformant planning problems. POMDP based techniques are currently the most successful approach for solving CPP but have the limitation of state- space explosion. Recent advances in deterministic and conformant planning have shown that plan-graphs can be used to enhance the performance significantly. We show that this enhancement can also be translated to CPP. We describe our process for developing the plan-graph heuristics and estimating the probability of a partial plan. We compare the performance of our planner PVHPOP when used with different heuristics. We also perform a comparison with a POMDP solver to show over a order of magnitude improvement in performance.

Performance planning for rural planning organizations - final report.

DOT National Transportation Integrated Search

2017-02-01

Recent federal rules place increased emphasis on performance-based management of the multimodal : transportation system and require the use of performance based methods in state, metropolitan, and : non-metropolitan transportation planning and progra...

Teacher Performance Assessment Instruments: Plans for Practice Rating.

ERIC Educational Resources Information Center

Capie, William; And Others

This manual consists of lesson plans developed to train data collectors in the use of the Teacher Performance Assessment Instruments (TPAI). Each set of plans was designed for one of three purposes. Lesson plans developed for the Teaching Plans and Materials Instrument (TPM) simulate a portfolio prepared by the teacher. One-day plans developed for…

Predicting actual weight loss: A review of the determinants according to the theory of planned behaviour.

PubMed

Chung, Louisa Ming Yan; Fong, Shirley Siu Ming

2015-01-01

Weight reduction that corresponds with lifestyle modification is difficult to foster. The theory of planned behaviour has been actively cited in explaining health-related behaviour. This review evaluated the application of the theory of planned behaviour to weight-loss behaviour. Among the three reviewed papers, cross-sectional survey designs and subjective outcome measurements were commonly applied. All of the studies recruited obese female adults as participants, limiting the generalisability of the studies' findings. The theory of planned behaviour can be effectively applied in weight-reduction programmes targeting female obese patients. This review confirmed critiques citing the limitations of experimental studies, the subjective measurement of behaviour and short follow-up periods.

13 CFR 308.3 - Planning performance awards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Planning performance awards. 308.3 Section 308.3 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION, DEPARTMENT OF COMMERCE PERFORMANCE INCENTIVES § 308.3 Planning performance awards. (a) A Recipient of Investment Assistance awarded...

The usefulness of electrodiagnostic studies in the diagnosis and management of neuromuscular disorders.

PubMed

Lindstrom, Heather; Ashworth, Nigel L

2018-03-13

This study seeks to evaluate the usefulness of electrodiagnostic (EDX) studies in terms of the patient's diagnosis and subsequent management and to identify patient groups in which EDX is particularly useful. The records of new patients referred to a single tertiary hospital EDX laboratory during 1 calendar year were reviewed to determine whether results of EDX studies led to a changed diagnosis and/or management plan. Logistic regression was used to determine whether any factors were associated with changed diagnosis or management. Results of EDX studies led to a change in diagnosis and a confirmation in diagnosis in 51.5% and 46.5% of the cases, respectively. Results of EDX studies led to a change in the management plan in 63.4% of all cases. The diagnosis and management plan were more likely to be changed in older patients and patients referred in hospital. EDX studies seem useful for confirming or changing the diagnosis and in guiding management in patients with suspected neuromuscular disorders. Muscle Nerve, 2018. © 2018 Wiley Periodicals, Inc.

Performance-based planning for small metropolitan areas

DOT National Transportation Integrated Search

2015-01-31

This report provides insights on effective practices in performance based planning by Metropolitan Planning Organizations (MPOs) that plan for Urbanized Areas with populations less than 200,000. It references existing best practices research on perfo...

Closure Report for Corrective Action Unit 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada with ROTC 1, Revision 0

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

Mark Burmeister

2007-09-01

This CR provides documentation and justification for the closure of CAU 118 without further corrective action. This justification is based on process knowledge and the results of the investigative and closure activities conducted in accordance with the CAU 118 SAFER Plan: Streamlined Approach for Environmental Restoration (SAFER) Plan for CAU 118: Area 27 Super Kukla Facility, Nevada Test Site, Nevada (NNSA/NSO, 2006). The SAFER Plan provides information relating to site history as well as the scope and planning of the investigation. This CR also provides the analytical and radiological survey data to confirm that the remediation goals were met asmore » specified in the CAU 118 SAFER Plan (NNSA/NSO, 2006). The Nevada Division of Environmental Protection (NDEP) approved the CAU 118 SAFER Plan (Murphy, 2006), which recommends closure in place with use restrictions (URs).« less

Utility of Megavoltage Fan-Beam CT for Treatment Planning in a Head-And-Neck Cancer Patient with Extensive Dental Fillings Undergoing Helical Tomotherapy

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

Yang, Claus; Liu Tianxiao; Jennelle, Richard L.

The purpose of this study was to demonstrate the potential utility of megavoltage fan-beam computed tomography (MV-FBCT) for treatment planning in a patient undergoing helical tomotherapy for nasopharyngeal carcinoma in the presence of extensive dental artifact. A 28-year-old female with locally advanced nasopharyngeal carcinoma presented for radiation therapy. Due to the extensiveness of the dental artifact present in the oral cavity kV-CT scan acquired at simulation, which made treatment planning impossible on tomotherapy planning system, MV-FBCT imaging was obtained using the HI-ART tomotherapy treatment machine, with the patient in the treatment position, and this information was registered with her originalmore » kV-CT scan for the purposes of structure delineation, dose calculation, and treatment planning. To validate the feasibility of the MV-FBCT-generated treatment plan, an electron density CT phantom (model 465, Gammex Inc., Middleton, WI) was scanned using MV-FBCT to obtain CT number to density table. Additionally, both a 'cheese' phantom (which came with the tomotherapy treatment machine) with 2 inserted ion chambers and a generic phantom called Quasar phantom (Modus Medical Devices Inc., London, ON, Canada) with one inserted chamber were used to confirm dosimetric accuracy. The MV-FBCT could be used to clearly visualize anatomy in the region of the dental artifact and provide sufficient soft-tissue contrast to assist in the delineation of normal tissue structures and fat planes. With the elimination of the dental artifact, the MV-FBCT images allowed more accurate dose calculation by the tomotherapy system. It was confirmed that the phantom material density was determined correctly by the tomotherapy MV-FBCT number to density table. The ion chamber measurements agreed with the calculations from the MV-FBCT generated phantom plan within 2%. MV-FBCT may be useful in radiation treatment planning for nasopharyngeal cancer patients in the setting of extensive dental artifacts.« less

Wilmington Area Planning Council, New Castle County, Delaware and Cecil County, Maryland : a performance-based approach to integrating congestion management into the metropolitan planning process

DOT National Transportation Integrated Search

2009-04-01

The Wilmington Area Planning Council takes an objectives-driven, performance-based approach to its metropolitan transportation planning, including paying special attention to integrating its Congestion Management Process into its planning efforts. Th...

Erythropoietic Protoporphyria (EPP) or Protoporphyria

MedlinePlus

... protoporphyrin can differentiate X-linked protoporphyria from EPP. Molecular genetic testing can confirm a diagnosis of X-linked ... systematically and comprehensively plan an affected child’s treatment. Genetic ... expression and characterization of erythroid-specific 5-aminolevulinate ...

BASF confirms plans for world-scale cracker on the Gulf Coast

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

Wood, A.

BASF Corp. has confirmed plans that it will build a world-scale cracker on the Gulf Coast. The company has completed preliminary work, and {open_quotes}the results of our project analysis have been extremely encouraging,{close_quotes} says chemicals president Carl A. Jennings. {open_quotes}We`ll proceed with high priority to have the cracker ready for startup in second-half 2000.{close_quotes} The company says it will select a location for the project by mid-1977. In addition to considering its sites at Geismar, LA; Freeport, TX; and Altamira, Mexico, BASF says that {open_quotes}cooperative arrangements{close_quotes} are being looked at. That could include locating the project at a different site,more » adjacent to a feedstock source, according to Jennings. He says the project could also include joint venture partners.« less

Planning a sports training program using Adaptive Particle Swarm Optimization with emphasis on physiological constraints.

PubMed

Kumyaito, Nattapon; Yupapin, Preecha; Tamee, Kreangsak

2018-01-08

An effective training plan is an important factor in sports training to enhance athletic performance. A poorly considered training plan may result in injury to the athlete, and overtraining. Good training plans normally require expert input, which may have a cost too great for many athletes, particularly amateur athletes. The objectives of this research were to create a practical cycling training plan that substantially improves athletic performance while satisfying essential physiological constraints. Adaptive Particle Swarm Optimization using ɛ-constraint methods were used to formulate such a plan and simulate the likely performance outcomes. The physiological constraints considered in this study were monotony, chronic training load ramp rate and daily training impulse. A comparison of results from our simulations against a training plan from British Cycling, which we used as our standard, showed that our training plan outperformed the benchmark in terms of both athletic performance and satisfying all physiological constraints.

Analysis of Tsunami Evacuation Issues Using Agent Based Modeling. A Case Study of the 2011 Tohoku Tsunami in Yuriage, Natori.

NASA Astrophysics Data System (ADS)

Mas, E.; Takagi, H.; Adriano, B.; Hayashi, S.; Koshimura, S.

2014-12-01

The 2011 Great East Japan earthquake and tsunami reminded that nature can exceed structural countermeasures like seawalls, breakwaters or tsunami gates. In such situations it is a challenging task for people to find nearby haven. This event, as many others before, confirmed the importance of early evacuation, tsunami awareness and the need for developing much more resilient communities with effective evacuation plans. To support reconstruction activities and efforts on developing resilient communities in areas at risk, tsunami evacuation simulation can be applied to tsunami mitigation and evacuation planning. In this study, using the compiled information related to the evacuation behavior at Yuriage in Natori during the 2011 tsunami, we simulated the evacuation process and explored the reasons for the large number of fatalities in the area. It was found that residents did evacuate to nearby shelter areas, however after the tsunami warning was increased some evacuees decided to conduct a second step evacuation to a far inland shelter. Simulation results show the consequences of such decision and the outcomes when a second evacuation would not have been performed. The actual reported number of fatalities in the event and the results from simulation are compared to verify the model. The case study shows the contribution of tsunami evacuation models as tools to be applied for the analysis of evacuees' decisions and the related outcomes. In addition, future evacuation plans and activities for reconstruction process and urban planning can be supported by the results provided from this kind of tsunami evacuation models.

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

Beaudry, J.; Bergman, A.; British Columbia Cancer Agency - Vancouver Centre, Vancouver, BC

Lung tumours move due to respiratory motion. This is managed during planning by acquiring a 4DCT and capturing the excursion of the GTV (gross tumour volume) throughout the breathing cycle within an IGTV (Internal Gross Tumour Volume) contour. Patients undergo a verification cone-beam CT (CBCT) scan immediately prior to treatment. 3D reconstructed images do not consider tumour motion, resulting in image artefacts, such as blurring. This may lead to difficulty in identifying the tumour on reconstructed images. It would be valuable to create a 4DCBCT reconstruction of the tumour motion to confirm that does indeed remain within the planned IGTV.more » CBCT projections of a Quasar Respiratory Motion Phantom are acquired in Treatment mode (half-fan scan) on a Varian TrueBeam accelerator. This phantom contains a mobile, low-density lung insert with an embedded 3cm diameter tumour object. It is programmed to create a 15s periodic, 2cm (sup/inf) displacement. A Varian Real-time Position Management (RPM) tracking-box is placed on the phantom breathing platform. Breathing phase information is automatically integrated into the projection image files. Using in-house Matlab programs and RTK (Reconstruction Tool Kit) open-source toolboxes, the projections are re-binned into 10 phases and a 4DCBCT scan reconstructed. The planning IGTV is registered to the 4DCBCT and the tumour excursion is verified to remain within the planned contour. This technique successfully reconstructs 4DCBCT images using clinical modes for a breathing phantom. UBC-BCCA ethics approval has been obtained to perform 4DCBCT reconstructions on lung patients (REB#H12-00192). Clinical images will be accrued starting April 2014.« less

Radiotherapy planning: PET/CT scanner performances in the definition of gross tumour volume and clinical target volume.

PubMed

Brianzoni, Ernesto; Rossi, Gloria; Ancidei, Sergio; Berbellini, Alfonso; Capoccetti, Francesca; Cidda, Carla; D'Avenia, Paola; Fattori, Sara; Montini, Gian Carlo; Valentini, Gianluca; Proietti, Alfredo; Algranati, Carlo

2005-12-01

Positron emission tomography is the most advanced scintigraphic imaging technology and can be employed in the planning of radiation therapy (RT). The aim of this study was to evaluate the possible role of fused images (anatomical CT and functional FDG-PET), acquired with a dedicated PET/CT scanner, in delineating gross tumour volume (GTV) and clinical target volume (CTV) in selected patients and thus in facilitating RT planning. Twenty-eight patients were examined, 24 with lung cancer (17 non-small cell and seven small cell) and four with non-Hodgkin's lymphoma in the head and neck region. All patients underwent a whole-body PET scan after a CT scan. The CT images provided morphological volumetric information, and in a second step, the corresponding PET images were overlaid to define the effective target volume. The images were exported off-line via an internal network to an RT simulator. Three patient were excluded from the study owing to change in the disease stage subsequent to the PET/CT study. Among the remaining 25 patients, PET significantly altered the GTV or CTV in 11 (44%) . In five of these 11 cases there was a reduction in GTV or CTV, while in six there was an increase in GTV or CTV. FDG-PET is a highly sensitive imaging modality that offers better visualisation of local and locoregional tumour extension. This study confirmed that co-registration of CT data and FDG-PET images may lead to significant modifications of RT planning and patient management.

EARLY ENTRANCE COPRODUCTION PLANT

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

David Storm; Govanon Nongbri; Steve Decanio

2004-01-12

The overall objective of this project is the three phase development of an Early Entrance Coproduction Plant (EECP) which uses petroleum coke to produce at least one product from at least two of the following three categories: (1) electric power (or heat), (2) fuels, and (3) chemicals using ChevronTexaco's proprietary gasification technology. The objective of Phase I is to determine the feasibility and define the concept for the EECP located at a specific site; develop a Research, Development, and Testing (RD&T) Plan to mitigate technical risks and barriers; and prepare a Preliminary Project Financing Plan. The objective of Phase IImore » is to implement the work as outlined in the Phase I RD&T Plan to enhance the development and commercial acceptance of coproduction technology. The objective of Phase III is to develop an engineering design package and a financing and testing plan for an EECP located at a specific site. The project's intended result is to provide the necessary technical, economic, and environmental information needed by industry to move the EECP forward to detailed design, construction, and operation. The partners in this project are Texaco Energy Systems LLC or TES (a subsidiary of ChevronTexaco), General Electric (GE), Praxair, and Kellogg Brown & Root (KBR) in addition to the U.S. Department of Energy (DOE). TES is providing gasification technology and Fischer-Tropsch (F-T) technology developed by Rentech, Inc., GE is providing combustion turbine technology, Praxair is providing air separation technology, and KBR is providing engineering. During Phase I, a design basis for the Fischer-Tropsch Synthesis section was developed based on limited experience with the specified feed gas and operating conditions. The objective of this Task in Phase II RD&T work was to confirm the performance of the F-T reactor at the set design conditions. Although much of the research, development, and testing work were done by TES outside of this project, several important issues were addressed in this phase of the project. They included Rejuvenation/Regeneration of the Fischer-Tropsch Catalyst, online Catalyst Withdrawal and Addition from the synthesis reactor, and the Fischer-Tropsch Design Basis Confirmation. In Phase III the results from these RD&T work will be incorporated in developing the engineering design package. This Topical Report documents the Phase II RD&T work that was completed for this task.« less

Phase 1 Methyl Iodide Deep-Bed Adsorption Tests

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

Soelberg, Nick; Watson, Tony

2014-08-22

Nuclear fission results in the production of fission products (FPs) and activation products including iodine-129, which could evolve into used fuel reprocessing facility off-gas systems, and could require off-gas control to limit air emissions to levels within acceptable emission limits. Research, demonstrations, and some reprocessing plant experience have indicated that diatomic iodine can be captured with efficiencies high enough to meet regulatory requirements. Research on the capture of organic iodides has also been performed, but to a lesser extent [Jubin 2012b]. Several questions remain open regarding the capture of iodine bound in organic compounds. Deep-bed methyl iodide adsorption testing hasmore » progressed according to a multi-laboratory methyl iodide adsorption test plan. This report summarizes the first phase of methyl iodide adsorption work performed according to this test plan using the deep-bed iodine adsorption test system at the Idaho National Laboratory (INL), performed during Fiscal Year (FY) 2013 and early FY-2014. Testing has been performed to address questions posed in the test plan, and followed the testing outline in the test plan. Tests established detection limits, developed procedures for sample analysis with minimal analytical interferences, and confirmed earlier results that show that the methyl iodide reacts when in contact with the AgZ sorbent, and not significantly in the gas flow upstream of the sorbent. The reaction(s) enable separation of the iodine from the organic moiety, so that the iodine can chemisorb onto the sorbent. The organic moiety can form other compounds, some of which are organic compounds that are detected and can be tentatively identified using GC-FID and GCMS. Test results also show that other gas constituents (NOx and/or H2O) can affect the methyl iodide reactions. With NOx and H2O present in the gas stream, the majority of uncaptured iodine exiting iodine-laden sorbent beds is in the form of I2 or HI, species that are soluble in NaOH scrubbing solution for iodine analysis. But when NOx and H2O are not present, then the majority of the uncaptured iodine exiting iodine-laden sorbent is in the form of methyl iodide. Methyl iodide adsorption efficiencies have been high enough so that initial DFs exceed 1,000 to 10,000. The methyl iodide mass transfer zone depths are estimated at 4-8 inches, possibly deeper than mass transfer zone depths estimated for I2 adsorption on AgZ. Additional deep-bed testing and analyses are recommended to (a) expand the data base for methyl iodide adsorption under various conditions specified in the methyl iodide test plan, and (b) provide more data for evaluating organic iodide reactions and reaction byproducts for different potential adsorption conditions.« less

Novel Application of Helical Tomotherapy in Whole Skull Palliative Radiotherapy

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

Rodrigues, George; Yartsev, Slav; Coad, Terry

2008-01-01

Helical tomotherapy (HT) is a radiation planning/delivery platform that combines inversely planned IMRT with on-board megavoltage imaging. A unique HT radiotherapy whole skull brain sparing technique is described in a patient with metastatic prostate cancer. An inverse HT plan and an accompanying back-up conventional lateral 6-MV parallel opposed pair (POP) plan with corresponding isodose distributions and dose-volume histograms (DVH) were created and assessed prior to initiation of therapy. Plans conforming to the planning treatment volume (PTV) with significant sparing of brain, optic nerve, and eye were created. Dose heterogeneity to the PTV target was slightly higher in the HT planmore » compared to the back-up POP plan. Conformal sparing of brain, optic nerve, and eye was achieved by the HT plan. Similar lens and brain stem/spinal cord doses were seen with both plans. Prospective clinical evaluation with relevant end points (quality of life, symptom relief) are required to confirm the potential benefits of highly conformal therapies applied to palliative situations such as this case.« less

Osiris-Rex and Hayabusa2 Sample Cleanroom Design and Construction Planning at NASA-JSC

NASA Technical Reports Server (NTRS)

Righter, Kevin; Pace, Lisa F.; Messenger, Keiko

2018-01-01

Final Paper and not the abstract is attached. The OSIRIS-REx asteroid sample return mission launched to asteroid Bennu September 8, 2016. The spacecraft will arrive at Bennu in late 2019, orbit and map the asteroid, and perform a touch and go (TAG) sampling maneuver in July 2020. After confirma-tion of successful sample stowage, the spacecraft will return to Earth, and the sample return capsule (SRC) will land in Utah in September 2023. Samples will be recovered from Utah and then transported and stored in a new sample cleanroom at NASA Johnson Space Center in Houston. All curation-specific ex-amination and documentation activities related to Ben-nu samples will be conducted in the dedicated OSIRIS-REx sample cleanroom to be built at NASA-JSC.

⁶Li-loaded directionally sensitive anti-neutrino detector for possible geo-neutrinographic imaging applications.

PubMed

Tanaka, H K M; Watanabe, H

2014-04-24

Despite the latent and unique benefits of imaging uranium and thorium's distribution in the earth's interior, previously proposed experimental techniques used to identify the incoming geo-neutrino's direction are not applicable to practical imaging due to the high miss-identification in a neutrino's track reconstruction. After performing experimental studies and Monte-Carlo simulations, we confirmed that a significant improvement is possible in neutrino tracking identification with a (6)Li-loaded neutrino detector. For possible imaging applications, we also explore the feasibility of producing geo-neutrinographic images of gigantic magmatic reservoirs and deep structure in the mantle. We anticipate and plan to apply these newly designed detectors to radiographic imaging of the Earth's interior, monitoring of nuclear reactors, and tracking astrophysical sources of neutrinos.

6Li-loaded directionally sensitive anti-neutrino detector for possible geo-neutrinographic imaging applications

PubMed Central

Tanaka, H. K. M.; Watanabe, H.

2014-01-01

Despite the latent and unique benefits of imaging uranium and thorium's distribution in the earth's interior, previously proposed experimental techniques used to identify the incoming geo-neutrino's direction are not applicable to practical imaging due to the high miss-identification in a neutrino's track reconstruction. After performing experimental studies and Monte-Carlo simulations, we confirmed that a significant improvement is possible in neutrino tracking identification with a 6Li-loaded neutrino detector. For possible imaging applications, we also explore the feasibility of producing geo-neutrinographic images of gigantic magmatic reservoirs and deep structure in the mantle. We anticipate and plan to apply these newly designed detectors to radiographic imaging of the Earth's interior, monitoring of nuclear reactors, and tracking astrophysical sources of neutrinos. PMID:24759616

Frameless fractionated stereotactic radiation therapy of intracranial lesions: impact of cone beam CT based setup correction on dose distribution

PubMed Central

2013-01-01

Background The purpose of this study was to evaluate the impact of Cone Beam CT (CBCT) based setup correction on total dose distributions in fractionated frameless stereotactic radiation therapy of intracranial lesions. Methods Ten patients with intracranial lesions treated with 30 Gy in 6 fractions were included in this study. Treatment planning was performed with Oncentra® for a SynergyS® (Elekta Ltd, Crawley, UK) linear accelerator with XVI® Cone Beam CT, and HexaPOD™ couch top. Patients were immobilized by thermoplastic masks (BrainLab, Reuther). After initial patient setup with respect to lasers, a CBCT study was acquired and registered to the planning CT (PL-CT) study. Patient positioning was corrected according to the correction values (translational, rotational) calculated by the XVI® system. Afterwards a second CBCT study was acquired and registered to the PL-CT to confirm the accuracy of the corrections. An in-house developed software was used for rigid transformation of the PL-CT to the CBCT geometry, and dose calculations for each fraction were performed on the transformed CT. The total dose distribution was achieved by back-transformation and summation of the dose distributions of each fraction. Dose distributions based on PL-CT, CBCT (laser set-up), and final CBCT were compared to assess the influence of setup inaccuracies. Results The mean displacement vector, calculated over all treatments, was reduced from (4.3 ± 1.3) mm for laser based setup to (0.5 ± 0.2) mm if CBCT corrections were applied. The mean rotational errors around the medial-lateral, superior-inferior, anterior-posterior axis were reduced from (−0.1 ± 1.4)°, (0.1 ± 1.2)° and (−0.2 ± 1.0)°, to (0.04 ± 0.4)°, (0.01 ± 0.4)° and (0.02 ± 0.3)°. As a consequence the mean deviation between planned and delivered dose in the planning target volume (PTV) could be reduced from 12.3% to 0.4% for D95 and from 5.9% to 0.1% for Dav. Maximum deviation was reduced from 31.8% to 0.8% for D95, and from 20.4% to 0.1% for Dav. Conclusion Real dose distributions differ substantially from planned dose distributions, if setup is performed according to lasers only. Thermoplasic masks combined with a daily CBCT enabled a sufficient accuracy in dose distribution. PMID:23800172

Predicting actual weight loss: A review of the determinants according to the theory of planned behaviour

PubMed Central

Fong, Shirley Siu Ming

2015-01-01

Weight reduction that corresponds with lifestyle modification is difficult to foster. The theory of planned behaviour has been actively cited in explaining health-related behaviour. This review evaluated the application of the theory of planned behaviour to weight-loss behaviour. Among the three reviewed papers, cross-sectional survey designs and subjective outcome measurements were commonly applied. All of the studies recruited obese female adults as participants, limiting the generalisability of the studies’ findings. The theory of planned behaviour can be effectively applied in weight-reduction programmes targeting female obese patients. This review confirmed critiques citing the limitations of experimental studies, the subjective measurement of behaviour and short follow-up periods. PMID:28070350

Increasing access to emergency contraception through online prescription requests.

PubMed

Averbach, Sarah; Wendt, Jacqueline Moro; Levine, Deborah K; Philip, Susan S; Klausner, Jeffrey D

2010-01-01

To describe a pilot program, Plan B Online Prescription Access, to provide easy access to prescriptions for emergency contraception via the Internet. We measured electronic prescriptions for Plan B (Duramed Pharmaceuticals, Cincinnati, Ohio) by month over time. Pharmacists faxed patient-generated prescriptions back to the Department of Public Health for confirmation. Despite no marketing, within the first 18 months of the program, 152 electronic prescriptions for Plan B were requested by 128 female San Francisco residents. Seventy-eight prescriptions were filled (51%) by pharmacists. If correctly marketed, online prescriptions for Plan B have the potential to be an effective means of increasing emergency contraception access in both urban and rural settings across the United States. Further user-acceptability studies are warranted.

Thinking about thinking: Neural mechanisms and effects on memory.

PubMed

Bonhage, Corinna; Weber, Friederike; Exner, Cornelia; Kanske, Philipp

2016-02-15

It is a well-established finding that memory encoding is impaired if an external secondary task (e.g. tone discrimination) is performed simultaneously. Yet, while studying we are also often engaged in internal secondary tasks such as planning, ruminating, or daydreaming. It remains unclear whether such a secondary internal task has similar effects on memory and what the neural mechanisms underlying such an influence are. We therefore measured participants' blood oxygenation level dependent responses while they learned word-pairs and simultaneously performed different types of secondary tasks (i.e., internal, external, and control). Memory performance decreased in both internal and external secondary tasks compared to the easy control condition. However, while the external task reduced activity in memory-encoding related regions (hippocampus), the internal task increased neural activity in brain regions associated with self-reflection (anterior medial prefrontal cortex), as well as in regions associated with performance monitoring and the perception of salience (anterior insula, dorsal anterior cingulate cortex). Resting-state functional connectivity analyses confirmed that anterior medial prefrontal cortex and anterior insula/dorsal anterior cingulate cortex are part of the default mode network and salience network, respectively. In sum, a secondary internal task impairs memory performance just as a secondary external task, but operates through different neural mechanisms. Copyright © 2015 Elsevier Inc. All rights reserved.

Factors that affect substance users' suicidal behavior: a view from the Addiction Severity Index in Korea.

PubMed

Kwon, Min; Yang, Soo; Park, Kyongran; Kim, Dai-Jin

2013-11-12

In South Korea, it has not been easy to negotiate studies that target drug users who are being punished by law, and accordingly, no study on suicidal ideation among substance users has been accomplished yet. In this study, the factors that affect substance users' suicidal ideation were confirmed. It was based on the data collected from 'The 2009 Study on Substance-Dependent Individuals in Korea' , which was conducted by The Catholic University of Korea in 2010 as a project sponsored by the Ministry of Health and Welfare of Korea. This study targeted 523 former hospital inpatients, prison inmates, and persons under protective supervision who had used substances such as psychotropic drugs, marijuana, and narcotic agents, and were in the recovery stage at various treatment/rehabilitation centers. Student's t and chi-square tests were used, and multivariate analysis was performed to examine the strength of the relationships between suicide ideation and various factors. According to this study, 41% of these substance users planned suicide with suicidal ideation. Suicidal ideation was confirmed as associated with an unsatisfactory domestic environment, insufficient and unsatisfactory spare time experiences with others, emotional abuse, severe depression, and trouble with controlling violent behavior. Of the substance users who had planned to commit suicide, 56% attempted suicide. Their suicide attempts were shown to have been associated with insufficient protective supervision and the experiences of physical abuse, trouble with controlling violent behavior, and doctors' prescriptions due to psychological or emotional problems. Based on this analysis of the factors that affect suicidal behavior, preventive measures and strategies for substance user were suggested in this study.

Wave-induced hydraulic forces on submerged aquatic plants in shallow lakes.

PubMed

Schutten, J; Dainty, J; Davy, A J

2004-03-01

Hydraulic pulling forces arising from wave action are likely to limit the presence of freshwater macrophytes in shallow lakes, particularly those with soft sediments. The aim of this study was to develop and test experimentally simple models, based on linear wave theory for deep water, to predict such forces on individual shoots. Models were derived theoretically from the action of the vertical component of the orbital velocity of the waves on shoot size. Alternative shoot-size descriptors (plan-form area or dry mass) and alternative distributions of the shoot material along its length (cylinder or inverted cone) were examined. Models were tested experimentally in a flume that generated sinusoidal waves which lasted 1 s and were up to 0.2 m high. Hydraulic pulling forces were measured on plastic replicas of Elodea sp. and on six species of real plants with varying morphology (Ceratophyllum demersum, Chara intermedia, Elodea canadensis, Myriophyllum spicatum, Potamogeton natans and Potamogeton obtusifolius). Measurements on the plastic replicas confirmed predicted relationships between force and wave phase, wave height and plant submergence depth. Predicted and measured forces were linearly related over all combinations of wave height and submergence depth. Measured forces on real plants were linearly related to theoretically derived predictors of the hydraulic forces (integrals of the products of the vertical orbital velocity raised to the power 1.5 and shoot size). The general applicability of the simplified wave equations used was confirmed. Overall, dry mass and plan-form area performed similarly well as shoot-size descriptors, as did the conical or cylindrical models of shoot distribution. The utility of the modelling approach in predicting hydraulic pulling forces from relatively simple plant and environmental measurements was validated over a wide range of forces, plant sizes and species.

A Total Quality-Control Plan with Right-Sized Statistical Quality-Control.

PubMed

Westgard, James O

2017-03-01

A new Clinical Laboratory Improvement Amendments option for risk-based quality-control (QC) plans became effective in January, 2016. Called an Individualized QC Plan, this option requires the laboratory to perform a risk assessment, develop a QC plan, and implement a QC program to monitor ongoing performance of the QC plan. Difficulties in performing a risk assessment may limit validity of an Individualized QC Plan. A better alternative is to develop a Total QC Plan including a right-sized statistical QC procedure to detect medically important errors. Westgard Sigma Rules provides a simple way to select the right control rules and the right number of control measurements. Copyright © 2016 Elsevier Inc. All rights reserved.

SU-E-T-470: Beam Performance of the Radiance 330 Proton Therapy System

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

Nazaryan, H; Nazaryan, V; Wang, F

2014-06-01

Purpose: The ProTom Radiance 330 proton radiotherapy system is a fully functional, compact proton radiotherapy system that provides advanced proton delivery capabilities. It supports three-dimensional beam scanning with energy and intensity modulation. A series of measurements have been conducted to characterize the beam performance of the first installation of the system at the McLaren Proton Therapy Center in Flint, Michigan. These measurements were part of the technical commissioning of the system. Select measurements and results are presented. Methods: The Radiance 330 proton beam energy range is 70–250 MeV for treatment, and up to 330 MeV for proton tomography and radiography.more » Its 3-D scanning capability, together with a small beam emittance and momentum spread, provides a highly efficient beam delivery. During the technical commissioning, treatment plans were created to deliver uniform maps at various energies to perform Gamma Index analysis. EBT3 Gafchromic films were irradiated using the Planned irradiation maps. Bragg Peak chamber was used to test the dynamic range during a scan in one layer for high (250 MeV) and Low (70 MeV) energies. The maximum and minimum range, range adjustment and modulation, distal dose falloff (80%–20%), pencil beam spot size, spot placement accuracy were also measured. The accuracy testing included acquiring images, image registration, receiving correction vectors and applying the corrections to the robotic patient positioner. Results: Gamma Index analysis of the Treatment Planning System (TPS) data vs. Measured data showed more than 90% of points within (3%, 3mm) for the maps created by the TPS. At Isocenter Beam Size (One sigma) < 3mm at highest energy (250 MeV) in air. Beam delivery was within 0.6 mm of the intended target at the entrance and the exit of the beam, through the phantom. Conclusion: The Radiance 330 Beam Performance Measurements have confirmed that the system operates as designed with excellent clinical performance specifications. Hovakim Nazaryan, Vahagn Nazaryan and Fuhua Wang are employees of ProTom International, Inc. who contributed to the development and completed the technical commissioning of the Radiance 330 proton therapy delivery system manufactured by ProTom International.« less

Self-perception and malocclusion and their relation to oral appearance and function.

PubMed

Peres, Sílvia Helena de Carvalho Sales; Goya, Suzana; Cortellazzi, Karine Laura; Ambrosano, Gláucia Maria Bovi; Meneghim, Marcelo de Castro; Pereira, Antonio Carlos

2011-10-01

The aim of this study was to evaluate the relationship between malocclusion and self-perception of oral appearance/function, in 12/15-year-old Brazilian adolescents. The cluster sample consisted of 717 teenagers attending 24 urban public (n=611) and 5 rural public (n=107) schools in Maringá/PR. Malocclusion was measured using the Dental Aesthetic Index (DAI), in accordance with WHO recommendations. A parental questionnaire was applied to collect information on esthetic perception level and oral variables related to oral health. Univariate and multiple logistic regression analyses were performed. Multiple logistic regression confirmed that for 12-year-old, missing teeth (OR=2.865) and presence of openbite (open occlusal relationship) (OR=2.865) were risk indicators for speech capability. With regard to 15-year-old, presence of mandibular overjet (horizontal overlap) (OR=4.016) was a risk indicator for speech capability and molar relationship (OR=1.661) was a risk indicator for chewing capability. The impact of malocclusion on adolescents' life was confirmed in this study. Speech and chewing capability were associated with orthodontic deviations, which should be taken into consideration in oral health planning, to identify risk groups and improve community health services.

Surgical repair of a congenital sternal cleft in a cat.

PubMed

Schwarzkopf, Ilona; Bavegems, Valerie C A; Vandekerckhove, Peter M F P; Melis, Sanne M; Cornillie, Pieter; de Rooster, Hilde

2014-07-01

To describe the clinical findings, diagnosis, and treatment of an incomplete cleft of the 5th-8th sternebra and a cranioventral abdominal wall hernia in a 2 month old Ragdoll kitten and to evaluate the short- and long-term outcome. Clinical report. Ragdoll cat (n = 1), 2 months old. Sternal cleft was confirmed by thoracic radiographs. Computed tomography (CT) was used to plan an optimal surgical approach. A ventral median incision was made, starting at the 3rd sternebra and extended into the abdomen. Ostectomy of the proximal part of the 5th left sternebra was performed. Lateral periosteal flaps were created, unfolded, and absorbable monofilament sutures preplaced to facilitate closure and the repair was reinforced by 2 peristernal sutures. A bone graft was applied, and the free margin of the omentum was sutured to the cranial aspect of the wound. No major complications occurred. At 3 weeks, CT scan confirmed approximation of the hemisternebrae and at 10 months, complete fusion of the hemisternebrae had not occurred, but a strong connection of the sternal bars was present. Sternal cleft is a rare congenital abnormality that can be corrected surgically with favorable outcome. © Copyright 2014 by The American College of Veterinary Surgeons.

Hypertensive crisis in pregnancy due to a metamorphosing pheochromocytoma with postdelivery Cushing's syndrome.

PubMed

Langton, Katharina; Gruber, Matthias; Masjkur, Jimmy; Steenblock, Charlotte; Peitzsch, Mirko; Meinel, Jörn; Lenders, Jacques; Bornstein, Stefan; Eisenhofer, Graeme

2018-01-01

Pheochromocytomas in pregnancy are rare but potentially lethal. Even rarer is the combination of pheochromocytoma in pregnancy with subsequent development of ectopic Cushing's syndrome. We report a 36-year-old woman, previously diagnosed with essential hypertension, who developed severe hypertension in pregnancy complicated by insulin-dependent gestational diabetes. A cesarean section was performed at 32 weeks following a hypertensive crisis after routine administration of betamethasone. Postnatal persistence of signs and symptoms of catecholamine excess led to the diagnosis of a left adrenal pheochromocytoma. Between diagnosis and planned tumor removal, the patient developed signs and symptoms of Cushing's syndrome (facial edema and hirsutism, myopathy and fatigue). Biochemical testing confirmed hypercortisolism with extremely elevated levels of plasma adrenocorticotropin, urinary cortisol and multiple steroids of a plasma panel that were all normal at previous testing. The previously noradrenergic tumor also started producing epinephrine. Histopathological examination confirmed the pheochromocytoma, which was also immunohistochemically positive for adrenocorticotropin. Full post-surgical recovery was sustained with normal blood pressure and biochemical findings after one year. This report not only underlines the chameleon behavior of pheochromocytoma but also illustrates its potential for a metamorphosing presentation. Corticosteroid administration in pregnancy requires a cautious approach in patients with hypertension.

Quantitative confirmation of diffusion-limited oxidation theories

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

Gillen, K.T.; Clough, R.L.

1990-01-01

Diffusion-limited (heterogeneous) oxidation effects are often important for studies of polymer degradation. Such effects are common in polymers subjected to ionizing radiation at relatively high dose rate. To better understand the underlying oxidation processes and to aid in the planning of accelerated aging studies, it would be desirable to be able to monitor and quantitatively understand these effects. In this paper, we briefly review a theoretical diffusion approach which derives model profiles for oxygen surrounded sheets of material by combining oxygen permeation rates with kinetically based oxygen consumption expressions. The theory leads to a simple governing expression involving the oxygenmore » consumption and permeation rates together with two model parameters {alpha} and {beta}. To test the theory, gamma-initiated oxidation of a sheet of commercially formulated EPDM rubber was performed under conditions which led to diffusion-limited oxidation. Profile shapes from the theoretical treatments are shown to accurately fit experimentally derived oxidation profiles. In addition, direct measurements on the same EPDM material of the oxygen consumption and permeation rates, together with values of {alpha} and {beta} derived from the fitting procedure, allow us to quantitatively confirm for the first time the governing theoretical relationship. 17 refs., 3 figs.« less

7 CFR 4279.156 - Planning and performing development.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Planning and performing development. 4279.156 Section 4279.156 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS... Industry Loans § 4279.156 Planning and performing development. (a) Design policy. The lender must ensure...

Performance measurement: A tool for program control

NASA Technical Reports Server (NTRS)

Abell, Nancy

1994-01-01

Performance measurement is a management tool for planning, monitoring, and controlling as aspects of program and project management--cost, schedule, and technical requirements. It is a means (concept and approach) to a desired end (effective program planning and control). To reach the desired end, however, performance measurement must be applied and used appropriately, with full knowledge and recognition of its power and of its limitations--what it can and cannot do for the project manager. What is the potential of this management tool? What does performance measurement do that a traditional plan vs. actual technique cannot do? Performance measurement provides an improvement over the customary comparison of how much money was spent (actual cost) vs. how much was planned to be spent based on a schedule of activities (work planned). This commonly used plan vs. actual comparison does not allow one to know from the numerical data if the actual cost incurred was for work intended to be done.

Market and plan characteristics related to HMO quality and improvement.

PubMed

Scanlon, Dennis P; Swaminathan, Shailender; Chernew, Michael; Lee, Woolton

2006-12-01

Existing research on health plan performance examines whether variation in plans' scores is related to enrollee and health plan traits, primarily using cross-sectional research designs. This study extends that literature by incorporating data on market characteristics using a longitudinal framework. We estimate multivariate growth models that relate plan performance on standard measures to market and HMO characteristics using an unbalanced panel of data for 1998 to 2002. We find that HMO competition is not associated with better performance or greater rates of improvement in performance on the HEDIS chronic care measures. HMO penetration, on the other hand, is positively associated with HEDIS performance in several of the chronic care process-and-outcomes measures but not with a greater rate of improvement through time. Our analysis indicates that a significant percentage of the unexplained variation in quality improvement is because of permanent, unobserved plan-level characteristics that future research should strive to identify.

Validation of a pretreatment delivery quality assurance method for the CyberKnife Synchrony system.

PubMed

Mastella, E; Vigorito, S; Rondi, E; Piperno, G; Ferrari, A; Strata, E; Rozza, D; Jereczek-Fossa, B A; Cattani, F

2016-08-01

To evaluate the geometric and dosimetric accuracies of the CyberKnife Synchrony respiratory tracking system (RTS) and to validate a method for pretreatment patient-specific delivery quality assurance (DQA). An EasyCube phantom was mounted on the ExacTrac gating phantom, which can move along the superior-inferior (SI) axis of a patient to simulate a moving target. The authors compared dynamic and static measurements. For each case, a Gafchromic EBT3 film was positioned between two slabs of the EasyCube, while a PinPoint ionization chamber was placed in the appropriate space. There were three steps to their evaluation: (1) the field size, the penumbra, and the symmetry of six secondary collimators were measured along the two main orthogonal axes. Dynamic measurements with deliberately simulated errors were also taken. (2) The delivered dose distributions (from step 1) were compared with the planned ones, using the gamma analysis method. The local gamma passing rates were evaluated using three acceptance criteria: 3% local dose difference (LDD)/3 mm, 2%LDD/2 mm, and 3%LDD/1 mm. (3) The DQA plans for six clinical patients were irradiated in different dynamic conditions, to give a total of 19 cases. The measured and planned dose distributions were evaluated with the same gamma-index criteria used in step 2 and the measured chamber doses were compared with the planned mean doses in the sensitive volume of the chamber. (1) A very slight enlargement of the field size and of the penumbra was observed in the SI direction (on average <1 mm), in line with the overall average CyberKnife system error for tracking treatments. (2) Comparison between the planned and the correctly delivered dose distributions confirmed the dosimetric accuracy of the RTS for simple plans. The multicriteria gamma analysis was able to detect the simulated errors, proving the robustness of their method of analysis. (3) All of the DQA clinical plans passed the tests, both in static and dynamic conditions. No statistically significant differences were found between static and dynamic cases, confirming the high degree of accuracy of the Synchrony RTS. The presented methods and measurements verified the mechanical and dosimetric accuracy of the Synchrony RTS. Their method confirms the fact that the RTS, if used properly, is able to treat a moving target with great precision. By combining PinPoint ion chamber, EBT3 films, and gamma evaluation of dose distributions, their DQA method robustly validated the effectiveness of CyberKnife and Synchrony system.

Nucleic Acid Amplification Test For Detection Of West Nile Virus Infection In Pakistani Blood Donors.

PubMed

Niazi, Saifullah Khan; Alam, Maqbool; Yazdani, Muhammad Sajid; Ghani, Eijaz; Rathore, Muhammad Ali

2017-01-01

The study was planned to determine the presence of West Nile Virus (WNV) infection in Pakistani blood donors, using Nucleic Acid Amplification Test (NAT). The blood donors for study were selected on the basis of the standard questionnaire and routine screening results. Six donors were pooled using an automated pipettor and NAT for WNV was performed on Roche Cobas s 201 NAT system. The reactive pools were resolved in Individual Donation-NAT (ID-NAT) format and a sample from FFP bags of reactive donations was retrieved. NAT was again performed on retrieved plasma bag (RPB) sample to confirm the reactive donations. The donors were also recalled and interviewed about history of illness related to recent WNV infection. After serological screening of 1929 donors during the study period, 1860 donors were selected for NAT test for WNV detection. The mean age of the donors was 28±8.77 (range: 18-57 years). 1847 (99.3%) donors were male and 13 (0.7%) were female. NAT for WNV identified six initially reactive pools (0.32%). On follow-up testing with RPB samples, 4 donors (0.21%) were found confirmed reactive for WNV RNA (NAT yield of 1 in 465 blood donors). WNV is a threat to safety of blood products in Pakistan. A screening strategy can be implemented after a large-scale study and financial considerations. One of the reduced cost screening strategies is seasonal screening of blood donors for WNV, with pooling of samples.

7 CFR 1924.105 - Planning/performing development.

Code of Federal Regulations, 2013 CFR

2013-01-01

... for a specific site. Planning must take into consideration topography, soils, climate, adjacent land... changing demands. All planning and performing development work is the responsibility of the applicant or...

7 CFR 1924.105 - Planning/performing development.

Code of Federal Regulations, 2012 CFR

2012-01-01

... for a specific site. Planning must take into consideration topography, soils, climate, adjacent land... changing demands. All planning and performing development work is the responsibility of the applicant or...

7 CFR 1924.105 - Planning/performing development.

Code of Federal Regulations, 2011 CFR

2011-01-01

... for a specific site. Planning must take into consideration topography, soils, climate, adjacent land... changing demands. All planning and performing development work is the responsibility of the applicant or...

7 CFR 1924.105 - Planning/performing development.

Code of Federal Regulations, 2010 CFR

2010-01-01

... for a specific site. Planning must take into consideration topography, soils, climate, adjacent land... changing demands. All planning and performing development work is the responsibility of the applicant or...

Performance indicators in water and sanitation for developing areas.

PubMed

Pybus, P; Schoema, G

2001-01-01

There is a move throughout the developed world to introduce benchmarking techniques to the management of water and sanitation systems. The indicators that are being considered for benchmarking purposes tend to cover a broad band of activities that are part of the scope of management of large organisations. Most of the lists that have been prepared do not really cater for the implementation and operation of small rural schemes. The greatest need is the implementation of sustainable schemes for this category of consumer. The implementation of a rural water and sanitation scheme involves the negotiation in the initial stages with the local community representatives of what the community wants and how it will be provided and operated. This may have to be preceded by a period of empowerment so that the negotiations can be conducted by informed people. At the conclusion of the negotiations a business plan can be prepared that should be implemented in association with the community. The project is at this stage mainly in the control of a professional engineer, responsible for the technical interpretation of the business plan and the management of the construction phase. Finally, after commissioning, a water service provider will be responsible for the operation, management and maintenance of the scheme on a sustainable basis. The key actions and activities are identified and performance criteria defined. As communication at the beginning of the project is a critical component, the success of this is confirmed by examination and discussion as to how much has in fact been communicated and understood correctly. Other performance indicators for the operational phase are derived from the conventional ones used in the developed world. Finally, it is important that the participants, do not see the measurement of performance as a threatening situation, but rather a stepping stone to improvement of not only performance, but also of subsequent reward.

The development and implementation of a strategic and tactical planning framework at Mayo Clinic Arizona.

PubMed

Frey, Keith; Cranmer, John Jack; Kirby, Lani J; Lenko, Paul H; Vrabel, Amy Z

2005-01-01

This article describes the Mayo Arizona process for developing an information technology strategic plan. The background of organizational events that gave rise to this strategic planning process is presented. A cross-functional team of key IT stakeholders was convened; the team used a facilitated process to derive a pro forma set of IT strategic objectives from the larger organization's emerging strategic plan. A broad set of leadership interviews was conducted to further identify detailed objectives that would confirm, complement, or conflict with the "strawperson." The IT strategic objectives then were refined and published by the organization. The article also describes the annual process of reviewing the IT strategic plan and translating it to a set of tactical objectives. This includes the committee structure for project prioritization, which is guided by the IT strategic plan. The outcome of the prioritization process is a five-year IT tactical plan, which is used to communicate the IT action plan for achievement of the strategic objectives. The strategic and tactical plans have resulted in stronger ownership and advocacy of IT activities by organizational leadership and a clearer view of the impact of technology on the organization's strategic plan.

The making of indigenous vascular prosthesis

PubMed Central

Unnikrishnan, Madathipat; Viswanathan, Sidharth; Balasubramaniam, K.; Muraleedharan, C.V.; Lal, Arthur Vijayan; Mohanan, P.V.; Mohanty, Meera; Kapilamoorthy, Tirur Raman

2016-01-01

Background & objectives: Vascular illnesses are on the rise in India, due to increase in lifestyle diseases and demographic transition, requiring intervention to save life, organ or limbs using vascular prosthesis. The aim of this study was to develop indigenous large diameter vascular graft for treatment of patients with vascular pathologies. Methods: The South India Textile Research Association, at Coimbatore, Tamil Nadu, India, developed seamless woven polyester (Polyethylene terephthalate) graft at its research wing. Further characterization and testing followed by clinical trials were conducted at Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. Fifteen in vivo experiments were carried out in 1992-1994 in pigs as animal model. Controlled (phase I) clinical trial in ten patients was performed along with control graft. Thereafter, phase II trial involved 22 patients who underwent multi-centre clinical trial in four centres across India. Results: Laboratory testing showed that polyester graft was non-toxic, non-leeching and non-haemolytic with preserved long-term quality, further confirming in pigs by implanting in thoracic aorta, comparable to control Dacron grafts. Perigraft incorporation and smooth neointima formation which are prime features of excellent healing characteristics, were noted at explantation at planned intervals. Subsequently in the phase I and II clinical trials, all patients had excellent recovery without mortality or device-related adverse events. Patients receiving the test graft were followed up for 10 and 5 years, respectively. Serial clinical, duplex scans and CT angiograms performed periodically confirmed excellent graft performance. Interpretation & conclusions: Indigenously developed Chitra vascular graft was comparable to commercially available Dacron graft, ready for clinical use at affordable cost to patients as against costly imported grafts. PMID:27748302

Aiding planning in air traffic control: an experimental investigation of the effects of perceptual information integration.

PubMed

Moertl, Peter M; Canning, John M; Gronlund, Scott D; Dougherty, Michael R P; Johansson, Joakim; Mills, Scott H

2002-01-01

Prior research examined how controllers plan in their traditional environment and identified various information uncertainties as detriments to planning. A planning aid was designed to reduce this uncertainty by perceptually representing important constraints. This included integrating spatial information on the radar screen with discrete information (planned sequences of air traffic). Previous research reported improved planning performance and decreased workload in the planning aid condition. The purpose of this paper was to determine the source of these performance improvements. Analysis of computer interactions using log-linear modeling showed that the planning interface led to less repetitive--but more integrated--information retrieval compared with the traditional planning environment. Ecological interface design principles helped explain how the integrated information retrieval gave rise to the performance improvements. Actual or potential applications of this research include the design and evaluation of interface automation that keeps users in active control by modification of perceptual task characteristics.

Feasibility of Proton Beam Therapy for Ocular Melanoma Using a Novel 3D Treatment Planning Technique

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

Hartsell, William F., E-mail: whartsell@chicagocancer.org; Kapur, Rashmi; Hartsell, Siobhan O'Connor

Purpose: We evaluated sparing of normal structures using 3-dimensional (3D) treatment planning for proton therapy of ocular melanomas. Methods and Materials: We evaluated 26 consecutive patients with choroidal melanomas on a prospective registry. Ophthalmologic work-up included fundoscopic photographs, fluorescein angiography, ultrasonographic evaluation of tumor dimensions, and magnetic resonance imaging of orbits. Three tantalum clips were placed as fiducial markers to confirm eye position for treatment. Macula, fovea, optic disc, optic nerve, ciliary body, lacrimal gland, lens, and gross tumor volume were contoured on treatment planning compute tomography scans. 3D treatment planning was performed using noncoplanar field arrangements. Patients were typicallymore » treated with 3 fields, with at least 95% of planning target volume receiving 50 GyRBE in 5 fractions. Results: Tumor stage was T1a in 10 patients, T2a in 10 patients, T2b in 1 patient, T3a in 2 patients, T3b in 1 patient, and T4a in 2 patients. Acute toxicity was mild. All patients completed treatment as planned. Mean optic nerve dose was 10.1 Gy relative biological effectiveness (RBE). Ciliary body doses were higher for nasal (mean: 11.4 GyRBE) than temporal tumors (5.8 GyRBE). Median follow-up was 31 months (range: 18-40 months). Six patients developed changes which required intraocular bevacizumab or corticosteroid therapy, but only 1 patient developed neovascular glaucoma. Five patients have since died: 1 from metastatic disease and 4 from other causes. Two patients have since required enucleation: 1 due to tumor and 1 due to neovascular glaucoma. Conclusions: 3D treatment planning can be used to obtain appropriate coverage of choroidal melanomas. This technique is feasible with relatively low doses to anterior structures, and appears to have acceptable rates of local control with low risk of enucleation. Further evaluation and follow-up is needed to determine optimal dose-volume relationships for organs at risk to decrease complications rates.« less

Helical Tomotherapy With Simultaneous Integrated Boost After Laparoscopic Staging in Patients With Cervical Cancer: Analysis of Feasibility and Early Toxicity

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

Marnitz, Simone, E-mail: simone.marnitz@charite.de; Koehler, Christhardt; Burova, Elena

Purpose: To demonstrate the feasibility and safety of the simultaneous integrated boost technique for dose escalation in combination with helical tomotherapy in patients with cervical cancer. Methods and Materials: Forty patients (International Federation of Gynecology and Obstetrics Stage IB1 pN1-IVA) underwent primary chemoradiation with helical tomotherapy. Before therapy, 29/40 patients underwent laparoscopic pelvic and para-aortic lymphadenectomy. In 21%, 31%, and 3% of the patients, pelvic, pelvic and para-aortic, and skip metastases in the para-aortic region could be confirmed. All patients underwent radiation with 1.8-50.4 Gy to the tumor region and the pelvic (para-aortic) lymph node region (planning target volume-A), andmore » a simultaneous boost with 2.12-59.36 Gy to the boost region (planning target volume-B). The boost region was defined using titan clips during laparoscopic staging. In all other patients, standardized borders for the planning target volume-B were defined. High-dose-rate brachytherapy was performed in 39/40 patients. The mean biologic effective dose to the macroscopic tumor ranged from 87.5 to 97.5 Gy. Chemotherapy consisted of weekly cisplatin 40 mg/m{sup 2}. Dose-volume histograms and acute gastrointestinal, genitourinary, and hematologic toxicity were evaluated. Results: The mean treatment time was 45 days. The mean doses to the small bowel, rectum, and bladder were 28.5 {+-} 6.1 Gy, 47.9 {+-} 3.8 Gy, and 48 {+-} 3 Gy, respectively. Hematologic toxicity Grade 3 occurred in 20% of patients, diarrhea Grade 2 in 5%, and diarrhea Grade 3 in 2.5%. There was no Grade 3 genitourinary toxicity. All patients underwent curettage 3 months after chemoradiation, which confirmed complete pathologic response in 38/40 patients. Conclusions: The concept of simultaneous integrated boost for dose escalation in patients with cervical cancer is feasible, with a low rate of acute gastrointestinal and genitourinary toxicity. Whether dose escalation can be translated into improved outcome will be assessed after a longer follow-up time.« less

Current status of Japanese detectors

NASA Astrophysics Data System (ADS)

Tatsumi, Daisuke; Takahashi, Ryutaro; Arai, Koji; Nakagawa, Noriyasu; Agatsuma, Kazuhiro; Yamazaki, Toshitaka; Fukushima, Mitsuhiro; Fujimoto, Masa-Katsu; Takamori, Akiteru; Bertolini, Alessandro; Sannibale, Virginio; DeSalvo, Riccardo; Márka, Szabolcs; Ando, Masaki; Tsubono, Kimio; Akutsu, Tomomi; Yamamoto, Kazuhiro; Ishitsuka, Hideki; Uchiyama, Takashi; Miyoki, Shinji; Ohashi, Masatake; Kuroda, Kazuaki; Awaya, Norichika; Kanda, Nobuyuki; Araya, Akito; Telada, Souichi; Tomaru, Takayuki; Haruyama, Tomiyoshi; Yamamoto, Akira; Sato, Nobuaki; Suzuki, Toshitaka; Shintomi, Takakazu

2007-10-01

The current status of the TAMA and CLIO detectors in Japan is reported in this paper. These two interferometric gravitational wave detectors are being developed for the large cryogenic gravitational wave telescope (LCGT) which is a future plan for detecting gravitational wave signals at least once per year. TAMA300 is being upgraded to improve the sensitivity in a low-frequency region after the last observational experiment in 2004. To reduce the seismic noises, we are installing a new seismic isolation system, called the TAMA seismic attenuation system, for the four test masses. We confirmed stable mass locks of a cavity and improvements of length and angular fluctuations by using two SASs. We are currently optimizing the performance of the third and fourth SASs. We continue TAMA300 operation and R&D studies for the LCGT. The next data taking is planned for the summer of 2007. CLIO is a 100 m baseline length prototype detector for LCGT to investigate interferometer performance in cryogenic condition. The key features of CLIO are that it locates the Kamioka underground site for a low-seismic noise level, and adopts cryogenic Sapphire mirrors for low-thermal noise level. The first operation of the cryogenic interferometer was successfully demonstrated in February 2006. Current sensitivity at room temperature is close to the target sensitivity within a factor of 4. Several observational experiments at room temperature have been done. Once the displacement noise reaches the thermal noise level of room temperature, its improvement by cooling test mass mirrors should be demonstrated.

Risk of Guillain-Barré syndrome after meningococcal conjugate vaccination.

PubMed

Velentgas, Priscilla; Amato, Anthony A; Bohn, Rhonda L; Chan, K Arnold; Cochrane, Thomas; Funch, Donnie P; Dashevsky, Inna; Duddy, April L; Gladowski, Patricia; Greenberg, Steven A; Kramer, Judith M; McMahill-Walraven, Cheryl; Nakasato, Cynthia; Spettell, Claire M; Syat, Beth L; Wahl, Peter M; Walker, Alexander M; Zhang, Fang; Brown, Jeffrey S; Platt, Richard

2012-12-01

A new meningococcal conjugate vaccine (MCV4) was introduced in 2005. Shortly after, case reports of Guillain-Barré syndrome (GBS), a serious demyelinating disease, began to be reported to the Vaccine Adverse Event Reporting System. In 2006, the Centers for Disease Control and Prevention and the Food and Drug Administration requested the evaluation of GBS risk after MCV4 vaccination. We conducted a study to assess the risk of GBS after MCV4 vaccination using health plan administrative and claims data together with the review of primary medical records of potential cases. Retrospective cohort study among 12.6 million 11- to 21-year-old members of five US health plans with a total membership of 50 million. Automated enrollment and medical claims data from March 2005 through August 2008 were used to identify the population, the vaccinations administered, and the medical services associated with possible GBS. Medical records were reviewed and adjudicated by a neurologist panel to confirm cases of GBS. The study used distributed data analysis methods that minimized sharing of protected health information. We confirmed 99 GBS cases during 18,322,800 person-years (5.4/1,000,000 person-years). More than 1.4 million MCV4 vaccinations were observed. No confirmed cases of GBS occurred within 6 weeks after vaccination. The upper 95% CI for the attributable risk of GBS associated with MCV4 is estimated as 1.5 cases per 1,000,000 doses. Among members of five US health plans, MCV4 vaccination was not associated with increased GBS risk. Copyright © 2012 John Wiley & Sons, Ltd.

77 FR 37683 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-22

... update of strategic plans and performance goals. Oversees the CMS Challenge Competition, working with... strategic plans with Department of Health and Human Services' 5-year strategic plan and performance goals...

The efficiency of indicator groups for the conservation of amphibians in the Brazilian Atlantic Forest

PubMed Central

Campos, Felipe Siqueira; Trindade-Filho, Joaquim; Brito, Daniel; Llorente, Gustavo A; Solé, Mirco

2014-01-01

The adequate selection of indicator groups of biodiversity is an important aspect of the systematic conservation planning. However, these assessments differ in the spatial scales, in the methods used and in the groups considered to accomplish this task, which generally produces contradictory results. The quantification of the spatial congruence between species richness and complementarity among different taxonomic groups is a fundamental step to identify potential indicator groups. Using a constructive approach, the main purposes of this study were to evaluate the performance and efficiency of eight potential indicator groups representing amphibian diversity in the Brazilian Atlantic Forest. Data on the geographic range of amphibian species that occur in the Brazilian Atlantic Forest were overlapped to the full geographic extent of the biome, which was divided into a regular equal-area grid. Optimization routines based on the concept of complementarily were applied to verify the performance of each indicator group selected in relation to the representativeness of the amphibians in the Brazilian Atlantic Forest as a whole, which were solved by the algorithm “simulated annealing,” through the use of the software MARXAN. Some indicator groups were substantially more effective than others in regard to the representation of the taxonomic groups assessed, which was confirmed by the high significance of the data (F = 312.76; P < 0.01). Leiuperidae was considered as the best indicator group among the families analyzed, as it showed a good performance, representing 71% of amphibian species in the Brazilian Atlantic Forest (i.e., 290 species), which may be associated with the diffuse geographic distribution of their species. In this sense, this study promotes understanding of how the diversity standards of amphibians can be informative for systematic conservation planning on a regional scale. PMID:25360282

Simultaneous Scalp, Skull, Kidney, and Pancreas Transplant from a Single Donor.

PubMed

Selber, Jesse C; Chang, Edward I; Clemens, Mark W; Gaber, Lilian; Hanasono, Matthew M; Klebuc, Michael; Skoracki, Roman J; Trask, Todd; Yu, Peirong; Gaber, A Osama

2016-06-01

Vascularized composite allotransplantation is an emerging field, but the complications of lifelong immunosuppression limit indications. Vascularized composite allotransplantation in solid organ recipients represents a unique opportunity because immunosuppression has already been accepted. This report of a simultaneous scalp, skull, kidney, and pancreas transplant represents both the first skull-scalp transplant and combination of a vascularized composite allotransplantation with double organ transplantation. A previous recipient of a kidney-pancreas transplant presented with osteoradionecrosis of the calvaria and a large area of unstable scalp following successful, curative treatment of a scalp tumor. His kidney and pancreas functions were also critically poor. A multidisciplinary, multi-institutional plan was developed to perform a simultaneous scalp, skull, and repeated kidney and pancreas transplantation, all from a single donor. Eighteen months after the patient was listed with the United Network for Organ Sharing, a donor was identified and the multiorgan vascularized composite allotransplantation was performed. Twenty physicians and 15 hours were required to perform donor and recipient procedures. The patient recovered well and was discharged on postoperative day 15. He has had one episode of scalp rejection confirmed by biopsy and treated successfully. His creatinine value is currently 0.8 mg/dl, from 5.0 mg/dl, and his blood glucose levels are normal without supplemental insulin. Aesthetic outcome is very satisfactory. The patient is now 1 year post-transplantation and doing well. Vascularized composite allotransplantation in solid organ recipients is an expansion of current indications to already immunosuppressed patients. Rejection of the vascularized composite allotransplant without solid organ rejection can occur and is treatable. Methodical planning, an interdisciplinary approach, and careful management of all organs are critical to success. Therapeutic, V.

Health Plan Performance Measurement within Medicare Subvention.

DTIC Science & Technology

1998-06-01

the causes of poor performance (Siren & Laffel, 1996). Although outcomes measures such as nosocomial infection rates, admission rates for select...defined. Traditional outcomes measures include infection rates, morbidity, and mortality. The problem with these traditional measures is... Maternal /Child Care Indicators Nursing Staffing Indicators Outcome Indicators Technical Outcomes Plan Performance Stability of Health Plan

34 CFR 300.601 - State performance plans and data collection.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Monitoring, Technical Assistance, and Enforcement § 300.601 State performance plans and data collection. (a... 34 Education 2 2010-07-01 2010-07-01 false State performance plans and data collection. 300.601... described in § 300.600(d). (b) Data collection. (1) Each State must collect valid and reliable information...

Plan Colombia: Reality of the Colombian Crisis and Implications for Hemispheric Security

DTIC Science & Technology

2002-12-01

before Plan Colombia began.”19 The Senator’s opinion should not come as a great surprise to those familiar with Colombia’s record in handling, or rather...to those familiar with his career. Yet none of his murky past was questioned during Koppel’s confirmation proceedings for ambassadorial appointment to...Negocios familiares ,” Cambio, June 10, 2002, p. 21. 53. “Diez meses de escándalos,” Semana, June 24, 2002, p. 21. 54. Tim Johnson, “Colombian Leader Begins

Health maintenance organization (HMO) performance and consumer complaints: an empirical study of frustrating HMO activities.

PubMed

Born, Patricia H; Query, J Tim

2004-01-01

Growing public interest in the operations of managed care plans has fueled a variety of activities to collect and analyze their performance. These activities include studies of financial performance, analysis of enrollment decisions, and, more recently, the development of systems for measuring healthcare quality to improve accountability to consumers. In this study, the authors focus on the activities of managed care plans that may frustrate patients and providers and, subsequently, motivate patients to file complaints. Using data from three sources, they evaluate the relationships between complaints against managed care plans and two metrics of performance: (a) the financial performance of the plan, and (b) the quality of care provided. Their findings indicate that complaints against health maintenance organizations are significantly related to the plans' levels of quality and to actions that may impede access to care.

Emperical Tests of Acceptance Sampling Plans

NASA Technical Reports Server (NTRS)

White, K. Preston, Jr.; Johnson, Kenneth L.

2012-01-01

Acceptance sampling is a quality control procedure applied as an alternative to 100% inspection. A random sample of items is drawn from a lot to determine the fraction of items which have a required quality characteristic. Both the number of items to be inspected and the criterion for determining conformance of the lot to the requirement are given by an appropriate sampling plan with specified risks of Type I and Type II sampling errors. In this paper, we present the results of empirical tests of the accuracy of selected sampling plans reported in the literature. These plans are for measureable quality characteristics which are known have either binomial, exponential, normal, gamma, Weibull, inverse Gaussian, or Poisson distributions. In the main, results support the accepted wisdom that variables acceptance plans are superior to attributes (binomial) acceptance plans, in the sense that these provide comparable protection against risks at reduced sampling cost. For the Gaussian and Weibull plans, however, there are ranges of the shape parameters for which the required sample sizes are in fact larger than the corresponding attributes plans, dramatically so for instances of large skew. Tests further confirm that the published inverse-Gaussian (IG) plan is flawed, as reported by White and Johnson (2011).

Evaluation of two commercially available chromogenic media for confirmation of methicillin-resistant Staphylococcus aureus from human, animal, and food samples.

PubMed

Ariza-Miguel, Jaime; Oniciuc, Elena-Alexandra; Sanz, Iván; Fernández-Natal, Isabel; Hernández, Marta; Rodríguez-Lázaro, David

2015-09-16

We compared the diagnostic performance of two chromogenic media, Brilliance MRSA 2 agar (Thermo Fisher Scientific) and ChromID MRSA agar (bioMérieux), for MRSA confirmation of 239 Staphylococcus aureus isolates from clinical, animal and food samples. Statistically significant differences were not observed between MRSA confirmation by mecA/mecC PCR, and by culture in both chromogenic media. However, a statistically significant difference was observed between the results obtained by both chromogenic media (p = 0.003). Segregated analysis of the results depending on the origin of the isolates (clinical, animal, and food) revealed a significant lower performance in the MRSA confirmation of food-derived isolates by using Brilliance MRSA 2 agar in comparison to PCR confirmation (p = 0.003) or ChromID MRSA agar (p<0.001). Both chromogenic media provided a good diagnostic performance for detection of MRSA isolates of human and animal origin. In conclusion, the use of chromogenic agar plates for MRSA confirmation of S. aureus isolates can provide a good diagnostic performance (sensitivity >92% and specificity >89%) regardless of the type of chromogenic media used or the origin of the S. aureus isolates. However, our results revealed a lower diagnostic performance for MRSA confirmation of S. aureus isolates from food samples by using Brilliance MRSA 2 agar. Copyright © 2015 Elsevier B.V. All rights reserved.

Evaluation of the Elekta Symmetry ™ 4D IGRT system by using a moving lung phantom

NASA Astrophysics Data System (ADS)

Shin, Hun-Joo; Kim, Shin-Wook; Kay, Chul Seung; Seo, Jae-Hyuk; Lee, Gi-Woong; Kang, Ki-Mun; Jang, Hong Seok; Kang, Young-nam

2015-07-01

Purpose: 4D cone-beam computed tomography (CBCT) is a beneficial tool for the treatment of movable tumors because it can help us to understand where the tumors are actually located and it has a precise treatment plan. However, general CBCT images have a limitation in that they cannot perfectly perform a sophisticated registration. On the other hand, the Symmetry TM 4D image-guided radiation therapy (IGRT) system of Elekta offers a 4D CBCT registration option. In this study, we evaluated the usefulness of Symmetry TM . Method and Materials: Planning CT images of the CIRS moving lung phantom were acquired 4D multi-detector CT (MDCT), and the images were sorted as 10 phases from 0% phase to 90% phase. The thickness of the CT images was 1 mm. Acquired MDCT images were transferred to the contouring software, and a virtual target was generated. A one-arc volumetric-modulated arc therapy (VMAT) plan was performed by using the treatment planning system on the virtual target. Finally, the movement of the phantom was verified by using the XVI Symmetry TM system. Results: The physical movement of the CIRS moving lung phantom was ±10.0 mm in the superiorinferior direction, ±1.0 mm in the lateral direction, and ±2.5 mm in the anterior-posterior direction. The movement of the phantom was measured from the 4D MDCT registration as ±10.2 mm in the superior-inferior direction, ±0.9 mm in the lateral direction, and ±2.45 mm in the anterior-posterior direction. The movement of the phantom was measured from the SymmetryTM registration as ±10.1 mm in the superior-inferior direction, ±0.9 mm in the lateral direction, and ±2.4 mm in the anterior-posterior direction. Conclusion: We confirmed that 4D CBCT is a beneficial tool for the treatment of movable tumors, and that the 4D registration of SymmetryTM can increase the precision of the registration when a movable tumor is the target of radiation treatment.

Dorsal premotor cortex is involved in switching motor plans

PubMed Central

Pastor-Bernier, Alexandre; Tremblay, Elsa; Cisek, Paul

2012-01-01

Previous studies have shown that neural activity in primate dorsal premotor cortex (PMd) can simultaneously represent multiple potential movement plans, and that activity related to these movement options is modulated by their relative subjective desirability. These findings support the hypothesis that decisions about actions are made through a competition within the same circuits that guide the actions themselves. This hypothesis further predicts that the very same cells that guide initial decisions will continue to update their activities if an animal changes its mind. For example, if a previously selected movement option suddenly becomes unavailable, the correction will be performed by the same cells that selected the initial movement, as opposed to some different group of cells responsible for online guidance. We tested this prediction by recording neural activity in the PMd of a monkey performing an instructed-delay reach selection task. In the task, two targets were simultaneously presented and their border styles indicated whether each would be worth 1, 2, or 3 juice drops. In a random subset of trials (FREE), the monkey was allowed a choice while in the remaining trials (FORCED) one of the targets disappeared at the time of the GO signal. In FORCED-LOW trials the monkey was forced to move to the less valuable target and started moving either toward the new target (Direct) or toward the target that vanished and then curved to reach the remaining one (Curved). Prior to the GO signal, PMd activity clearly reflected the monkey's subjective preference, predicting his choices in FREE trials even with equally valued options. In FORCED-LOW trials, PMd activity reflected the switch of the monkey's plan as early as 100 ms after the GO signal, well before movement onset (MO). This confirms that the activity is not related to feedback from the movement itself, and suggests that PMd continues to participate in action selection even when the animal changes its mind on-line. These findings were reproduced by a computational model suggesting that switches between action plans can be explained by the same competition process responsible for initial decisions. PMID:22493577

SU-D-BRB-01: A Comparison of Learning Methods for Knowledge Based Dose Prediction for Coplanar and Non-Coplanar Liver Radiotherapy

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

Tran, A; Ruan, D; Woods, K

Purpose: The predictive power of knowledge based planning (KBP) has considerable potential in the development of automated treatment planning. Here, we examine the predictive capabilities and accuracy of previously reported KBP methods, as well as an artificial neural networks (ANN) method. Furthermore, we compare the predictive accuracy of these methods on coplanar volumetric-modulated arc therapy (VMAT) and non-coplanar 4π radiotherapy. Methods: 30 liver SBRT patients previously treated using coplanar VMAT were selected for this study. The patients were re-planned using 4π radiotherapy, which involves 20 optimally selected non-coplanar IMRT fields. ANNs were used to incorporate enhanced geometric information including livermore » and PTV size, prescription dose, patient girth, and proximity to beams. The performance of ANN was compared to three methods from statistical voxel dose learning (SVDL), wherein the doses of voxels sharing the same distance to the PTV are approximated by either taking the median of the distribution, non-parametric fitting, or skew-normal fitting. These three methods were shown to be capable of predicting DVH, but only median approximation can predict 3D dose. Prediction methods were tested using leave-one-out cross-validation tests and evaluated using residual sum of squares (RSS) for DVH and 3D dose predictions. Results: DVH prediction using non-parametric fitting had the lowest average RSS with 0.1176(4π) and 0.1633(VMAT), compared to 0.4879(4π) and 1.8744(VMAT) RSS for ANN. 3D dose prediction with median approximation had lower RSS with 12.02(4π) and 29.22(VMAT), compared to 27.95(4π) and 130.9(VMAT) for ANN. Conclusion: Paradoxically, although the ANNs included geometric features in addition to the distances to the PTV, it did not perform better in predicting DVH or 3D dose compared to simpler, faster methods based on the distances alone. The study further confirms that the prediction of 4π non-coplanar plans were more accurate than VMAT. NIH R43CA183390 and R01CA188300.« less

Prospective study of cone-beam computed tomography image-guided radiotherapy for prone accelerated partial breast irradiation.

PubMed

Jozsef, Gabor; DeWyngaert, J Keith; Becker, Stewart J; Lymberis, Stella; Formenti, Silvia C

2011-10-01

To report setup variations during prone accelerated partial breast irradiation (APBI). New York University (NYU) 07-582 is an institutional review board-approved protocol of cone-beam computed tomography (CBCT) to deliver image-guided ABPI in the prone position. Eligible are postmenopausal women with pT1 breast cancer excised with negative margins and no nodal involvement. A total dose of 30 Gy in five daily fractions of 6 Gy are delivered to the planning target volume (the tumor cavity with 1.5-cm margin) by image-guided radiotherapy. Patients are set up prone, on a dedicated mattress, used for both simulation and treatment. After positioning with skin marks and lasers, CBCTs are performed and the images are registered to the planning CT. The resulting shifts (setup corrections) are recorded in the three principal directions and applied. Portal images are taken for verification. If they differ from the planning digital reconstructed radiographs, the patient is reset, and a new CBCT is taken. 70 consecutive patients have undergone a total of 343 CBCTs: 7 patients had four of five planned CBCTs performed. Seven CBCTs (2%) required to be repeated because of misalignment in the comparison between portal and digital reconstructed radiograph image after the first CBCT. The mean shifts and standard deviations in the anterior-posterior (AP), superior-inferior (SI), and medial-lateral (ML) directions were -0.19 (0.54), -0.02 (0.33), and -0.02 (0.43) cm, respectively. The average root mean squares of the daily shifts were 0.50 (0.28), 0.29 (0.17), and 0.38 (0.20). A conservative margin formula resulted in a recommended margin of 1.26, 0.73, 0.96 cm in the AP, SI, and ML directions. CBCTs confirmed that the NYU prone APBI setup and treatment technique are reproducible, with interfraction variation comparable to those reported for supine setup. The currently applied margin (1.5 cm) adequately compensates for the setup variation detected. Copyright © 2011 Elsevier Inc. All rights reserved.

Design of a continuous quality improvement program to prevent falls among community-dwelling older adults in an integrated healthcare system.

PubMed

Ganz, David A; Yano, Elizabeth M; Saliba, Debra; Shekelle, Paul G

2009-11-16

Implementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant randomized trial evidence supports creating fall prevention programs for community-dwelling older adults, but adoption in routine care has been limited. Nationally-collected data indicated that our local facility could improve its performance on fall prevention in community-dwelling older people. We sought to develop a sustainable local fall prevention program, using theory to guide program development. We planned program development to include important stakeholders within our organization. The theory-derived plan consisted of 1) an initial leadership meeting to agree on whether creating a fall prevention program was a priority for the organization, 2) focus groups with patients and health care professionals to develop ideas for the program, 3) monthly workgroup meetings with representatives from key departments to develop a blueprint for the program, 4) a second leadership meeting to confirm that the blueprint developed by the workgroup was satisfactory, and also to solicit feedback on ideas for program refinement. The leadership and workgroup meetings occurred as planned and led to the development of a functional program. The focus groups did not occur as planned, mainly due to the complexity of obtaining research approval for focus groups. The fall prevention program uses an existing telephonic nurse advice line to 1) place outgoing calls to patients at high fall risk, 2) assess these patients' risk factors for falls, and 3) triage these patients to the appropriate services. The workgroup continues to meet monthly to monitor the progress of the program and improve it. A theory-driven program development process has resulted in the successful initial implementation of a fall prevention program.

Computer-aided design and computer-aided manufacturing cutting guides and customized titanium plates are useful in upper maxilla waferless repositioning.

PubMed

Mazzoni, Simona; Bianchi, Alberto; Schiariti, Giulio; Badiali, Giovanni; Marchetti, Claudio

2015-04-01

The purpose of the present study was to develop a computer-aided design (CAD) and computer-aided manufacturing (CAM) technique that enabled fabrication of surgical cutting guides and titanium fixation plates that would allow the upper maxilla to be repositioned correctly without a surgical splint in orthognathic patients. Ten patients were recruited. A complete CAD-CAM workflow for orthognathic surgery has 3 steps: 1) virtual planning of the surgical treatment, 2) CAD-CAM and 3-dimensional printing of customized surgical devices (surgical cutting guide and titanium fixation plates), and 3) computer-aided surgery. Upper maxilla repositioning was performed in a waferless manner using a CAD-CAM device: the surgical cutting guide was used during surgery to pilot the osteotomy line that had been planned preoperatively at the computer and the custom-made fixation titanium plates allowed desired repositioning of the maxilla. To evaluate the reproducibility of this CAD-CAM orthognathic surgical method, the virtually planned and actually achieved positions of the upper maxilla were compared. Overlap errors using a threshold value smaller than 2 mm were evaluated, and the frequency of such errors was used as a measurement of accuracy. By this definition, the accuracy was 100% in 7 patients (range in all patients, 62 to 100%; median, 92.7%). These results tend to confirm that the use of CAD-CAM cutting guides and customized titanium plates for upper maxilla repositioning represents a promising method for the accurate reproduction of preoperative virtual planning without the use of surgical splints. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Facilitating NASA's Use of GEIA-STD-0005-1, Performance Standard for Aerospace and High Performance Electronic Systems Containing Lead-Free Solder

NASA Technical Reports Server (NTRS)

Plante, Jeannete

2010-01-01

GEIA-STD-0005-1 defines the objectives of, and requirements for, documenting processes that assure customers and regulatory agencies that AHP electronic systems containing lead-free solder, piece parts, and boards will satisfy the applicable requirements for performance, reliability, airworthiness, safety, and certify-ability throughout the specified life of performance. It communicates requirements for a Lead-Free Control Plan (LFCP) to assist suppliers in the development of their own Plans. The Plan documents the Plan Owner's (supplier's) processes, that assure their customer, and all other stakeholders that the Plan owner's products will continue to meet their requirements. The presentation reviews quality assurance requirements traceability and LFCP template instructions.

Planning or something else? Examining neuropsychological predictors of Zoo Map performance.

PubMed

Oosterman, Joukje M; Wijers, Marijn; Kessels, Roy P C

2013-01-01

The Zoo Map Test of the Behavioral Assessment of the Dysexecutive Syndrome battery is often applied to measure planning ability as part of executive function. Successful performance on this test is, however, dependent on various cognitive functions, and deficient Zoo Map performance does therefore not necessarily imply selectively disrupted planning abilities. To address this important issue, we examined whether planning is still the most important predictor of Zoo Map performance in a heterogeneous sample of neurologic and psychiatric outpatients (N = 71). In addition to the Zoo Map Test, the patients completed other neuropsychological tests of planning, inhibition, processing speed, and episodic memory. Planning was the strongest predictor of the total raw score and inappropriate places visited, and no additional contribution of other cognitive scores was found. One exception to this was the total time, which was associated with processing speed. Overall, our findings indicate that the Zoo Map Test is a valid indicator of planning ability in a heterogeneous patient sample.

Influence of visual clutter on the effect of navigated safety inspection: a case study on elevator installation.

PubMed

Liao, Pin-Chao; Sun, Xinlu; Liu, Mei; Shih, Yu-Nien

2018-01-11

Navigated safety inspection based on task-specific checklists can increase the hazard detection rate, theoretically with interference from scene complexity. Visual clutter, a proxy of scene complexity, can theoretically impair visual search performance, but its impact on the effect of safety inspection performance remains to be explored for the optimization of navigated inspection. This research aims to explore whether the relationship between working memory and hazard detection rate is moderated by visual clutter. Based on a perceptive model of hazard detection, we: (a) developed a mathematical influence model for construction hazard detection; (b) designed an experiment to observe the performance of hazard detection rate with adjusted working memory under different levels of visual clutter, while using an eye-tracking device to observe participants' visual search processes; (c) utilized logistic regression to analyze the developed model under various visual clutter. The effect of a strengthened working memory on the detection rate through increased search efficiency is more apparent in high visual clutter. This study confirms the role of visual clutter in construction-navigated inspections, thus serving as a foundation for the optimization of inspection planning.

Three-dimensional printing of orbital and peri-orbital masses in three dogs and its potential applications in veterinary ophthalmology.

PubMed

Dorbandt, Daniel M; Joslyn, Stephen K; Hamor, Ralph E

2017-01-01

To describe the technique and utility of three-dimensional (3D) printing for orbital and peri-orbital masses and discuss other potential applications for 3D printing. Three dogs with a chronic history of nonpainful exophthalmos. Computed tomography (CT) and subsequent 3D printing of the head was performed on each case. CT confirmed a confined mass, and an ultrasound-guided biopsy was obtained in each circumstance. An orbitotomy was tentatively planned for each case, and a 3D print of each head with the associated globe and mass was created to assist in surgical planning. In case 1, the mass was located in the cranioventral aspect of the right orbit, and the histopathologic diagnosis was adenoma. In case 2, the mass was located within the lateral masseter muscle, ventral to the right orbit between the zygomatic arch and the ramus of the mandible. The histopathologic diagnosis in case 2 was consistent with a lipoma. In case 3, the mass was located in the ventral orbit, and the histopathologic diagnosis was histiocytic cellular infiltrate. Three-dimensional printing in cases with orbital and peri-orbital masses has exceptional potential for improved surgical planning and provides another modality for visualization to help veterinarians, students, and owners understand distribution of disease. Additionally, as the techniques of 3D printing continue to evolve, the potential exists to revolutionize ocular surgery and drug delivery. © 2016 American College of Veterinary Ophthalmologists.

[Conservative treatment of ectopic pregnancy in a 27 years old patient with stage-Ia ovarian cancer after conservative surgical treatment and chemotherapy].

PubMed

Malinowski, Andrzej; Augustyniak, Tomasz; Bartosiak, Ilona; Maciołek-Bleniewska, Grazyna; Ciesielski, Arkadiusz

2004-01-01

We report a case of conservative treatment of ectopic pregnancy in a 27 years old patient, previously treated for ovarian cancer. Two years before she had surgery because of tumour in the left ovary. Ovarian cancer in stage la according to FIGO was confirmed. Considering the patient s young age, future reproductive plans and the early stage of cancer, the patient qualified for conservative treatment. Left adnexectomy with consequent chemotherapy (6 courses) was performed. Two years later on the ground of clinical symptoms, gynaecologic examination, sonography and changes in HCG serum concentration, ectopic pregnancy was recognised in the right tube. We applied conservative management with intramuscularly administrated Methotrexate. The patient, in good condition, was discharged from hospital on day 12 after injection of Methotrexate.

Euromir 95 T4 experiment 'Human Posture in microgravity': global results and future perspectives.

PubMed

Pedrocchi, A; Baroni, G; Ferrigno, G; Massion, J; Pedotti, A

2002-07-01

After 7 years of studies on Euromir 95 T4 experiment 'Human Posture in microgravity' dataset, some important remarks can be proposed for best exploiting future experimental campaigns as well as for neurophysiological investigations on-ground. The main focus of such experiments was to monitor the process of learning and adapting to the new environment in performing complex voluntary movements. Euromir 95 was the first quantitative investigation with high technology instrumentation (ELITE-S) involving two subjects starting from 15 days after the launch until 5 months of mission. Results confirm the excellent capability of mutation of motor planning by the central nervous system (CNS) in order to best exploit environmental constraints and advantages. Under this view, the results offer a unique cue for improving the design of rehabilitation processes in motor pathologies.

The Willard L. Eccles Observatory: Commissioning and Development of Remote Operation Capabilities

NASA Astrophysics Data System (ADS)

Springer, Wayne; Dawson, Kyle; Gondolo, Paolo; Ricketts, Paul; Ramsrud, Nicolas; Samarasingha, Upul

2011-03-01

The University of Utah completed construction of the Willard L. Eccles Observatory located on Frisco Peak near Milford, UT in October 2009. The observatory site is located on a prominent peak at an altitude of approximately 9600 feet in a region with minimal light pollution. The Frisco Peak site was chosen after careful consideration of many factors including climate, light pollution and available infrastructure. The facility houses a 32" telescope manufactured by DFM Engineering of Longmont, CO. Further development of remote operation capabilities is currently being undertaken. Monitoring of the weather and seeing conditions are being performed and confirm the excellent nature of the site for astronomical observations. The observatory facilities will be used for educational and public outreach activities as well as research projects. A description of the facility and its planned use will be provided.

Thoracic trauma.

PubMed

Kagan, K G

1980-08-01

The physiologic equilibrium of chest injury patients is frequently precarious, and mild stress during examination and treatment may precipitate acute decompensation and death. This is particularly true with the respiratory system, where the normally large respiratory reserve capacity may be rapidly lost. Accurate assessment of the nature of the thoracic injury and the severity of that injury must be determined in order to formulate a therapeutic plan. Many thoracic injuries, such as pneumothorax, pulmonary contusions, or rib fractures, will be self-limiting. Other conditions must be recognized for their potentially lethal nature and dealt with aggressively, and these include cardiac tamponade, tension pneumothorax, and esophageal perforation. By performing a systematic evaluation of the patient and confirming or denying the presence of all possible types of thoracic injury, the veterinarian may avoid overtreatment of self-limiting lesions and recognize and aggressively treat those with potentially fatal outcomes.

Succession Planning and Financial Performance: Does Competition Matter?

PubMed

Patidar, Nitish; Gupta, Shivani; Azbik, Ginger; Weech-Maldonado, Robert

2016-01-01

Succession planning has been defined as the process by which one or more successors are identified for key positions, development activities are planned for identified successors, or both. Limited research exists pertaining to the relationship between hospital succession planning and financial performance, particularly in the context of market competition. We used the resource-based view framework to analyze the differential effect of succession planning on hospitals' financial performance based on market competition. According to RBV, organizations can achieve higher performance by using their superior resources and capabilities. We used a panel design consisting of a national sample of hospitals in the United States for 2006-2010. We analyzed data using multivariate linear regression with facility random effects and year and state fixed effects. The sample included 22,717 hospital-year observations; more than one half of the hospitals (55.4%) had a succession planning program. The study found a positive relationship between the presence of succession planning and financial performance (β = 1.41, p < .01), which was stronger in competitive markets (β = 2.31, p = .03) than in monopolistic markets (β = 1.06, p = .01). Hospitals can use these results to make informed decisions about investing in succession planning programs on the basis of competition in their market.

Individual versus interprofessional team performance in formulating care transition plans: A randomised study of trainees from five professional groups.

PubMed

Farrell, Timothy W; Supiano, Katherine P; Wong, Bob; Luptak, Marilyn K; Luther, Brenda; Andersen, Troy C; Wilson, Rebecca; Wilby, Frances; Yang, Rumei; Pepper, Ginette A; Brunker, Cherie P

2018-05-01

Health professions trainees' performance in teams is rarely evaluated, but increasingly important as the healthcare delivery systems in which they will practice move towards team-based care. Effective management of care transitions is an important aspect of interprofessional teamwork. This mixed-methods study used a crossover design to randomise health professions trainees to work as individuals and as teams to formulate written care transition plans. Experienced external raters assessed the quality of the written care transition plans as well as both the quality of team process and overall team performance. Written care transition plan quality did not vary between individuals and teams (21.8 vs. 24.4, respectively, p = 0.42). The quality of team process did not correlate with the quality of the team-generated written care transition plans (r = -0.172, p = 0.659). However, there was a significant correlation between the quality of team process and overall team performance (r = 0.692, p = 0.039). Teams with highly engaged recorders, performing an internal team debrief, had higher-quality care transition plans. These results suggest that high-quality interprofessional care transition plans may require advance instruction as well as teamwork in finalising the plan.

The Task Is Not Enough: Processing Approaches to Task-Based Performance

ERIC Educational Resources Information Center

Skehan, Peter; Xiaoyue, Bei; Qian, Li; Wang, Zhan

2012-01-01

This article reports on three research studies, all of which concern second language task performance. The first focuses on planning, and compares on-line and strategic planning as well as task repetition. The second study examines the role of familiarity on task performance, and compares this with conventional strategic planning. The third study…

A Multifaceted Approach to Investigating Pre-Task Planning Effects on Paired Oral Test Performance

ERIC Educational Resources Information Center

Nitta, Ryo; Nakatsuhara, Fumiyo

2014-01-01

Despite the growing popularity of paired format speaking assessments, the effects of pre-task planning time on performance in these formats are not yet well understood. For example, some studies have revealed the benefits of planning but others have not. Using a multifaceted approach including analysis of the process of speaking performance, the…

Interval estimation of the overall treatment effect in a meta-analysis of a few small studies with zero events.

PubMed

Pateras, Konstantinos; Nikolakopoulos, Stavros; Mavridis, Dimitris; Roes, Kit C B

2018-03-01

When a meta-analysis consists of a few small trials that report zero events, accounting for heterogeneity in the (interval) estimation of the overall effect is challenging. Typically, we predefine meta-analytical methods to be employed. In practice, data poses restrictions that lead to deviations from the pre-planned analysis, such as the presence of zero events in at least one study arm. We aim to explore heterogeneity estimators behaviour in estimating the overall effect across different levels of sparsity of events. We performed a simulation study that consists of two evaluations. We considered an overall comparison of estimators unconditional on the number of observed zero cells and an additional one by conditioning on the number of observed zero cells. Estimators that performed modestly robust when (interval) estimating the overall treatment effect across a range of heterogeneity assumptions were the Sidik-Jonkman, Hartung-Makambi and improved Paul-Mandel. The relative performance of estimators did not materially differ between making a predefined or data-driven choice. Our investigations confirmed that heterogeneity in such settings cannot be estimated reliably. Estimators whose performance depends strongly on the presence of heterogeneity should be avoided. The choice of estimator does not need to depend on whether or not zero cells are observed.

Teacher Performance Evaluation Plan: A Personalized Approach to Supervision, Staff Development, and Evaluation. An Implementation Guide. Revised Edition.

ERIC Educational Resources Information Center

Knight, Jeanne; And Others

This guide provides assistance to New Mexico school districts in implementing a state-sponsored teacher performance evaluation plan (Provision III of the New Mexico Staff Accountability Plan, adopted by the State Board of Education). This plan involves five basic procedures: (1) determine specific definitions of the six essential teaching…

Advancing metropolitan planning for operations : an objectives-driven, performance-based approach : a guidebook

DOT National Transportation Integrated Search

2010-02-01

This guidebook presents an approach for integrating management and operations (M&O) strategies into the metropolitan transportation planning process that is designed to maximize the performance of the existing and planned transportation system. This ...

SU-F-T-76: Total Skin Electron Therapy: An-End-To-End Examination of the Absolute Dosimetry with a Rando Phantom

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

Cui, G; Ha, J; Zhou, S

Purpose: To examine and validate the absolute dose for total skin electron therapy (TSET) through an end-to-end test with a Rando phantom using optically stimulated luminescent dosimeters (OSLDs) and EBT3 radiochromic films. Methods: A Varian Trilogy linear accelerator equipped with the special procedure 6 MeV HDTSe- was used to perform TSET irradiations using a modified Stanford 6-dual-field technique. The absolute dose was calibrated using a Markus ion chamber at a reference depth of 1.3cm at 100 cm SSD with a field size of 36 × 36 cm at the isocenter in solid water slabs. The absolute dose was cross validatedmore » by a farmer ion chamber. Then the dose rate in the unit of cGy/Mu was calibrated using the Markus chamber at the treatment position. OSLDs were used to independently verify the dose using the calibrated dose rate. Finally, a patient treatment plan (200 cGy/cycle) was delivered in the QA mode to a Rando phantom, which had 16 pairs of OSLDs and EBT3 films taped onto its surface at different anatomical positions. The doses recorded were read out to validate the absolute dosimetry for TSET. Results: The OSLD measurements were within 7% agreement with the planned dose except the shoulder areas, where the doses recorded were 23% lower on average than those of the planned. The EBT3 film measurements were within 10% agreement with the planned dose except the shoulder and the scalp vertex areas, where the respective doses recorded were 18% and 14% lower on average than those of the planned. The OSLDs gave more consistent dose measurements than those of the EBT3 films. Conclusion: The absolute dosimetry for TSET was validated by an end-to-end test with a Rando phantom using the OSLDs and EBT3 films. The beam calibration and monitor unit calculations were confirmed.« less

Mechanically assisted 3D ultrasound for pre-operative assessment and guiding percutaneous treatment of focal liver tumors

NASA Astrophysics Data System (ADS)

Sadeghi Neshat, Hamid; Bax, Jeffery; Barker, Kevin; Gardi, Lori; Chedalavada, Jason; Kakani, Nirmal; Fenster, Aaron

2014-03-01

Image-guided percutaneous ablation is the standard treatment for focal liver tumors deemed inoperable and is commonly used to maintain eligibility for patients on transplant waitlists. Radiofrequency (RFA), microwave (MWA) and cryoablation technologies are all delivered via one or a number of needle-shaped probes inserted directly into the tumor. Planning is mostly based on contrast CT/MRI. While intra-procedural CT is commonly used to confirm the intended probe placement, 2D ultrasound (US) remains the main, and in some centers the only imaging modality used for needle guidance. Corresponding intraoperative 2D US with planning and other intra-procedural imaging modalities is essential for accurate needle placement. However, identification of matching features of interest among these images is often challenging given the limited field-of-view (FOV) and low quality of 2D US images. We have developed a passive tracking arm with a motorized scan-head and software tools to improve guiding capabilities of conventional US by large FOV 3D US scans that provides more anatomical landmarks that can facilitate registration of US with both planning and intra-procedural images. The tracker arm is used to scan the whole liver with a high geometrical accuracy that facilitates multi-modality landmark based image registration. Software tools are provided to assist with the segmentation of the ablation probes and tumors, find the 2D view that best shows the probe(s) from a 3D US image, and to identify the corresponding image from planning CT scans. In this paper, evaluation results from laboratory testing and a phase 1 clinical trial for planning and guiding RFA and MWA procedures using the developed system will be presented. Early clinical results show a comparable performance to intra-procedural CT that suggests 3D US as a cost-effective alternative with no side-effects in centers where CT is not available.

Strategic planning processes and financial performance among hospitals in Lebanon.

PubMed

Saleh, Shadi; Kaissi, Amer; Semaan, Adele; Natafgi, Nabil Maher

2013-01-01

Strategic planning has been presented as a valuable management tool. However, evidence of its deployment in healthcare and its effect on organizational performance is limited in low-income and middle-income countries (LMICs). The study aimed to explore the use of strategic planning processes in Lebanese hospitals and to investigate its association with financial performance. The study comprised 79 hospitals and assessed occupancy rate (OR) and revenue-per-bed (RPB) as performance measures. The strategic planning process included six domains: having a plan, plan development, plan implementation, responsibility of planning activities, governing board involvement, and physicians' involvement. Approximately 90% of hospitals have strategic plans that are moderately developed (mean score of 4.9 on a 1-7 scale) and implemented (score of 4.8). In 46% of the hospitals, the CEO has the responsibility for the plan. The level of governing board involvement in the process is moderate to high (score of 5.1), whereas physician involvement is lower (score of 4.1). The OR and RPB amounted to respectively 70% and 59 304 among hospitals with a strategic plan as compared with 62% and 33 564 for those lacking such a plan. No statistical association between having a strategic plan and either of the two measures was detected. However, the findings revealed that among hospitals that had a strategic plan, higher implementation levels were associated with lower OR (p < 0.05). In an LMIC healthcare environment characterized by resource limitation, complexity, and political and economic volatility, flexibility rather than rigid plans allow organizations to better cope with environmental turbulence. Copyright © 2012 John Wiley & Sons, Ltd.

The impact of health plan delivery system organization on clinical quality and patient satisfaction.

PubMed

Gillies, Robin R; Chenok, Kate Eresian; Shortell, Stephen M; Pawlson, Gregory; Wimbush, Julian J

2006-08-01

The purpose of this study was to examine the extent to which measures of health plan clinical performance and measures of patient perceptions of care are associated with health plan organizational characteristics, including the percentage of care provided based on a group or staff model delivery system, for-profit (tax) status, and affiliation with a national managed care firm. Data describing health plans on region, age of health plan, for-profit status, affiliation with a national managed care firm, percentage of Medicare business, total enrollment, ratio of primary care physicians to specialists, HMO penetration, and form of health care delivery system (e.g., IPA, network, mixed, staff, group) were obtained from InterStudy. Clinical performance measures for women's health screening rates, child and adolescent immunization rates, heart disease screening rates, diabetes screening rates, and smoking cessation were developed from HEDIS data. Measures of patient perceptions of care are obtained from CAHPS survey data submitted as Healthplan Employer Data and Information Set, Consumer Assessment of Health Plans 2.0 H. Multivariate regression cross-sectional analysis of 272 health plans was used to evaluate the relationship of health plan characteristics with measures of clinical performance and patient perceptions of care. The form of delivery system, measured by percent of care delivered by staff and group model systems, is significantly related (p < or = .05) with four of the five clinical performance indices but none of the three satisfaction performance indices. Other variables significantly associated with performance were being geographically located in the Northeast, having nonprofit status, and for patient satisfaction, not being part of a larger insurance company. These comparative results provide evidence suggesting that the type of delivery system used by health plans is related to many clinical performance measures but is not related to patient perceptions of care. These findings underscore the importance of the form of the delivery system and the need for further inquiry that examines the relationship between organizational form and performance.

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

Abraham, TJ

A testing facility (Cold Test Loop) was constructed and operated to demonstrate the efficacy of the Accelerated Waste Retrieval (AWR) Project's planned sluicing approach to the remediation of Silos 1 and 2 at the Fernald Environmental Management Project near Cincinnati, Ohio. The two silos contain almost 10,000 tons of radium-bearing low-level waste, which consists primarily of solids of raffinates from processing performed on ores from the Democratic Republic of Congo (commonly referred to as ''Belgium Congo ores'') for the recovery of uranium. These silos are 80 ft in diameter, 36 ft high to the center of the dome, and 26.75more » ft to the top of the vertical side walls. The test facility contained two test systems, each designed for a specific purpose. The first system, the Integrated Test Loop (ITL), a near-full-scale plant including the actual equipment to be installed at the Fernald Site, was designed to demonstrate the sluicing operation and confirm the selection of a slurry pump, the optimal sluicing nozzle operation, and the preliminary design material balance. The second system, the Component Test Loop (CTL), was designed to evaluate many of the key individual components of the waste retrieval system over an extended run. The major results of the initial testing performed during July and August 2002 confirmed that the AWR approach to sluicing was feasible. The ITL testing confirmed the following: (1) The selected slurry pump (Hazleton 3-20 type SHW) performed well and is suitable for AWR application. However, the pump's motor should be upgraded to a 200-hp model and be driven by a 150-hp variable-frequency drive (VFD). A 200-hp VFD is not much more expensive and would allow the pump to operate at full speed. (2) The best nozzle performance was achieved by using 15/16-in. nozzles operated alternately. This configuration appeared to most effectively mine the surrogate. (3) The Solartron densitometer, which was tested as an alternative mass flow measurement device, did not operate effectively. Consequently, it is not suitable for application to the AWR process. (4) Initially, the spray ring (operated at approximately 2300 psi) and the nozzles provided by the pump vendor did not perform acceptably. The nozzles were replaced with a more robust model, and the performance was then acceptable. (5) The average solids concentration achieved in the slurry before Bentogrout addition was approximately 16% by weight. The solids concentration of the slurry after Bentogrout addition ranged from 26% to approximately 40%. The slurry pump and ITL system performed well at every concentration. No line plugging or other problems were noted. The results of the CTL runs and later ITL testing are summarized in an appendix to this report.« less

U.S. Army Aviator Job Analysis

DTIC Science & Technology

2006-08-01

Differences by Airframe AH-64D CH-47 OH-58 UH-60 Task M SD M SD M SD M SD Plan IFR flight 3.56 1.25 3.41 1.15 2.00 1.43 4.07 .84 Perform aircraft...1.64 3.13 1.36 night systems Perform flight navigation by dead 3.91 .98 3.86 1.03 3.29 1.07 4.06 .87 reckoning Perform appropriate IFR approach 3.67...2. Check status of aircraft @ (D () T 3. Plan VFR flight T (Z 3 e 4. Plan IFR flight @ T 0 3 e 5. Perform tactical flight mission planning using the

78 FR 28243 - Senior Executive Service; Performance Review Board; Members

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-14

... NATIONAL CAPITAL PLANNING COMMISSION Senior Executive Service; Performance Review Board; Members AGENCY: National Capital Planning Commission. ACTION: Notice of Members of Senior Executive Service... Senior Executive Service. The PRB established for the National Capital Planning Commission also makes...

76 FR 29013 - Senior Executive Service; Performance Review Board; Members

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-19

... NATIONAL CAPITAL PLANNING COMMISSION Senior Executive Service; Performance Review Board; Members AGENCY: National Capital Planning Commission. ACTION: Notice of Members of Senior Executive Service... Senior Executive Service. The PRB established for the National Capital Planning Commission also makes...

SU-D-BRD-01: Cloud-Based Radiation Treatment Planning: Performance Evaluation of Dose Calculation and Plan Optimization

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

Na, Y; Kapp, D; Kim, Y

2014-06-01

Purpose: To report the first experience on the development of a cloud-based treatment planning system and investigate the performance improvement of dose calculation and treatment plan optimization of the cloud computing platform. Methods: A cloud computing-based radiation treatment planning system (cc-TPS) was developed for clinical treatment planning. Three de-identified clinical head and neck, lung, and prostate cases were used to evaluate the cloud computing platform. The de-identified clinical data were encrypted with 256-bit Advanced Encryption Standard (AES) algorithm. VMAT and IMRT plans were generated for the three de-identified clinical cases to determine the quality of the treatment plans and computationalmore » efficiency. All plans generated from the cc-TPS were compared to those obtained with the PC-based TPS (pc-TPS). The performance evaluation of the cc-TPS was quantified as the speedup factors for Monte Carlo (MC) dose calculations and large-scale plan optimizations, as well as the performance ratios (PRs) of the amount of performance improvement compared to the pc-TPS. Results: Speedup factors were improved up to 14.0-fold dependent on the clinical cases and plan types. The computation times for VMAT and IMRT plans with the cc-TPS were reduced by 91.1% and 89.4%, respectively, on average of the clinical cases compared to those with pc-TPS. The PRs were mostly better for VMAT plans (1.0 ≤ PRs ≤ 10.6 for the head and neck case, 1.2 ≤ PRs ≤ 13.3 for lung case, and 1.0 ≤ PRs ≤ 10.3 for prostate cancer cases) than for IMRT plans. The isodose curves of plans on both cc-TPS and pc-TPS were identical for each of the clinical cases. Conclusion: A cloud-based treatment planning has been setup and our results demonstrate the computation efficiency of treatment planning with the cc-TPS can be dramatically improved while maintaining the same plan quality to that obtained with the pc-TPS. This work was supported in part by the National Cancer Institute (1R01 CA133474) and by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (MSIP) (Grant No.2009-00420)« less

40 CFR 52.1237 - Control strategy: Carbon monoxide.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1237 Control... Minnesota Pollution Control Agency submitted a request to redesignate the Minneapolis/St. Paul CO... must be confirmed by the State), Minnesota will implement one or more appropriate contingency measure(s...

40 CFR 52.1237 - Control strategy: Carbon monoxide.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1237 Control... Minnesota Pollution Control Agency submitted a request to redesignate the Minneapolis/St. Paul CO... must be confirmed by the State), Minnesota will implement one or more appropriate contingency measure(s...

40 CFR 52.1237 - Control strategy: Carbon monoxide.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1237 Control... Minnesota Pollution Control Agency submitted a request to redesignate the Minneapolis/St. Paul CO... must be confirmed by the State), Minnesota will implement one or more appropriate contingency measure(s...

40 CFR 52.1237 - Control strategy: Carbon monoxide.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Minnesota § 52.1237 Control... Minnesota Pollution Control Agency submitted a request to redesignate the Minneapolis/St. Paul CO... must be confirmed by the State), Minnesota will implement one or more appropriate contingency measure(s...

U.S. Department of Transportation performance report fiscal year 2000 and performance plan fiscal year 2002

DOT National Transportation Integrated Search

2001-04-01

This document affirms the U.S. Department of Transportation's (DOT) commitment to managing for results. It is DOT's second annual performance report and fourth annual performance plan. By combining the DOT performance report on 2000 results with the ...

SU-E-T-325: The New Evaluation Method of the VMAT Plan Delivery Using Varian DynaLog Files and Modulation Complexity Score (MCS)

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

Tateoka, K; Graduate School of Medicine, Sapporo Medical University, Sapporo, JP; Fujimomo, K

2014-06-01

Purpose: The aim of the study is to evaluate the use of Varian DynaLog files to verify VMAT plans delivery and modulation complexity score (MCS) of VMAT. Methods: Delivery accuracy of machine performance was quantified by multileaf collimator (MLC) position errors, gantry angle errors and fluence delivery accuracy for volumetric modulated arc therapy (VMAT). The relationship between machine performance and plan complexity were also investigated using the modulation complexity score (MCS). Plan and Actual MLC positions, gantry angles and delivered fraction of monitor units were extracted from Varian DynaLog files. These factors were taken from the record and verify systemmore » of MLC control file. Planned and delivered beam data were compared to determine leaf position errors and gantry angle errors. Analysis was also performed on planned and actual fluence maps reconstructed from those of the DynaLog files. This analysis was performed for all treatment fractions of 5 prostate VMAT plans. The analysis of DynaLog files have been carried out by in-house programming in Visual C++. Results: The root mean square of leaf position and gantry angle errors were about 0.12 and 0.15, respectively. The Gamma of planned and actual fluence maps at 3%/3 mm criterion was about 99.21. The gamma of the leaf position errors were not directly related to plan complexity as determined by the MCS. Therefore, the gamma of the gantry angle errors were directly related to plan complexity as determined by the MCS. Conclusion: This study shows Varian dynalog files for VMAT plan can be diagnosed delivery errors not possible with phantom based quality assurance. Furthermore, the MCS of VMAT plan can evaluate delivery accuracy for patients receiving of VMAT. Machine performance was found to be directly related to plan complexity but this is not the dominant determinant of delivery accuracy.« less

Adoption of Rapid Diagnostic Tests for the Diagnosis of Malaria, a Preliminary Analysis of the Global Fund Program Data, 2005 to 2010

PubMed Central

Zhao, Jinkou; Lama, Marcel; Korenromp, Eline; Aylward, Patrick; Shargie, Estifanos; Filler, Scott; Komatsu, Ryuichi; Atun, Rifat

2012-01-01

Introduction The World Health Organization Guidelines for the Treatment of Malaria, in 2006 and 2010, recommend parasitological confirmation of malaria before commencing treatment. Although microscopy has been the mainstay of malaria diagnostics, the magnitude of diagnostic scale up required to follow the Guidelines suggests that rapid diagnostic tests (RDTs) will be a large component. This study analyzes the adoption of rapid diagnostic testing in malaria programs supported by the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund), the leading international funder of malaria control globally. Methods and Findings We analyzed, for the period 2005 to 2010, Global Fund programmatic data for 81 countries on the quantity of RDTs planned; actual quantities of RDTs and artemisinin-based combination treatments (ACTs) procured in 2009 and 2010; RDT-related activities including RDTs distributed, RDTs used, total diagnostic tests including RDTs and microscopy performed, health facilities equipped with RDTs; personnel trained to perform rapid diagnostic malaria test; and grant budgets allocated to malaria diagnosis. In 2010, diagnosis accounted for 5.2% of malaria grant budget. From 2005 to 2010, the procurement plans include148 million RDTs through 96 malaria grants in 81 countries. Around 115 million parasitological tests, including RDTs, had reportedly been performed from 2005 to 2010. Over this period, 123,132 health facilities were equipped with RDTs and 137,140 health personnel had been trained to perform RDT examinations. In 2009 and 2010, 41 million RDTs and 136 million ACTs were purchased. The ratio of procured RDTs to ACTs was 0.26 in 2009 and 0.34 in 2010. Conclusions/significance Global Fund financing has enabled 81 malaria-endemic countries to adopt WHO guidelines by investing in RDTs for malaria diagnosis, thereby helping improve case management of acute febrile illness in children. However, roll-out of parasitological diagnosis lags behind the roll-out of ACT-based treatment, and will require prioritization of investments. PMID:22952703

Developing performance measures for alcohol and other drug services in managed care plans. Washington Circle Group.

PubMed

McCorry, F; Garnick, D W; Bartlett, J; Cotter, F; Chalk, M

2000-11-01

Monitoring the quality and availability of alcohol and other drug (AOD) services must be a central tenet of any health-related performance measurement system. The Washington Circle Group (WCG), which was convened by the Center for Substance Abuse Treatment Office of Managed Care in March 1998, has developed a core set of performance measures for AOD services for public- and private-sector health plans. It is also collaborating with a broad range of stakeholders to ensure widespread adoption of these performance measures by health plans, private employers, public payers, and accrediting organizations. Four domains were identified, with specific measures developed for each domain: (1) prevention/education, (2) recognition, (3) treatment (including initiation of alcohol and other plan services, linkage of detoxification and AOD plan services, treatment engagement, and interventions for family members/significant others), and (4) maintenance of treatment effects. Four measures that are based on administrative information from health plans and two measures that require a consumer survey of behavioral health care are undergoing extensive pilot testing. The WCG has reached out to a broad range of stakeholders in performance measurement and managed care to acquaint them with the measures and to promote their investigation and adoption. As results of pilot testing become available, these outreach efforts will continue. Performance measures for AOD services need to become an integral part of a comprehensive set of behavioral and physical health performance measures for managed care plans.

EPR/alanine dosimetry for two therapeutic proton beams

NASA Astrophysics Data System (ADS)

Marrale, Maurizio; Carlino, Antonio; Gallo, Salvatore; Longo, Anna; Panzeca, Salvatore; Bolsi, Alessandra; Hrbacek, Jan; Lomax, Tony

2016-02-01

In this work the analysis of the electron paramagnetic resonance (EPR) response of alanine pellets exposed to two different clinical proton beams employed for radiotherapy is performed. One beam is characterized by a passive delivery technique and is dedicated to the eyes treatment (OPTIS2 beam line). Alanine pellets were irradiated with a 70 MeV proton beam corresponding to 35 mm range in eye tissue. We investigated how collimators with different sizes and shape used to conform the dose to the planned target volume influence the delivered dose. For this purpose we performed measurements with varying the collimator size (Output Factor) and the results were compared with those obtained with other dosimetric techniques (such as Markus chamber and diode detector). This analysis showed that the dosimeter response is independent of collimator diameter if this is larger than or equal to 10 mm. The other beam is characterized by an active spot-scanning technique, the Gantry1 beam line (maximum energy 230 MeV), and is used to treat deep-seated tumors. The dose linearity of alanine response in the clinical dose range was tested and the alanine dose response at selected locations in depth was measured and compared with the TPS planned dose in a quasi-clinical scenario. The alanine response was found to be linear in the dose in the clinical explored range (from 10 to 70 Gy). Furthermore, a depth dose profile in a quasi-clinical scenario was measured and compared to the dose computed by the Treatment Planning System PSIPLAN. The comparison of calibrated proton alanine measurements and TPS dose shows a difference under 1% in the SOBP and a "quenching" effect up to 4% in the distal part of SOBP. The positive dosimetric characteristics of the alanine pellets confirm the feasibility to use these detectors for "in vivo" dosimetry in clinical proton beams.

Evaluating the substantive effectiveness of SEA: Towards a better understanding

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

Doren, D. van; Driessen, P.P.J., E-mail: p.driessen@uu.nl; Schijf, B.

Evaluating the substantive effectiveness of strategic environmental assessment (SEA) is vital in order to know to what extent the tool fulfills its purposes and produces expected results. However, the studies that have evaluated the substantive effectiveness of SEA produce varying outcomes as regards the tool's contribution to decision-making and have used a variety of approaches to appraise its effectiveness. The aim of this article is to discuss the theoretical concept of SEA substantive effectiveness and to present a new approach that can be applied for evaluation studies. The SEA effectiveness evaluation framework that will be presented is composed of conceptsmore » of, and approaches to, SEA effectiveness derived from SEA literature and planning theory. Lessons for evaluation can be learned from planning theory in particular, given its long history of analyzing and understanding how sources of information and decisions affect (subsequent) decision-making. Key concepts of this new approach are 'conformance' and 'performance'. In addition, this article presents a systematic overview of process and context factors that can explain SEA effectiveness, derived from SEA literature. To illustrate the practical value of our framework for the assessment and understanding of substantive effectiveness of SEA, three Dutch SEA case studies are examined. The case studies have confirmed the usefulness of the SEA effectiveness assessment framework. The framework proved helpful in order to describe the cumulative influence of the three SEAs on decision-making and the ultimate plan. - Highlights: Black-Right-Pointing-Pointer A new framework to evaluate the substantive effectiveness of SEA is presented. Black-Right-Pointing-Pointer The framework is based on two key concepts: 'conformance' and 'performance.' Black-Right-Pointing-Pointer The practical applicability of the framework is demonstrated by three Dutch cases. Black-Right-Pointing-Pointer The framework allows for a more systematic understanding of SEA effectiveness. Black-Right-Pointing-Pointer Finally, this paper presents explanations for SEA effectiveness.« less

Curative procedures of oral health and structural characteristics of primary dental care.

PubMed

Baumgarten, Alexandre; Hugo, Fernando Neves; Bulgarelli, Alexandre Fávero; Hilgert, Juliana Balbinot

2018-04-09

To evaluate if the provision of clinical dental care, by means of the main curative procedures recommended in Primary Health Care, is associated with team structural characteristics, considering the presence of a minimum set of equipment, instrument, and supplies in Brazil's primary health care services. A cross-sectional exploratory study based on data collected from 18,114 primary healthcare services with dental health teams in Brazil, in 2014. The outcome was created from the confirmation of five clinical procedures performed by the dentist, accounting for the presence of minimum equipment, instrument, and supplies to carry them out. Covariables were related to structural characteristics. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios, with 95% confidence intervals. A total of 1,190 (6.5%) dental health teams did not present the minimum equipment to provide clinical dental care and only 2,498 (14.8%) had all the instrument and supplies needed and provided the five curative procedures assessed. There was a positive association between the outcome and the composition of dental health teams, higher workload, performing analysis of health condition, and monitoring of oral health indicators. Additionally, the dental health teams that planned and programmed oral health actions with the primary care team monthly provided the procedures more frequently. Dentists with better employment status, career plans, graduation in public health or those who underwent permanent education activities provided the procedures more frequently. A relevant number of Primary Health Care services did not have the infrastructure to provide clinical dental care. However, better results were found in dental health teams with oral health technicians, with higher workload and that plan their activities, as well as in those that employed dentists with better working relationships, who had dentists with degrees in public health and who underwent permanent education activities.

Selective magnetic resonance imaging (MRI) in invasive lobular breast cancer based on mammographic density: does it lead to an appropriate change in surgical treatment?

PubMed

Bansal, Gaurav J; Santosh, Divya; Davies, Eleri L

2016-01-01

The purpose of this study was to evaluate whether high mammographic density can be used as one of the selection criteria for MRI in invasive lobular breast cancer (ILC). In our institute, high breast density has been used as one of the indications for performing MRI scan in patients with ILC. We divided the patients in two groups, one with MRI performed pre-operatively and other without MRI. We compared their surgical procedures and analyzed whether surgical plan was altered after MRI. In case of alteration of plan, we analyzed whether the change was adequate by comparing post-operative histological findings. Between 2011 and 2015, there were a total of 1601 breast cancers with 97 lobular cancers, out of which 36 had pre-operative MRI and 61 had no MRI scan. 12 (33.3%) had mastectomy following MRI, out of which 9 (25%) had change in surgical plan from conservation to mastectomy following MRI. There were no unnecessary mastectomies in the MRI group. However, utilization of MRI in this cohort of patients did not reduce reoperation rate (19.3%). Lobular carcinoma in situ (LCIS) was identified in 60% of reoperations on post-surgical histology. Patients in the "No MRI" group had higher mastectomy rate 26 (42.6%), which was again appropriate. High mammographic density is a useful risk stratification criterion for selective MRI in ILC within a multidisciplinary team meeting setting. Provided additional lesions identified on MRI are confirmed with biopsy, pre-operative MRI does not cause unnecessary mastectomies. Used in this selective manner, reoperation rates were not eliminated, albeit reduced when compared to literature. High mammographic breast density can be used as one of the selection criteria for pre-operative MRI in ILC without an increase in inappropriate mastectomies with potential time and cost savings. In this cohort, re-excisions were not reduced markedly with pre-operative MRI.

5 CFR 430.206 - Planning performance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Planning performance. 430.206 Section 430.206 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.206...

5 CFR 430.206 - Planning performance.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Planning performance. 430.206 Section 430.206 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.206...

5 CFR 430.206 - Planning performance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Planning performance. 430.206 Section 430.206 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.206...

5 CFR 430.206 - Planning performance.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Planning performance. 430.206 Section 430.206 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PERFORMANCE MANAGEMENT Performance Appraisal for General Schedule, Prevailing Rate, and Certain Other Employees § 430.206...

Government Performance and Results Act: Performance plan FY 1999, U.S. Nuclear Regulatory Commission. Volume 1

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

Fuches, J.L.

1998-02-01

The Nuclear Regulatory Commission`s (NRC) strategic plan [NUREG-1614, Vol. 1, September 1997] establishes a strategic framework that will guide future decision-making and will help the NRC continue to meet its responsibility for protecting public health and safety, promoting the common defense and security, and protecting the environment. This performance plan complements the agency`s strategic plan by setting annual goals with measurable target levels of performance for FY 1999, as required by the Government Performance and Results Act. No significant contribution was made to the preparation of the performance plan by any non-Federal entity. However, a contractor was used to helpmore » facilitate discussions and resolution of issues. Within six months after the close of FY 1999, the NRC will submit to the President and the Congress a report on program performance for FY 1999. This performance report will review the success of the agency in achieving the performance goals established for FY 1999. Where those goals have been achieved, the underlying assumptions and strategies will be examined to ensure that continued applicability is warranted in the future. If any of the FY 1999 performance goals are not met, the agency will conduct a thorough analysis of why it did not meet the goal and the actions necessary to meet-the goal in the future. One result of this analysis will be the documentation of plans and schedules for achieving the established performance goal. If the analysis should indicate that the performance goal is impractical or infeasible, the performance report will document why that is the case and what action is recommended.« less

CAPP Panel Discussion: The Future of Astronomy & Astrophysics at NASA

NASA Astrophysics Data System (ADS)

Burns, Jack O.

2006-12-01

The president's proposed budget for FY2007 for NASA sets out significant reductions in the growth for space science funding, as well as reductions to previously planned Explorer and Flagship missions. With this proposed budget and recent changes in NASA's Advisory structure, this is a good time to assess the state of astronomy and astrophysics at NASA. The AAS Committee on Astronomy & Public Policy has assembled a distinguished panel to discuss the FY2007 budget and what it implies for the future. Panel Members: Dr. Jack Schmitt, Chair of NAC (confirmed). Dr. Anneila Sargent, Cal Tech, chair of NRC Board of Physics and Astronomy (confirmed). Dr. Neil deGrasse Tyson, American Museum of Natural History, member of NAC. Dr. Garth Illingworth, University of California at Santa Cruz, Chair of AAAC (confirmed) Dr. Len Fisk, University of Michigan, Chair of SSB and ex-officio member of NAC (confirmed).

SPES-2, an experimental program to support the AP600 development

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

Tarantini, M.; Medich, C.

1995-09-01

In support of the development of the AP600 reactor, ENEA, ENEL, ANSALDO and Westinghouse have signed a research agreement. In the framework of this agreement a complex Full Height Full Pressure (FHFP) integral system testing program has been planned on SPES-2 facility. The main purpose of this paper is to point out the status of the test program; describe the hot per-operational test performed and the complete test matrix, giving all the necessary references on the work already published. Two identical Small Break LOCA transients, performed with Pressurizer to Core Make-up Tank (PRZ-CMT) balance line (Test S00203) and without PRZ-CMTmore » balance line (Test S00303) are then compared, to show how the SPES-2 facility can contribute in confirming the new AP600 reactor design choices and can give useful indications to designers. Although the detailed analysis of test data has not been completed, some consideration on the analytical tools utilized and on the SPES-2 capability to simulate the reference plant is then drawn.« less

Mission activities planning for a Hermes mission by means of AI-technology

NASA Technical Reports Server (NTRS)

Pape, U.; Hajen, G.; Schielow, N.; Mitschdoerfer, P.; Allard, F.

1993-01-01

Mission Activities Planning is a complex task to be performed by mission control centers. AI technology can offer attractive solutions to the planning problem. This paper presents the use of a new AI-based Mission Planning System for crew activity planning. Based on a HERMES servicing mission to the COLUMBUS Man Tended Free Flyer (MTFF) with complex time and resource constraints, approximately 2000 activities with 50 different resources have been generated, processed, and planned with parametric variation of operationally sensitive parameters. The architecture, as well as the performance of the mission planning system, is discussed. An outlook to future planning scenarios, the requirements, and how a system like MARS can fulfill those requirements is given.

Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan

NASA Astrophysics Data System (ADS)

Jardim, Kevin P.

Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.

Influence of Planning Time and First-Move Strategy on Tower of Hanoi Problem-Solving Performance of Mentally Retarded Young Adults and Nonretarded Children.

ERIC Educational Resources Information Center

Spitz, Herman H.; And Others

1985-01-01

In two experiments using a computer-interfaced problem, planning time of 50 retarded young adults was as long as or longer than that of higher performing nonretarded children. In neither group was there a reliable correlation between planning time and performance. There were group differences in preferred strategies, possibly associated with…

The pros and cons of intraoperative CT scan in evaluation of deep brain stimulation lead implantation: A retrospective study

PubMed Central

Servello, Domenico; Zekaj, Edvin; Saleh, Christian; Pacchetti, Claudio; Porta, Mauro

2016-01-01

Background: Deep brain stimulation (DBS) is an established therapy for movement disorders, such as Parkinson's disease (PD), dystonia, and tremor. The efficacy of DBS depends on the correct lead positioning. The commonly adopted postoperative radiological evaluation is performed with computed tomography (CT) scan and/or magnetic resonance imaging (MRI). Methods: We conducted a retrospective study on 202 patients who underwent DBS from January 2009 to October 2013. DBS indications were PD, progressive supranuclear palsy, tremor, dystonia, Tourette syndrome, obsessive compulsive disorder, depression, and Huntington's disease. Preoperatively, all patients underwent brain MRI and brain CT scan with the stereotactic frame positioned. The lead location was confirmed intraoperatively with CT. The CT images were subsequently transferred to the Stealth Station Medtronic and merged with the preoperative planning. On the first or second day after, implantation we performed a brain MRI to confirm the correct position of the lead. Results: In 14 patients, leads were in suboptimal position after intraoperative CT scan positioning. The cases with alteration in the Z-axis were corrected immediately under fluoroscopic guidance. In all the 14 patients, an immediate repositioning was done. Conclusions: Based on our data, intraoperative CT scan is fast, safe, and a useful tool in the evaluation of the position of the implanted lead. It also reduces the patient's discomfort derived from the transfer of the patient from the operating room to the radiological department. However, intraoperative CT should not be considered as a substitute for postoperative MRI. PMID:27583182

Community-acquired necrotizing fasciitis caused by Acinetobacter calcoaceticus: a case report and literature review.

PubMed

Nonaka, Yuko; Nagae, Masaaki; Omae, Takahito; Yamamoto, Shuhei; Horitani, Ryosuke; Maeda, Daigen; Yoshinaga, Takayuki

2014-05-01

A 61-year-old man presented with pain in the abdomen and right lower limb. He had a history of hepatitis B virus-induced liver cirrhosis, but had not been visiting the outpatient clinic and did not receive any medication. Cutaneous necrosis and bulla were observed on his abdomen and right lower limb. The necrotic skin was incised, and he was diagnosed with necrotizing fasciitis. A nonfermentative Gram-negative bacillus infection was confirmed from aspirated fluid and blood cultures. Therefore, meropenem and immunoglobulins were administered. Because necrosis was widespread, surgical debridement was performed. Thereafter, Acinetobacter calcoaceticus infection was confirmed by semi-quantitative PCR using the bullous fluid and blood cultures. Meropenem was administered for 3 weeks, followed by levofloxacin alone for 1 week. The patient's condition improved; therefore, skin grafting was performed as planned and yielded a favorable response. After rehabilitation, the patient could walk without support and infection did not recur. However, he had severe liver cirrhosis and large esophageal varices, and he eventually died from sudden varix rupture. Necrotizing fasciitis is an uncommon soft tissue infection, associated with high morbidity and mortality, and early recognition and treatment are crucial for survival. Acinetobacter is rarely associated with necrotizing fasciitis. Although this is a very rare case of the occurrence of necrotizing fasciitis due to A. calcoaceticus infection, we believe that this organism can be pathogenic in immunocompromised patients such as those with liver cirrhosis by reporting this case. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Occurrence of selected zoonotic food-borne parasites and first molecular identification of Alaria alata in wild boars (Sus scrofa) in Italy.

PubMed

Gazzonis, Alessia Libera; Villa, Luca; Riehn, Katharina; Hamedy, Ahmad; Minazzi, Stefano; Olivieri, Emanuela; Zanzani, Sergio Aurelio; Manfredi, Maria Teresa

2018-05-11

Wild boar is a source of human infections with zoonotic pathogens, including food-borne parasites. With the aim of a characterization of the human exposure risk, a survey on wild boars intended for human consumption was planned, selecting three pathogens, Toxoplasma gondii, Alaria alata, and Trichinella spp., as markers of meat infection. Diaphragm muscle samples from 100 wild boars hunted in Piedmont region (Northern Italy) in two hunting seasons (2015-2016) were collected. Concerning T. gondii, a combined approach of antibody detection and molecular techniques with genotyping was performed. For the detection of A. alata and Trichinella spp., the larva migration technique and the magnetic stirrer method were employed, respectively; in addition, molecular confirmation of the morphological identification of the recovered specimen was performed. Anti-T. gondii antibodies were found in meat juice samples (43.3%) and T. gondii DNA (type II) was detected in three animals (7.1%) out of 42 seropositive examined. In none of the sampled wild boars (0%), Trichinella spp. larvae were found, whereas one animal (1%) scored positive to A. alata mesocercariae. The molecular diagnosis proved the morphological identification of the trematode. This is the first finding of A. alata in Italian wild boar population. The present study confirmed the role of wild boars as a source of parasitic zoonotic diseases and thus the risk derived for humans posed by the consumption of game meat. Considering the zoonotic implications, the results underline the importance of monitoring and surveillance of zoonotic parasites in Italian wild boar populations.

Dimensionality and summary measures of the SF-36 v1.6: comparison of scale- and item-based approach across ECRHS II adults population.

PubMed

Grassi, Mario; Nucera, Andrea

2010-01-01

The objective of this study was twofold: 1) to confirm the hypothetical eight scales and two-component summaries of the questionnaire Short Form 36 Health Survey (SF-36), and 2) to evaluate the performance of two alternative measures to the original physical component summary (PCS) and mental component summary (MCS). We performed principal component analysis (PCA) based on 35 items, after optimal scaling via multiple correspondence analysis (MCA), and subsequently on eight scales, after standard summative scoring. Item-based summary measures were planned. Data from the European Community Respiratory Health Survey II follow-up of 8854 subjects from 25 centers were analyzed to cross-validate the original and the novel PCS and MCS. Overall, the scale- and item-based comparison indicated that the SF-36 scales and summaries meet the supposed dimensionality. However, vitality, social functioning, and general health items did not fit data optimally. The novel measures, derived a posteriori by unit-rule from an oblique (correlated) MCA/PCA solution, are simple item sums or weighted scale sums where the weights are the raw scale ranges. These item-based scores yielded consistent scale-summary results for outliers profiles, with an expected known-group differences validity. We were able to confirm the hypothesized dimensionality of eight scales and two summaries of the SF-36. The alternative scoring reaches at least the same required standards of the original scoring. In addition, it can reduce the item-scale inconsistencies without loss of predictive validity.

Battling Arrow's Paradox to Discover Robust Water Management Alternatives

NASA Astrophysics Data System (ADS)

Kasprzyk, J. R.; Reed, P. M.; Hadka, D.

2013-12-01

This study explores whether or not Arrow's Impossibility Theorem, a theory of social choice, affects the formulation of water resources systems planning problems. The theorem discusses creating an aggregation function for voters choosing from more than three alternatives for society. The Impossibility Theorem is also called Arrow's Paradox, because when trying to add more voters, a single individual's preference will dictate the optimal group decision. In the context of water resources planning, our study is motivated by recent theoretical work that has generalized the insights for Arrow's Paradox to the design of complex engineered systems. In this framing of the paradox, states of society are equivalent to water planning or design alternatives, and the voters are equivalent to multiple planning objectives (e.g. minimizing cost or maximizing performance). Seen from this point of view, multi-objective water planning problems are functionally equivalent to the social choice problem described above. Traditional solutions to such multi-objective problems aggregate multiple performance measures into a single mathematical objective. The Theorem implies that a subset of performance concerns will inadvertently dictate the overall design evaluations in unpredictable ways using such an aggregation. We suggest that instead of aggregation, an explicit many-objective approach to water planning can help overcome the challenges posed by Arrow's Paradox. Many-objective planning explicitly disaggregates measures of performance while supporting the discovery of the planning tradeoffs, employing multiobjective evolutionary algorithms (MOEAs) to find solutions. Using MOEA-based search to address Arrow's Paradox requires that the MOEAs perform robustly with increasing problem complexity, such as adding additional objectives and/or decisions. This study uses comprehensive diagnostic evaluation of MOEA search performance across multiple problem formulations (both aggregated and many-objective) to show whether or not aggregating performance measures biases decision making. In this study, we explore this hypothesis using an urban water portfolio management case study in the Lower Rio Grande Valley. The diagnostic analysis shows that modern self-adaptive MOEA search is efficient, effective, and reliable for the more complex many-objective LRGV planning formulations. Results indicate that although many classical water systems planning frameworks seek to account for multiple objectives, the common practice of reducing the problem into one or more highly aggregated performance measures can severely and negatively bias planning decisions.

High performance computing and communications: FY 1997 implementation plan

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

NONE

1996-12-01

The High Performance Computing and Communications (HPCC) Program was formally authorized by passage, with bipartisan support, of the High-Performance Computing Act of 1991, signed on December 9, 1991. The original Program, in which eight Federal agencies participated, has now grown to twelve agencies. This Plan provides a detailed description of the agencies` FY 1996 HPCC accomplishments and FY 1997 HPCC plans. Section 3 of this Plan provides an overview of the HPCC Program. Section 4 contains more detailed definitions of the Program Component Areas, with an emphasis on the overall directions and milestones planned for each PCA. Appendix A providesmore » a detailed look at HPCC Program activities within each agency.« less

Towards a new generation of mission planning systems: Flexibility and performance

NASA Technical Reports Server (NTRS)

Gasquet, A.; Parrod, Y.; Desaintvincent, A.

1994-01-01

This paper presents some new approaches which are required for a better adequacy of Mission Planning Systems. In particular, the performance flexibility and genericity issues are discussed based on experience acquired through various Mission Planning systems developed by Matra Marconi Space.

Framework for implementing performance planning for rural planning organizations : project summary.

DOT National Transportation Integrated Search

2017-01-01

Performance-based transportation planning has existed for many years and is being put in practice more as a result of recent federal rules. Moving Ahead for Progress in the 21st Century (MAP-21) and the Fixing Americas Surface Transportation Act p...

SU-E-T-163: Evaluation of Dose Distributions Recalculated with Per-Field Measurement Data Under the Condition of Respiratory Motion During IMRT for Liver Cancer

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

Song, J; Yoon, M; Nam, T

2014-06-01

Purpose: The dose distributions within the real volumes of tumor targets and critical organs during internal target volume-based intensity-modulated radiation therapy (ITV-IMRT) for liver cancer were recalculated by applying the effects of actual respiratory organ motion, and the dosimetric features were analyzed through comparison with gating IMRT (Gate-IMRT) plan results. Methods: The 4DCT data for 10 patients who had been treated with Gate-IMRT for liver cancer were selected to create ITV-IMRT plans. The ITV was created using MIM software, and a moving phantom was used to simulate respiratory motion. The period and range of respiratory motion were recorded in allmore » patients from 4DCT-generated movie data, and the same period and range were applied when operating the dynamic phantom to realize coincident respiratory conditions in each patient. The doses were recalculated with a 3 dose-volume histogram (3DVH) program based on the per-field data measured with a MapCHECK2 2-dimensional diode detector array and compared with the DVHs calculated for the Gate-IMRT plan. Results: Although a sufficient prescription dose covered the PTV during ITV-IMRT delivery, the dose homogeneity in the PTV was inferior to that with the Gate-IMRT plan. We confirmed that there were higher doses to the organs-at-risk (OARs) with ITV-IMRT, as expected when using an enlarged field, but the increased dose to the spinal cord was not significant and the increased doses to the liver and kidney could be considered as minor when the reinforced constraints were applied during IMRT plan optimization. Conclusion: Because Gate-IMRT cannot always be considered an ideal method with which to correct the respiratory motional effect, given the dosimetric variations in the gating system application and the increased treatment time, a prior analysis for optimal IMRT method selection should be performed while considering the patient's respiratory condition and IMRT plan results.« less

Does performance management affect nurses' well-being?

PubMed

Decramer, Adelien; Audenaert, Mieke; Van Waeyenberg, Thomas; Claeys, Tine; Claes, Claudia; Vandevelde, Stijn; van Loon, Jos; Crucke, Saskia

2015-04-01

This article focuses on employee performance-management practices in the healthcare sector. We specifically aim to contribute to a better understanding of the impact of employee performance-management practices on affective well-being of nurses in hospitals. Theory suggests that the features of employee-performance management (planning and evaluation of individual performances) predict affective well-being (in this study: job satisfaction and affective commitment). Performance-management planning and evaluation and affective well-being were drawn from a survey of nurses at a Flemish hospital. Separate estimations were performed for different aspects of affective well-being. Performance planning has a negative effect on job satisfaction of nurses. Both vertical alignment and satisfaction with the employee performance-management system increase the affective well-being of nurses; however, the impact of vertical alignment differs for different aspects of affective well-being (i.e. job satisfaction and affective commitment). Performance-management planning and evaluation of nurses are associated with attitudinal outcomes. The results indicate that employee performance-management features have different impacts on different aspects of well-being. Copyright © 2014 Elsevier Ltd. All rights reserved.

Patient-centered interviewing is associated with decreased responses to painful stimuli: an initial fMRI study.

PubMed

Sarinopoulos, Issidoros; Hesson, Ashley M; Gordon, Chelsea; Lee, Seungcheol A; Wang, Lu; Dwamena, Francesca; Smith, Robert C

2013-02-01

To identify the functional magnetic resonance imaging (fMRI) changes associated with a patient-centered interview (PCI) and a positive provider-patient relationship (PPR). Nine female patients participated, five randomly selected to undergo a replicable, evidence-based PCI, the other four receiving standard clinician-centered interviews (CCI). To verify that PCI differed from CCI, we rated the interviews and administered a patient satisfaction with the provider-patient relationship (PPR) questionnaire. Patients were then scanned as they received painful stimulation while viewing pictures of the interviewing doctor and control images (unknown doctor). Interview ratings and questionnaire results confirmed that PCIs and CCIs were performed as planned and PCIs led to a much more positive PPR. We found significantly reduced pain-related neural activation in the left anterior insula region in the PCI group when the interviewing doctor's picture was shown. This study identifies an association between a PCI that produced a positive PPR and reduced pain-related neural responses in the anterior insula. This is an initial step in understanding the neural underpinnings of a PCI. If confirmed, our results indicate one neurobiological underpinning of an effective PCI, providing an additional scientific rationale for its use clinically. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Successful implant placement in a Case of Florid Cemento-osseous Dysplasia: a case report and literature review.

PubMed

Esfahanizadeh, Nasrin; Yousefi, Hila

2018-02-06

Florid cemento-osseus dysplasia (FCOD) has been described as a reactive process in which normal bone is replaced by fibrous connective tissues and cementum-like materials. Radiographically it appears as dense, lobulated masses, often occurring bilaterally with symmetric involvement. In this case report a successful implant placement has been reported in a 62-year-old Caucasian woman with a chief complaint of mandibular partial edentulous. Radiographic images showed the bilateral radio-opaque lesions in edentulous regions of mandible, and mandibular anterior teeth alike. All mandibular teeth were vital and no root resorption was detected. The findings of X-ray images were attributable to FCOD. A highly conservative step-by-step two-stage implant surgery was performed. After 6 months the implants loaded with fixed prosthesis. 2, 4,6,12 and 18 months after the surgery radiographic images were taken, which revealed an optimal functional rehabilitation and complete integration of implants. This report confirms that treating the edentulous area near the FCOD lesions could be planned, if conservative and step-by-step implant placement been considered. To the best of our knowledge, a case of FCOD with successful implant placement has not been reported previously. More studies in more patients are needed to confirm results of such a therapeutic modality.

Empowerment in the Treatment of Diabetes and Obesity.

PubMed

Łuczyński, Włodzimierz; Głowińska-Olszewska, Barbara; Bossowski, Artur

2016-01-01

As the available therapies for diabetes and obesity are not effective enough, diabetologists and educators search for new methods to collaborate with patients in order to support their health behaviors. The aim of this review is to discuss perspectives for the development of new empowerment-type therapies in the treatment of diabetes/obesity. Empowerment is a process whereby patients gain the necessary knowledge to influence their own behavior to improve the quality of their lives. It is carried out in five stages: (1) identify the problem, (2) explain the feelings and meanings, (3) build a plan, (4) act, and (5) experience and assess the execution. Although many years have passed since the advent and popularization of the concept of empowerment, the area remains controversial, mainly with regard to the methodology of therapy. Some previous studies have confirmed the positive effect of empowerment on body weight, metabolic control, and quality of life of patients with type 2 diabetes; however, few studies have been conducted in patients with type 1 diabetes. There is still a need to confirm the effectiveness of empowerment in accordance with Evidence Based Medicine by performing long-term observational studies in a large group of patients. In future, empowerment may become part of the standard of care for patients with diabetes and/or obesity.

Empowerment in the Treatment of Diabetes and Obesity

PubMed Central

2016-01-01

As the available therapies for diabetes and obesity are not effective enough, diabetologists and educators search for new methods to collaborate with patients in order to support their health behaviors. The aim of this review is to discuss perspectives for the development of new empowerment-type therapies in the treatment of diabetes/obesity. Empowerment is a process whereby patients gain the necessary knowledge to influence their own behavior to improve the quality of their lives. It is carried out in five stages: (1) identify the problem, (2) explain the feelings and meanings, (3) build a plan, (4) act, and (5) experience and assess the execution. Although many years have passed since the advent and popularization of the concept of empowerment, the area remains controversial, mainly with regard to the methodology of therapy. Some previous studies have confirmed the positive effect of empowerment on body weight, metabolic control, and quality of life of patients with type 2 diabetes; however, few studies have been conducted in patients with type 1 diabetes. There is still a need to confirm the effectiveness of empowerment in accordance with Evidence Based Medicine by performing long-term observational studies in a large group of patients. In future, empowerment may become part of the standard of care for patients with diabetes and/or obesity. PMID:28090541

The Effects of Guided vs. Unguided Pressured Planning on EFL Learners' Writing Fluency

ERIC Educational Resources Information Center

Mohammadnia, Zhila; Ayaz, Parisa

2015-01-01

Task-based planning can be conceptualized as the opportunity to work out task performance before the actual performance. It allows learners to process the content and language of their planned production at a deeper and more meaningful level. In the face of the wide range of research conducted on the effects of pre-task planning on L2 production,…

42 CFR 423.34 - Enrollment of low-income subsidy eligible individuals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... unless they affirmatively enroll in a Part D plan or contact CMS and confirm that they wish to be auto-enrolled in a PDP. Individuals who elect not to be auto-enrolled, may enroll in Medicare Part D at a later...

7 CFR 762.148 - Bankruptcy.

Code of Federal Regulations, 2012 CFR

2012-01-01

... it appears additional recoveries are likely. (6) Monitor confirmed plans under chapters 11, 12 and 13... documentation for the loss claim, and any additional information requested by the Agency, including..., the lender may submit a revised estimated loss claim to obtain payment of the additional amount owed...

7 CFR 762.148 - Bankruptcy.

Code of Federal Regulations, 2011 CFR

2011-01-01

... it appears additional recoveries are likely. (6) Monitor confirmed plans under chapters 11, 12 and 13... documentation for the loss claim, and any additional information requested by the Agency, including..., the lender may submit a revised estimated loss claim to obtain payment of the additional amount owed...

7 CFR 762.148 - Bankruptcy.

Code of Federal Regulations, 2013 CFR

2013-01-01

... it appears additional recoveries are likely. (6) Monitor confirmed plans under chapters 11, 12 and 13... documentation for the loss claim, and any additional information requested by the Agency, including..., the lender may submit a revised estimated loss claim to obtain payment of the additional amount owed...

42 CFR 423.34 - Enrollment of low-income subsidy eligible individuals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... unless they affirmatively enroll in a Part D plan or contact CMS and confirm that they wish to be auto-enrolled in a PDP. Individuals who elect not to be auto-enrolled, may enroll in Medicare Part D at a later...

Outbreaks following wild poliovirus importations --- Europe, Africa, and Asia, January 2009-September 2010.

PubMed

2010-11-05

The Global Polio Eradication Initiative (GPEI) began in 1988. By 2006, indigenous transmission of wild poliovirus (WPV) had been interrupted in all but four countries (Afghanistan, India, Nigeria, and Pakistan). However, outbreaks following WPV importations into previously polio-free countries remain an ongoing risk until polio is eradicated. The GPEI Strategic Plan for 2010-2012 set the following two goals for outbreak control: 1) end outbreaks occurring in 2009 by mid-2010 and 2) end outbreaks occurring during 2010 to mid-2012 within 6 months of confirmation. This report describes new outbreaks that have occurred in the World Health Organization (WHO) European Region and updates previous reports on the status of outbreaks in Africa and Asia. In 2010, the first WPV importation into the European Region since the region was declared polio-free in 2002 resulted in 476 confirmed cases: 458 in Tajikistan, 14 in Russia, three in Turkmenistan, and one in Kazakhstan. In Africa and Asia, 11 new importations into six countries were observed in 2010; 30 WPV importations that occurred during 2008-2009 resulted in 215 cases in 15 African countries during 2009-2010. An outbreak is considered interrupted if 6 months have elapsed since the latest confirmed case and surveillance performance indicators meet WHO standards. All 2009 outbreaks in Africa appear to have been interrupted, and 2010 outbreaks in three countries appear to have been interrupted. Maintaining high routine vaccination coverage and sensitive surveillance at all times and rapidly instituting additional immunization programs to control outbreaks are key to limiting and stopping the spread of WPV.

A Shigella sonnei outbreak traced to imported basil--the importance of good typing tools and produce traceability systems, Norway, 2011.

PubMed

Guzman-Herrador, B R; Nilsen, E; Cudjoe, K S; Jensvoll, L; Kvamme, J M; Lindegård Aanstad, A; Lindstedt, B A; Nygård, K; Severinsen, G; Werner-Johansen, Ø; Wester, A L; Wiklund, M; Vold, L

2013-12-05

On 9 October 2011, the University Hospital of North Norway alerted the Norwegian Institute of Public Health (NIPH) about an increase in Shigella sonnei infections in Tromsø. The isolates had an identical ‘multilocus variable-number tandem repeat analysis’ (MLVA) profile. Most cases had consumed food provided by delicatessen X. On 14 October, new S. sonnei cases with the same MLVA-profile were reported from Sarpsborg, south-eastern Norway. An outbreak investigation was started to identify the source and prevent further cases. All laboratory-confirmed cases from both clusters were attempted to be interviewed. In addition, a cohort study was performed among the attendees of a banquet in Tromsø where food from delicatessen X had been served and where some people had reported being ill. A trace-back investigation was initiated. In total, 46 cases were confirmed (Tromsø= 42; Sarpsborg= 4). Having eaten basil pesto sauce or fish soup at the banquet in Tromsø were independent risk factors for disease. Basil pesto was the only common food item that had been consumed by confirmed cases occurring in Tromsø and Sarpsborg. The basil had been imported and delivered to both municipalities by the same supplier. No basil from the specific batch was left on the Norwegian market when it was identified as the likely source. As a result of the multidisciplinary investigation, which helped to identify the source, the Norwegian Food Safety Authority, together with NIPH, planned to develop recommendations for food providers on how to handle fresh plant produce prior to consumption.

The Siblings With Ischemic Stroke Study (SWISS) Protocol

PubMed Central

Meschia, James F; Brown, Robert D; Brott, Thomas G; Chukwudelunzu, Felix E; Hardy, John; Rich, Stephen S

2002-01-01

Background Family history and twins studies suggest an inherited component to ischemic stroke risk. Candidate gene association studies have been performed but have limited capacity to identify novel risk factor genes. The Siblings With Ischemic Stroke Study (SWISS) aims to conduct a genome-wide scan in sibling pairs concordant or discordant for ischemic stroke to identify novel genetic risk factors through linkage analysis. Methods Screening at multiple clinical centers identifies patients (probands) with radiographically confirmed ischemic stroke and a family history of at least 1 living full sibling with stroke. After giving informed consent, without violating privacy among other family members, the proband invites siblings concordant and discordant for stroke to participate. Siblings then contact the study coordinating center. The diagnosis of ischemic stroke in potentially concordant siblings is confirmed by systematic centralized review of medical records. The stroke-free status of potentially discordant siblings is confirmed by validated structured telephone interview. Blood samples for DNA analysis are taken from concordant sibling pairs and, if applicable, from 1 discordant sibling. Epstein-Barr virus-transformed lymphoblastoid cell lines are created, and a scan of the human genome is planned. Discussion Conducting adequately powered genomics studies of stroke in humans is challenging because of the heterogeneity of the stroke phenotype and the difficulty of obtaining DNA samples from clinically well-characterized members of a cohort of stroke pedigrees. The multicentered design of this study is intended to efficiently assemble a cohort of ischemic stroke pedigrees without invoking community consent or using cold-calling of pedigree members. PMID:11882254

Issues in Perspective. Critical Issues Papers 1-17.

ERIC Educational Resources Information Center

Duttweiler, Patricia Cloud

The papers in this collection are based on the document "Perspectives on Performance-Based Incentive Plans" and offer brief overviews of the following critical issues in education: (1) performance-based incentive plans; (2) needed organizational changes; (3) successful and unsuccessful teacher incentive plans; (4) compensation strategies and…

20 CFR 1002.5 - What definitions apply to USERRA?

Code of Federal Regulations, 2010 CFR

2010-04-01

... than wages or salary for work performed) that accrues to the employee because of an employment contract... pension plan, health plan, or employee stock ownership plan, insurance coverage and awards, bonuses... wages for work performed, or that has control over employment opportunities, including— (i) A person...

Ohio Agriscience Lesson Plans.

ERIC Educational Resources Information Center

Sommers, Robert D., II, Comp.; Waidelich, William D., Comp.

This document, which is intended for Ohio agriculture teachers, contains lesson plans for an eight-unit competency-based course in agriscience. Each lesson plan contains some or all of the following items: (1) unit title; (2) competency/terminal performance objective; (3) competency builders/pupil performance objectives; (4) list of applied…

Systems design study of the Pioneer Venus spacecraft. Volume 2. Preliminary program development plan

NASA Technical Reports Server (NTRS)

1973-01-01

The preliminary development plan for the Pioneer Venus program is presented. This preliminary plan treats only developmental aspects that would have a significant effect on program cost. These significant development areas were: master program schedule planning; test planning - both unit and system testing for probes/orbiter/ probe bus; ground support equipment; performance assurance; and science integration Various test planning options and test method techniques were evaluated in terms of achieving a low-cost program without degrading mission performance or system reliability. The approaches studied and the methodology of the selected approach are defined.

31 CFR 29.301 - Purpose and scope.

Code of Federal Regulations, 2014 CFR

2014-07-01

... employee's total retirement benefits under the Police and Firefighters Plan or the Teachers Plan. (2) This... Firefighters Plan or the Teachers Plan for individuals who have performed service creditable under these... Judges Plan. ...

31 CFR 29.301 - Purpose and scope.

Code of Federal Regulations, 2013 CFR

2013-07-01

... employee's total retirement benefits under the Police and Firefighters Plan or the Teachers Plan. (2) This... Firefighters Plan or the Teachers Plan for individuals who have performed service creditable under these... Judges Plan. ...

Towards a framework for geospatial tangible user interfaces in collaborative urban planning

NASA Astrophysics Data System (ADS)

Maquil, Valérie; Leopold, Ulrich; De Sousa, Luís Moreira; Schwartz, Lou; Tobias, Eric

2018-04-01

The increasing complexity of urban planning projects today requires new approaches to better integrate stakeholders with different professional backgrounds throughout a city. Traditional tools used in urban planning are designed for experts and offer little opportunity for participation and collaborative design. This paper introduces the concept of geospatial tangible user interfaces (GTUI) and reports on the design and implementation as well as the usability of such a GTUI to support stakeholder participation in collaborative urban planning. The proposed system uses physical objects to interact with large digital maps and geospatial data projected onto a tabletop. It is implemented using a PostGIS database, a web map server providing OGC web services, the computer vision framework reacTIVision, a Java-based TUIO client, and GeoTools. We describe how a GTUI has be instantiated and evaluated within the scope of two case studies related to real world collaborative urban planning scenarios. Our results confirm the feasibility of our proposed GTUI solutions to (a) instantiate different urban planning scenarios, (b) support collaboration, and (c) ensure an acceptable usability.

Comparative analysis of operational forecasts versus actual weather conditions in airline flight planning, volume 2

NASA Technical Reports Server (NTRS)

Keitz, J. F.

1982-01-01

The impact of more timely and accurate weather data on airline flight planning with the emphasis on fuel savings is studied. This volume of the report discusses the results of Task 2 of the four major tasks included in the study. Task 2 compares various catagories of flight plans and flight tracking data produced by a simulation system developed for the Federal Aviation Administrations by SRI International. (Flight tracking data simulate actual flight tracks of all aircraft operating at a given time and provide for rerouting of flights as necessary to resolve traffic conflicts.) The comparisons of flight plans on the forecast to flight plans on the verifying analysis confirm Task 1 findings that wind speeds are generally underestimated. Comparisons involving flight tracking data indicate that actual fuel burn is always higher than planned, in either direction, and even when the same weather data set is used. Since the flight tracking model output results in more diversions than is known to be the case, it was concluded that there is an error in the flight tracking algorithm.

Towards a framework for geospatial tangible user interfaces in collaborative urban planning

NASA Astrophysics Data System (ADS)

Maquil, Valérie; Leopold, Ulrich; De Sousa, Luís Moreira; Schwartz, Lou; Tobias, Eric

2018-03-01

The increasing complexity of urban planning projects today requires new approaches to better integrate stakeholders with different professional backgrounds throughout a city. Traditional tools used in urban planning are designed for experts and offer little opportunity for participation and collaborative design. This paper introduces the concept of geospatial tangible user interfaces (GTUI) and reports on the design and implementation as well as the usability of such a GTUI to support stakeholder participation in collaborative urban planning. The proposed system uses physical objects to interact with large digital maps and geospatial data projected onto a tabletop. It is implemented using a PostGIS database, a web map server providing OGC web services, the computer vision framework reacTIVision, a Java-based TUIO client, and GeoTools. We describe how a GTUI has be instantiated and evaluated within the scope of two case studies related to real world collaborative urban planning scenarios. Our results confirm the feasibility of our proposed GTUI solutions to (a) instantiate different urban planning scenarios, (b) support collaboration, and (c) ensure an acceptable usability.

Effect of Different Sampling Schedules on Results of Bioavailability and Bioequivalence Studies: Evaluation by Means of Monte Carlo Simulations.

PubMed

Kano, Eunice Kazue; Chiann, Chang; Fukuda, Kazuo; Porta, Valentina

2017-08-01

Bioavailability and bioequivalence study is one of the most frequently performed investigations in clinical trials. Bioequivalence testing is based on the assumption that 2 drug products will be therapeutically equivalent when they are equivalent in the rate and extent to which the active drug ingredient or therapeutic moiety is absorbed and becomes available at the site of drug action. In recent years there has been a significant growth in published papers that use in silico studies based on mathematical simulations to analyze pharmacokinetic and pharmacodynamic properties of drugs, including bioavailability and bioequivalence aspects. The goal of this study is to evaluate the usefulness of in silico studies as a tool in the planning of bioequivalence, bioavailability and other pharmacokinetic assays, e.g., to determine an appropriate sampling schedule. Monte Carlo simulations were used to define adequate blood sampling schedules for a bioequivalence assay comparing 2 different formulations of cefadroxil oral suspensions. In silico bioequivalence studies comparing different formulation of cefadroxil oral suspensions using various sampling schedules were performed using models. An in vivo study was conducted to confirm in silico results. The results of in silico and in vivo bioequivalence studies demonstrated that schedules with fewer sampling times are as efficient as schedules with larger numbers of sampling times in the assessment of bioequivalence, but only if T max is included as a sampling time. It was also concluded that in silico studies are useful tools in the planning of bioequivalence, bioavailability and other pharmacokinetic in vivo assays. © Georg Thieme Verlag KG Stuttgart · New York.

Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania.

PubMed

Agarwal, Smisha; Lasway, Christine; L'Engle, Kelly; Homan, Rick; Layer, Erica; Ollis, Steve; Braun, Rebecca; Silas, Lucy; Mwakibete, Anna; Kudrati, Mustafa

2016-06-20

To address low contraceptive use in Tanzania, a pilot intervention using a mobile job aid was developed to guide community health workers (CHWs) to deliver integrated counseling on family planning, HIV, and other sexually transmitted infections (STIs). In this article, we describe the process of developing the family planning algorithms and implementation of the mobile job aid, discuss how the job aid supported collection of real-time data for decision making, and present the cost of the overall system based on an evaluation of the pilot. The family planning algorithm was developed, beginning in June 2011, in partnership with the Tanzania Ministry of Health and Social Welfare based on a combination of evidence-based tools such as the Balanced Counseling Strategy Plus Toolkit. The pilot intervention and study was implemented with 25 CHWs in 3 wards in Ilala district in Dar es Salaam between January 2013 and July 2013. A total of 710 family planning users (455 continuing users and 255 new users) were registered and counseled using the mobile job aid over the 6-month intervention period. All users were screened for current pregnancy, questioned on partner support for contraceptive use, counseled on a range of contraceptives, and screened for HIV/STI risk. Most new and continuing family planning users chose pills and male condoms (59% and 73%, respectively). Pills and condoms were provided by the CHW at the community level. Referrals were made to the health facility for pregnancy confirmation, injectable contraceptives, long-acting reversible contraceptives and HIV/STI testing. Follow-up visits with clients were planned to confirm completion of the health facility referral. The financial cost of implementing this intervention with 25 CHWs and 3 supervisors are estimated to be US$26,000 for the first year. For subsequent years, the financial costs are estimated to be 73% lower at $7,100. Challenges such as limited client follow-up by CHWs and use of data by supervisors identified during the pilot are currently being addressed during the scale-up phase by developing accountability and incentive mechanisms for CHWs and dashboards for data access and use. © Agarwal et al.

Family Planning Counseling in Your Pocket: A Mobile Job Aid for Community Health Workers in Tanzania

PubMed Central

Agarwal, Smisha; Lasway, Christine; L’Engle, Kelly; Homan, Rick; Layer, Erica; Ollis, Steve; Braun, Rebecca; Silas, Lucy; Mwakibete, Anna; Kudrati, Mustafa

2016-01-01

Abstract To address low contraceptive use in Tanzania, a pilot intervention using a mobile job aid was developed to guide community health workers (CHWs) to deliver integrated counseling on family planning, HIV, and other sexually transmitted infections (STIs). In this article, we describe the process of developing the family planning algorithms and implementation of the mobile job aid, discuss how the job aid supported collection of real-time data for decision making, and present the cost of the overall system based on an evaluation of the pilot. The family planning algorithm was developed, beginning in June 2011, in partnership with the Tanzania Ministry of Health and Social Welfare based on a combination of evidence-based tools such as the Balanced Counseling Strategy Plus Toolkit. The pilot intervention and study was implemented with 25 CHWs in 3 wards in Ilala district in Dar es Salaam between January 2013 and July 2013. A total of 710 family planning users (455 continuing users and 255 new users) were registered and counseled using the mobile job aid over the 6-month intervention period. All users were screened for current pregnancy, questioned on partner support for contraceptive use, counseled on a range of contraceptives, and screened for HIV/STI risk. Most new and continuing family planning users chose pills and male condoms (59% and 73%, respectively). Pills and condoms were provided by the CHW at the community level. Referrals were made to the health facility for pregnancy confirmation, injectable contraceptives, long-acting reversible contraceptives and HIV/STI testing. Follow-up visits with clients were planned to confirm completion of the health facility referral. The financial cost of implementing this intervention with 25 CHWs and 3 supervisors are estimated to be US$26,000 for the first year. For subsequent years, the financial costs are estimated to be 73% lower at $7,100. Challenges such as limited client follow-up by CHWs and use of data by supervisors identified during the pilot are currently being addressed during the scale-up phase by developing accountability and incentive mechanisms for CHWs and dashboards for data access and use. PMID:27353622

Variations in disaster evacuation behavior: public responses versus private sector executive decision-making processes.

PubMed

Drabek, T E

1992-06-01

Data obtained from 65 executives working for tourism firms in three sample communities permitted comparison with the public warning response literature regarding three topics: disaster evacuation planning, initial warning responses, and disaster evacuation behavior. Disaster evacuation planning was reported by nearly all of these business executives, although it was highly variable in content, completeness, and formality. Managerial responses to post-disaster warnings paralleled the type of complex social processes that have been documented within the public response literature, except that warning sources and confirmation behavior were significantly affected by contact with authorities. Five key areas of difference were discovered in disaster evacuation behavior pertaining to: influence of planning, firm versus family priorities, shelter selection, looting concerns, and media contacts.

Training at a faith-based institution matters for obstetrics and gynecology residents: results from a regional survey.

PubMed

Guiahi, Maryam; Westhoff, Carolyn L; Summers, Sondra; Kenton, Kimberly

2013-06-01

Prior data suggest that opportunities in family planning training may be limited during obstetrics and gynecology (Ob-Gyn) residency training, particularly at faith-based institutions with moral and ethical constraints, although this aspect of the Ob-Gyn curriculum has not been formally studied to date. We compared Ob-Gyn residents' self-rated competency and intentions to provide family planning procedures at faith-based versus those of residents at non-faith-based programs. We surveyed residents at all 20 Ob-Gyn programs in Illinois, Indiana, Iowa, and Wisconsin from 2008 to 2009. Residents were queried about current skills and future plans to perform family planning procedures. We examined associations based on program and residents' personal characteristics and performed multivariable logistic regression analysis. A total of 232 of 340 residents (68%) from 17 programs (85%) returned surveys. Seven programs were faith-based. Residents from non-faith-based programs were more likely to be completely satisfied with family planning training (odds ratio [OR]  =  3.4, 95% confidence limit [CI], 1.9-6.2) and to report they "understand and can perform on own" most procedures. Most residents, regardless of program type, planned to provide all surveyed family planning services. Despite similar intentions to provide family planning procedures after graduation, residents at faith-based training programs were less satisfied with their family planning training and rate their ability to perform family planning services lower than residents at non-faith-based training programs.

Planning performance in schizophrenia patients: a meta-analysis of the influence of task difficulty and clinical and sociodemographic variables.

PubMed

Knapp, F; Viechtbauer, W; Leonhart, R; Nitschke, K; Kaller, C P

2017-08-01

Despite a large body of research on planning performance in adult schizophrenia patients, results of individual studies are equivocal, suggesting either no, moderate or severe planning deficits. This meta-analysis therefore aimed to quantify planning deficits in schizophrenia and to examine potential sources of the heterogeneity seen in the literature. The meta-analysis comprised outcomes of planning accuracy of 1377 schizophrenia patients and 1477 healthy controls from 31 different studies which assessed planning performance using tower tasks such as the Tower of London, the Tower of Hanoi and the Stockings of Cambridge. A meta-regression analysis was applied to assess the influence of potential moderator variables (i.e. sociodemographic and clinical variables as well as task difficulty). The findings indeed demonstrated a planning deficit in schizophrenia patients (mean effect size: ; 95% confidence interval 0.56-0.78) that was moderated by task difficulty in terms of the minimum number of moves required for a solution. The results did not reveal any significant relationship between the extent of planning deficits and sociodemographic or clinical variables. The current results provide first meta-analytic evidence for the commonly assumed impairments of planning performance in schizophrenia. Deficits are more likely to become manifest in problem items with higher demands on planning ahead, which may at least partly explain the heterogeneity of previous findings. As only a small fraction of studies reported coherent information on sample characteristics, future meta-analyses would benefit from more systematic reports on those variables.

Engineering Task Plan for the Ultrasonic Inspection of Hanford Double Shell Tanks (DST) FY2000

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

JENSEN, C.E.

2000-01-10

This document facilitates the ultrasonic examination of Hanford double-shell tanks. Included are a plan for engineering activities (individual responsibilities), plan for performance demonstration testing, and a plan for field activities (tank inspection). Also included are a Statement of Work for contractor performance of the work and a protocol to be followed should tank flaws that exceed the acceptance criteria be discovered.

NASA Performance Plan

NASA Technical Reports Server (NTRS)

1999-01-01

The Government Performance and Results Act (GPRA) passed by Congress and signed by the President in 1993 provides a new tool to improve the efficiency of all Federal agencies. The goals of GPRA are to: Improve citizen confidence in Government performance; Improve Federal program management, effectiveness, and public accountability; and Improve congressional decisionmaking on where to commit the Nation's financial and human resources. The Act directs Executive Branch agencies to develop a customer-focused strategic plan that aligns activities with concrete missions and goals. The first plans were submitted in September 1998 as part of the Fiscal Year 1999 (FY99) budget process. These budget submissions were expected to support the goals expressed in the agency strategic plans. The Act also directs agencies to manage and measure results to justify congressional appropriations and authorizations. Six months after the completion of the fiscal year, agencies will report on the degree of success in achieving the goals and evaluation measures defined in the strategic and performance plans. The plans required by GPRA have been submitted to the Office of Management and Budget (OMB) and to Congress. Copies of NASA plans are available from the Office of Policy and Plans at NASA Headquarters and can be accessed on the i nterinet web sites identified in the Appendix.

Three cases of neonatal tetanus in Papua New Guinea lead to development of national action plan for maternal and neonatal tetanus elimination

PubMed Central

Barnabas, Roland; Sitther, Adeline; Guarenti, Laura; Toikilik, Steven; Kariwiga, Grace; Sui, Gerard Pai

2013-01-01

Maternal or neonatal tetanus causes deaths primarily in Asia and Africa and is usually the result of poor hygiene during delivery. In 2011, three neonatal tetanus cases were investigated in Papua New Guinea, and all three cases were delivered at home by untrained assistants. The babies were normal at birth but subsequently developed spasms. A neonatal tetanus case must be viewed as a sentinel event indicating a failure of public health services including immunization, antenatal care and delivery care. The confirmation of these cases led to the drafting of the Papua New Guinea National Action Plan for Maternal and Neonatal Tetanus Elimination. This included three rounds of a tetanus toxoid supplementary immunization campaign targeting women of childbearing age (WBCA) and strengthening of other clean delivery practices. The first immunization round was conducted in April and May 2012, targeting 1.6 million WBCA and achieved coverage of 77%. The government of Papua New Guinea should ensure detailed investigation of all neonatal tetanus cases reported in the health information system and perform subprovincial analysis of tetanus toxoid coverage following completion of all three immunization rounds. Efforts also should be made to strengthen clean delivery practices to help eliminate maternal and neonatal tetanus in Papua New Guinea. PMID:24015370

Inter-comparison of Dose Distributions Calculated by FLUKA, GEANT4, MCNP, and PHITS for Proton Therapy

NASA Astrophysics Data System (ADS)

Yang, Zi-Yi; Tsai, Pi-En; Lee, Shao-Chun; Liu, Yen-Chiang; Chen, Chin-Cheng; Sato, Tatsuhiko; Sheu, Rong-Jiun

2017-09-01

The dose distributions from proton pencil beam scanning were calculated by FLUKA, GEANT4, MCNP, and PHITS, in order to investigate their applicability in proton radiotherapy. The first studied case was the integrated depth dose curves (IDDCs), respectively from a 100 and a 226-MeV proton pencil beam impinging a water phantom. The calculated IDDCs agree with each other as long as each code employs 75 eV for the ionization potential of water. The second case considered a similar condition of the first case but with proton energies in a Gaussian distribution. The comparison to the measurement indicates the inter-code differences might not only due to different stopping power but also the nuclear physics models. How the physics parameter setting affect the computation time was also discussed. In the third case, the applicability of each code for pencil beam scanning was confirmed by delivering a uniform volumetric dose distribution based on the treatment plan, and the results showed general agreement between each codes, the treatment plan, and the measurement, except that some deviations were found in the penumbra region. This study has demonstrated that the selected codes are all capable of performing dose calculations for therapeutic scanning proton beams with proper physics settings.

Co-operation, participation and conflicts faced in public health--lessons learned from a long-term prevention programme in Sweden.

PubMed

Brännström, I; Emmelin, M; Dahlgren, L; Johansson, M; Wall, S

1994-09-01

A comprehensive community-based programme for prevention of cardiovascular diseases (CVD) and diabetes was established in 1985 in a small municipality in northern Sweden. A cross-sectional survey to the general public was performed and semi-structured open-ended interviews were taken of actors at different levels. Notes from official records were also included in the study. The aim was to describe and discuss some factors that promote or constrain community participation in health programmes. The results generally confirmed that the right of definition concerning the health programme mainly remained with the health professionals. Community participation was mainly defined by the actors based on the medical and health planning approach and, thereby, as a means to transform health policy plans into reality by transmitting health knowledge and increasing consciousness among the citizens of the need for changing lifestyles. However, participation as a means of identifying problems and demonstrating power relationships and as elements in promoting local democracy was hardly represented among the actors at all. Overall, the CVD health programme was characterized by consensus between the actors. Despite this, debates and arguments about interpretations, social interests, personal conflicts and ideological constraints were observed. However, a majority of the public wanted the CVD preventive programme to continue.

Three-dimensional printed prototypes refine the anatomy of post-modified Norwood-1 complex aortic arch obstruction and allow presurgical simulation of the repair.

PubMed

Kiraly, Laszlo; Tofeig, Magdi; Jha, Neerod Kumar; Talo, Haitham

2016-02-01

Three-dimensional (3D) printed prototypes of malformed hearts have been used for education, communication, presurgical planning and simulation. We present a case of a 5-month old infant with complex obstruction at the neoaortic to transverse arch and descending aortic junction following the neonatal modified Norwood-1 procedure for hypoplastic left heart syndrome. Digital 3D models were created from a routine 64-slice CT dataset; then life-size solid and magnified hollow models were printed with a 3D printer. The solid model provided further insights into details of the anatomy, whereas the surgical approach and steps of the operation were simulated on the hollow model. Intraoperative assessment confirmed the anatomical accuracy of the 3D models. The operation was performed in accordance with preoperative simulation: sliding autologous flaps achieved relief of the obstruction without additional patching. Knowledge gained from the models fundamentally contributed to successful outcome and improved patient safety. This case study presents an effective use of 3D models in exploring complex spatial relationship at the aortic arch and in simulation-based planning of the operative procedure. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Crisis Planning: Survey Results from Hurricane Katrina and Implications for Performance Improvement Professionals

ERIC Educational Resources Information Center

Hutchins, Holly M.; Annulis, Heather; Gaudet, Cyndi

2008-01-01

Modern organizations constantly face unparalleled changes and uncertainty in the competitive world, thus requiring strategic planning to mitigate crisis conditions. Underscoring crisis plans are performance interventions that prepare employees, technological systems, and the organizational culture to effectively respond to a crisis event. However,…

Vis-A-Plan /visualize a plan/ management technique provides performance-time scale

NASA Technical Reports Server (NTRS)

Ranck, N. H.

1967-01-01

Vis-A-Plan is a bar-charting technique for representing and evaluating project activities on a performance-time basis. This rectilinear method presents the logic diagram of a project as a series of horizontal time bars. It may be used supplementary to PERT or independently.

Presenting an Approach for Conducting Knowledge Architecture within Large-Scale Organizations

PubMed Central

Varaee, Touraj; Habibi, Jafar; Mohaghar, Ali

2015-01-01

Knowledge architecture (KA) establishes the basic groundwork for the successful implementation of a short-term or long-term knowledge management (KM) program. An example of KA is the design of a prototype before a new vehicle is manufactured. Due to a transformation to large-scale organizations, the traditional architecture of organizations is undergoing fundamental changes. This paper explores the main strengths and weaknesses in the field of KA within large-scale organizations and provides a suitable methodology and supervising framework to overcome specific limitations. This objective was achieved by applying and updating the concepts from the Zachman information architectural framework and the information architectural methodology of enterprise architecture planning (EAP). The proposed solution may be beneficial for architects in knowledge-related areas to successfully accomplish KM within large-scale organizations. The research method is descriptive; its validity is confirmed by performing a case study and polling the opinions of KA experts. PMID:25993414

Initiation of a lightning search using the lightning and airglow camera onboard the Venus orbiter Akatsuki

NASA Astrophysics Data System (ADS)

Takahashi, Yukihiro; Sato, Mitsuteru; Imai, Masataka; Lorenz, Ralph; Yair, Yoav; Aplin, Karen; Fischer, Georg; Nakamura, Masato; Ishii, Nobuaki; Abe, Takumi; Satoh, Takehiko; Imamura, Takeshi; Hirose, Chikako; Suzuki, Makoto; Hashimoto, George L.; Hirata, Naru; Yamazaki, Atsushi; Sato, Takao M.; Yamada, Manabu; Murakami, Shin-ya; Yamamoto, Yukio; Fukuhara, Tetsuya; Ogohara, Kazunori; Ando, Hiroki; Sugiyama, Ko-ichiro; Kashimura, Hiroki; Ohtsuki, Shoko

2018-05-01

The existence of lightning discharges in the Venus atmosphere has been controversial for more than 30 years, with many positive and negative reports published. The lightning and airglow camera (LAC) onboard the Venus orbiter, Akatsuki, was designed to observe the light curve of possible flashes at a sufficiently high sampling rate to discriminate lightning from other sources and can thereby perform a more definitive search for optical emissions. Akatsuki arrived at Venus during December 2016, 5 years following its launch. The initial operations of LAC through November 2016 have included a progressive increase in the high voltage applied to the avalanche photodiode detector. LAC began lightning survey observations in December 2016. It was confirmed that the operational high voltage was achieved and that the triggering system functions correctly. LAC lightning search observations are planned to continue for several years.

Diagnostics in the Extendable Integrated Support Environment (EISE)

NASA Technical Reports Server (NTRS)

Brink, James R.; Storey, Paul

1988-01-01

Extendable Integrated Support Environment (EISE) is a real-time computer network consisting of commercially available hardware and software components to support systems level integration, modifications, and enhancement to weapons systems. The EISE approach offers substantial potential savings by eliminating unique support environments in favor of sharing common modules for the support of operational weapon systems. An expert system is being developed that will help support diagnosing faults in this network. This is a multi-level, multi-expert diagnostic system that uses experiential knowledge relating symptoms to faults and also reasons from structural and functional models of the underlying physical model when experiential reasoning is inadequate. The individual expert systems are orchestrated by a supervisory reasoning controller, a meta-level reasoner which plans the sequence of reasoning steps to solve the given specific problem. The overall system, termed the Diagnostic Executive, accesses systems level performance checks and error reports, and issues remote test procedures to formulate and confirm fault hypotheses.

Microbial Monitoring Challenges and Needs for Mars Applications

NASA Technical Reports Server (NTRS)

Roman, M. C.; Ott, C. M.; Castro, V. A.; Birmele, M. N.; Roberts, M. S.; Venkateswaran, K. J.; Jan, D. L.

2012-01-01

The monitoring of microorganisms will be an important part of a mission to Mars. Microbial monitoring equipment will be needed to look for the presence of microorganisms on the planet, to confirm that planetary protection measures are working, to monitor the health of plants, bioreactors and humans living in a habitat and to monitor the performance of the life support systems that will keep them alive during their stay on Mars. Coordinating the different microbial monitoring needs during the early days of mission planning, can provide NASA with equipment that could meet more than one need while also providing complementary analysis options, which can enhance the research capabilities. The early coordination between the different NASA groups that will need microbial monitoring equipment on the surface of Mars, could also make the mission more affordable, as development of the needed equipment could be potentially cost shared.

Motivation and engagement in music and sport: testing a multidimensional framework in diverse performance settings.

PubMed

Martin, Andrew J

2008-02-01

The present study assessed the application of a multidimensional model of motivation and engagement (the Motivation and Engagement Wheel) and its accompanying instrumentation (the Motivation and Engagement Scale) to the music and sport domains. Participants were 463 young classical musicians (N=224) and sportspeople (N=239). In both music and sport samples, the data confirmed the good fit of the four hypothesized higher-order dimensions and their 11 first-order dimensions: adaptive cognitions (self-efficacy, valuing, mastery orientation), adaptive behaviors (planning, task management, persistence), impeding/maladaptive cognitions (uncertain control, anxiety, failure avoidance), and maladaptive behaviors (self-handicapping, disengagement). Multigroup tests of factor invariance showed that in terms of underlying motivational constructs and the composition of and relationships among these constructs, key subsamples are not substantially different. Moreover-and of particular relevance to issues around the generalizability of the framework-the factor structure for music and sport samples was predominantly invariant.

Design and development of a quad copter (UMAASK) using CAD/CAM/CAE

NASA Astrophysics Data System (ADS)

Manarvi, Irfan Anjum; Aqib, Muhammad; Ajmal, Muhammad; Usman, Muhammad; Khurshid, Saqib; Sikandar, Usman

Micro flying vehicles1 (MFV) have become a popular area of research due to economy of production, flexibility of launch and variety of applications. A large number of techniques from pencil sketching to computer based software are being used for designing specific geometries and selection of materials to arrive at novel designs for specific requirements. Present research was focused on development of suitable design configuration using CAD/CAM/CAE tools and techniques. A number of designs were reviewed for this purpose. Finally, rotary wing Quadcopter flying vehicle design was considered appropriate for this research. Performance requirements were planned as approximately 10 meters ceiling, weight less than 500grams and ability to take videos and pictures. Parts were designed using Finite Element Analysis, manufactured using CNC machines and assembled to arrive at final design named as UMAASK. Flight tests were carried out which confirmed the design requirements.

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia

PubMed Central

Mitsugi, Masaharu; Alcalde, Rafael E.; Yano, Tomoyuki; Uemura, Noriko; Okazaki, Mutsumi

2015-01-01

Backgrounds: The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. Methods: After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. Results: As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Conclusion Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained. PMID:26301156

Rotational Distraction for the Treatment of Severe Mandibular Retrognathia.

PubMed

Ito, Osamu; Mitsugi, Masaharu; Alcalde, Rafael E; Yano, Tomoyuki; Uemura, Noriko; Okazaki, Mutsumi

2015-07-01

The main problem with intraoral distraction of the mandible is the inability to achieve the three-dimensional mandibular correction as planned preoperatively. We developed a technique that allows spontaneous changes in the direction of mandibular elongation using an intraoral distractor. After mandibular osteotomy, the distractor is fixed to the distal segment of the mandible using a single bicortical screw, allowing anterior-posterior, vertical and limited lateromedial changes in the vector of distraction. Mandibular lengthening is performed while keeping the maxilla and mandible in class I occlusion with intermaxillary fixation. As the distraction device is activated allowing mandibular elongation, the proximal segment, guided by the surrounding soft tissues, moves and rotates posterosuperiorly. Mandibular lengthening is continued until the condylar head reaches an adequate position in the mandibular fossa as confirmed clinically and radiographically. Thirty-three patients with mandibular retrognathia received this treatment and good results were obtained.

[Family groups in nursing graduation teaching practice].

PubMed

de Assis, Aisllan Diego; da Silva, Priscila Patrícia; Claudino, Talita Xavier; de Oliveira, Alice Guimarães Bottaro

2010-09-01

The centers of psychosocial care (CAPS, acronym in Portuguese) are strategic devices for mental health care currently available in Brazil. Nurses are professionals required to compose the minimum staff of this device, which values the group activities involving users. This study presents a report of the experience of nursing undergraduates from Universidade Federal do Mato Grosso (UFMT) on their conducting waiting-room group sessions with relatives of users of a CAPS from Cuiabá, Mato Grosso state. This experience is justified by the fact that nursing students have few opportunities to develop group approach abilities during their graduation course, which focuses mainly on clinical individual care. The aim of the experience was to provide theoretical-practical learning of all the work stages of group work: recognizing the need and possibility of conducting the activity, planning, coordination and group evaluation. The results confirm the need and possibility of performing group experiences in mental health care and in nursing education.

[The possibility of local control of cancer by neoadjuvant chemoradiation therapy with gemcitabine and surgical resection for advanced cholangiocarcinoma].

PubMed

Nakagawa, Kei; Katayose, Yu; Rikiyama, Toshiki; Okaue, Adoru; Unno, Michiaki

2009-11-01

Surgical resection is the gold standard of treatment for cholangiocarcinoma. However, there are also many recurrences after operation, because of the anatomical background and the tendency of invasion. We thought that eliminating the remnant of the cancer could yield a better prognosis. Therefore, an introduction of the neoadjuvant chemoradiation therapy with gemcitabine and surgical resection for advanced cholangiocarcinoma patient (NACRAC) was planned. The safety of NACRAC was confirmed by a pilot study. The recommended dose of gemcitabine (600 mg/m2) was determined by a phase I study. A phase II study is now being performed for evaluating the effectiveness and safety. NACRAC may control the frontal part of the tumor with difficult distinctions made by MDCT, and abolishing the cancer remnant is expected. The possibility of extended prognosis by NACRAC can be considered.

Ultrasound-guided percutaneous injection of methylene blue to identify nerve pathology and guide surgery.

PubMed

Osorio, Joseph A; Breshears, Jonathan D; Arnaout, Omar; Simon, Neil G; Hastings-Robinson, Ashley M; Aleshi, Pedram; Kliot, Michel

2015-09-01

OBJECT The objective of this study was to provide a technique that could be used in the preoperative period to facilitate the surgical exploration of peripheral nerve pathology. METHODS The authors describe a technique in which 1) ultrasonography is used in the immediate preoperative period to identify target peripheral nerves, 2) an ultrasound-guided needle electrode is used to stimulate peripheral nerves to confirm their position, and then 3) a methylene blue (MB) injection is performed to mark the peripheral nerve pathology to facilitate surgical exploration. RESULTS A cohort of 13 patients with varying indications for peripheral nerve surgery is presented in which ultrasound guidance, stimulation, and MB were used to localize and create a road map for surgeries. CONCLUSIONS Preoperative ultrasound-guided MB administration is a promising technique that peripheral nerve surgeons could use to plan and execute surgery.

Report by the Aerospace Safety Advisory Panel

NASA Technical Reports Server (NTRS)

1981-01-01

The process of preparation for the first two shuttle flights was observed and information from both flights was gathered in order to confirm the concept and performance of the major elements of the space transportation system. To achieve truly operational operating safety, regularity, and minimum practical cost, the organization of efforts between the R&D community and any transportation service organization should be clearly separated with the latter organization assuming responsibilities for marketing its services; planning and acquiring prime hardware and spares; maintainance; certification of procedures; training; and creation of requirements for future development. A technical audit of the application of redundancy concepts to shuttle systems is suggested. The state of the art of space transportation hardware suggests that a number of concept changes may improve reliability, costs, and operational safety. For the remaining R&D flights, it is suggested that a redline audit be made of limits that should not be exceeded for ready to launch.

The NASA Ames Life Sciences Data Archive: Biobanking for the Final Frontier

NASA Technical Reports Server (NTRS)

Rask, Jon; Chakravarty, Kaushik; French, Alison J.; Choi, Sungshin; Stewart, Helen J.

2017-01-01

The NASA Ames Institutional Scientific Collection involves the Ames Life Sciences Data Archive (ALSDA) and a biospecimen repository, which are responsible for archiving information and non-human biospecimens collected from spaceflight and matching ground control experiments. The ALSDA also manages a biospecimen sharing program, performs curation and long-term storage operations, and facilitates distribution of biospecimens for research purposes via a public website (https:lsda.jsc.nasa.gov). As part of our best practices, a tissue viability testing plan has been developed for the repository, which will assess the quality of samples subjected to long-term storage. We expect that the test results will confirm usability of the samples, enable broader science community interest, and verify operational efficiency of the archives. This work will also support NASA open science initiatives and guides development of NASA directives and policy for curation of biological collections.

Presenting an Approach for Conducting Knowledge Architecture within Large-Scale Organizations.

PubMed

Varaee, Touraj; Habibi, Jafar; Mohaghar, Ali

2015-01-01

Knowledge architecture (KA) establishes the basic groundwork for the successful implementation of a short-term or long-term knowledge management (KM) program. An example of KA is the design of a prototype before a new vehicle is manufactured. Due to a transformation to large-scale organizations, the traditional architecture of organizations is undergoing fundamental changes. This paper explores the main strengths and weaknesses in the field of KA within large-scale organizations and provides a suitable methodology and supervising framework to overcome specific limitations. This objective was achieved by applying and updating the concepts from the Zachman information architectural framework and the information architectural methodology of enterprise architecture planning (EAP). The proposed solution may be beneficial for architects in knowledge-related areas to successfully accomplish KM within large-scale organizations. The research method is descriptive; its validity is confirmed by performing a case study and polling the opinions of KA experts.

Golden angle based scanning for robust corneal topography with OCT

PubMed Central

Wagner, Joerg; Goldblum, David; Cattin, Philippe C.

2017-01-01

Corneal topography allows the assessment of the cornea’s refractive power which is crucial for diagnostics and surgical planning. The use of optical coherence tomography (OCT) for corneal topography is still limited. One limitation is the susceptibility to disturbances like blinking of the eye. This can result in partially corrupted scans that cannot be evaluated using common methods. We present a new scanning method for reliable corneal topography from partial scans. Based on the golden angle, the method features a balanced scan point distribution which refines over measurement time and remains balanced when part of the scan is removed. The performance of the method is assessed numerically and by measurements of test surfaces. The results confirm that the method enables numerically well-conditioned and reliable corneal topography from partially corrupted scans and reduces the need for repeated measurements in case of abrupt disturbances. PMID:28270961

On the efficiency of multiple media family planning promotion campaigns.

PubMed

1999-01-01

This article presents the result of a study conducted by Miriam N. Jato on the impact of multimedia family planning communication campaigns on contraceptive use. The study was conducted in Tanzania, where a government program integrated family planning into maternal and child health care services in 1988, while in 1992 a private-sector condom-marketing program begun and a national population policy for wider distribution of family planning information was adopted by the government. In less than 3 years, contraceptive use was found to have doubled to a level of 11.3% and the total fertility rate declined from an average of 6.3 to 5.8 live births. The result of the study indicates that exposure to media sources of family planning messages was directly associated with increased contraceptive use. Moreover, the use of modern methods increased among women who were exposed to a greater number of media sources, as did discussion of family planning with spouses and attendance of health facilities. The programmatic implications of the results confirm that utilization of multiple media channels in the promotion of family planning and other reproductive issues must be continued, with emphasis on media sources that reach large audiences.

SU-E-T-562: Motion Tracking Optimization for Conformal Arc Radiotherapy Plans: A QUASAR Phantom Based Study

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

Xu, Z; Wang, I; Yao, R

Purpose: This study is to use plan parameters optimization (Dose rate, collimator angle, couch angle, initial starting phase) to improve the performance of conformal arc radiotherapy plans with motion tracking by increasing the plan performance score (PPS). Methods: Two types of 3D conformal arc plans were created based on QUASAR respiratory motion phantom with spherical and cylindrical targets. Sinusoidal model was applied to the MLC leaves to generate motion tracking plans. A MATLAB program was developed to calculate PPS of each plan (ranges from 0–1) and optimize plan parameters. We first selected the dose rate for motion tracking plans andmore » then used simulated annealing algorithm to search for the combination of the other parameters that resulted in the plan of the maximal PPS. The optimized motion tracking plan was delivered by Varian Truebeam Linac. In-room cameras and stopwatch were used for starting phase selection and synchronization between phantom motion and plan delivery. Gaf-EBT2 dosimetry films were used to measure the dose delivered to the target in QUASAR phantom. Dose profiles and Truebeam trajectory log files were used for plan delivery performance evaluation. Results: For spherical target, the maximal PPS (PPSsph) of the optimized plan was 0.79: (Dose rate: 500MU/min, Collimator: 90°, Couch: +10°, starting phase: 0.83π). For cylindrical target, the maximal PPScyl was 0.75 (Dose rate: 300MU/min, Collimator: 87°, starting phase: 0.97π) with couch at 0°. Differences of dose profiles between motion tracking plans (with the maximal and the minimal PPS) and 3D conformal plans were as follows: PPSsph=0.79: %ΔFWHM: 8.9%, %Dmax: 3.1%; PPSsph=0.52: %ΔFWHM: 10.4%, %Dmax: 6.1%. PPScyl=0.75: %ΔFWHM: 4.7%, %Dmax: 3.6%; PPScyl=0.42: %ΔFWHM: 12.5%, %Dmax: 9.6%. Conclusion: By achieving high plan performance score through parameters optimization, we can improve target dose conformity of motion tracking plan by decreasing total MLC leaf travel distance and leaf speed.« less

Comparability of [0-Level] GCE Grades in 1968 and 1973.

ERIC Educational Resources Information Center

Backhouse, John K.

1978-01-01

Willmott's comparison of General Certificate of Education (GCE) scores in 1968 and 1973 is reexamined. The trend toward an increasing percentage of students who pass is confirmed, but estimates of standard errors indicate that subtest differences may be attributed to the sampling plan. (CP)

Probabilities of having minimum amounts of available soil water at wheat planting

USDA-ARS?s Scientific Manuscript database

Winter wheat (Triticum aestivum L.)-fallow (WF) remains a prominent cropping system throughout the Central Great Plains despite documentation confirming the inefficiency of precipitation storage during the second summer fallow period. Wheat yield is greatly influenced by available soil water at plan...

48 CFR 552.270-20 - Payment.

Code of Federal Regulations, 2013 CFR

2013-10-01

..., ABOA square footage delivered will be confirmed by either: (1) The Government's measurement of plans... of ABOA square footage stated in the lease. (c) If the amount of ABOA square footage delivered is... space delivered and the annual rental will be adjusted as follows: ABOA square feet not delivered...

48 CFR 552.270-20 - Payment.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., ABOA square footage delivered will be confirmed by either: (1) The Government's measurement of plans... of ABOA square footage stated in the lease. (c) If the amount of ABOA square footage delivered is... space delivered and the annual rental will be adjusted as follows: ABOA square feet not delivered...

48 CFR 552.270-20 - Payment.

Code of Federal Regulations, 2012 CFR

2012-10-01

..., ABOA square footage delivered will be confirmed by either: (1) The Government's measurement of plans... of ABOA square footage stated in the lease. (c) If the amount of ABOA square footage delivered is... space delivered and the annual rental will be adjusted as follows: ABOA square feet not delivered...

48 CFR 552.270-20 - Payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., usable square footage delivered will be confirmed by either: (1) The Government's measurement of plans... of usable square footage stated in the lease. (c) If the amount of usable square footage delivered is... space delivered and the annual rental will be adjusted as follows: Usable square feet (USF) not...

48 CFR 552.270-20 - Payment.

Code of Federal Regulations, 2014 CFR

2014-10-01

..., ABOA square footage delivered will be confirmed by either: (1) The Government's measurement of plans... of ABOA square footage stated in the lease. (c) If the amount of ABOA square footage delivered is... space delivered and the annual rental will be adjusted as follows: ABOA square feet not delivered...

The executive personal finance scale: item analyses.

PubMed

Lester, David; Spinella, Marcello

2007-12-01

A scale devised to measure executive personal money management was examined for its factorial structure using 138 college students. On the whole, the factor analysis confirmed the subscale structure of the scale, but the Planning subscale appeared to consist of two distinct components, investment behavior and saving behavior.

76 FR 58020 - Prescription Drug User Fee Act IV Information Technology Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

...] Prescription Drug User Fee Act IV Information Technology Plan AGENCY: Food and Drug Administration, HHS. ACTION... information technology (IT) plan entitled ``PDUFA IV Information Technology Plan'' (updated plan) to achieve... Information Technology Plan.'' This plan will meet one of the performance goals agreed to under the 2007...

Measuring the Performance and Intelligence of Systems: Proceedings of the 2002 PerMIS Workshop

NASA Technical Reports Server (NTRS)

Messina, E. R.; Meystel, A. M.

2002-01-01

Contents include the following: Performance Metrics; Performance of Multiple Agents; Performance of Mobility Systems; Performance of Planning Systems; General Discussion Panel 1; Uncertainty of Representation I; Performance of Robots in Hazardous Domains; Modeling Intelligence; Modeling of Mind; Measuring Intelligence; Grouping: A Core Procedure of Intelligence; Uncertainty in Representation II; Towards Universal Planning/Control Systems.

Louisiana Airport System Plan : measures of performance.

DOT National Transportation Integrated Search

1992-07-01

This report applies measures of performance to gauge the extent to which the airport system achieves its goals and objectives by the implementation of the Airport System Plan. Measures of Performance are expressed as percentages of the given demograp...

20 CFR 669.520 - What information is required in the NFJP grant plans?

Code of Federal Regulations, 2010 CFR

2010-04-01

..., DEPARTMENT OF LABOR NATIONAL FARMWORKER JOBS PROGRAM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Performance Accountability, Planning and Waiver Provision § 669.520 What information is required in the NFJP... performance indicators and proposed levels of performance used to assess the performance of such entity...

78 FR 22253 - Agency Information Collection Activities; Comment Request; IDEA Part C State Performance Plan...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

... DEPARTMENT OF EDUCATION [Docket No. ED-2013-ICCD-0048] Agency Information Collection Activities; Comment Request; IDEA Part C State Performance Plan (SPP) and Annual Performance Report (APR) AGENCY... to this notice will be considered public records. Title of Collection: IDEA Part C State Performance...

24 CFR 91.520 - Performance reports.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 24 Housing and Urban Development 1 2014-04-01 2014-04-01 false Performance reports. 91.520 Section... Requirements § 91.520 Performance reports. (a) General. Each jurisdiction that has an approved consolidated... carrying out its strategic plan and its action plan. The performance report must include a description of...

24 CFR 91.520 - Performance reports.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Performance reports. 91.520 Section... Requirements § 91.520 Performance reports. (a) General. Each jurisdiction that has an approved consolidated... carrying out its strategic plan and its action plan. The performance report must include a description of...

24 CFR 91.520 - Performance reports.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 24 Housing and Urban Development 1 2012-04-01 2012-04-01 false Performance reports. 91.520 Section... Requirements § 91.520 Performance reports. (a) General. Each jurisdiction that has an approved consolidated... carrying out its strategic plan and its action plan. The performance report must include a description of...

24 CFR 91.520 - Performance reports.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Performance reports. 91.520 Section... Requirements § 91.520 Performance reports. (a) General. Each jurisdiction that has an approved consolidated... carrying out its strategic plan and its action plan. The performance report must include a description of...

24 CFR 91.520 - Performance reports.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 24 Housing and Urban Development 1 2013-04-01 2013-04-01 false Performance reports. 91.520 Section... Requirements § 91.520 Performance reports. (a) General. Each jurisdiction that has an approved consolidated... carrying out its strategic plan and its action plan. The performance report must include a description of...

Can we improve patient safety?

PubMed

Corbally, Martin Thomas

2014-01-01

Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out World Health Organization (WHO), errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO Surgical Pause/Time Out aims to capture these errors and prevent them, but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical Pause and Time Out, perhaps to avoid additional stress. In addition, surgeons, like pilots, are subject to the phenomenon of "plan-continue-fail" with potentially disastrous outcomes. If we wish to improve patient safety during surgery and avoid wrong site errors then we must include parents in the Surgical Pause/Time Out. A recent pilot study has shown that neither staff nor parents found it added to their stress, but, moreover, 100% of parents considered that it should be a mandatory component of the Surgical Pause nor does it add to the stress of surgery. Surgeons should be required to confirm that the planned procedure is in keeping with the operative findings especially in extirpative surgery and this "step back" should be incorporated into the standard Surgical Pause. It is clear that we must improve patient safety further and these simple measures should add to that potential.

Pediatric access to dermatologists: Medicaid versus private insurance.

PubMed

Chaudhry, Sofia B; Armbrecht, Eric S; Shin, Yoon; Matula, Sarah; Caffrey, Charles; Varade, Reena; Jones, Lisa; Siegfried, Elaine

2013-05-01

There is disparity in access to outpatient care for Medicaid beneficiaries. This inequity disproportionately impacts children. Access for children with skin disease may be especially limited. We sought to compare access to dermatologists for new pediatric patients insured by Medicaid versus a private plan. We surveyed 13 metropolitan markets by conducting secret-shopper scripted telephone calls to dermatology providers listed by Medicaid health plans. Paired calls, differing by insurance type, were made to each office on the same day, portraying a parent requesting a new appointment for a child with eczema. We called the offices of 723 Medicaid-listed providers. Final analysis included 471 dermatologists practicing general dermatology. Of these, an average of 44% refused a new Medicaid-insured pediatric patient. The average wait time for an appointment did not significantly vary between insurance types. Assuming that dermatologists not listed as Medicaid providers do not see Medicaid-insured children, our data indicate that pediatric Medicaid acceptance rates ranged from 6% to 64% by market, with an overall market size-weighted average acceptance rate of 19%. Relative reimbursement levels for Medicaid-insured patients did not correlate with acceptance rates. Although the most current health plan directories were used to create calling lists, these are dynamic. The sample sizes of confirmed appointments were in part limited by a lack of referral letters and/or health plan identification numbers. Only confirmed appointments were used to calculate average wait times. Access to dermatologists is limited for Medicaid-insured children with eczema. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Planning Abilities in Bilingual and Monolingual Children: Role of Verbal Mediation.

PubMed

Gangopadhyay, Ishanti; McDonald, Margarethe; Ellis Weismer, Susan; Kaushanskaya, Margarita

2018-01-01

We examined the role of verbal mediation in planning performance of English-Spanish-speaking bilingual children and monolingual English-speaking children, between the ages of 9 and 12 years. To measure planning, children were administered the Tower of London (ToL) task. In a dual-task paradigm, children completed ToL problems under three conditions: with no secondary task (baseline), with articulatory suppression, and with non-verbal motor suppression. Analyses revealed generally shorter planning times for bilinguals than monolinguals but both groups performed similarly on number of moves and execution times. Additionally, bilingual children were more efficient at planning throughout the duration of the task while monolingual children showed significant gains with more practice. Children's planning times under articulatory suppression were significantly shorter than under motor suppression as well as the baseline condition, and there was no difference in planning times between monolingual and bilingual children during articulatory suppression. These results demonstrate that bilingualism influences performance on a complex EF measure like planning, and that these effects are not related to verbal mediation.

Planning Abilities in Bilingual and Monolingual Children: Role of Verbal Mediation

PubMed Central

Gangopadhyay, Ishanti; McDonald, Margarethe; Ellis Weismer, Susan; Kaushanskaya, Margarita

2018-01-01

We examined the role of verbal mediation in planning performance of English–Spanish-speaking bilingual children and monolingual English-speaking children, between the ages of 9 and 12 years. To measure planning, children were administered the Tower of London (ToL) task. In a dual-task paradigm, children completed ToL problems under three conditions: with no secondary task (baseline), with articulatory suppression, and with non-verbal motor suppression. Analyses revealed generally shorter planning times for bilinguals than monolinguals but both groups performed similarly on number of moves and execution times. Additionally, bilingual children were more efficient at planning throughout the duration of the task while monolingual children showed significant gains with more practice. Children’s planning times under articulatory suppression were significantly shorter than under motor suppression as well as the baseline condition, and there was no difference in planning times between monolingual and bilingual children during articulatory suppression. These results demonstrate that bilingualism influences performance on a complex EF measure like planning, and that these effects are not related to verbal mediation. PMID:29593620

34 CFR 668.133 - Conditions under which an institution shall require documentation and request secondary...

Code of Federal Regulations, 2010 CFR

2010-07-01

... documentation required under § 668.33(a)(2) and request the INS to perform secondary confirmation for a student... not request that INS perform secondary confirmation, if the student— (i) Demonstrates eligibility...

Examining social-cognitive predictors of parenting skills among mothers with preschool and early elementary school-aged children.

PubMed

Norouzi, Saiideh; Moghaddam, Mohammad Hossein Baghiani; Morowatisharifabad, Mohammad Ali; Norouzi, Ali; Jafari, Ali Reza; Fallahzadeh, Hossein

2015-01-01

Identification of parenting skills determinants among mothers is an ongoing field of research. The aim of this study was to identify the social cognitive predictors of parenting skills among mothers. Previous studies have demonstrated the health action process approach (HAPA) as a credible frame for predicting behavior, but the number of studies considering the predictive value of parenting skills determinants among mothers is rare. An 8 months prospective design was applied. Participants were mothers with preschool and early elementary school-aged children. At the 1(st) time, 120 participants completed self-report questionnaires regarding their risk perception, outcome expectancies, task self-efficacy, and intentions toward parenting skills. At the 2(nd) time, they returned a follow-up questionnaire, which measured planning, coping self-efficacy, and recovery self-efficacy and finally, 8 months later as the 3(rd) time, parenting skills were measured. Path analysis was used for analysis. Path analysis indicated that, in the motivational phase, there was no relationship between parenting skills intention and risk perception, outcome expectancies, and task self-efficacy. Furthermore, no relationship was found between parenting skills intention and planning. In the volitional phase, coping self-efficacy, recovery self-efficacy, and planning were statistically significant predictors of parenting skills. The results of this study confirm that volitional phase of the HAPA model is useful in determining parenting skills. However, the role motivational variables seem to be unimportant in performing these behaviors. It was concluded that everybody intended to apply parenting skills, in nature, and intervention strategies should be focused on turning intentions into behavior.

Secondary Maxillary and Orbital Floor Reconstruction With a Free Scapular Flap Using Cutting and Fixation Guides Created by Computer-Aided Design/Computer-Aided Manufacturing.

PubMed

Morita, Daiki; Numajiri, Toshiaki; Tsujiko, Shoko; Nakamura, Hiroko; Yamochi, Ryo; Sowa, Yoshihiro; Yasuda, Makoto; Hirano, Shigeru

2017-11-01

Computer-aided design/computer-aided manufacturing (CAD/CAM) guides are now widely used in maxillofacial reconstruction. However, there are few reports of CAD/CAM guides being used for scapular flaps. The authors performed the secondary maxillary and orbital floor reconstruction using a free latissimus dorsi muscle, cutaneous tissue, and scapular flap designed using CAD/CAM techniques in a 72-year-old man who had undergone partial maxillectomy four years previously. The patient had diplopia, the vertical dystopia of eye position, and a large oral-nasal-cutaneous fistula. After the operation, the authors confirmed that the deviation between the postoperative and preoperative planning three-dimensional images was less than 2 mm. Because scapular guides require 3 cutting surfaces, the shape of the scapular guide is more complex than that of a conventional fibular guide. In orbital floor reconstruction, the use of a CAM technique such as that used to manufacture the authors' fixation guide is as necessary for accurate, safe, and easy reconstruction as is preoperative CAD planning. The production of a fixation guide as well as a cutting guide is particularly useful because it is difficult to determine the angle for reconstructing the orbital floor by freehand techniques. In this case, the orbital floor was reconstructed based on a mirror image of the healthy side to avoid overcompression of the orbital tissue. Although the patient's vertical dystopia of eye position was improved, diplopia was not improved because, for greater safety, the authors did not plan overcorrection of the orbital volume.

Commissioning and validation of fluence-based 3D VMAT dose reconstruction system using new transmission detector.

PubMed

Nakaguchi, Yuji; Oono, Takeshi; Maruyama, Masato; Shimohigashi, Yoshinobu; Kai, Yudai; Nakamura, Yuya

2018-06-01

In this study, we evaluated the basic performance of the three-dimensional dose verification system COMPASS (IBA Dosimetry). This system is capable of reconstructing 3D dose distributions on the patient anatomy based on the fluence measured using a new transmission detector (Dolphin, IBA Dosimetry) during treatment. The stability of the absolute dose and geometric calibrations of the COMPASS system with the Dolphin detector were investigated for fundamental validation. Furthermore, multileaf collimator (MLC) test patterns and a complicated volumetric modulated arc therapy (VMAT) plan were used to evaluate the accuracy of the reconstructed dose distributions determined by the COMPASS. The results from the COMPASS were compared with those of a Monte Carlo simulation (MC), EDR2 film measurement, and a treatment planning system (TPS). The maximum errors for the absolute dose and geometrical position were - 0.28% and 1.0 mm for 3 months, respectively. The Dolphin detector, which consists of ionization chamber detectors, was firmly mounted on the linear accelerator and was very stable. For the MLC test patterns, the TPS showed a > 5% difference at small fields, while the COMPASS showed good agreement with the MC simulation at small fields. However, the COMPASS produced a large error for complex small fields. For a clinical VMAT plan, COMPASS was more accurate than TPS. COMPASS showed real delivered-dose distributions because it uses the measured fluence, a high-resolution detector, and accurate beam modeling. We confirm here that the accuracy and detectability of the delivered dose of the COMPASS system are sufficient for clinical practice.

Three-dimensional radiochromic film dosimetry for volumetric modulated arc therapy using a spiral water phantom.

PubMed

Tanooka, Masao; Doi, Hiroshi; Miura, Hideharu; Inoue, Hiroyuki; Niwa, Yasue; Takada, Yasuhiro; Fujiwara, Masayuki; Sakai, Toshiyuki; Sakamoto, Kiyoshi; Kamikonya, Norihiko; Hirota, Shozo

2013-11-01

We validated 3D radiochromic film dosimetry for volumetric modulated arc therapy (VMAT) using a newly developed spiral water phantom. The phantom consists of a main body and an insert box, each of which has an acrylic wall thickness of 3 mm and is filled with water. The insert box includes a spiral film box used for dose-distribution measurement, and a film holder for positioning a radiochromic film. The film holder has two parallel walls whose facing inner surfaces are equipped with spiral grooves in a mirrored configuration. The film is inserted into the spiral grooves by its side edges and runs along them to be positioned on a spiral plane. Dose calculation was performed by applying clinical VMAT plans to the spiral water phantom using a commercial Monte Carlo-based treatment-planning system, Monaco, whereas dose was measured by delivering the VMAT beams to the phantom. The calculated dose distributions were resampled on the spiral plane, and the dose distributions recorded on the film were scanned. Comparisons between the calculated and measured dose distributions yielded an average gamma-index pass rate of 87.0% (range, 91.2-84.6%) in nine prostate VMAT plans under 3 mm/3% criteria with a dose-calculation grid size of 2 mm. The pass rates were increased beyond 90% (average, 91.1%; range, 90.1-92.0%) when the dose-calculation grid size was decreased to 1 mm. We have confirmed that 3D radiochromic film dosimetry using the spiral water phantom is a simple and cost-effective approach to VMAT dose verification.

Working memory and organizational skills problems in ADHD.

PubMed

Kofler, Michael J; Sarver, Dustin E; Harmon, Sherelle L; Moltisanti, Allison; Aduen, Paula A; Soto, Elia F; Ferretti, Nicole

2018-01-01

This study tested model-driven predictions regarding working memory's role in the organizational problems associated with ADHD. Children aged 8-13 (M = 10.33, SD = 1.42) with and without ADHD (N = 103; 39 girls; 73% Caucasian/Non-Hispanic) were assessed on multiple, counterbalanced working memory tasks. Parents and teachers completed norm-referenced measures of organizational problems (Children's Organizational Skills Scale; COSS). Results confirmed large magnitude working memory deficits (d = 1.24) and organizational problems in ADHD (d = 0.85). Bias-corrected, bootstrapped conditional effects models linked impaired working memory with greater parent- and teacher-reported inattention, hyperactivity/impulsivity, and organizational problems. Working memory predicted organization problems across all parent and teacher COSS subscales (R 2  = .19-.23). Approximately 38%-57% of working memory's effect on organization problems was conveyed by working memory's association with inattentive behavior. Unique effects of working memory remained significant for both parent- and teacher-reported task planning, as well as for teacher-reported memory/materials management and overall organization problems. Attention problems uniquely predicted worse organizational skills. Hyperactivity was unrelated to parent-reported organizational skills, but predicted better teacher-reported task planning. Children with ADHD exhibit multisetting, broad-based organizational impairment. These impaired organizational skills are attributable in part to performance deficits secondary to working memory dysfunction, both directly and indirectly via working memory's role in regulating attention. Impaired working memory in ADHD renders it extraordinarily difficult for these children to consistently anticipate, plan, enact, and maintain goal-directed actions. © 2017 Association for Child and Adolescent Mental Health.

Energy modulated electron therapy: Design, implementation, and evaluation of a novel method of treatment planning and delivery

NASA Astrophysics Data System (ADS)

Al-Yahya, Khalid

Energy modulated electron therapy (EMET) is a promising treatment modality that has the fundamental capabilities to enhance the treatment planning and delivery of superficially located targets. Although it offers advantages over x-ray intensity modulated radiation therapy (IMRT), EMET has not been widely implemented to the same level of accuracy, automation, and clinical routine as its x-ray counterpart. This lack of implementation is attributed to the absence of a remotely automated beam shaping system as well as the deficiency in dosimetric accuracy of clinical electron pencil beam algorithms in the presence of beam modifiers and tissue heterogeneities. In this study, we present a novel technique for treatment planning and delivery of EMET. The delivery is achieved using a prototype of an automated "few leaf electron collimator" (FLEC). It consists of four copper leaves driven by stepper motors which are synchronized with the x-ray jaws in order to form a series of collimated rectangular openings or "fieldlets". Based on Monte Carlo studies, the FLEC has been designed to serve as an accessory tool to the current accelerator equipment. The FLEC was constructed and its operation was fully automated and integrated with the accelerator through an in-house assembled control unit. The control unit is a portable computer system accompanied with customized software that delivers EMET plans after acquiring them from the optimization station. EMET plans are produced based on dose volume constraints that employ Monte Carlo pre-generated and patient-specific kernels which are utilized by an in-house developed optimization algorithm. The structure of the optimization software is demonstrated. Using Monte Carlo techniques to calculate dose allows for accurate modeling of the collimation system as well as the patient heterogeneous geometry and take into account their impact on optimization. The Monte Carlo calculations were validated by comparing them against output measurements with an ionization chamber. Comparisons with measurements using nearly energy-independent radiochromic films were performed to confirm the Monte Carlo calculation accuracy for 1-D and 2-D dose distributions. We investigated the clinical significance of EMET on cancer sites that are inherently difficult to plan with IMRT. Several parameters were used to analyze treatment plans where they show that EMET provides significant overall improvements over IMRT.

Children's planning performance in the Zoo Map task (BADS-C): Is it driven by general cognitive ability, executive functioning, or prospection?

PubMed

Ballhausen, Nicola; Mahy, Caitlin E V; Hering, Alexandra; Voigt, Babett; Schnitzspahn, Katharina M; Lagner, Prune; Ihle, Andreas; Kliegel, Matthias

2017-01-01

A minimal amount of research has examined the cognitive predictors of children's performance in naturalistic, errand-type planning tasks such as the Zoo Map task of the Behavioral Assessment of the Dysexecutive Syndrome for Children (BADS-C). Thus, the current study examined prospection (i.e., the ability to remember to carry out a future intention), executive functioning, and intelligence markers as predictors of performance in this widely used naturalistic planning task in 56 children aged 7- to 12-years-old. Measures of planning, prospection, inhibition, crystallized intelligence, and fluid intelligence were collected in an individual differences study. Regression analyses showed that prospection (rather than traditional measures of intelligence or inhibition) predicted planning, suggesting that naturalistic planning tasks such as the Zoo Map task may rely on future-oriented cognitive processes rather than executive problem solving or general knowledge.

Development of performance measures for the assessment of rural planning organizations.

DOT National Transportation Integrated Search

2011-04-27

In order for the Transportation Planning Board to provide oversight and assistance to the 20 RPOs in the state, they : need effective evaluation criteria and performance measures. The existing measures, including the annual : performance report, do n...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2012 CFR

2012-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2014 CFR

2014-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

48 CFR 970.1100-1 - Performance-based contracting.

Code of Federal Regulations, 2013 CFR

2013-10-01

... methods of accomplishing the work; use measurable (i.e., terms of quality, timeliness, quantity) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... work and other documents used to establish work requirements. (d) Quality assurance surveillance plans...

Medication adherence and measures of health plan quality.

PubMed

Seabury, Seth A; Lakdawalla, Darius N; Dougherty, J Samantha; Sullivan, Jeff; Goldman, Dana P

2015-06-01

Medication adherence is increasingly being considered as a measure for performance-based reimbursement contracts in healthcare systems. However, the association between health outcomes and adherence at the plan level is unknown. Retrospective analysis of medical and pharmacy claims from a large private sector claims database from 2000 to 2009. We compared plan-level measures of medication adherence and health outcomes for patients with diabetes and congestive heart failure (CHF). Plan performance was based on average rates of disease complications. Medication adherence was calculated as the percent of patients having 80% of days covered for medications treating diabetes or CHF. Both adherence and outcomes were adjusted for patient differences using multivariate regression. Plans were stratified into low, moderate, and high adherence, based on adherence in the bottom quartile, middle 2 quartiles, and top quartile, respectively. Average adherence varied significantly across plans. Plans with low adherence to diabetes medications had adjusted rates of uncontrolled diabetes admissions of 13.2 per 1000 patients, compared with 11.2 in moderate adherence plans and 8.3 in high adherence plans (P < .001). The adjusted rate of CHF-related hospitalization was 15.3% in low adherence plans, compared with 12.4% in moderate adherence plans and 12.2% in high adherence plans (P < .001). These patterns were consistent across different types of complications for both diabetes and CHF. Private health plans vary considerably in average adherence to medications treating chronic diseases. Plans with higher average adherence had lower rates of disease complications, suggesting that medication adherence measures are potentially useful tools for improving the performance of health plans.

SU-F-T-65: AutomaticTreatment Planning for High-Dose Rate (HDR) Brachytherapy with a VaginalCylinder Applicator

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

Zhou, Y; Tan, J; Jiang, S

Purpose: High dose rate (HDR) brachytherapy treatment planning is conventionally performed in a manual fashion. Yet it is highly desirable to perform computerized automated planning to improve treatment planning efficiency, eliminate human errors, and reduce plan quality variation. The goal of this research is to develop an automatic treatment planning tool for HDR brachytherapy with a cylinder applicator for vaginal cancer. Methods: After inserting the cylinder applicator into the patient, a CT scan was acquired and was loaded to an in-house developed treatment planning software. The cylinder applicator was automatically segmented using image-processing techniques. CTV was generated based on user-specifiedmore » treatment depth and length. Locations of relevant points (apex point, prescription point, and vaginal surface point), central applicator channel coordinates, and dwell positions were determined according to their geometric relations with the applicator. Dwell time was computed through an inverse optimization process. The planning information was written into DICOM-RT plan and structure files to transfer the automatically generated plan to a commercial treatment planning system for plan verification and delivery. Results: We have tested the system retrospectively in nine patients treated with vaginal cylinder applicator. These cases were selected with different treatment prescriptions, lengths, depths, and cylinder diameters to represent a large patient population. Our system was able to generate treatment plans for these cases with clinically acceptable quality. Computation time varied from 3–6 min. Conclusion: We have developed a system to perform automated treatment planning for HDR brachytherapy with a cylinder applicator. Such a novel system has greatly improved treatment planning efficiency and reduced plan quality variation. It also served as a testbed to demonstrate the feasibility of automatic HDR treatment planning for more complicated cases.« less

Revising superior planning performance in chess players: the impact of time restriction and motivation aspects.

PubMed

Unterrainer, Josef Martin; Kaller, Christoph Philipp; Leonhart, Rainer; Rahm, Benjamin

2011-01-01

In a previous study (Unterrainer, Kaller, Halsband, & Rahm, 2006), chess players outperformed non-chess players in the Tower of London planning task but exhibited disproportionately longer processing times. This pattern of results raises the question of whether chess players' planning capabilities are superior or whether the results reflect differences in the speed-accuracy trade-off between the groups, possibly attributable to sports motivation. The present study was designed to disambiguate these alternative suggestions by implementing various constraints on planning time and by assessing self-reported motivation. In contrast to the previous study, chess players' performance was not superior, independently of whether problems had to be solved with (Experiment 1) or without (Experiment 2) time limits. As expected, chess players reported higher overall trait and state motivation scores across both experiments. These findings revise the notion of superior planning performance in chess players. In consequence, they do not conform with the assumption of a general transfer of chess-related planning expertise to other cognitive domains, instead suggesting that superior performance may be possible only under specific circumstances such as receiving competitive instructions.

Paying for Performance to Improve the Delivery and Uptake of Family Planning in Low and Middle Income Countries: A Systematic Review.

PubMed

Blacklock, Claire; MacPepple, Ekelechi; Kunutsor, Setor; Witter, Sophie

2016-12-01

Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted. © 2016 The Population Council, Inc.

A Comparison of Organizational Climate and Nurses' Intention to Leave Among Excellence Awarded Hospitals and Other Hospitals in 2013.

PubMed

Mohamadzadeh Nojehdehi, Maryam; Ashgholi Farahani, Mansoureh; Rafii, Forough; Bahrani, Nasser

2015-05-01

Human resource is the most important factor of performance, success and better revelation of excellence goals of each organization. By performing excellence plan, healthcare organizations improve their organizational climate and play a valuable role in retaining nurses and improving the quality of their services to patients. The aim of this study was to compare hospital organizational climate and intention to leave among working nurses in hospitals performing the excellence plan and other hospitals of Tehran University of Medical Sciences. This was a cross-sectional descriptive comparison study. Its population included 248 nurses of the hospitals performing the excellence plan and other hospitals of Tehran University of Medical Sciences in Iran selected by random sampling. The used instrument had three parts: the first part was related to personal characteristics, the second part was the Munn's organizational climate questionnaire and the third part was Hinshaw's questionnaire of "anticipated turnover scale". Data was analyzed using SPSS software, version 17 and indices of descriptive statistics and inferential statistics. The results of the mean and standard deviation for organizational climate and intention to leave in both performing and non-performing hospitals of the organizational excellence plan were respectively (65.28 ± 19.31 and 56.42 ± 21.36) and (33.64 ± 5.58 and 35.59 ± 4.94). Independent T test revealed a significant difference between the mean scores for organizational climate in both performing and non-performing hospitals, and also a significant difference between the mean scores for intention to leave in both performing and non-performing hospitals (P = 0.004). Moreover, Pearson Correlation test showed a reverse significant correlation between organizational climate and intention to leave in performing hospitals of the organizational excellence plan (r = -0.337) and non-performing hospitals (r = -0.282) (P = 0.001). Performing quality improvement pattern such as organization's excellence plan improves organizational climate of healthcare sectors, it can reduce nurses' intentions to leave and retain human resources.

[Unwanted children].

PubMed

Sulová, L; Fait, T

2009-06-01

Aim of the study is review of knowledges about psychosocial aspects of unwanted pregnancy for child. Literary review. Department of psychology, Faculty of psychology, Charles University Prague. In our review article we give results of studies which evaluate physical, psychological and social aspects of beeing unwanted baby. Especially we show unique results of Prague study. The majority of studies confirm that unwanted children are significantly discriminated against wanted children. Unwanted children have more diseases, worse school result with identical inteligence quotient, higher frequency of nervous and psychosomatic disables and worse social adaptibility. Results of studies confirm order to find for every women safe and effective method for familly planning.

The Collaborative School: A Work Environment for Effective Instruction.

ERIC Educational Resources Information Center

Smith, Stuart C.; Scott, James J.

The benefits of a collaborative work setting--including such practices as mutual help, exchange of ideas, joint planning, and participative decision-making--have been consistently confirmed by studies of effective schools and successful businesses. However, teacher isolation remains the norm. Drawing on recent research and educators' firsthand…

78 FR 65751 - Integrated Corridor Management Deployment Planning Grants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-01

... Cronin, Team Leader, Research, Research and Innovative Technology Administration (RITA) ITS-Joint Program...:00 p.m. e.t. Registering with Grants.gov is a one-time process; however, processing delays may occur and it can take up to several weeks for first-time registrants to receive confirmation and a user...

42 CFR 455.436 - Federal database checks.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Federal database checks. 455.436 Section 455.436....436 Federal database checks. The State Medicaid agency must do all of the following: (a) Confirm the... databases. (b) Check the Social Security Administration's Death Master File, the National Plan and Provider...

42 CFR 455.436 - Federal database checks.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Federal database checks. 455.436 Section 455.436....436 Federal database checks. The State Medicaid agency must do all of the following: (a) Confirm the... databases. (b) Check the Social Security Administration's Death Master File, the National Plan and Provider...

42 CFR 455.436 - Federal database checks.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Federal database checks. 455.436 Section 455.436....436 Federal database checks. The State Medicaid agency must do all of the following: (a) Confirm the... databases. (b) Check the Social Security Administration's Death Master File, the National Plan and Provider...

42 CFR 455.436 - Federal database checks.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Federal database checks. 455.436 Section 455.436....436 Federal database checks. The State Medicaid agency must do all of the following: (a) Confirm the... databases. (b) Check the Social Security Administration's Death Master File, the National Plan and Provider...

76 FR 77264 - Exemptions From Certain Prohibited Transaction Restrictions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-12

... consistently exceeded the minimum funding requirement. Bayer also explained it had an obligation to pay bonuses... Discrepancy At the Department's request, Bayer confirmed that it had made the Contribution to the Plan on... Representation 14 of the Notice. This discrepancy concerned the Department, which requested a written explanation...

9 CFR 116.1 - Applicability and general considerations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... imported products, each permittee shall maintain at the permittee's place of business detailed and accurate... manufacturer may maintain and retain records required under this part at an alternative location. Such authorization shall be confirmed by the filing of an addendum to the plot plan legend. The addendum shall list...

78 FR 30306 - Partnerships To Advance the National Occupational Research Agenda (NORA)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

... NORA and on plans for evaluating the second decade of NORA. Brief written updates will be available... (capacity 50). Each participant is requested to register for the free meeting by sending an email to...: computer, Internet connection, and telephone, preferably with `mute' capability). An email confirming...

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

Coburn, Natalie, E-mail: natalie.coburn@swahs.health.nsw.gov.au; Beldham-Collins, Rachael; Radiation Oncology Network, Westmead Cancer Care Centre, University of Sydney, Sydney, New South Wales

Protocols commonly implemented in radiotherapy work areas may be classified as being either rigid (class solution) or flexible. Because formal evaluation of these protocol types has not occurred within the literature, we evaluated the efficiency of a rigid compared with flexible prostate planning protocol by assessing a series of completed 3D conformal prostate plans. Twenty prostate cancer patients with an average age of 70 years (range, 52-77) and sizes comprising 8 small, 10 medium, and 2 large were planned on the Phillips Pinnacle treatment planning system 6 times by radiation therapists with <2 years, 2-5 years, and >5 years ofmore » experience using a rigid and flexible protocol. Plans were critiqued using critical organ doses, confirmation numbers, and conformity index. Plans were then classified as being acceptable or not. Plans produced with the flexible protocol were 53% less likely to require modification (OR 0.47, 95% CI: 0.26, 0.84, p = 0.01). Planners with >5 years of experience were 78% more likely to produce plans requiring modification (OR 1.78, 95% CI: 1.12, 2.83, P = 0.02). Plans according to the flexible protocol took longer (112 min) compared with the time taken using a rigid protocol (68 min) (p < 0.001). The results suggest that further studies are needed; however, we propose that all radiation therapy planners should start with the same limitations, and if an acceptable plan is not reached, then flexibility should be given to improve the plan to meet the desired results.« less

Use of 3D reconstruction cloacagrams and 3D printing in cloacal malformations.

PubMed

Ahn, Jennifer J; Shnorhavorian, Margarett; Amies Oelschlager, Anne-Marie E; Ripley, Beth; Shivaram, Giridhar M; Avansino, Jeffrey R; Merguerian, Paul A

2017-08-01

Cloacal anomalies are complex to manage, and the anatomy affects prognosis and management. Assessment historically includes examination under anesthesia, and genitography is often performed, but these do not consistently capture three-dimensional (3D) detail or spatial relationships of the anatomic structures. Three-dimensional reconstruction cloacagrams can provide a high level of detail including channel measurements and the level of the cloaca (<3 cm vs. >3 cm), which typically determines the approach for surgical reconstruction and can impact long-term prognosis. Yet this imaging modality has not yet been directly compared with intra-operative or endoscopic findings. Our objective was to compare 3D reconstruction cloacagrams with endoscopic and intraoperative findings, as well as to describe the use of 3D printing to create models for surgical planning and education. An IRB-approved retrospective review of all cloaca patients seen by our multi-disciplinary program from 2014 to 2016 was performed. All patients underwent examination under anesthesia, endoscopy, 3D reconstruction cloacagram, and subsequent reconstructive surgery at a later date. Patient characteristics, intraoperative details, and measurements from endoscopy and cloacagram were reviewed and compared. One of the 3D cloacagrams was reformatted for 3D printing to create a model for surgical planning. Four patients were included for review, with the Figure illustrating 3D cloacagram results. Measurements of common channel length and urethral length were similar between modalities, particularly with confirming the level of cloaca. No patient experienced any complications or adverse effects from cloacagram or endoscopy. A model was successfully created from cloacagram images with the use of 3D printing technology. Accurate preoperative assessment for cloacal anomalies is important for counseling and surgical planning. Three-dimensional cloacagrams have been shown to yield a high level of anatomic detail. Here, cloacagram measurements are shown to correlate well with endoscopic and intraoperative findings with regards to level of cloaca and Müllerian development. Measurement discrepancies may be due to technical variation indicating a need for further evaluation. The translation of the cloacagram images into a 3D printed model demonstrates potential applications of these models for pre-operative planning and education of both families and trainees. In our series, 3D reconstruction cloacagrams yielded accurate measurements of urethral length and level of cloaca common channel and urethral length, similar to those found on endoscopy. Three-dimensional models can be printed from using cloacagram images, and may be useful for surgical planning and education. Copyright © 2017 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

25 CFR 216.8 - Performance bond.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Performance bond. 216.8 Section 216.8 Indians BUREAU OF... RECLAMATION OF LANDS General Provisions § 216.8 Performance bond. (a) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000...

25 CFR 216.8 - Performance bond.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Performance bond. 216.8 Section 216.8 Indians BUREAU OF... RECLAMATION OF LANDS General Provisions § 216.8 Performance bond. (a) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000...

43 CFR 23.9 - Performance bond.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Performance bond. 23.9 Section 23.9 Public... LANDS § 23.9 Performance bond. (a)(1) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000 with satisfactory surety...

25 CFR 216.8 - Performance bond.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Performance bond. 216.8 Section 216.8 Indians BUREAU OF... RECLAMATION OF LANDS General Provisions § 216.8 Performance bond. (a) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000...

43 CFR 23.9 - Performance bond.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Performance bond. 23.9 Section 23.9 Public... LANDS § 23.9 Performance bond. (a)(1) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000 with satisfactory surety...

25 CFR 216.8 - Performance bond.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Performance bond. 216.8 Section 216.8 Indians BUREAU OF... RECLAMATION OF LANDS General Provisions § 216.8 Performance bond. (a) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000...

43 CFR 23.9 - Performance bond.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Performance bond. 23.9 Section 23.9 Public... LANDS § 23.9 Performance bond. (a)(1) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000 with satisfactory surety...

43 CFR 23.9 - Performance bond.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Performance bond. 23.9 Section 23.9 Public... LANDS § 23.9 Performance bond. (a)(1) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000 with satisfactory surety...

25 CFR 216.8 - Performance bond.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Performance bond. 216.8 Section 216.8 Indians BUREAU OF... RECLAMATION OF LANDS General Provisions § 216.8 Performance bond. (a) Upon approval of an exploration plan or mining plan, the operator shall be required to file a suitable performance bond of not less than $2,000...

Assessing the Sustainability Performance of Urban Plans based on Ecosystem Services

NASA Astrophysics Data System (ADS)

Menteşe, E. Y.; Tezer, A.

2017-12-01

Aiming at efficient and mindful use of natural resources while enabling social cohesion and economic development; sustainable development is one of the most emerging phenomenon in last decade. In this regard, role of urban development is critical by means of achieving sustainability since more than half of the world's population lives in cities. However, there is no solid and widely accepted approach for sustainability assessment in land use planning because there is not enough evidence on the relation between land use plans and environmental sustainability. With the basic aim of setting up relation between environmental sustainability and urban plans, this study utilizes ecosystem services phenomenon to define sustainability performance of a land use plan. Since ecosystem services can easily be related with land cover and land use they can be used as an efficient tool to act as indicators of sustainability. Meanwhile, while urban plans can provide ecosystem services and their level of service provision can be quantified, this is not solely enough for understanding its sustainability. Because it is also known that a land use plan mostly has negative impact on sustainability. Hence, this study embraces land use plans as a source of ecosystem services and environmental impacts. The difference between these entities are assumed to be the sustainability performance of a plan. The analysis relies on four parameters: ecosystem service capacity (environmental impact capacity), areal quantity of a land cover / use function, fragmantation level of the land use / cover and weight of ecosystem services / environmental impacts. Lastly, this approach is adopted for Istanbul's environmental master plan of 2009 and actual land cover of the same period. By calculating both data's environmental performance, the change of sustainability level sourced from environmental plan is analyzed.

The role of short-term memory impairment in nonword repetition, real word repetition, and nonword decoding: A case study.

PubMed

Peter, Beate

2018-01-01

In a companion study, adults with dyslexia and adults with a probable history of childhood apraxia of speech showed evidence of difficulty with processing sequential information during nonword repetition, multisyllabic real word repetition and nonword decoding. Results suggested that some errors arose in visual encoding during nonword reading, all levels of processing but especially short-term memory storage/retrieval during nonword repetition, and motor planning and programming during complex real word repetition. To further investigate the role of short-term memory, a participant with short-term memory impairment (MI) was recruited. MI was confirmed with poor performance during a sentence repetition and three nonword repetition tasks, all of which have a high short-term memory load, whereas typical performance was observed during tests of reading, spelling, and static verbal knowledge, all with low short-term memory loads. Experimental results show error-free performance during multisyllabic real word repetition but high counts of sequence errors, especially migrations and assimilations, during nonword repetition, supporting short-term memory as a locus of sequential processing deficit during nonword repetition. Results are also consistent with the hypothesis that during complex real word repetition, short-term memory is bypassed as the word is recognized and retrieved from long-term memory prior to producing the word.

Seizures are common in term infants undergoing head cooling.

PubMed

Yap, Vivien; Engel, Murray; Takenouchi, Toshiki; Perlman, Jeffrey M

2009-11-01

Selective head cooling was used to treat infants at risk of developing encephalopathy within 6 hours as part of a practice plan. Amplitude-integrated electroencephalography and raw, single-channel electroencephalography tracings were performed continuously during cooling. Routine electroencephalography was performed intermittently during, and video electroencephalography immediately after, selective head cooling. Magnetic resonance imaging was performed at the end of week 1. We sought a better delineation of the occurrence and timing of clinical and electrographic seizures during selective head cooling. Twenty term infants are described. Eleven received chest compressions, all at pH <7. Upon admission, encephalopathy was characterized clinically as moderate (n = 13) or severe (n = 7), and by amplitude-integrated electroencephalography as moderate (n = 8), severe (n = 6), or indeterminate (n = 6). Clinical seizures (n = 18) were most prominent on day 1. Amplitude-integrated electroencephalography seizures (n = 9) were evident upon admission and on day 1 (n = 19), and were continuous between 24-36 hours (n = 9). Amplitude-integrated electroencephalography seizures were confirmed by routine electroencephalography. Magnetic resonance imaging was abnormal in nine infants, with predominantly bilateral involvement of the basal ganglia (n = 8). Magnesium was at

[Circulating vaccine-derived poliovirus type 2 outbreak in Democratic Republic of Congo 2011-2012].

PubMed

Bazira, L; Coulibaly, T; Mayenga, M; Ncharre, C; Yogolelo, R; Mbule, A; Moudzeo, H; Lwamba, P; Mulumba, A W; Cabore, J

2015-10-01

According to the WHO records of 2013, the incidence of poliomyelitis was reduced by more than 99%, the number of endemic countries decreased from 125 in 1988 to 3 in 2013 and over 10 million cases were prevented from poliomyelitis thanks to the intensive use of Oral polio vaccine (OPV). However, the emergence of circulating vaccine-derived poliovirus strains (cVDPV), causing serious epidemics like the wild poliovirus, is a major challenge on the final straight towards the goal of eradication and OPV cessation. This paper describes the cVDPVoutbreak that occurred in the Democratic Republic of Congo (DRC) from November 2011 to April 2012. All children under 15 years of age with acute flaccid paralysis (AFP) and confirmed presence of cVDPV in the stool samples were included. Thirty (30) children, all from the administrative territories of Bukama and Malemba Nkulu in the Katanga Province (south-east DRC), were reported. The virus responsible was the cVDPV type 2 (0.7% -3.5% divergent from the reference Sabin 2 strain) in 29 children (97%) and the ambiguous vaccine-derived poliovirus strain (0.7% divergent) was confirmed in one case (3%), a boy seventeen months old and already vaccinated four times with OPV. Twentyfive children (83%) were protected by any of the routine EPI vaccines and 3 children (10%) had never received any dose of OPV. In reaction, DRC has conducted five local campaigns over a period of 10 months (from January to October 2012) and the epidemic was stopped after the second round performed in March 2012. As elsewhere in similar conditions, low immunization coverage, poor sanitation conditions and the stop of the use of OPV2 have favoured the emergence of the third cVDPV epidemic in DRC. The implementation of the Strategic Plan for Polio eradication and endgame strategic plan 2013-2018 will prevent the emergence of cVDPV and set up the conditions for a coordinated OPV phase out.

Integration Test of the High Voltage Hall Accelerator System Components

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Haag, Thomas; Huang, Wensheng; Pinero, Luis; Peterson, Todd; Dankanich, John

2013-01-01

NASA Glenn Research Center is developing a 4 kilowatt-class Hall propulsion system for implementation in NASA science missions. NASA science mission performance analysis was completed using the latest high voltage Hall accelerator (HiVHAc) and Aerojet-Rocketdyne's state-of-the-art BPT-4000 Hall thruster performance curves. Mission analysis results indicated that the HiVHAc thruster out performs the BPT-4000 thruster for all but one of the missions studied. Tests of the HiVHAc system major components were performed. Performance evaluation of the HiVHAc thruster at NASA Glenn's vacuum facility 5 indicated that thruster performance was lower than performance levels attained during tests in vacuum facility 12 due to the lower background pressures attained during vacuum facility 5 tests when compared to vacuum facility 12. Voltage-Current characterization of the HiVHAc thruster in vacuum facility 5 showed that the HiVHAc thruster can operate stably for a wide range of anode flow rates for discharge voltages between 250 and 600 volts. A Colorado Power Electronics enhanced brassboard power processing unit was tested in vacuum for 1,500 hours and the unit demonstrated discharge module efficiency of 96.3% at 3.9 kilowatts and 650 volts. Stand-alone open and closed loop tests of a VACCO TRL 6 xenon flow control module were also performed. An integrated test of the HiVHAc thruster, brassboard power processing unit, and xenon flow control module was performed and confirmed that integrated operation of the HiVHAc system major components. Future plans include continuing the maturation of the HiVHAc system major components and the performance of a single-string integration test.

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

Lian, Jun, E-mail: jun-lian@med.unc.edu; Chera, Bhishamjit S.; Chang, Sha

Purpose: To build a statistical model to quantitatively correlate the anatomic features of structures and the corresponding dose-volume histogram (DVH) of head and neck (HN) Tomotherapy (Tomo) plans. To study if the model built upon one intensity modulated radiation therapy (IMRT) technique (such as conventional Linac) can be used to predict anticipated organs-at-risk (OAR) DVH of patients treated with a different IMRT technique (such as Tomo). To study if the model built upon the clinical experience of one institution can be used to aid IMRT planning for another institution. Methods: Forty-four Tomotherapy intensity modulate radiotherapy plans of HN cases (Tomo-IMRT)more » from Institution A were included in the study. A different patient group of 53 HN fixed gantry IMRT (FG-IMRT) plans was selected from Institution B. The analyzed OARs included the parotid, larynx, spinal cord, brainstem, and submandibular gland. Two major groups of anatomical features were considered: the volumetric information and the spatial information. The volume information includes the volume of target, OAR, and overlapped volume between target and OAR. The spatial information of OARs relative to PTVs was represented by the distance-to-target histogram (DTH). Important anatomical and dosimetric features were extracted from DTH and DVH by principal component analysis. Two regression models, one for Tomotherapy plan and one for IMRT plan, were built independently. The accuracy of intratreatment-modality model prediction was validated by a leave one out cross-validation method. The intertechnique and interinstitution validations were performed by using the FG-IMRT model to predict the OAR dosimetry of Tomo-IMRT plans. The dosimetry of OARs, under the same and different institutional preferences, was analyzed to examine the correlation between the model prediction and planning protocol. Results: Significant patient anatomical factors contributing to OAR dose sparing in HN Tomotherapy plans have been analyzed and identified. For all the OARs, the discrepancies of dose indices between the model predicted values and the actual plan values were within 2.1%. Similar results were obtained from the modeling of FG-IMRT plans. The parotid gland was spared in a comparable fashion during the treatment planning of two institutions. The model based on FG-IMRT plans was found to predict the median dose of the parotid of Tomotherapy plans quite well, with a mean error of 2.6%. Predictions from the FG-IMRT model suggested the median dose of the larynx, median dose of the brainstem and D2 of the brainstem could be reduced by 10.5%, 12.8%, and 20.4%, respectively, in the Tomo-IMRT plans. This was found to be correlated to the institutional differences in OAR constraint settings. Re-planning of six Tomotherapy patients confirmed the potential of optimization improvement predicted by the FG-IMRT model was correct. Conclusions: The authors established a mathematical model to correlate the anatomical features and dosimetric indexes of OARs of HN patients in Tomotherapy plans. The model can be used for the setup of patient-specific OAR dose sparing goals and quality control of planning results. The institutional clinical experience was incorporated into the model which allows the model from one institution to generate a reference plan for another institution, or another IMRT technique.« less

First evidence for "The backup plan paradox".

PubMed

Napolitano, Christopher M; Freund, Alexandra M

2017-08-01

This research is a first test of the backup plan paradox. We hypothesized that investing in a backup plan may facilitate the conditions that it was developed to address: Plan A's insufficiency. Five studies provide initial, primarily correlative support for the undermining effect of investing in a backup plan. Study 1 (n= 160) demonstrated that the more participants perceived they had invested in developing a backup plan (preparing a "crib sheet"), the more likely they were to use it, although greater investments were unrelated to backup plan utility. Studies 2-4 used a simulated negotiation task. Study 2 (n = 247) demonstrated that when goal-relevant resources are limited, investing in developing backup plans and perceiving them as highly instrumental can decrease goal performance through the indirect effect of increased means replacing. Study 3 (n = 248) replicated this effect when goal-relevant resources were plentiful. Study 4 (n = 204) used an experimental variant of the simulated negotiation task and demonstrated that simply having a backup plan is not detrimental, but perceiving backup plans to be highly instrumental decreased goal performance, again through the indirect effect of increased means replacing. Study 5 (n = 160) replicated findings from Studies 1-4 using a lab-based motor task (throwing a ball). Together, these results provide first evidence that backup plans can introduce costs that may jeopardize goal performance. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Technical Note: Development and performance of a software tool for quality assurance of online replanning with a conventional Linac or MR-Linac.

PubMed

Chen, Guang-Pei; Ahunbay, Ergun; Li, X Allen

2016-04-01

To develop an integrated quality assurance (QA) software tool for online replanning capable of efficiently and automatically checking radiation treatment (RT) planning parameters and gross plan quality, verifying treatment plan data transfer from treatment planning system (TPS) to record and verify (R&V) system, performing a secondary monitor unit (MU) calculation with or without a presence of a magnetic field from MR-Linac, and validating the delivery record consistency with the plan. The software tool, named ArtQA, was developed to obtain and compare plan and treatment parameters from both the TPS and the R&V system database. The TPS data are accessed via direct file reading and the R&V data are retrieved via open database connectivity and structured query language. Plan quality is evaluated with both the logical consistency of planning parameters and the achieved dose-volume histograms. Beams in between the TPS and R&V system are matched based on geometry configurations. To consider the effect of a 1.5 T transverse magnetic field from MR-Linac in the secondary MU calculation, a method based on modified Clarkson integration algorithm was developed and tested for a series of clinical situations. ArtQA has been used in their clinic and can quickly detect inconsistencies and deviations in the entire RT planning process. With the use of the ArtQA tool, the efficiency for plan check including plan quality, data transfer, and delivery check can be improved by at least 60%. The newly developed independent MU calculation tool for MR-Linac reduces the difference between the plan and calculated MUs by 10%. The software tool ArtQA can be used to perform a comprehensive QA check from planning to delivery with conventional Linac or MR-Linac and is an essential tool for online replanning where the QA check needs to be performed rapidly.

Technical Note: Development and performance of a software tool for quality assurance of online replanning with a conventional Linac or MR-Linac

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

Chen, Guang-Pei, E-mail: gpchen@mcw.edu; Ahunbay, Ergun; Li, X. Allen

Purpose: To develop an integrated quality assurance (QA) software tool for online replanning capable of efficiently and automatically checking radiation treatment (RT) planning parameters and gross plan quality, verifying treatment plan data transfer from treatment planning system (TPS) to record and verify (R&V) system, performing a secondary monitor unit (MU) calculation with or without a presence of a magnetic field from MR-Linac, and validating the delivery record consistency with the plan. Methods: The software tool, named ArtQA, was developed to obtain and compare plan and treatment parameters from both the TPS and the R&V system database. The TPS data aremore » accessed via direct file reading and the R&V data are retrieved via open database connectivity and structured query language. Plan quality is evaluated with both the logical consistency of planning parameters and the achieved dose–volume histograms. Beams in between the TPS and R&V system are matched based on geometry configurations. To consider the effect of a 1.5 T transverse magnetic field from MR-Linac in the secondary MU calculation, a method based on modified Clarkson integration algorithm was developed and tested for a series of clinical situations. Results: ArtQA has been used in their clinic and can quickly detect inconsistencies and deviations in the entire RT planning process. With the use of the ArtQA tool, the efficiency for plan check including plan quality, data transfer, and delivery check can be improved by at least 60%. The newly developed independent MU calculation tool for MR-Linac reduces the difference between the plan and calculated MUs by 10%. Conclusions: The software tool ArtQA can be used to perform a comprehensive QA check from planning to delivery with conventional Linac or MR-Linac and is an essential tool for online replanning where the QA check needs to be performed rapidly.« less

Transportation planning performance measures : final report.

DOT National Transportation Integrated Search

2005-10-01

Oregon transportation plans, including the statewide Oregon Transportation Plan, and current regional transportation plans for the Portland, Salem, Eugene, and Medford metropolitan areas, contain some policy areas that are not adequately addressed by...

Improving Pediatric Rapid Response Team Performance Through Crew Resource Management Training of Team Leaders.

PubMed

Siems, Ashley; Cartron, Alexander; Watson, Anne; McCarter, Robert; Levin, Amanda

2017-02-01

Rapid response teams (RRTs) improve the detection of and response to deteriorating patients. Professional hierarchies and the multidisciplinary nature of RRTs hinder team performance. This study assessed whether an intervention involving crew resource management training of team leaders could improve team performance. In situ observations of RRT activations were performed pre- and post-training intervention. Team performance and dynamics were measured by observed adherence to an ideal task list and by the Team Emergency Assessment Measure tool, respectively. Multiple quartile (median) and logistic regression models were developed to evaluate change in performance scores or completion of specific tasks. Team leader and team introductions (40% to 90%, P = .004; 7% to 45%, P = .03), floor team presentations in Situation Background Assessment Recommendation format (20% to 65%, P = .01), and confirmation of the plan (7% to 70%, P = .002) improved after training in patients transferred to the ICU (n = 35). The Team Emergency Assessment Measure metric was improved in all 4 categories: leadership (2.5 to 3.5, P < .001), teamwork (2.7 to 3.7, P < .001), task management (2.9 to 3.8, P < .001), and global scores (6.0 to 9.0, P < .001) for teams caring for patients who required transfer to the ICU. Targeted crew resource management training of the team leader resulted in improved team performance and dynamics for patients requiring transfer to the ICU. The intervention demonstrated that training the team leader improved behavior in RRT members who were not trained. Copyright © 2017 by the American Academy of Pediatrics.

Connected Vehicle Pilot Deployment Program phase 1 : performance measurement and evaluation support plan : New York City : final report.

DOT National Transportation Integrated Search

2016-07-12

This document describes the Performance Measurement and Evaluation Support Plan for the New York City Department of Transportation New York City (NYC) Connected Vehicle Pilot Deployment (CVPD) Project. The report documents the performance metrics tha...

Connected Vehicle Pilot Deployment Program phase 1 : performance measurement and evaluation support plan : Tampa (THEA) : final report.

DOT National Transportation Integrated Search

2016-03-14

The Performance Measurement and Evaluation Support Plan for the Connected Vehicle Pilot Deployment Program Phase 1, Tampa Hillsborough Expressway Authority, outlines the goals and objectives for the Pilot as well as the proposed performance metrics. ...

Effects of the Original Versus Revised Bloom's Taxonomy on Lesson Planning Skills: A Turkish Study Among Pre-Service Teachers

NASA Astrophysics Data System (ADS)

Bümen, Nilay T.

2007-07-01

The original taxonomy of educational objectives, developed by Benjamin S.␣Bloom and his associates in the 1950s, was revised several decades later by a group of educationists and cognitive psychologists, who developed a revised taxonomy (RT). This article describes a Turkish study carried out among a group of pre-service teachers in order to compare the influence of the two systems on lesson planning skills. The results confirmed other studies that have indicated a number of advantages of the revised system over the earlier one.

Ames Research Center FY 2000 Implementation Plan: Leading Technology into the New Millennium

NASA Technical Reports Server (NTRS)

2000-01-01

This document presents the implementation plan for Ames Research Center (ARC) within the overall framework of the NASA Strategic Plan. It describes how ARC intends to implement its Center of Excellence responsibilities, Agency assigned missions, Agency and Enterprise lead programs, and other roles in support of NASA's vision and mission. All Federal agencies are required by the 1993 Government Performance and Results Act to implement a long-term strategic planning process that includes measurable outcomes and strict accountability. At NASA, this planning process is shaped by the Space Act of 1958, annual appropriations, and other external mandates, as well as by customer requirements. The resulting Strategic Plan sets the overall architecture for what we do, identifies who our customers are, and directs where we are going and why. The Strategic Plan is the basis upon which decisions regarding program implementation and resource deployment are made. Whereas the strategic planning process examines the long-term direction of the organization and identifies a specific set of goals, the implementation planning process examines the detailed performance of the organization and allocates resources toward meeting these goals. It is the purpose of this implementation document to provide the connection between the NASA Strategic Plan and the specific programs and support functions that ARC employees perform. This connection flows from the NASA Strategic Plan, through the various Strategic Enterprise plans to the ARC Center of Excellence, primary missions, Lead Center programs, program support responsibilities, and ultimately, to the role of the individual ARC employee.

Transgender Surgery in Denmark From 1994 to 2015: 20-Year Follow-Up Study.

PubMed

Aydin, Dogu; Buk, Liv Johanne; Partoft, Søren; Bonde, Christian; Thomsen, Michael Vestergaard; Tos, Tina

2016-04-01

Gender dysphoria is a mismatch between a person's biological sex and gender identity. The best treatment is believed to be hormonal therapy and gender-confirming surgery that will transition the individual toward the desired gender. Treatment in Denmark is covered by public health care, and gender-confirming surgery in Denmark is centralized at a single-center with few specialized plastic surgeons conducting top surgery (mastectomy or breast augmentation) and bottom surgery (vaginoplasty or phalloplasty and metoidioplasty). To report the first nationwide single-center review on transsexual patients in Denmark undergoing gender-confirming surgery performed by a single surgical team and to assess whether age at time of gender-confirming surgery decreased during a 20-year period. Electronic patient databases were used to identify patients diagnosed with gender identity disorders from January 1994 through March 2015. Patients were excluded from the study if they were pseudohermaphrodites or if their gender was not reported. Gender distribution, age trends, and surgeries performed for Danish patients who underwent gender-confirming surgery. One hundred fifty-eight patients referred for gender-confirming surgery were included. Fifty-five cases (35%) were male-to-female (MtF) and 103 (65%) were female-to-male (FtM). In total, 126 gender-confirming surgeries were performed. For FtM cases, top surgery (mastectomy) was conducted in 62 patients and bottom surgery (phalloplasty and metoidioplasty) was conducted in 17 patients. For MtF cases, 45 underwent bottom surgery (vaginoplasty), 2 of whom received breast augmentation. The FtM:MtF ratio of the referred patients was 1.9:1. The median age at the time of surgery decreased from 40 to 27 years during the 20-year period. Gender-confirming surgery was performed on 65 FtM and 40 MtF cases at our hospital, and 21 transsexuals underwent surgery abroad. Mastectomy was performed in 62 FtM and bottom surgery in 17 FtM cases. Vaginoplasty was performed in 45 MtF and breast augmentation in 2 MtF cases. There was a significant decrease in age at the time of gender-confirming surgery during the course of the study period. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Soil simulant sourcing for the ExoMars rover testbed

NASA Astrophysics Data System (ADS)

Gouache, Thibault P.; Patel, Nildeep; Brunskill, Christopher; Scott, Gregory P.; Saaj, Chakravarthini M.; Matthews, Marcus; Cui, Liang

2011-06-01

ExoMars is the European Space Agency (ESA) mission to Mars planned for launch in 2018, focusing on exobiology with the primary objective of searching for any traces of extant or extinct carbon-based micro-organisms. The on-surface mission is performed by a near-autonomous mobile robotic vehicle (also referred to as the rover) with a mission design life of 180 sols (Patel et al., 2010). In order to obtain useful data on the tractive performance of the ExoMars rover before flight, it is necessary to perform mobility tests on representative soil simulant materials producing a Martian terrain analogue under terrestrial laboratory conditions. Three individual types of regolith shown to be found extensively on the Martian surface were identified for replication using commercially available terrestrial materials, sourced from UK sites in order to ensure easy supply and reduce lead times for delivery. These materials (also referred to as the Engineering Soil (ES-x) simulants) are: a fine dust analogue (ES-1); a fine aeolian sand analogue (ES-2); and a coarse sand analogue (ES-3). Following a detailed analysis, three fine sand regolith types were identified from commercially available products. Each material was used in its off-the-shelf state, except for ES-2, where further processing methods were used to reduce the particle size range. These materials were tested to determine their physical characteristics, including the particle size distribution, particle density, particle shape (including angularity/sphericity) and moisture content. The results are analysed to allow comparative analysis with existing soil simulants and the published results regarding in situ analysis of Martian soil on previous NASA (National Aeronautics and Space Administration) missions. The findings have shown that in some cases material properties vary significantly from the specifications provided by material suppliers. This has confirmed the need for laboratory testing to determine the actual parameters to prove that standard geotechnical processes are indeed suitable. The outcomes have allowed the confirmation of each simulant material as suitable for replicating their respective regolith types.

Site planning and integration fiscal year 1999 multi-year work plan (MYWP) update for WBS 1.8.2.1

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

SCHULTZ, E.A.

The primary mission of the Site Planning and Integration (SP and I) project is to assist Fluor Daniel Project Direction to ensure that all work performed under the Project Hanford Management Contract (PHMC) is adequately planned, executed, controlled, and that performance is measured and reported in an integrated fashion. Furthermore, SP and I is responsible for the development, implementation, and management of systems and processes that integrate technical, schedule, and cost baselines for PHMC work.

40 CFR 60.2899 - What is a waste management plan?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 6 2011-07-01 2011-07-01 false What is a waste management plan? 60... (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Preconstruction Siting Analysis Waste Management Plan § 60.2899 What is a waste management plan? A waste management plan is a written plan that...

40 CFR 60.2899 - What is a waste management plan?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 7 2012-07-01 2012-07-01 false What is a waste management plan? 60... (CONTINUED) STANDARDS OF PERFORMANCE FOR NEW STATIONARY SOURCES Preconstruction Siting Analysis Waste Management Plan § 60.2899 What is a waste management plan? A waste management plan is a written plan that...

Does Your Health Plan Measure Up? How Can You Tell?

ERIC Educational Resources Information Center

Edwards, Tom

1999-01-01

Describes the process behind health-plan selection for school district employees and offers suggestions on how managers might enhance their current healthcare plan purchasing process. Areas of health-plan review and critique are listed as are tips for measuring plan performance and advice on acquiring backup data on plan quality. (GR)

Maintenance Business Plans.

ERIC Educational Resources Information Center

Adams, Matt

2002-01-01

Discusses maintenance business plans, statements which provide accountability for facilities maintenance organizations' considerable budgets. Discusses the plan's components: statement of plan objectives, macro and detailed description of the facility assets, maintenance function descriptions, description of key performance indicators, milestone…

Scenario-based transportation planning with involvement of metropolitan planning organizations.

DOT National Transportation Integrated Search

2009-01-01

The Office of Virginia's Secretary of Transportation identified 21 transportation policies and 42 performance criteria in Virginia's long-range multimodal transportation plan, VTrans2025. A subsequent planning effort, VTrans2035, provided direction f...

Clinical implementation of an exit detector-based dose reconstruction tool for helical tomotherapy delivery quality assurance.

PubMed

Deshpande, Shrikant; Xing, Aitang; Metcalfe, Peter; Holloway, Lois; Vial, Philip; Geurts, Mark

2017-10-01

The aim of this study was to validate the accuracy of an exit detector-based dose reconstruction tool for helical tomotherapy (HT) delivery quality assurance (DQA). Exit detector-based DQA tool was developed for patient-specific HT treatment verification. The tool performs a dose reconstruction on the planning image using the sinogram measured by the HT exit detector with no objects in the beam (i.e., static couch), and compares the reconstructed dose to the planned dose. Vendor supplied (three "TomoPhant") plans with a cylindrical solid water ("cheese") phantom were used for validation. Each "TomoPhant" plan was modified with intentional multileaf collimator leaf open time (MLC LOT) errors to assess the sensitivity and robustness of this tool. Four scenarios were tested; leaf 32 was "stuck open," leaf 42 was "stuck open," random leaf LOT was closed first by mean values of 2% and then 4%. A static couch DQA procedure was then run five times (once with the unmodified sinogram and four times with modified sinograms) for each of the three "TomoPhant" treatment plans. First, the original optimized delivery plan was compared with the original machine agnostic delivery plan, then the original optimized plans with a known modification applied (intentional MLC LOT error) were compared to the corresponding error plan exit detector measurements. An absolute dose comparison between calculated and ion chamber (A1SL, Standard Imaging, Inc., WI, USA) measured dose was performed for the unmodified "TomoPhant" plans. A 3D gamma evaluation (2%/2 mm global) was performed by comparing the planned dose ("original planned dose" for unmodified plans and "adjusted planned dose" for each intentional error) to exit detector-reconstructed dose for all three "Tomophant" plans. Finally, DQA for 119 clinical (treatment length <25 cm) and three cranio-spinal irradiation (CSI) plans were measured with both the ArcCHECK phantom (Sun Nuclear Corp., Melbourne, FL, USA) and the exit detector DQA tool to assess the time required for DQA and similarity between two methods. The measured ion chamber dose agreed to within 1.5% of the reconstructed dose computed by the exit detector DQA tool on a cheese phantom for all unmodified "Tomophant" plans. Excellent agreement in gamma pass rate (>95%) was observed between the planned and reconstructed dose for all "Tomophant" plans considered using the tool. The gamma pass rate from 119 clinical plan DQA measurements was 94.9% ± 1.5% and 91.9% ± 4.37% for the exit detector DQA tool and ArcCHECK phantom measurements (P = 0.81), respectively. For the clinical plans (treatment length <25 cm), the average time required to perform DQA was 24.7 ± 3.5 and 39.5 ± 4.5 min using the exit detector QA tool and ArcCHECK phantom, respectively, whereas the average time required for the 3 CSI treatments was 35 ± 3.5 and 90 ± 5.2 min, respectively. The exit detector tool has been demonstrated to be faster for performing the DQA with equivalent sensitivity for detecting MLC LOT errors relative to a conventional phantom-based QA method. In addition, comprehensive MLC performance evaluation and features of reconstructed dose provide additional insight into understanding DQA failures and the clinical relevance of DQA results. © 2017 American Association of Physicists in Medicine.

Planning abilities and chess: a comparison of chess and non-chess players on the Tower of London task.

PubMed

Unterrainer, J M; Kaller, C P; Halsband, U; Rahm, B

2006-08-01

Playing chess requires problem-solving capacities in order to search through the chess problem space in an effective manner. Chess should thus require planning abilities for calculating many moves ahead. Therefore, we asked whether chess players are better problem solvers than non-chess players in a complex planning task. We compared planning performance between chess ( N=25) and non-chess players ( N=25) using a standard psychometric planning task, the Tower of London (ToL) test. We also assessed fluid intelligence (Raven Test), as well as verbal and visuospatial working memory. As expected, chess players showed better planning performance than non-chess players, an effect most strongly expressed in difficult problems. On the other hand, they showed longer planning and movement execution times, especially for incorrectly solved trials. No differences in fluid intelligence and verbal/visuospatial working memory were found between both groups. These findings indicate that better performance in chess players is associated with disproportionally longer solution times, although it remains to be investigated whether motivational or strategic differences account for this result.

Gender and rapid alterations of hemispheric dominance during planning.

PubMed

Schuepbach, Daniel; Skotchko, Tatjana; Duschek, Stefan; Theodoridou, Anastasia; Grimm, Simone; Boeker, Heinz; Seifritz, Erich

2012-01-01

Mental planning and carrying out a plan provoke specific cerebral hemodynamic responses. Gender aspects of hemispheric laterality using rapid cerebral hemodynamics have not been reported. Here, we applied functional transcranial Doppler sonography to examine lateralization of cerebral hemodynamics of the middle cerebral arteries of 28 subjects (14 women and 14 men) performing a standard planning task. There were easy and difficult problems, and mental planning without motor activity was separated from movement execution. Difficult mental planning elicited lateralization to the right hemisphere after 2 or more seconds, a feature that was not observed during movement execution. In females, there was a dominance to the left hemisphere during movement execution. Optimized problem solving yielded an increased laterality change to the right during mental planning. Gender-related hemispheric dominance appears to be condition-dependent, and change of laterality to the right may play a role in optimized performance. Results are of relevance when considering laterality from a perspective of performance enhancement of higher cognitive functions, and also of psychiatric disorders with cognitive dysfunctions and abnormal lateralization patterns such as schizophrenia. Copyright © 2012 S. Karger AG, Basel.

Impact of Onyx Embolization on Radiosurgical Management of Cerebral Arteriovenous Malformations: Treatment and Outcome.

PubMed

Strauss, Ido; Haim, Oz; Umansky, Daniel; Corn, Benjamin W; Frolov, Vladimir; Shtraus, Natan; Maimon, Shimon; Kanner, Andrew A

2017-12-01

Stereotactic radiosurgery (SRS) is a well-established treatment modality for cerebral arteriovenous malformations (AVMs). The main limiting factor in the radiosurgical treatment of AVMs is the volume of the nidus, with high-grade lesions often requiring combined treatment to reduce the SRS target volume. To overcome this limitation, we have been using a combined treatment approach consisting of endovascular embolization with Onyx followed by SRS. To evaluate our clinical experience for safety and feasibility of this multimodality treatment approach. This is a retrospective review of all adult patients with cerebral AVMs who received SRS treatment to their AVM after endovascular embolization with Onyx between June 2007 and June 2014. Thirty-five consecutive patients were identified. The mean follow-up period was 52.4 ± 22.6 months (range 18-97 months). We confirmed 18 (51.4%) complete nidus closures at a median time of 49.5 months (range 6.5-81 months) from SRS. High-resolution Magnetic resonance imaging/magnetic resonance angiography was performed routinely in all patients until closure of the nidus. Digital subtraction angiography was performed to confirm complete obliteration in 5 of the patients (28%); 13 patients are either planned for digital subtraction angiography or have refused it. In 6 patients (17%) a significant flow reduction was noted after a mean of 32 ± 16 months. No significant improvement was observed in 9 patients (26%) during the follow-up period. Two patients were lost to follow-up. The multimodality treatment of cerebral AVMs using embolization with Onyx followed by SRS is feasible and safe. The use of Onyx significantly reduced the SRS treatment target volume. Copyright © 2017 Elsevier Inc. All rights reserved.

The importance of serological and molecular analyses for the diagnosis of measles cases and for meeting elimination targets in Turkey from 2007 to 2015.

PubMed

Cosgun, Yasemin; Guldemir, Dilek; Coskun, Aslihan; Yolbakan, Sultan; Kalaycioglu, Atila Taner; Korukluoglu, Gulay; Durmaz, Riza

2018-04-01

Measles is an important childhood infection targeted to be eliminated by the World Health Organization (WHO). Virus circulation has not been interrupted in the European Region because high vaccination rates could not be achieved among some countries of the WHO European Region including Turkey. The purpose of this study was to evaluate the laboratory findings of measles cases confirmed in the last nine years, to assess the epidemiological data of the cases, to determine the molecular genotyping studies and to emphasise the importance of laboratory-based surveillance in measles. From 2007 to 2010, only 18 imported cases were detected in Turkey. However, this number increased with a local outbreak of 111 cases in 2011, followed by another outbreak in 2012 in Istanbul that spread countrywide in the following two years; a total of 8661 laboratory-confirmed measles cases were reported from 2012 to 2015. After ELISA detection of a measles IgM-positive result in serum samples of potential measles cases, RT-PCR was performed with urine or nasopharyngeal swab samples of patients, and amplicons were subjected to sequencing. In the samples of 2010 and 2011, D4 and D9 genotypes were mainly detected; as of 2012, the D8 genotype has gained importance. Although D8 was also identified in 2014, in the same year genotype H1 viruses were detected in Turkey for the first time. Therefore, it is important to perform a genotypic analysis of the virus causing the outbreak, analyse epidemiological connections of the contact, determine the source of the outbreak and plan measures based on this information.

Social-cognitive antecedents of hand washing: Action control bridges the planning-behaviour gap.

PubMed

Reyes Fernández, Benjamín; Knoll, Nina; Hamilton, Kyra; Schwarzer, Ralf

2016-08-01

To examine motivational and volitional factors for hand washing in young adults, using the Health Action Process Approach (HAPA) as a theoretical framework. In a longitudinal design with two measurement points, six weeks apart, university students (N = 440) completed paper-based questionnaires. Prior hand washing frequency, self-efficacy, outcome expectancies, intention and action planning were measured at baseline, and coping planning, action control and hand washing frequency were measured at follow-up. A theory-based structural equation model was specified. In line with the HAPA, the motivational factors of self-efficacy and outcome expectancies predicted intention, whereas the volitional factors of planning and action control mediated between intention and changes in hand washing frequency. Action control was confirmed as the most proximal factor on hand washing behaviour, thus representing a bridge of the planning-behaviour gap. Both motivational and volitional processes are important to consider in the improvement of hand hygiene practices. Moreover, the statistically significant effects for planning and action control illustrate the importance of these key self-regulatory factors in the prediction of hand hygiene. The current study highlights the importance of adopting models that account for motivational and volitional factors to better understand hand washing behaviour.

Quantifying the impact of cross coverage on physician's workload and performance in radiation oncology.

PubMed

Mosaly, Prithima R; Mazur, Lukasz M; Jones, Ellen L; Hoyle, Lesley; Zagar, Timothy; Chera, Bhishamjit S; Marks, Lawrence B

2013-01-01

To quantitatively assess the difference in workload and performance of radiation oncology physicians during radiation therapy treatment planning tasks under the conditions of "cross coverage" versus planning a patient with whom they were familiar. Eight physicians (3 experienced faculty physicians and 5 physician residents) performed 2 cases. The first case represented a "cross-coverage" scenario where the physicians had no prior information about the case to be planned. The second exposure represented a "regular-coverage" scenario where the physicians were familiar with the patient case to be planned. Each case involved 3 tasks to be completed systematically. Workload was assessed both subjectively (perceived) using National Aeronautics and Space Administration-Task Load Index (NASA-TLX), and objectively (physiological) throughout the task using eye data (via monitoring pupil size and blink rate). Performance of each task and the case was measured using completion time. Subjective willingness to approve or disapprove the generated plan was obtained after completion of the case only. Forty-eight perceived and 48 physiological workload assessments were obtained. Overall, results revealed a significant increase in perceived workload (high NASA-TLX score) and decrease in performance (longer completion time and reduced approval rate) during cross coverage. There were nonsignificant increases in pupil diameter and decreases in the blink rate during cross-coverage versus regular-coverage scenario. In both cross-coverage and regular-coverage scenarios the level of experience did not affect workload and performance. The cross-coverage scenario significantly increases perceived workload and degrades performance versus regular coverage. Hence, to improve patient safety, efforts must be made to develop policies, standard operating procedures, and usability improvements to electronic medical record and treatment planning systems for "easier" information processing to deal with cross coverage, while recognizing strengths and limitations of human performance. Published by Elsevier Inc.

The Zagora cryptograph

NASA Astrophysics Data System (ADS)

Coucouzeli, A.

A unique lead seal from the well-known eighth century B.C. settlement of Zagora on the island of Andros dramatically confirms and expands our knowledge of the town planning identified at the site and constituting the earliest example of an orthogonal grid plan in the Greek world. The seal in question is decorated with a symbolic design that constitutes a rare representation of the Dioskouroi as part of the constellation Gemini. This design appears to have acted as a cryptograph enciphering the basic mathematical and astronomical principles behind the planning of Zagora. Besides offering us new insights into early Greek settlement planning, the cryptograph seems to reveal an advanced practical competence in mathematics and celestial observation, which was hitherto unsuspected for such an early period. The Zagora cryptograph also suggests that astronomy and mathematics played a crucial role in the strengthening of the ruling elite's power at Zagora in the framework of the rising city-state or polis. The tight interweaving of astronomical, mathematical, architectural and social considerations in the planning of Zagora is an entirely new discovery for Greece, whose implications are far-reaching.

How Planful Is Routine Behavior? A Selective-Attention Model of Performance in the Tower of Hanoi

ERIC Educational Resources Information Center

Patsenko, Elena G.; Altmann, Erik M.

2010-01-01

Routine human behavior has often been attributed to plans--mental representations of sequences goals and actions--but can also be attributed to more opportunistic interactions of mind and a structured environment. This study asks whether performance on a task traditionally analyzed in terms of plans can be better understood from a "situated" (or…

A case study in programming a quantum annealer for hard operational planning problems

NASA Astrophysics Data System (ADS)

Rieffel, Eleanor G.; Venturelli, Davide; O'Gorman, Bryan; Do, Minh B.; Prystay, Elicia M.; Smelyanskiy, Vadim N.

2015-01-01

We report on a case study in programming an early quantum annealer to attack optimization problems related to operational planning. While a number of studies have looked at the performance of quantum annealers on problems native to their architecture, and others have examined performance of select problems stemming from an application area, ours is one of the first studies of a quantum annealer's performance on parametrized families of hard problems from a practical domain. We explore two different general mappings of planning problems to quadratic unconstrained binary optimization (QUBO) problems, and apply them to two parametrized families of planning problems, navigation-type and scheduling-type. We also examine two more compact, but problem-type specific, mappings to QUBO, one for the navigation-type planning problems and one for the scheduling-type planning problems. We study embedding properties and parameter setting and examine their effect on the efficiency with which the quantum annealer solves these problems. From these results, we derive insights useful for the programming and design of future quantum annealers: problem choice, the mapping used, the properties of the embedding, and the annealing profile all matter, each significantly affecting the performance.

Encoding and choice in the task span paradigm.

PubMed

Reiman, Kaitlin M; Weaver, Starla M; Arrington, Catherine M

2015-03-01

Cognitive control during sequences of planned behaviors requires both plan-level processes such as generating, maintaining, and monitoring the plan, as well as task-level processes such as selecting, establishing and implementing specific task sets. The task span paradigm (Logan in J Exp Psychol Gen 133:218-236, 2004) combines two common cognitive control paradigms, task switching and working memory span, to investigate the integration of plan-level and task-level processes during control of sequential behavior. The current study expands past task span research to include measures of encoding processes and choice behavior with volitional sequence generation, using the standard task span as well as a novel voluntary task span paradigm. In two experiments, we consider how sequence complexity, defined separately for plan-level and task-level complexity, influences sequence encoding (Experiment 1), sequence choice (Experiment 2), sequence memory, and task performance of planned sequences of action. Results indicate that participants were sensitive to sequence complexity, but that different aspects of behavior are most strongly influenced by different types of complexity. Hierarchical complexity at the plan level best predicts voluntary sequence generation and memory; while switch frequency at the task level best predicts encoding of externally defined sequences and task performance. Furthermore, performance RTs were similar for externally and internally defined plans, whereas memory was improved for internally defined sequences. Finally, participants demonstrated a significant sequence choice bias in the voluntary task span. Consistent with past research on choice behavior, volitional selection of plans was markedly influenced by both the ease of memory and performance.

What determines real-world meal size? Evidence for pre-meal planning.

PubMed

Fay, Stephanie H; Ferriday, Danielle; Hinton, Elanor C; Shakeshaft, Nicholas G; Rogers, Peter J; Brunstrom, Jeffrey M

2011-04-01

The customary approach to the study of meal size suggests that 'events' occurring during a meal lead to its termination. Recent research, however, suggests that a number of decisions are made before eating commences that may affect meal size. The present study sought to address three key research questions around meal size: the extent to which plate-cleaning occurs; prevalence of pre-meal planning and its influence on meal size; and the effect of within-meal experiences, notably the development of satiation. To address these, a large-cohort internet-based questionnaire was developed. Results showed that plate-cleaning occurred at 91% of meals, and was planned from the outset in 92% of these cases. A significant relationship between plate-cleaning and meal planning was observed. Pre-meal plans were resistant to modification over the course of the meal: only 18% of participants reported consumption that deviated from expected. By contrast, 28% reported continuing eating beyond satiation, and 57% stated that they could have eaten more at the end of the meal. Logistic regression confirmed pre-meal planning as the most important predictor of consumption. Together, our findings demonstrate the importance of meal planning as a key determinant of meal size and energy intake. Copyright © 2011 Elsevier Ltd. All rights reserved.

State survey of medical boards regarding abrupt loss of a prescriber of controlled substances.

PubMed

Sera, Leah; Brown, Micke; McPherson, Mary Lynn; Walker, Kathryn A; Klein-Schwartz, Wendy

The purpose of the study was to evaluate states' experiences with abrupt changes in controlled substances (CS) prescribing, to determine whether states have action plans in place to manage such situations, and describe the components of any such plans. A survey of executive directors of 51 medical boards was conducted to evaluate states' experiences with abrupt changes in CS prescribing, the extent of consumer complaints attributed to these events, and the types of plans in place to manage these situations. Forty-six executive directors of medical boards responded. Twenty boards (43.5 percent) confirmed that their state had experienced abrupt loss of CS providers and 11 (55 percent) of these executive directors indicated that the loss resulted in increased consumer complaints. The majority of executive directors (86 percent) had no action plan. Six executive directors reported some type of action plan or process consisting of regulatory action, patient-provider connection, professional education, patient education, or public notice. Most states do not have operational plans in place. However, a few have key strategies that may be useful in addressing potential problems following abrupt loss of a CS prescriber. State medical boards can play a significant role in the development of comprehensive preparedness plans to mitigate damage from the loss of CS prescribers in the community.

Automated treatment planning for a dedicated multi-source intracranial radiosurgery treatment unit using projected gradient and grassfire algorithms.

PubMed

Ghobadi, Kimia; Ghaffari, Hamid R; Aleman, Dionne M; Jaffray, David A; Ruschin, Mark

2012-06-01

The purpose of this work is to develop a framework to the inverse problem for radiosurgery treatment planning on the Gamma Knife(®) Perfexion™ (PFX) for intracranial targets. The approach taken in the present study consists of two parts. First, a hybrid grassfire and sphere-packing algorithm is used to obtain shot positions (isocenters) based on the geometry of the target to be treated. For the selected isocenters, a sector duration optimization (SDO) model is used to optimize the duration of radiation delivery from each collimator size from each individual source bank. The SDO model is solved using a projected gradient algorithm. This approach has been retrospectively tested on seven manually planned clinical cases (comprising 11 lesions) including acoustic neuromas and brain metastases. In terms of conformity and organ-at-risk (OAR) sparing, the quality of plans achieved with the inverse planning approach were, on average, improved compared to the manually generated plans. The mean difference in conformity index between inverse and forward plans was -0.12 (range: -0.27 to +0.03) and +0.08 (range: 0.00-0.17) for classic and Paddick definitions, respectively, favoring the inverse plans. The mean difference in volume receiving the prescribed dose (V(100)) between forward and inverse plans was 0.2% (range: -2.4% to +2.0%). After plan renormalization for equivalent coverage (i.e., V(100)), the mean difference in dose to 1 mm(3) of brainstem between forward and inverse plans was -0.24 Gy (range: -2.40 to +2.02 Gy) favoring the inverse plans. Beam-on time varied with the number of isocenters but for the most optimal plans was on average 33 min longer than manual plans (range: -17 to +91 min) when normalized to a calibration dose rate of 3.5 Gy/min. In terms of algorithm performance, the isocenter selection for all the presented plans was performed in less than 3 s, while the SDO was performed in an average of 215 min. PFX inverse planning can be performed using geometric isocenter selection and mathematical modeling and optimization techniques. The obtained treatment plans all meet or exceed clinical guidelines while displaying high conformity. © 2012 American Association of Physicists in Medicine.

Rural performance based planning guidebook.

DOT National Transportation Integrated Search

2017-02-01

Performance-based transportation planning has existed for many years. Recently, it is becoming : more accepted and practiced as a result of federal rules. It is fast becoming the cornerstone for : transportation decision making throughout the country...

Multi-AUV autonomous task planning based on the scroll time domain quantum bee colony optimization algorithm in uncertain environment

PubMed Central

Zhang, Rubo; Yang, Yu

2017-01-01

Research on distributed task planning model for multi-autonomous underwater vehicle (MAUV). A scroll time domain quantum artificial bee colony (STDQABC) optimization algorithm is proposed to solve the multi-AUV optimal task planning scheme. In the uncertain marine environment, the rolling time domain control technique is used to realize a numerical optimization in a narrowed time range. Rolling time domain control is one of the better task planning techniques, which can greatly reduce the computational workload and realize the tradeoff between AUV dynamics, environment and cost. Finally, a simulation experiment was performed to evaluate the distributed task planning performance of the scroll time domain quantum bee colony optimization algorithm. The simulation results demonstrate that the STDQABC algorithm converges faster than the QABC and ABC algorithms in terms of both iterations and running time. The STDQABC algorithm can effectively improve MAUV distributed tasking planning performance, complete the task goal and get the approximate optimal solution. PMID:29186166

Multi-AUV autonomous task planning based on the scroll time domain quantum bee colony optimization algorithm in uncertain environment.

PubMed

Li, Jianjun; Zhang, Rubo; Yang, Yu

2017-01-01

Research on distributed task planning model for multi-autonomous underwater vehicle (MAUV). A scroll time domain quantum artificial bee colony (STDQABC) optimization algorithm is proposed to solve the multi-AUV optimal task planning scheme. In the uncertain marine environment, the rolling time domain control technique is used to realize a numerical optimization in a narrowed time range. Rolling time domain control is one of the better task planning techniques, which can greatly reduce the computational workload and realize the tradeoff between AUV dynamics, environment and cost. Finally, a simulation experiment was performed to evaluate the distributed task planning performance of the scroll time domain quantum bee colony optimization algorithm. The simulation results demonstrate that the STDQABC algorithm converges faster than the QABC and ABC algorithms in terms of both iterations and running time. The STDQABC algorithm can effectively improve MAUV distributed tasking planning performance, complete the task goal and get the approximate optimal solution.

The impact of health reform on the Medicare Advantage program: realigning payment with performance.

PubMed

Biles, Brian; Casillas, Giselle; Arnold, Grace; Guterman, Stuart

2012-10-01

The Affordable Care Act enacts a new payment system for private health plans available to Medicare beneficiaries through the Medicare Advantage (MA) program. The system, which is being phased in through 2017, aims to (1) reduce the excess pay­ments received by private plans relative to per capita spending in traditional Medicare, and (2) reward plans that earn high performance ratings. Using 2009 data, this issue brief pres­ents analysis of the distributional impact on MA plan payments of these new policies as if they had been fully implemented in that year. We find that, when the polices [sic] are in place, they will bring overall MA plan payments nationwide down from 114 percent to 102 per­cent of what spending would have been for the same enrollees if they had been enrolled in traditional Medicare. While payments will vary across the nation, high-performing MA plans stand to benefit from this new arrangement.

A study of a nursing department performance measurement system: using the Balanced Scorecard and the Analytic Hierarchy Process.

PubMed

Chu, Hsuan-Lien; Wang, Chen-Chin; Dai, Yu-Tzu

2009-01-01

The health care industry is under pressure from government and private entities as well as from market conditions to contain costs. In an effort to respond to these pressures, the case hospital in this study implemented a Balanced Scorecard (BSC) in January 2003 and integrated it with the hospital's formal incentive plan for non-physicians in January 2005. The nursing department's performance improved in the 2 years following the introduction of the plan. This study contributes to the literature by demonstrating the performance improvement that results from integrating the BSC with an incentive plan in the nursing field. The results provide insight into the current BSC performance metrics applied by the case nursing department, and could be used as guidelines by other health care organizations that wish to implement BSC-based incentive plans.

Goal striving strategies and effort mobilization: When implementation intentions reduce effort-related cardiac activity during task performance.

PubMed

Freydefont, Laure; Gollwitzer, Peter M; Oettingen, Gabriele

2016-09-01

Two experiments investigate the influence of goal and implementation intentions on effort mobilization during task performance. Although numerous studies have demonstrated the beneficial effects of setting goals and making plans on performance, the effects of goals and plans on effort-related cardiac activity and especially the cardiac preejection period (PEP) during goal striving have not yet been addressed. According to the Motivational Intensity Theory, participants should increase effort mobilization proportionally to task difficulty as long as success is possible and justified. Forming goals and making plans should allow for reduced effort mobilization when participants perform an easy task. However, when the task is difficult, goals and plans should differ in their effect on effort mobilization. Participants who set goals should disengage, whereas participants who made if-then plans should stay in the field showing high effort mobilization during task performance. As expected, using an easy task in Experiment 1, we observed a lower cardiac PEP in both the implementation intention and the goal intention condition than in the control condition. In Experiment 2, we varied task difficulty and demonstrated that while participants with a mere goal intention disengaged from difficult tasks, participants with an implementation intention increased effort mobilization proportionally with task difficulty. These findings demonstrate the influence of goal striving strategies (i.e., mere goals vs. if-then plans) on effort mobilization during task performance. Copyright © 2016 Elsevier B.V. All rights reserved.

Magnetic resonance image guided transurethral ultrasound prostate ablation: a preclinical safety and feasibility study with 28-day followup.

PubMed

Burtnyk, Mathieu; Hill, Tracy; Cadieux-Pitre, Heather; Welch, Ian

2015-05-01

We determine the safety and feasibility of magnetic resonance image guided transurethral ultrasound prostate ablation using active temperature feedback control in a preclinical canine model with 28-day followup. After a long acclimatization period we performed ultrasound treatment in 8 subjects using the magnetic resonance image guided TULSA-PRO™ transurethral ultrasound prostate ablation system. Comprehensive examinations and observations were done before and throughout the 28-day followup, including assessment of clinically significant treatment related adverse events. In addition to gross pathology evaluation, extensive histopathological analysis was done to assess cell kill inside and outside the prostate. We evaluated prostate conformal heating by comparing the spatial difference between the treatment plan and the 55C isotherm measured on magnetic resonance imaging thermometry acquired during treatment. These findings were confirmed on contrast enhanced magnetic resonance imaging immediately after treatment and at 28 days. Clinically there were no adverse events in any of the 8 subjects throughout the 28-day followup. All subjects had normal urinary and bowel function. Gross necropsy and histology confirmed that the intended thermal cell kill was confined to the prostate. No surrounding tissue was damaged, including the rectum and the external urinary sphincter. Conformal heating was achieved with an average -0.9 mm accuracy and 0.9 mm precision. Contrast enhanced magnetic resonance imaging and histological analysis confirmed tissue ablation in targeted areas of the prostate. Urethral tissue was spared from thermal damage. Magnetic resonance image guided transurethral ultrasound is a safe, feasible procedure for accurate and precise conformal thermal ablation of prostate tissue, as demonstrated in a preclinical model with 28-day followup. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Audiometric analyses confirm a cochlear component, disproportional to age, in stapedial otosclerosis.

PubMed

Topsakal, Vedat; Fransen, Erik; Schmerber, Sébastien; Declau, Frank; Yung, Matthew; Gordts, Frans; Van Camp, Guy; Van de Heyning, Paul

2006-09-01

To report the preoperative audiometric profile of surgically confirmed otosclerosis. Retrospective, multicenter study. Four tertiary referral centers. One thousand sixty-four surgically confirmed patients with otosclerosis. Therapeutic ear surgery for hearing improvement. Preoperative audiometric air conduction (AC) and bone conduction (BC) hearing thresholds were obtained retrospectively for 1064 patients with otosclerosis. A cross-sectional multiple linear regression analysis was performed on audiometric data of affected ears. Influences of age and sex were analyzed and age-related typical audiograms were created. Bone conduction thresholds were corrected for Carhart effect and presbyacusis; in addition, we tested to see if separate cochlear otosclerosis component existed. Corrected thresholds were than analyzed separately for progression of cochlear otosclerosis. The study population consisted of 35% men and 65% women (mean age, 44 yr). The mean pure-tone average at 0.5, 1, and 2 kHz was 57 dB hearing level. Multiple linear regression analysis showed significant progression for all measured AC and BC thresholds. The average annual threshold deterioration for AC was 0.45 dB/yr and the annual threshold deterioration for BC was 0.37 dB/yr. The average annual gap expansion was 0.08 dB/year. The corrected BC thresholds for Carhart effect and presbyacusis remained significantly different from zero, but only showed progression at 2 kHz. The preoperative audiological profile of otosclerosis is described. There is a significant sensorineural component in patients with otosclerosis planned for stapedotomy, which is worse than age-related hearing loss by itself. Deterioration rates of AC and BC thresholds have been reported, which can be helpful in clinical practice and might also guide the characterization of allegedly different phenotypes for familial and sporadic otosclerosis.

40 CFR 281.35 - Release response and corrective action.

Code of Federal Regulations, 2014 CFR

2014-07-01

... soil and ground water, and any nearby surface waters. The extent of soil and ground water contamination... from UST systems are cleaned up through soil and ground water remediation and any other steps, as... § 280.67, the state must notify the affected public of all confirmed releases requiring a plan for soil...

40 CFR 281.35 - Release response and corrective action.

Code of Federal Regulations, 2010 CFR

2010-07-01

... soil and ground water, and any nearby surface waters. The extent of soil and ground water contamination... from UST systems are cleaned up through soil and ground water remediation and any other steps, as... § 280.67, the state must notify the affected public of all confirmed releases requiring a plan for soil...

The Comparability of Focus Group and Survey Results: Three Case Studies.

ERIC Educational Resources Information Center

Ward, Victoria M.; And Others

1991-01-01

Focus group findings were compared with survey findings for three studies in which both methods were used. Studies conducted on voluntary sterilization in Guatemala, Honduras, and Zaire with over 2,000 subjects confirm that focus groups yield information similar to that obtained from surveys and are useful in program planning. (SLD)

78 FR 45869 - Approval and Promulgation of State Implementation Plans; State of Montana; Interstate Transport...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-30

... of Montana's submission because the submission did not include any technical analysis to support its..., EPA disagrees with that concern. Our technical analysis confirmed that emissions from Montana in total... irrelevant factors and lacks any technical analysis to support the State's conclusion with respect to...

Anthrax in America: A Chronology and Analysis of the Fall 2001 Attacks

DTIC Science & Technology

2002-11-01

Glenville, CT, 55 miles west of Oxford. • Officials confirm that the anthrax spores in a letter received by Santiago, Chile pediatrician Antonio Barfi were...process of opening the Leahy letter after two weeks of planning and rehearsals. In charge is John Ezzell , a man described by the Weekend Australian as

40 CFR 281.35 - Release response and corrective action.

Code of Federal Regulations, 2013 CFR

2013-07-01

... soil and ground water, and any nearby surface waters. The extent of soil and ground water contamination... from UST systems are cleaned up through soil and ground water remediation and any other steps, as... § 280.67, the state must notify the affected public of all confirmed releases requiring a plan for soil...

40 CFR 281.35 - Release response and corrective action.

Code of Federal Regulations, 2011 CFR

2011-07-01

... soil and ground water, and any nearby surface waters. The extent of soil and ground water contamination... from UST systems are cleaned up through soil and ground water remediation and any other steps, as... § 280.67, the state must notify the affected public of all confirmed releases requiring a plan for soil...

Development and clinical introduction of automated radiotherapy treatment planning for prostate cancer

NASA Astrophysics Data System (ADS)

Winkel, D.; Bol, G. H.; van Asselen, B.; Hes, J.; Scholten, V.; Kerkmeijer, L. G. W.; Raaymakers, B. W.

2016-12-01

To develop an automated radiotherapy treatment planning and optimization workflow to efficiently create patient specifically optimized clinical grade treatment plans for prostate cancer and to implement it in clinical practice. A two-phased planning and optimization workflow was developed to automatically generate 77Gy 5-field simultaneously integrated boost intensity modulated radiation therapy (SIB-IMRT) plans for prostate cancer treatment. A retrospective planning study (n  =  100) was performed in which automatically and manually generated treatment plans were compared. A clinical pilot (n  =  21) was performed to investigate the usability of our method. Operator time for the planning process was reduced to  <5 min. The retrospective planning study showed that 98 plans met all clinical constraints. Significant improvements were made in the volume receiving 72Gy (V72Gy) for the bladder and rectum and the mean dose of the bladder and the body. A reduced plan variance was observed. During the clinical pilot 20 automatically generated plans met all constraints and 17 plans were selected for treatment. The automated radiotherapy treatment planning and optimization workflow is capable of efficiently generating patient specifically optimized and improved clinical grade plans. It has now been adopted as the current standard workflow in our clinic to generate treatment plans for prostate cancer.

Planning paths to multiple targets: memory involvement and planning heuristics in spatial problem solving.

PubMed

Wiener, J M; Ehbauer, N N; Mallot, H A

2009-09-01

For large numbers of targets, path planning is a complex and computationally expensive task. Humans, however, usually solve such tasks quickly and efficiently. We present experiments studying human path planning performance and the cognitive processes and heuristics involved. Twenty-five places were arranged on a regular grid in a large room. Participants were repeatedly asked to solve traveling salesman problems (TSP), i.e., to find the shortest closed loop connecting a start location with multiple target locations. In Experiment 1, we tested whether humans employed the nearest neighbor (NN) strategy when solving the TSP. Results showed that subjects outperform the NN-strategy, suggesting that it is not sufficient to explain human route planning behavior. As a second possible strategy we tested a hierarchical planning heuristic in Experiment 2, demonstrating that participants first plan a coarse route on the region level that is refined during navigation. To test for the relevance of spatial working memory (SWM) and spatial long-term memory (LTM) for planning performance and the planning heuristics applied, we varied the memory demands between conditions in Experiment 2. In one condition the target locations were directly marked, such that no memory was required; a second condition required participants to memorize the target locations during path planning (SWM); in a third condition, additionally, the locations of targets had to retrieved from LTM (SWM and LTM). Results showed that navigation performance decreased with increasing memory demands while the dependence on the hierarchical planning heuristic increased.

Advanced Receiver/Converter Experiments for Laser Wireless Power Transmission

NASA Technical Reports Server (NTRS)

Howell, Joe T.; ONeill, Mark; Fork, Richard

2004-01-01

For several years NASA Marshall Space Flight Center, UAH and ENTECH have been working on various aspects of space solar power systems. The current activity was just begun in January 2004 to further develop this new photovoltaic concentrator laser receiver/converter technology. During the next few months, an improved prototype will be designed, fabricated, and thoroughly tested under laser illumination. The final paper will describe the new concept, present its advantages over other laser receiver/converter approaches (including planar photovoltaic arrays), and provide the latest experiment results on prototype hardware (including the effects of laser irradiance level and cell temperature). With NASA's new human exploration plans to first return to the Moon, and then to proceed to Mars, the new photovoltaic concentrator laser receiver/converter technology could prove to be extremely useful in providing power to the landing sites and other phases of the missions. For example, to explore the scientifically interesting and likely resource-rich poles of the Moon (which may contain water) or the poles of Mars (which definitely contain water and carbon dioxide), laser power beaming could represent the simplest means of providing power to these regions, which receive little or no sunlight, making solar arrays useless there. In summary, the authors propose a paper on definition and experimental results of a novel photovoltaic concentrator approach for collecting and converting laser radiation to electrical power. The new advanced photovoltaic concentrator laser receiver/converter offers higher performance, lighter weight, and lower cost than competing concepts, and early experimental results are confirming the expected excellent Performance levels. After the small prototypes are successfully demonstrated, a larger array with even better performance is planned for the next phase experiments and demonstrations. Thereafter, a near-term flight experiment of the new technology should be developed and flown, to lay the groundwork for future space power applications in the Earth-Moon neighborhood, and ultimately encompassing Mars and its environs.

Post-Flight Assessment of Avcoat Thermal Protection System for the Exploration Flight Test-1

NASA Technical Reports Server (NTRS)

Bose, Deepak; Santos, Jose; Rodriguez, Erika; Mahzari, Milad; Remark, Brian; Muppidi, Suman

2016-01-01

On December 5, 2014 NASA conducted the first flight test of its next generation human-class Orion spacecraft. The flight was called the Exploration Flight Test -1 (EFT-1) which lasted for 4 hours and culminated into a re-entry trajectory at 9 km/s. This flight test of the 5-meter Orion Crew Module demonstrated various sub-systems including the Avcoat ablative thermal protection system (TPS) on the heat shield. The Avcoat TPS had been developed from the Apollo-era recipe with a few key modifications. The engineering for thermal sizing was supported by modeling, analysis, and ground tests in arc jet facilities. This paper will describe a postlfight analysis plan and present results from post-recovery inspections, data analysis from embedded sensors, TPS sample extraction and characterization in the laboratory. After the recovery of the vehicle, a full photographic survey and surface scans of the TPS were performed. The recovered vehicle showed physical evidence of flow disturbances, varying degrees of surface roughness, and excessive recession downstream of compression pads. The TPS recession was measured at more than 200 locations of interest on the Avcoat surface. The heat shield was then processed for sample extraction prior to TPS removal using the 7-Axis Milling machine at Marshall Space Flight Center. Around 182 rectangular TPS samples were extracted for subsequent analysis and investigation. The final paper will also present results of sample analysis. The planned investigation includes sidewall imaging, followed by image analysis to characterize TPS response by quantifying different layers in the char and pyrolysis zones. A full postmortem of the instrumentation and sensor ports will also be performed to confirm no adverse effects due to the sensors themselves. A subset of the samples will undergo structural testing and perform detailed characterization of any cracks and integrity of gore seams. Finally, the material will be characterized with layer-by-layer density measurements and SEM investigations to evaluate material morphology at microstructural level including identification of elements and compounds.

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

Arai, K; Tohoku University Graduate School of Medicine, Sendal, Miyagi; Kadoya, N

Purpose: The aim of this study was to confirm On-Board Imager cone-beam computed tomography (CBCT) using a histogram-matching algorithm as a useful method for proton dose calculation in head and neck radiotherapy. Methods: We studied one head and neck phantom and ten patients with head and neck cancer treated using intensity-modulated radiation therapy (IMRT) and proton beam therapy. We modified Hounsfield unit (HU) values of CBCT (mCBCT) using a histogram-matching algorithm. In order to evaluate the accuracy of the proton dose calculation, we compared dose differences in dosimetric parameters (Dmean) for clinical target volume (CTV), planning target volume (PTV) andmore » left parotid and proton ranges (PR) between the planning CT (reference) and CBCT or mCBCT, and gamma passing rates of CBCT and mCBCT. To minimize the effect of organ deformation, we also performed image registration. Results: For patients, the average differences in Dmean for CTV, PTV, and left parotid between planning CT and CBCT were 1.63 ± 2.34%, 3.30 ± 1.02%, and 5.42 ± 3.06%, respectively. Similarly, the average differences between planning CT and mCBCT were 0.20 ± 0.19%, 0.58 ±0.43%, and 3.53 ±2.40%, respectively. The average differences in PR between planning CT and CBCT or mCBCT of a 50° beam for ten patients were 2.1 ± 2.1 mm and 0.3 ± 0.5 mm, respectively. Similarly, the average differences in PR of a 120° beam were 2.9 ± 2.6 mm and 1.1 ± 0.9 mm, respectively. The average dose and PR differences of mCBCT were smaller than those of CBCT. Additionally, the average gamma passing rates of mCBCT were larger than those of CBCT. Conclusion: We evaluated the accuracy of the proton dose calculation in CBCT and mCBCT with the image registration for ten patients. Our results showed that HU modification using a histogram-matching algorithm could improve the accuracy of the proton dose calculation.« less

Financial performance of health plans in Medicaid managed care.

PubMed

McCue, Mike

2012-01-01

This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly traded, and provider-sponsored. National Association of Insurance Commissioners (NAIC) financial data, coupled with selected state financial data, were analyzed for 170 Medicaid health plans for 2009. A mean test compared the mean values for medical loss, administrative cost, and operating margin ratios across these plan traits. Medicaid dominant plans are plans with 75 percent of their total enrollment in the Medicaid line of business. Plans that are Medicaid dominant and publicly traded incurred a lower medical loss ratio and higher administrative cost ratio than multi-product and non-publicly traded plans. Medicaid dominant plans also earned a higher operating profit margin. Plans offering commercial and Medicare products are operating at a loss for their Medicaid line of business. Health plans that do not specialize in Medicaid are losing money. Higher medical cost rather than administrative cost is the underlying reason for this financial loss. Since Medicaid enrollees do not account for their primary book of business, these plans may not have invested in the medical management programs to reduce inappropriate emergency room use and avoid costly hospitalization.

On the effectiveness of ion range determination from in-beam PET data

NASA Astrophysics Data System (ADS)

Fiedler, Fine; Shakirin, Georgy; Skowron, Judith; Braess, Henning; Crespo, Paulo; Kunath, Daniela; Pawelke, Jörg; Pönisch, Falk; Enghardt, Wolfgang

2010-04-01

At present, in-beam positron emission tomography (PET) is the only method for in vivo and in situ range verification in ion therapy. At the GSI Helmholtzzentrum für Schwerionenforschung GmbH (GSI) Darmstadt, Germany, a unique in-beam PET installation has been operated from 1997 until the shut down of the carbon ion therapy facility in 2008. Therapeutic irradiation by means of 12C ion beams of more than 400 patients have been monitored. In this paper a first quantitative study on the accuracy of the in-beam PET method to detect range deviations between planned and applied treatment in clinically relevant situations using simulations based on clinical data is presented. Patient treatment plans were used for performing simulations of positron emitter distributions. For each patient a range difference of ± 6 mm in water was applied and compared to simulations without any changes. The comparisons were performed manually by six experienced evaluators for data of 81 patients. The number of patients required for the study was calculated using the outcome of a pilot study. The results indicate a sensitivity of (91 ± 3)% and a specificity of (96 ± 2)% for detecting an overrange, a reduced range is recognized with a sensitivity of (92 ± 3)% and a specificity of (96 ± 2)%. The positive and the negative predictive value of this method are 94% and 87%, respectively. The interobserver coefficient of variation is between 3 and 8%. The in-beam PET method demonstrated a high sensitivity and specificity for the detection of range deviations. As the range is a most indicative factor of deviations in the dose delivery, the promising results shown in this paper confirm the in-beam PET method as an appropriate tool for monitoring ion therapy.

Lateral cephalometric analysis for treatment planning in orthodontics based on MRI compared with radiographs: A feasibility study in children and adolescents

PubMed Central

Lazo Gonzalez, Eduardo; Hilgenfeld, Tim; Kickingereder, Philipp; Bendszus, Martin; Heiland, Sabine; Ozga, Ann-Kathrin; Sommer, Andreas; Lux, Christopher J.; Zingler, Sebastian

2017-01-01

Objective The objective of this prospective study was to evaluate whether magnetic resonance imaging (MRI) is equivalent to lateral cephalometric radiographs (LCR, “gold standard”) in cephalometric analysis. Methods The applied MRI technique was optimized for short scanning time, high resolution, high contrast and geometric accuracy. Prior to orthodontic treatment, 20 patients (mean age ± SD, 13.95 years ± 5.34) received MRI and LCR. MRI datasets were postprocessed into lateral cephalograms. Cephalometric analysis was performed twice by two independent observers for both modalities with an interval of 4 weeks. Eight bilateral and 10 midsagittal landmarks were identified, and 24 widely used measurements (14 angles, 10 distances) were calculated. Statistical analysis was performed by using intraclass correlation coefficient (ICC), Bland-Altman analysis and two one-sided tests (TOST) within the predefined equivalence margin of ± 2°/mm. Results Geometric accuracy of the MRI technique was confirmed by phantom measurements. Mean intraobserver ICC were 0.977/0.975 for MRI and 0.975/0.961 for LCR. Average interobserver ICC were 0.980 for MRI and 0.929 for LCR. Bland-Altman analysis showed high levels of agreement between the two modalities, bias range (mean ± SD) was -0.66 to 0.61 mm (0.06 ± 0.44) for distances and -1.33 to 1.14° (0.06 ± 0.71) for angles. Except for the interincisal angle (p = 0.17) all measurements were statistically equivalent (p < 0.05). Conclusions This study demonstrates feasibility of orthodontic treatment planning without radiation exposure based on MRI. High-resolution isotropic MRI datasets can be transformed into lateral cephalograms allowing reliable measurements as applied in orthodontic routine with high concordance to the corresponding measurements on LCR. PMID:28334054

Milan Army Ammunition Plant focused feasibility study for the northern industrial area soil. Final report

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

Locandro, R.R.; Okusu, N.M.; Case, J.

1995-04-01

ICF Kaiser Engineers (ICF) and Environmental Resources Management (ERM) have been contracted by the US Army Environmental Center (USAEC) to perform a Focused Feasibility Study (FS) for contaminated soil within the northern industrial areas of Milan Army Ammunition Plant (MAAP), Tennessee. The purpose of the Focused FS is to develop and evaluate remedial alternatives such that an appropriate remedy can be selected for the site. The MAAP Remedial Investigation (RI) performed in 1989--1991 confirmed that the O-Line Ponds area, facility drainage ditches that received industrial wastewater, and manufacturing and disposal areas have been sources of groundwater contamination. One finding ofmore » the RI Report was that sufficient information was available concerning the O-Line Ponds area to proceed with a Focused FS. The O-Line Ponds area was further divided into two operable units (OUs): OU1 is the groundwater immediately downgradient of the O-Line Ponds area, and OU2 is the soil, surface water, and sediment at the O-Line Ponds area. A Proposed Plan and Record of Decision (ROD) for OU1 were finalized in 1992, which called for groundwater extraction, treatment, and reinjection of the treated water upgradient of the O-Line Ponds. The design of this system was completed in 1993, and construction of the system is currently underway. For OU2, the Proposed Plan and ROD (finalized in 1993) called for the extension of the existing multi-layered cap to cover the contaminated soil around the perimeter of the existing cap. The design of the cap extension was completed in 1994, and construction will begin in late 1994.« less

Lateral cephalometric analysis for treatment planning in orthodontics based on MRI compared with radiographs: A feasibility study in children and adolescents.

PubMed

Heil, Alexander; Lazo Gonzalez, Eduardo; Hilgenfeld, Tim; Kickingereder, Philipp; Bendszus, Martin; Heiland, Sabine; Ozga, Ann-Kathrin; Sommer, Andreas; Lux, Christopher J; Zingler, Sebastian

2017-01-01

The objective of this prospective study was to evaluate whether magnetic resonance imaging (MRI) is equivalent to lateral cephalometric radiographs (LCR, "gold standard") in cephalometric analysis. The applied MRI technique was optimized for short scanning time, high resolution, high contrast and geometric accuracy. Prior to orthodontic treatment, 20 patients (mean age ± SD, 13.95 years ± 5.34) received MRI and LCR. MRI datasets were postprocessed into lateral cephalograms. Cephalometric analysis was performed twice by two independent observers for both modalities with an interval of 4 weeks. Eight bilateral and 10 midsagittal landmarks were identified, and 24 widely used measurements (14 angles, 10 distances) were calculated. Statistical analysis was performed by using intraclass correlation coefficient (ICC), Bland-Altman analysis and two one-sided tests (TOST) within the predefined equivalence margin of ± 2°/mm. Geometric accuracy of the MRI technique was confirmed by phantom measurements. Mean intraobserver ICC were 0.977/0.975 for MRI and 0.975/0.961 for LCR. Average interobserver ICC were 0.980 for MRI and 0.929 for LCR. Bland-Altman analysis showed high levels of agreement between the two modalities, bias range (mean ± SD) was -0.66 to 0.61 mm (0.06 ± 0.44) for distances and -1.33 to 1.14° (0.06 ± 0.71) for angles. Except for the interincisal angle (p = 0.17) all measurements were statistically equivalent (p < 0.05). This study demonstrates feasibility of orthodontic treatment planning without radiation exposure based on MRI. High-resolution isotropic MRI datasets can be transformed into lateral cephalograms allowing reliable measurements as applied in orthodontic routine with high concordance to the corresponding measurements on LCR.

Dosimetry audit of radiotherapy treatment planning systems.

PubMed

Bulski, Wojciech; Chełmiński, Krzysztof; Rostkowska, Joanna

2015-07-01

In radiotherapy Treatment Planning Systems (TPS) various calculation algorithms are used. The accuracy of dose calculations has to be verified. Numerous phantom types, detectors and measurement methodologies are proposed to verify the TPS calculations with dosimetric measurements. A heterogeneous slab phantom has been designed within a Coordinated Research Project (CRP) of the IAEA. The heterogeneous phantom was developed in the frame of the IAEA CRP. The phantom consists of frame slabs made with polystyrene and exchangeable inhomogeneity slabs equivalent to bone or lung tissue. Special inserts allow to position thermoluminescent dosimeters (TLD) capsules within the polystyrene slabs below the bone or lung equivalent slabs and also within the lung equivalent material. Additionally, there are inserts that allow to position films or ionisation chamber in the phantom. Ten Polish radiotherapy centres (of 30 in total) were audited during on-site visits. Six different TPSs and five calculation algorithms were examined in the presence of inhomogeneities. Generally, most of the results from TLD were within 5 % tolerance. Differences between doses calculated by TPSs and measured with TLD did not exceed 4 % for bone and polystyrene equivalent materials. Under the lung equivalent material, on the beam axis the differences were lower than 5 %, whereas inside the lung equivalent material, off the beam axis, in some cases they were of around 7 %. The TLD results were confirmed with the ionisation chamber measurements. The comparison results of the calculations and the measurements allow to detect limitations of TPS calculation algorithms. The audits performed with the use of heterogeneous phantom and TLD seem to be an effective tool for detecting the limitations in the TPS performance or beam configuration errors at audited radiotherapy departments. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.