Distributed Synchronization Technique for OFDMA-Based Wireless Mesh Networks Using a Bio-Inspired Algorithm

PubMed Central

Kim, Mi Jeong; Maeng, Sung Joon; Cho, Yong Soo

2015-01-01

In this paper, a distributed synchronization technique based on a bio-inspired algorithm is proposed for an orthogonal frequency division multiple access (OFDMA)-based wireless mesh network (WMN) with a time difference of arrival. The proposed time- and frequency-synchronization technique uses only the signals received from the neighbor nodes, by considering the effect of the propagation delay between the nodes. It achieves a fast synchronization with a relatively low computational complexity because it is operated in a distributed manner, not requiring any feedback channel for the compensation of the propagation delays. In addition, a self-organization scheme that can be effectively used to construct 1-hop neighbor nodes is proposed for an OFDMA-based WMN with a large number of nodes. The performance of the proposed technique is evaluated with regard to the convergence property and synchronization success probability using a computer simulation. PMID:26225974

Distributed Synchronization Technique for OFDMA-Based Wireless Mesh Networks Using a Bio-Inspired Algorithm.

PubMed

Kim, Mi Jeong; Maeng, Sung Joon; Cho, Yong Soo

2015-07-28

In this paper, a distributed synchronization technique based on a bio-inspired algorithm is proposed for an orthogonal frequency division multiple access (OFDMA)-based wireless mesh network (WMN) with a time difference of arrival. The proposed time- and frequency-synchronization technique uses only the signals received from the neighbor nodes, by considering the effect of the propagation delay between the nodes. It achieves a fast synchronization with a relatively low computational complexity because it is operated in a distributed manner, not requiring any feedback channel for the compensation of the propagation delays. In addition, a self-organization scheme that can be effectively used to construct 1-hop neighbor nodes is proposed for an OFDMA-based WMN with a large number of nodes. The performance of the proposed technique is evaluated with regard to the convergence property and synchronization success probability using a computer simulation.

Universal filtered multi-carrier system for asynchronous uplink transmission in optical access network

NASA Astrophysics Data System (ADS)

Kang, Soo-Min; Kim, Chang-Hun; Han, Sang-Kook

2016-02-01

In passive optical network (PON), orthogonal frequency division multiplexing (OFDM) has been studied actively due to its advantages such as high spectra efficiency (SE), dynamic resource allocation in time or frequency domain, and dispersion robustness. However, orthogonal frequency division multiple access (OFDMA)-PON requires tight synchronization among multiple access signals. If not, frequency orthogonality could not be maintained. Also its sidelobe causes inter-channel interference (ICI) to adjacent channel. To prevent ICI caused by high sidelobes, guard band (GB) is usually used which degrades SE. Thus, OFDMA-PON is not suitable for asynchronous uplink transmission in optical access network. In this paper, we propose intensity modulation/direct detection (IM/DD) based universal filtered multi-carrier (UFMC) PON for asynchronous multiple access. The UFMC uses subband filtering to subsets of subcarriers. Since it reduces sidelobe of each subband by applying subband filtering, it could achieve better performance compared to OFDM. For the experimental demonstration, different sample delay was applied to subbands to implement asynchronous transmission condition. As a result, time synchronization robustness of UFMC was verified in asynchronous multiple access system.

Communication and Jamming BDA of OFDMA Communication Systems Using the Software Defined Radio Platform WARP

DTIC Science & Technology

2015-03-01

62 5.13 Probabilty of correct SC modulation detection for 95 OFDM bursts using sixth order cumulants during interference techniques...0.9 1 Tx Node RF Gain P c m o d u la ti o n Figure 5.13: Probabilty of correct SC modulation detection for 95 OFDM bursts using sixth order

Design and performance evaluation of a distributed OFDMA-based MAC protocol for MANETs.

PubMed

Park, Jaesung; Chung, Jiyoung; Lee, Hyungyu; Lee, Jung-Ryun

2014-01-01

In this paper, we propose a distributed MAC protocol for OFDMA-based wireless mobile ad hoc multihop networks, in which the resource reservation and data transmission procedures are operated in a distributed manner. A frame format is designed considering the characteristics of OFDMA that each node can transmit or receive data to or from multiple nodes simultaneously. Under this frame structure, we propose a distributed resource management method including network state estimation and resource reservation processes. We categorize five types of logical errors according to their root causes and show that two of the logical errors are inevitable while three of them are avoided under the proposed distributed MAC protocol. In addition, we provide a systematic method to determine the advertisement period of each node by presenting a clear relation between the accuracy of estimated network states and the signaling overhead. We evaluate the performance of the proposed protocol in respect of the reservation success rate and the success rate of data transmission. Since our method focuses on avoiding logical errors, it could be easily placed on top of the other resource allocation methods focusing on the physical layer issues of the resource management problem and interworked with them.

IQ imbalance tolerable parallel-channel DMT transmission for coherent optical OFDMA access network

NASA Astrophysics Data System (ADS)

Jung, Sang-Min; Mun, Kyoung-Hak; Jung, Sun-Young; Han, Sang-Kook

2016-12-01

Phase diversity of coherent optical communication provides spectrally efficient higher-order modulation for optical communications. However, in-phase/quadrature (IQ) imbalance in coherent optical communication degrades transmission performance by introducing unwanted signal distortions. In a coherent optical orthogonal frequency division multiple access (OFDMA) passive optical network (PON), IQ imbalance-induced signal distortions degrade transmission performance by interferences of mirror subcarriers, inter-symbol interference (ISI), and inter-channel interference (ICI). We propose parallel-channel discrete multitone (DMT) transmission to mitigate transceiver IQ imbalance-induced signal distortions in coherent orthogonal frequency division multiplexing (OFDM) transmissions. We experimentally demonstrate the effectiveness of parallel-channel DMT transmission compared with that of OFDM transmission in the presence of IQ imbalance.

Two-Level Scheduling for Video Transmission over Downlink OFDMA Networks

PubMed Central

Tham, Mau-Luen

2016-01-01

This paper presents a two-level scheduling scheme for video transmission over downlink orthogonal frequency-division multiple access (OFDMA) networks. It aims to maximize the aggregate quality of the video users subject to the playback delay and resource constraints, by exploiting the multiuser diversity and the video characteristics. The upper level schedules the transmission of video packets among multiple users based on an overall target bit-error-rate (BER), the importance level of packet and resource consumption efficiency factor. Instead, the lower level renders unequal error protection (UEP) in terms of target BER among the scheduled packets by solving a weighted sum distortion minimization problem, where each user weight reflects the total importance level of the packets that has been scheduled for that user. Frequency-selective power is then water-filled over all the assigned subcarriers in order to leverage the potential channel coding gain. Realistic simulation results demonstrate that the proposed scheme significantly outperforms the state-of-the-art scheduling scheme by up to 6.8 dB in terms of peak-signal-to-noise-ratio (PSNR). Further test evaluates the suitability of equal power allocation which is the common assumption in the literature. PMID:26906398

An Adaptive OFDMA-Based MAC Protocol for Underwater Acoustic Wireless Sensor Networks

PubMed Central

Khalil, Issa M.; Gadallah, Yasser; Hayajneh, Mohammad; Khreishah, Abdallah

2012-01-01

Underwater acoustic wireless sensor networks (UAWSNs) have many applications across various civilian and military domains. However, they suffer from the limited available bandwidth of acoustic signals and harsh underwater conditions. In this work, we present an Orthogonal Frequency Division Multiple Access (OFDMA)-based Media Access Control (MAC) protocol that is configurable to suit the operating requirements of the underwater sensor network. The protocol has three modes of operation, namely random, equal opportunity and energy-conscious modes of operation. Our MAC design approach exploits the multi-path characteristics of a fading acoustic channel to convert it into parallel independent acoustic sub-channels that undergo flat fading. Communication between node pairs within the network is done using subsets of these sub-channels, depending on the configurations of the active mode of operation. Thus, the available limited bandwidth gets fully utilized while completely avoiding interference. We derive the mathematical model for optimal power loading and subcarrier selection, which is used as basis for all modes of operation of the protocol. We also conduct many simulation experiments to evaluate and compare our protocol with other Code Division Multiple Access (CDMA)-based MAC protocols. PMID:23012517

An adaptive OFDMA-based MAC protocol for underwater acoustic wireless sensor networks.

PubMed

Khalil, Issa M; Gadallah, Yasser; Hayajneh, Mohammad; Khreishah, Abdallah

2012-01-01

Underwater acoustic wireless sensor networks (UAWSNs) have many applications across various civilian and military domains. However, they suffer from the limited available bandwidth of acoustic signals and harsh underwater conditions. In this work, we present an Orthogonal Frequency Division Multiple Access (OFDMA)-based Media Access Control (MAC) protocol that is configurable to suit the operating requirements of the underwater sensor network. The protocol has three modes of operation, namely random, equal opportunity and energy-conscious modes of operation. Our MAC design approach exploits the multi-path characteristics of a fading acoustic channel to convert it into parallel independent acoustic sub-channels that undergo flat fading. Communication between node pairs within the network is done using subsets of these sub-channels, depending on the configurations of the active mode of operation. Thus, the available limited bandwidth gets fully utilized while completely avoiding interference. We derive the mathematical model for optimal power loading and subcarrier selection, which is used as basis for all modes of operation of the protocol. We also conduct many simulation experiments to evaluate and compare our protocol with other Code Division Multiple Access (CDMA)-based MAC protocols.

Space-Time Processing for Tactical Mobile Ad Hoc Networks

DTIC Science & Technology

2010-05-01

Spatial Diversity and Imperfect Channel Estimation on Wideband MC- DS - CDMA and MC- CDMA " IEEE Transactions on Communications, Vol. 57, No. 10, pp. 2988...include direct sequence code division multiple access ( DS - CDMA ), Frequency Hopped (FH) CDMA and Orthogonal Frequency Division Multiple Access (OFDMA...capability, LPD/LPI, and operability in non-continuous spectrum. In addition, FH- CDMA is robust to the near-far problem, while DS - CDMA requires

Game theoretic wireless resource allocation for H.264 MGS video transmission over cognitive radio networks

NASA Astrophysics Data System (ADS)

Fragkoulis, Alexandros; Kondi, Lisimachos P.; Parsopoulos, Konstantinos E.

2015-03-01

We propose a method for the fair and efficient allocation of wireless resources over a cognitive radio system network to transmit multiple scalable video streams to multiple users. The method exploits the dynamic architecture of the Scalable Video Coding extension of the H.264 standard, along with the diversity that OFDMA networks provide. We use a game-theoretic Nash Bargaining Solution (NBS) framework to ensure that each user receives the minimum video quality requirements, while maintaining fairness over the cognitive radio system. An optimization problem is formulated, where the objective is the maximization of the Nash product while minimizing the waste of resources. The problem is solved by using a Swarm Intelligence optimizer, namely Particle Swarm Optimization. Due to the high dimensionality of the problem, we also introduce a dimension-reduction technique. Our experimental results demonstrate the fairness imposed by the employed NBS framework.

Awareness of Emerging Wireless Technologies: Ad-hoc and Personal Area Networks Standards and Emerging Technologies (Sensibilisation a l’emergence des technologies sans fil: technologies emergeantes et normes de reseaux personnels et ad-hoc)

DTIC Science & Technology

2007-04-01

for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data...Control Organization NRL Navy Research Laboratory nrtPS Non-real- time Polling Services OFDM Orthogonal frequency division multiplex OFDMA...Routeur IDentifier RTG RTO Task Group RTO Research & Technology Organization rtPS Real- time Polling Services SC Single-carrier modulation

A Synchronous Digital Duplexing Technique for OFDMA-Based Indoor Communications

NASA Astrophysics Data System (ADS)

Park, Chang-Hwan; Ko, Yo-Han; Kim, Yeong-Jun; Park, Kyung-Won; Jeon, Won-Gi; Paik, Jong-Ho; Lee, Seok-Pil; Cho, Yong-Soo

In this paper, we propose a new digital duplexing scheme, called synchronous digital duplexing (SDD), which can increase data efficiency and flexibility of resource by transmitting uplink signal and downlink signal simultaneously in wireless communication. In order to transmit uplink and downlink signals simultaneously, the proposed SDD obtains mutual information among subscriber stations (SSs) with a mutual ranging symbol. This information is used for selection of transmission time, decision on cyclic suffix (CS) insertion, determination of CS length, and re-establishment of FFT starting point.

Experimental demonstration of high spectral efficient 4 × 4 MIMO SCMA-OFDM/OQAM radio over multi-core fiber system.

PubMed

Liu, Chang; Deng, Lei; He, Jiale; Li, Di; Fu, Songnian; Tang, Ming; Cheng, Mengfan; Liu, Deming

2017-07-24

In this paper, 4 × 4 multiple-input multiple-output (MIMO) radio over 7-core fiber system based on sparse code multiple access (SCMA) and OFDM/OQAM techniques is proposed. No cyclic prefix (CP) is required by properly designing the prototype filters in OFDM/OQAM modulator, and non-orthogonally overlaid codewords by using SCMA is help to serve more users simultaneously under the condition of using equal number of time and frequency resources compared with OFDMA, resulting in the increase of spectral efficiency (SE) and system capacity. In our experiment, 11.04 Gb/s 4 × 4 MIMO SCMA-OFDM/OQAM signal is successfully transmitted over 20 km 7-core fiber and 0.4 m air distance in both uplink and downlink. As a comparison, 6.681 Gb/s traditional MIMO-OFDM signal with the same occupied bandwidth has been evaluated for both uplink and downlink transmission. The experimental results show that SE could be increased by 65.2% with no bit error rate (BER) performance degradation compared with the traditional MIMO-OFDM technique.

Optimized scheduling technique of null subcarriers for peak power control in 3GPP LTE downlink.

PubMed

Cho, Soobum; Park, Sang Kyu

2014-01-01

Orthogonal frequency division multiple access (OFDMA) is a key multiple access technique for the long term evolution (LTE) downlink. However, high peak-to-average power ratio (PAPR) can cause the degradation of power efficiency. The well-known PAPR reduction technique, dummy sequence insertion (DSI), can be a realistic solution because of its structural simplicity. However, the large usage of subcarriers for the dummy sequences may decrease the transmitted data rate in the DSI scheme. In this paper, a novel DSI scheme is applied to the LTE system. Firstly, we obtain the null subcarriers in single-input single-output (SISO) and multiple-input multiple-output (MIMO) systems, respectively; then, optimized dummy sequences are inserted into the obtained null subcarrier. Simulation results show that Walsh-Hadamard transform (WHT) sequence is the best for the dummy sequence and the ratio of 16 to 20 for the WHT and randomly generated sequences has the maximum PAPR reduction performance. The number of near optimal iteration is derived to prevent exhausted iterations. It is also shown that there is no bit error rate (BER) degradation with the proposed technique in LTE downlink system.

Optimized Scheduling Technique of Null Subcarriers for Peak Power Control in 3GPP LTE Downlink

PubMed Central

Park, Sang Kyu

2014-01-01

Orthogonal frequency division multiple access (OFDMA) is a key multiple access technique for the long term evolution (LTE) downlink. However, high peak-to-average power ratio (PAPR) can cause the degradation of power efficiency. The well-known PAPR reduction technique, dummy sequence insertion (DSI), can be a realistic solution because of its structural simplicity. However, the large usage of subcarriers for the dummy sequences may decrease the transmitted data rate in the DSI scheme. In this paper, a novel DSI scheme is applied to the LTE system. Firstly, we obtain the null subcarriers in single-input single-output (SISO) and multiple-input multiple-output (MIMO) systems, respectively; then, optimized dummy sequences are inserted into the obtained null subcarrier. Simulation results show that Walsh-Hadamard transform (WHT) sequence is the best for the dummy sequence and the ratio of 16 to 20 for the WHT and randomly generated sequences has the maximum PAPR reduction performance. The number of near optimal iteration is derived to prevent exhausted iterations. It is also shown that there is no bit error rate (BER) degradation with the proposed technique in LTE downlink system. PMID:24883376

Zadoff-Chu sequence-based hitless ranging scheme for OFDMA-PON configured 5G fronthaul uplinks

NASA Astrophysics Data System (ADS)

Reza, Ahmed Galib; Rhee, June-Koo Kevin

2017-05-01

A Zadoff-Chu (ZC) sequence-based low-complexity hitless upstream time synchronization scheme is proposed for an orthogonal frequency division multiple access passive optical network configured cloud radio access network fronthaul. The algorithm is based on gradual loading of the ZC sequences, where the phase discontinuity due to the cyclic prefix is alleviated by a frequency domain phase precoder, eliminating the requirements of guard bands to mitigate intersymbol interference and inter-carrier interference. Simulation results for uncontrolled-wavelength asynchronous transmissions from four concurrent transmitting optical network units are presented to demonstrate the effectiveness of the proposed scheme.

Suppression of optical beat interference-noise in orthogonal frequency division multiple access-passive optical network link using self-homodyne balanced detection

NASA Astrophysics Data System (ADS)

Won, Yong-Yuk; Jung, Sang-Min; Han, Sang-Kook

2014-08-01

A new technique, which reduces optical beat interference (OBI) noise in orthogonal frequency division multiple access-passive optical network (OFDMA-PON) links, is proposed. A self-homodyne balanced detection, which uses a single laser for the optical line terminal (OLT) as well as for the optical network unit (ONU), reduces OBI noise and also improves the signal to noise ratio (SNR) of the discrete multi-tone (DMT) signal. The proposed scheme is verified by transmitting quadrature phase shift keying (QPSK)-modulated DMT signal over a 20-km single mode fiber. The optical signal to noise ratio (OSNR), that is required for BER of 10-5, is reduced by 2 dB in the balanced detection compared with a single channel due to the cancellation of OBI noise in conjunction with the local laser.

An investigation of interference coordination in heterogeneous network for LTE-Advanced systems

NASA Astrophysics Data System (ADS)

Hasan, M. K.; Ismail, A. F.; H, Aisha-Hassan A.; Abdullah, Khaizuran; Ramli, H. A. M.

2013-12-01

The novel "femtocell" in Heterogeneous Network (HetNet) for LTE-Advanced (LTE-A) set-up will allow Malaysian wireless telecommunication operators (Maxis, Celcom, Digi, U-Mobile, P1, YTL and etc2.) to extend connectivity coverage where access would otherwise be limited or unavailable, particularly indoors of large building complexes. A femtocell is a small-sized cellular base station that encompasses all the functionality of a typical station. It therefore allows a simpler and self-contained deployment including private residences. For the Malaysian service providers, the main attractions of femtocell usage are the improvements to both coverage and capacity. The operators can provide a better service to end-users in turn reduce much of the agitations and complaints. There will be opportunity for new services at reduced cost. In addition, the operator not only benefits from the improved capacity and coverage but also can reduce both capital expenditure and operating expense i.e. alternative to brand new base station or macrocell installation. Interference is a key issue associated with femtocell development. There are a large number of issues associated with interference all of which need to be investigated, identified, quantified and solved. This is to ensure that the deployment of any femtocells will take place successfully. Among the most critical challenges in femtocell deployment is the interference between femtocell-to-macrocell and femtocell-to-femtocell in HetNets. In this paper, all proposed methods and algorithms will be investigated in the OFDMA femtocell system considering HetNet scenarios for LTE-A.

Energy-efficient downlink resource management in self-organized OFDMA-based two-tier femtocell networks

NASA Astrophysics Data System (ADS)

Shahid, Adnan; Aslam, Saleem; Kim, Hyung Seok; Lee, Kyung-Geun

2015-12-01

Femtocell is a novel technology that is used for escalating indoor coverage as well as the capacity of traditional cellular networks. However, interference is the limiting factor for performance improvement due to co-channel deployment between macrocells and femtocells. The traditional network planning is not feasible because of the random deployment of femtocells. Therefore, self-organization approaches are the key to having successful deployment of femtocells. This study presents the joint resource block (RB) and power allocation task for the two-tier femtocell network in a self-organizing manner, with the concern to minimizing the impact of interference and maximizing the energy efficiency. In this study, we analyze the performance of the system in terms of the energy efficiency, which is composed of both the transmission and circuit power. Most of the previous studies investigate the performance regarding the throughput requirement of the two-tier femtocell network while the energy efficiency aspect is largely ignored. Here, the joint allocation task is modeled as a non-cooperative game which is demonstrated to exhibit pure and unique Nash equilibrium. In order to reduce the complexity of the proposed non-cooperative game, the joint RB and power allocation task is divided into two subproblems: an RB allocation and a particle swarm optimization-based power allocation. The analysis of the proposed game is carried out in terms of not only energy efficiency but also throughput. With practical 3rd Generation Partnership Project (3GPP) Long-Term Evolution (LTE) parameters, the simulation results illustrate the superior performance of the proposed game as compared to the traditional methods. Also, the comparison is carried out with the joint allocation scheme which only considers the throughput as the objective function. The results illustrate that significant performance improvement is achieved in terms of energy efficiency with slight loss in the throughput. The analysis in regard to energy efficiency and throughput of the two-tier femtocell network is carried out in terms of the performance metrics, which include convergence, impact of varying RBs, impact of femtocell density, and the fairness index.

Optimum Adaptive Modulation and Channel Coding Scheme for Frequency Domain Channel-Dependent Scheduling in OFDM Based Evolved UTRA Downlink

NASA Astrophysics Data System (ADS)

Miki, Nobuhiko; Kishiyama, Yoshihisa; Higuchi, Kenichi; Sawahashi, Mamoru; Nakagawa, Masao

In the Evolved UTRA (UMTS Terrestrial Radio Access) downlink, Orthogonal Frequency Division Multiplexing (OFDM) based radio access was adopted because of its inherent immunity to multipath interference and flexible accommodation of different spectrum arrangements. This paper presents the optimum adaptive modulation and channel coding (AMC) scheme when resource blocks (RBs) is simultaneously assigned to the same user when frequency and time domain channel-dependent scheduling is assumed in the downlink OFDMA radio access with single-antenna transmission. We start by presenting selection methods for the modulation and coding scheme (MCS) employing mutual information both for RB-common and RB-dependent modulation schemes. Simulation results show that, irrespective of the application of power adaptation to RB-dependent modulation, the improvement in the achievable throughput of the RB-dependent modulation scheme compared to that for the RB-common modulation scheme is slight, i.e., 4 to 5%. In addition, the number of required control signaling bits in the RB-dependent modulation scheme becomes greater than that for the RB-common modulation scheme. Therefore, we conclude that the RB-common modulation and channel coding rate scheme is preferred, when multiple RBs of the same coded stream are assigned to one user in the case of single-antenna transmission.

A Patient Record-Filing System for Family Practice

PubMed Central

Levitt, Cheryl

1988-01-01

The efficient storage and easy retrieval of quality records are a central concern of good family practice. Many physicians starting out in practice have difficulty choosing a practical and lasting system for storing their records. Some who have established practices are installing computers in their offices and finding that their filing systems are worn, outdated, and incompatible with computerized systems. This article describes a new filing system installed simultaneously with a new computer system in a family-practice teaching centre. The approach adopted solved all identifiable problems and is applicable in family practices of all sizes.

The virtual practice: using the residents' continuity clinic to teach practice management and systems-based practice.

PubMed

Perez, Jose A; Faust, Cheryl; Kenyon, Angie

2009-09-01

Education in systems-based practice is a required component of all postgraduate medical education programs in the United States. Competency in this area requires that trainees have an understanding of the health care system sufficient to provide optimal care to patients. Most trainees in residency programs have little understanding of the complexities and challenges of present-day practice in the current system of care and consider themselves unprepared to undertake this activity following completion of training. Training in practice management in residency programs has not been emphasized as an important component of systems-based practice. Historically, practice management training in residency programs has been done using a fully didactic model, and residents have expressed a desire to learn this skill by becoming more directly involved in the operations and management of a practice. The patient visit touches many aspects of the health care system, including clinic operations, insurance, quality, and finances. At our institution, we used the residents' continuity clinic practices as a vehicle to provide education in practice management and systems-based practice by creating a curriculum that included the residents' perceived gaps in knowledge regarding going into practice. This is known as the virtual practice. This curriculum is taught using data obtained from residents' practice to illustrate concepts in many areas, including primary practice operations, malpractice insurance, financial benchmarks, and career planning. Resident self-assessed knowledge of these areas increased after participating in the curriculum, and resident testimonials indicate satisfaction with the project. In addition, residents have become engaged and interested in how their effort translates into performance and how they participate in the health care system.

Development of Physical Therapy Practical Assessment System by Using Multisource Feedback

ERIC Educational Resources Information Center

Hengsomboon, Ninwisan; Pasiphol, Shotiga; Sujiva, Siridej

2017-01-01

The purposes of the research were (1) to develop the physical therapy practical assessment system by using the multisource feedback (MSF) approach and (2) to investigate the effectiveness of the implementation of the developed physical therapy practical assessment system. The development of physical therapy practical assessment system by using MSF…

Systems and complexity thinking in the general practice literature: an integrative, historical narrative review.

PubMed

Sturmberg, Joachim P; Martin, Carmel M; Katerndahl, David A

2014-01-01

Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline's philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform.

Systems and Complexity Thinking in the General Practice Literature: An Integrative, Historical Narrative Review

PubMed Central

Sturmberg, Joachim P.; Martin, Carmel M.; Katerndahl, David A.

2014-01-01

PURPOSE Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine. METHODS We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice. RESULTS General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine. CONCLUSIONS This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline’s philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform. PMID:24445105

Main dimensions of human practical directives system

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

Lewicka-Strzalecka, A.

1992-12-31

A hypothesis is made that due to the uncertainty and complexity of the practical inference schemes, the acting subject exerts his/her own system of beliefs about efficient ways of attaining the given goals. These beliefs are termed here: Practical Directives, and their system: Practical Attitude. An attempt was made to reconstruct such a system and its main dimensions. To this end, an instrument was constructed: the Questionnaire of Practical Directives (QPD), which is meant as an operational definition of Practical Attitude. A group of 218 subjects was tested with the aid of QPD and the factor analysis of the resultsmore » revealed nine factors interpreted as main dimensions of the system of Practical Directives. 19 refs.« less

Complexity theory and the "puzzling" competencies: Systems-based Practice And Practice-based Learning explored.

PubMed

Gonnering, Russell S

2010-01-01

Of all the clinical competencies, the least understood are Systems-Based Practice and Practice-Based Learning and Improvement. With a shift to competency-based education and evaluation across the spectrum of surgical education and practice, a clear understanding of the power and utility of each competency is paramount. Health care operates as a complex adaptive system, with dynamics foreign to many health care professionals and educators. The adaptation and evolution of such a system is related directly to both the individual and the organizational learning of the agents within the system and knowledge management strategies. Far from being "difficult," Systems-Based Practice and Practice-Based Learning form the heart of quality improvement initiatives and future productivity advances in health care. Copyright 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Implementing Practical Based Courses under Open and Distance Learning System: A Study of the Perception of Learners and Counsellors

ERIC Educational Resources Information Center

Basantia, Tapan Kumar

2018-01-01

Implementing practical based courses under Open and Distance Learning (ODL) system is a very difficult and challenging task as the teaching of practical based courses involves intensive practical work. For removing the difficulties and challenges in implementing the practical based courses under ODL system, there is a need to study the existing…

Practicing Technology Implementation: The Case of an Enterprise System

ERIC Educational Resources Information Center

Awazu, Yukika

2013-01-01

Drawing on four theories of practice--Communities of Practice (CoP), Bourdieu's theory of practice, Pickering's mangle of practice, and Actor Network Theory (ANT), the study provides an in-depth understanding about technology implementation practice. Analysis of an Enterprise System implementation project in a software manufacturing…

Models of practice organisation using dental therapists: English case studies.

PubMed

Sun, N; Harris, R V

2011-08-12

A new dental remuneration system based on bands of activity has changed the reward system operating in dental practices and influenced practitioner behaviour in relation to the delegation of tasks to English dental therapists (DTs). Since dental practitioners operate as independent contractors they are free to innovate. A variety of models incorporating DTs in general practice teams exist, some of which may overcome the apparent delegation constraints embedded within this system of remuneration. To describe the way different practices are organised to take account of DTs in their teams and identify whether any of these models address delegation disincentives arising from the system of remuneration. A purposive sample of six dental practices was identified, comprising two small, two medium and two large dental practices, including a variety of models of practice organisation. Semi-structured interviews were carried out with principal dentists, associate dentists, DTs, practice managers and dental hygienists (35 participants in total). A thematic analysis was applied to interview transcripts. The six dental practices demonstrated six different models of practice organisation which could be grouped into 'practice payment' and 'dentist payment' models according to whether the salary costs of the DT were met by a central practice fund or from the income of individual dentists in the team. In both of the large practices only some of the dentists in the team referred work to the DT because of reimbursement issues. In two practices the system was perceived to be satisfactory to all parties, one of these being a single-handed practice with two DTs. Although the remuneration system contained some potential disincentives to DT delegation, some practices innovated in their organisations to overcome these issues.

Traditional and emerging forms of dental practice. Cost, accessibility, and quality factors.

PubMed Central

Rovin, S; Nash, J

1982-01-01

The traditional and predominant manner of delivering dental care is through a fee-for-service, private practice system. A number of alternative dental care delivery systems have emerged and are being tested, and others are just emerging. These systems include department store practices, hospital dental services, health maintenance organizations, the independent practice of dental hygiene, and denturism. Although it is too soon to draw final conclusions about the efficacy and effectiveness of these systems, we examine them for their potential to compete with and change the way dental care is currently delivered. Using the parameters of cost, accessibility, and quality, we compare these systems to traditional dental practice. Some of these emerging forms clearly have the potential to complete favorably with traditional practice. Other seem less likely to alter the existing system substantially. The system which can best control costs, increase accessibility, and enhance quality will gain the competitive edge. PMID:7091453

Monitoring of continuous-variable quantum key distribution system in real environment.

PubMed

Liu, Weiqi; Peng, Jinye; Huang, Peng; Huang, Duan; Zeng, Guihua

2017-08-07

How to guarantee the practical security of continuous-variable quantum key distribution (CVQKD) system has been an important issue in the quantum cryptography applications. In contrast to the previous practical security strategies, which focus on the intercept-resend attack or the Gaussian attack, we investigate the practical security strategy based on a general attack, i.e., an arbitrated individual attack or collective attack on the system by Eve in this paper. The low bound of intensity disturbance of the local oscillator signal for eavesdropper successfully concealing herself is obtained, considering all noises can be used by Eve in the practical environment. Furthermore, we obtain an optimal monitoring condition for the practical CVQKD system so that legitimate communicators can monitor the general attack in real-time. As examples, practical security of two special systems, i.e., the Gaussian modulated coherent state CVQKD system and the middle-based CVQKD system, are investigated under the intercept-resend attacks.

Sustaining Competitive Advantage: Mental Models and Organizational Learning for Future Marines

DTIC Science & Technology

2007-01-01

Soft Systems Methodology : Other Voices.” Systemic Practice and Action Research. 13, no. 6, (2000): 773. Larsen, Kai R. T., Claire McInerney...30. Mingers, John. “An Idea Ahead of Its Time: The History and Development of Soft Systems Methodology .” Systemic Practice and Action...Soft System Dynamics Methodology (SSDM): Combinging Soft Systems Methodology (SSM) and System Dynamics (SD).” Systemic Practice and Action

Spoken Grammar Practice and Feedback in an ASR-Based CALL System

ERIC Educational Resources Information Center

de Vries, Bart Penning; Cucchiarini, Catia; Bodnar, Stephen; Strik, Helmer; van Hout, Roeland

2015-01-01

Speaking practice is important for learners of a second language. Computer assisted language learning (CALL) systems can provide attractive opportunities for speaking practice when combined with automatic speech recognition (ASR) technology. In this paper, we present a CALL system that offers spoken practice of word order, an important aspect of…

GP Networks as enablers of quality of care: implementing a practice engagement framework in a General Practice Network.

PubMed

Pearce, Christopher; Shearer, Marianne; Gardner, Karina; Kelly, Jill; Xu, Tony Baixian

2012-01-01

This paper describes how the Melbourne East General Practice Network supports general practice to enable quality of care, it describes the challenges and enablers of change, and the evidence of practice capacity building and improved quality of care. Primary care is well known as a place where quality, relatively inexpensive medical care occurs. General practice is made up of multiple small sites with fragmented systems and a funding system that challenges a whole-of-practice approach to clinical care. General Practice Networks support GPs to synthesise complexity and crystallise solutions that enhance general practice beyond current capacity. Through a culture of change management, GP Networks create the link between the practice and the big picture of the whole health system and reduce the isolation of general practice. They distribute information (evidence-based learning and resources) and provide individualised support, responding to practice need and capacity.

Intermittent use of an "anchor system" improves postural control in healthy older adults.

PubMed

Freitas, Milena de Bem Zavanella; Mauerberg-deCastro, Eliane; Moraes, Renato

2013-07-01

Haptic information, provided by a non-rigid tool (i.e., an "anchor system"), can reduce body sway in individuals who perform a standing postural task. However, it was not known whether or not continuous use of the anchor system would improve postural control after its removal. Additionally, it was unclear as to whether or not frequency of use of the anchor system is related to improved control in older adults. The present study evaluated the effect of the prolonged use of the anchor system on postural control in healthy older individuals, at different frequencies of use, while they performed a postural control task (semi-tandem position). Participants were divided into three groups according to the frequency of the anchor system's use (0%, 50%, and 100%). Pre-practice phase (without anchor) was followed by a practice phase (they used the anchor system at the predefined frequency), and a post-practice phase (immediate and late-without anchor). All three groups showed a persistent effect 15min after the end of the practice phase (immediate post-practice phase). However, only the 50% group showed a persistent effect in the late post-practice phase (24h after finishing the practice phase). Older adults can improve their postural control by practicing the standing postural task, and use of the anchor system limited to half of their practice time can provide additional improvement in their postural control. Copyright © 2013 Elsevier B.V. All rights reserved.

The evolution and practical application of machine translation system (1)

NASA Astrophysics Data System (ADS)

Tominaga, Isao; Sato, Masayuki

This paper describes a development, practical applicatioin, problem of a system, evaluation of practical system, and development trend of machine translation. Most recent system contains next four problems. 1) the vagueness of a text, 2) a difference of the definition of the terminology between different language, 3) the preparing of a large-scale translation dictionary, 4) the development of a software for the logical inference. Machine translation system is already used practically in many industry fields. However, many problems are not solved. The implementation of an ideal system will be after 15 years. Also, this paper described seven evaluation items detailedly. This English abstract was made by Mu system.

States' Successful Practices Weigh-in-Motion Handbook

DOT National Transportation Integrated Search

1997-12-15

The purpose of this Handbook is to provide practical advice for users of weigh-in-motion (WIM) technology, systems, sites, and states' "Successful Practices" using WIM systems. The states selected for each WIM system discussed in this Handbook are: C...

Managing Safety and Operations: The Effect of Joint Management System Practices on Safety and Operational Outcomes.

PubMed

Tompa, Emile; Robson, Lynda; Sarnocinska-Hart, Anna; Klassen, Robert; Shevchenko, Anton; Sharma, Sharvani; Hogg-Johnson, Sheilah; Amick, Benjamin C; Johnston, David A; Veltri, Anthony; Pagell, Mark

2016-03-01

The aim of this study was to determine whether management system practices directed at both occupational health and safety (OHS) and operations (joint management system [JMS] practices) result in better outcomes in both areas than in alternative practices. Separate regressions were estimated for OHS and operational outcomes using data from a survey along with administrative records on injuries and illnesses. Organizations with JMS practices had better operational and safety outcomes than organizations without these practices. They had similar OHS outcomes as those with operations-weak practices, and in some cases, better outcomes than organizations with safety-weak practices. They had similar operational outcomes as those with safety-weak practices, and better outcomes than those with operations-weak practices. Safety and operations appear complementary in organizations with JMS practices in that there is no penalty for either safety or operational outcomes.

Implementation of a next-generation electronic nursing records system based on detailed clinical models and integration of clinical practice guidelines.

PubMed

Min, Yul Ha; Park, Hyeoun-Ae; Chung, Eunja; Lee, Hyunsook

2013-12-01

The purpose of this paper is to describe the components of a next-generation electronic nursing records system ensuring full semantic interoperability and integrating evidence into the nursing records system. A next-generation electronic nursing records system based on detailed clinical models and clinical practice guidelines was developed at Seoul National University Bundang Hospital in 2013. This system has two components, a terminology server and a nursing documentation system. The terminology server manages nursing narratives generated from entity-attribute-value triplets of detailed clinical models using a natural language generation system. The nursing documentation system provides nurses with a set of nursing narratives arranged around the recommendations extracted from clinical practice guidelines. An electronic nursing records system based on detailed clinical models and clinical practice guidelines was successfully implemented in a hospital in Korea. The next-generation electronic nursing records system can support nursing practice and nursing documentation, which in turn will improve data quality.

A System Approach to Advanced Practice Clinician Standardization and High Reliability.

PubMed

Okuno-Jones, Susan; Siehoff, Alice; Law, Jennifer; Juarez, Patricia

Advanced practice clinicians (APCs) are an integral part of the health care team. Opportunities exist within Advocate Health Care to standardize and optimize APC practice across the system. To enhance the role and talents of APCs, an approach to role definition and optimization of practice and a structured approach to orientation and evaluation are shared. Although in the early stages of development, definition and standardization of accountabilities in a framework to support system changes are transforming the practice of APCs.

Nursing: caring or codependent?

PubMed

Caffrey, R A; Caffrey, P A

1994-01-01

Can nurses practice caring within a healthcare system that promotes codependency? Caring promotes mutual empowerment of all participants while codependent caring disempowers. Nurses are expected to practice caring with clients, The authors contend, however, that nursing, as historically and currently practiced within bureaucratic/patriarchal organizations, is founded on a value system that fosters codependency. Until nursing is practiced within the context of caring organizations and a caring healthcare system, nurses will continue to be powerless to shape their own practice as carers and burnout will continue to be a problem.

Abortion training at multiple sites: an unexpected curriculum for teaching systems-based practice.

PubMed

Herbitter, Cara; Kumar, Vanita; Karasz, Alison; Gold, Marji

2010-04-01

In 1999, the Accreditation Council for Graduate Medical Education endorsed systems-based practice as one of six general competencies. The objective is to explore the paradigm of teaching residents systems-based practice during a women's health rotation that included abortion training in multiple settings. During a routine women's health rotation, residents from two urban family medicine residency programs received early abortion training at a high-volume abortion clinic and their continuity clinic. Thirty-min semistructured interviews were conducted with all 26 residents who rotated between July 2005 and August 2006. Transcripts were analyzed using thematic codes. Through exposure to different healthcare delivery systems, residents learned about systems-based practice, including understanding the failure of the larger system to meet patients' reproductive healthcare needs, differences between two systems, and potential systems barriers they might face as providers. Abortion training in multiple settings may serve as a paradigm for teaching systems-based practice during other rotations that include training in multiple sites.

A system of safety management practices and worker engagement for reducing and preventing accidents: an empirical and theoretical investigation.

PubMed

Wachter, Jan K; Yorio, Patrick L

2014-07-01

The overall research objective was to theoretically and empirically develop the ideas around a system of safety management practices (ten practices were elaborated), to test their relationship with objective safety statistics (such as accident rates), and to explore how these practices work to achieve positive safety results (accident prevention) through worker engagement. Data were collected using safety manager, supervisor and employee surveys designed to assess and link safety management system practices, employee perceptions resulting from existing practices, and safety performance outcomes. Results indicate the following: there is a significant negative relationship between the presence of ten individual safety management practices, as well as the composite of these practices, with accident rates; there is a significant negative relationship between the level of safety-focused worker emotional and cognitive engagement with accident rates; safety management systems and worker engagement levels can be used individually to predict accident rates; safety management systems can be used to predict worker engagement levels; and worker engagement levels act as mediators between the safety management system and safety performance outcomes (such as accident rates). Even though the presence of safety management system practices is linked with incident reduction and may represent a necessary first-step in accident prevention, safety performance may also depend on mediation by safety-focused cognitive and emotional engagement by workers. Thus, when organizations invest in a safety management system approach to reducing/preventing accidents and improving safety performance, they should also be concerned about winning over the minds and hearts of their workers through human performance-based safety management systems designed to promote and enhance worker engagement. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Understanding the use of standardized nursing terminology and classification systems in published research: A case study using the International Classification for Nursing Practice(®).

PubMed

Strudwick, Gillian; Hardiker, Nicholas R

2016-10-01

In the era of evidenced based healthcare, nursing is required to demonstrate that care provided by nurses is associated with optimal patient outcomes, and a high degree of quality and safety. The use of standardized nursing terminologies and classification systems are a way that nursing documentation can be leveraged to generate evidence related to nursing practice. Several widely-reported nursing specific terminologies and classifications systems currently exist including the Clinical Care Classification System, International Classification for Nursing Practice(®), Nursing Intervention Classification, Nursing Outcome Classification, Omaha System, Perioperative Nursing Data Set and NANDA International. However, the influence of these systems on demonstrating the value of nursing and the professions' impact on quality, safety and patient outcomes in published research is relatively unknown. This paper seeks to understand the use of standardized nursing terminology and classification systems in published research, using the International Classification for Nursing Practice(®) as a case study. A systematic review of international published empirical studies on, or using, the International Classification for Nursing Practice(®) were completed using Medline and the Cumulative Index for Nursing and Allied Health Literature. Since 2006, 38 studies have been published on the International Classification for Nursing Practice(®). The main objectives of the published studies have been to validate the appropriateness of the classification system for particular care areas or populations, further develop the classification system, or utilize it to support the generation of new nursing knowledge. To date, most studies have focused on the classification system itself, and a lesser number of studies have used the system to generate information about the outcomes of nursing practice. Based on the published literature that features the International Classification for Nursing Practice, standardized nursing terminology and classification systems appear to be well developed for various populations, settings and to harmonize with other health-related terminology systems. However, the use of the systems to generate new nursing knowledge, and to validate nursing practice is still in its infancy. There is an opportunity now to utilize the well-developed systems in their current state to further what is know about nursing practice, and how best to demonstrate improvements in patient outcomes through nursing care. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Agreement of three interpretation systems of intrapartum foetal heart rate monitoring by different levels of physicians.

PubMed

Pruksanusak, Ninlapa; Thongphanang, Putthaporn; Chainarong, Natthicha; Suntharasaj, Thitima; Kor-Anantakul, Ounjai; Suwanrath, Chitkasaem; Petpichetchian, Chusana

2017-11-01

A prospective study was conducted in centre in Southern Thailand, to evaluate agreement in EFM interpretation among various physicians in order to find out the most practical system for daily use. We found strong agreement of very normal FHR tracings among the FIGO, NICHD 3-tier and 5-tier systems. The NICHD 3-tier was more compatible with the FIGO system than 5-tier system. Overall inter-observer agreement was moderate for the NICHD 3-tier system while inter-observer agreement of 5-tier system was fair also the intra-observer agreement was higher in the NICHD 3-tier system. So the 3-tier systems are more suitable than the 5-tier system in general obstetric practice. Impact statement What is already known on this subject: The 3-tier and 5-tier systems were widely used in general obstetrics practice. What the results of this study add: The inter- and intra-observer agreement of NICHD 3-tier system was higher than the 5-tier system. What the implications are of these findings for clinical practice and/or further research: The 3-tier systems were more suitable than the 5-tier systems in general obstetrics practice.

Soil microbiome characteristics and soilborne disease development associated with long-term potato cropping system practices

USDA-ARS?s Scientific Manuscript database

Potato cropping system practices substantially affect soil microbial communities and the development of soilborne diseases. Cropping systems incorporating soil health management practices, such as longer rotations, disease-suppressive crops, reduced tillage, and/or organic amendments can potentially...

Guidance, Navigation and Control (GN&C): Best Practices for Human-Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Lebsock, Ken; West, John

2008-01-01

In 2007 the NESC completed an in-depth assessment to identify, define and document engineering considerations for the Design Development Test and Evaluation (DDT&E) of human-rated spacecraft systems. This study had been requested by the Astronaut Office at JSC to help them to better understand what is required to ensure safe, robust, and reliable human-rated spacecraft systems. The 22 GN&C engineering Best Practices described in this paper are a condensed version of what appears in the NESC Technical Report. These Best Practices cover a broad range from fundamental system architectural considerations to more specific aspects (e.g., stability margin recommendations) of GN&C system design and development. 15 of the Best Practices address the early phases of a GN&C System development project and the remaining 7 deal with the later phases. Some of these Best Practices will cross-over between both phases. We recognize that this set of GN&C Best Practices will not be universally applicable to all projects and mission applications.

Diabetes Patient Tracker, a personal digital assistant-based diabetes management system for primary care practices in Oklahoma.

PubMed

Nagykaldi, Zsolt; Mold, James W

2003-01-01

It has been demonstrated that electronic patient registries combined with a clinical decision support system have a significant positive impact on the documentation and delivery of services provided by health care professionals. While implementation of available commercial systems has not always been proven effective in a number of primary care practices, development and implementation of such a system in a practice-based research network might enhance successful implementation. Physicians in our practice-based research network (Oklahoma Physicians Resource/Research Network) initiated a project that aimed at designing, testing, and implementing a personal digital assistant-based diabetes management system. We utilized the "best practice" approach to determine the principles on which the application must operate. System development and beta testing were also accomplished based on the direct feedback of user clinicians. Practice Enhancement Assistants (PEAs) were available in the practices for assistance with implementation. Implementation of the Diabetes Patient Tracker (DPT) resulted in a significant improvement (p<0.05) in nine of 10 diabetic quality of care measures compared with pre-intervention levels in 20 primary care practices. Regular PEA visits similarly increased the number of foot exams and retinal exams performed in the last year (p=0.03 and 0.02, respectively). DPT is a low-cost, feasible, easily implementable, and very effective paper-less tool that significantly improves patient care and documentation in primary care practices.

Communities of Practice and Social Learning Systems: the Career of a Concept

NASA Astrophysics Data System (ADS)

Wenger, Etienne

The concept of community of practice was not born in the systems theory tradition. It has its roots in attempts to develop accounts of the social nature of human learning inspired by anthropology and social theory (Lave, 1988; Bourdieu, 1977; Giddens, 1984; Foucault, 1980; Vygotsky, 1978). But the concept of community of practice is well aligned with the perspective of systems traditions. A community of practice itself can be viewed as a simple social system. And a complex social system can be viewed as constituted by interrelated communities of practice. In this essay I first explore the systemic nature of the concept at these two levels. Then I use this foundation to look at the applications of the concept, some of its main critiques, and its potential for developing a social discipline of learning.

75 FR 22844 - Construction Fall Protection Systems Criteria and Practices and Training Requirements; Extension...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-30

...] Construction Fall Protection Systems Criteria and Practices and Training Requirements; Extension of the Office of Management and Budget's (OMB) Approval of Information Collection (Paperwork) Requirements AGENCY... requirements contained in the construction standards on Fall Protection Systems Criteria and Practices (29 CFR...

Business intelligence: using insight to improve the value and performance of your practice.

PubMed

Coan, Tim

2007-01-01

Using information to improve the value of your practice can be a great way to create leverage and improve the performance of your practice. Business intelligence (BI) is the result of a complete system that produces meaningful insights by providing the information necessary to make business decisions. Changes made from these insights improve both the performance and value of your practice. It is important to identify the key elements required of a good BI system and the areas within a practice that can directly benefit from an effective BI system.

Evidence-based use of electronic clinical tracking systems in advanced practice registered nurse education: an integrative review.

PubMed

Branstetter, M Laurie; Smith, Lynette S; Brooks, Andrea F

2014-07-01

Over the past decade, the federal government has mandated healthcare providers to incorporate electronic health records into practice by 2015. This technological update in healthcare documentation has generated a need for advanced practice RN programs to incorporate information technology into education. The National Organization of Nurse Practitioner Faculties created core competencies to guide program standards for advanced practice RN education. One core competency is Technology and Information Literacy. Educational programs are moving toward the utilization of electronic clinical tracking systems to capture students' clinical encounter data. The purpose of this integrative review was to evaluate current research on advanced practice RN students' documentation of clinical encounters utilizing electronic clinical tracking systems to meet advanced practice RN curriculum outcome goals in information technology as defined by the National Organization of Nurse Practitioner Faculties. The state of the science depicts student' and faculty attitudes, preferences, opinions, and data collections of students' clinical encounters. Although electronic clinical tracking systems were utilized to track students' clinical encounters, these systems have not been evaluated for meeting information technology core competency standards. Educational programs are utilizing electronic clinical tracking systems with limited evidence-based literature evaluating the ability of these systems to meet the core competencies in advanced practice RN programs.

Relationship between quality of care and choice of clinical computing system: retrospective analysis of family practice performance under the UK's quality and outcomes framework.

PubMed

Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim

2013-08-02

To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Retrospective longitudinal study. Data for 2007-2008 to 2010-2011, extracted from the clinical computer systems of general practices in England. All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system.

12 CFR 227.14 - Unfair or deceptive practices involving cosigners.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 3 2012-01-01 2012-01-01 false Unfair or deceptive practices involving cosigners. 227.14 Section 227.14 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule...

12 CFR 227.14 - Unfair or deceptive practices involving cosigners.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 3 2011-01-01 2011-01-01 false Unfair or deceptive practices involving cosigners. 227.14 Section 227.14 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule...

12 CFR 227.14 - Unfair or deceptive practices involving cosigners.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Unfair or deceptive practices involving cosigners. 227.14 Section 227.14 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule...

The mediating effect of context variation in mixed practice for transfer of basic science.

PubMed

Kulasegaram, Kulamakan; Min, Cynthia; Howey, Elizabeth; Neville, Alan; Woods, Nicole; Dore, Kelly; Norman, Geoffrey

2015-10-01

Applying a previously learned concept to a novel problem is an important but difficult process called transfer. Practicing multiple concepts together (mixed practice mode) has been shown superior to practicing concepts separately (blocked practice mode) for transfer. This study examined the effect of single and multiple practice contexts for both mixed and blocked practice modalities on transfer performance. We looked at performance on near transfer (familiar contexts) cases and far transfer (unfamiliar contexts) cases. First year psychology students (n = 42) learned three physiological concepts in a 2 × 2 factorial study (one or two practice contexts and blocked or mixed practice). Each concept was practiced with two clinical cases; practice context was defined as the number of organ systems used (one system per concept vs. two systems). In blocked practice, two practice cases followed each concept; in mixed practice, students learned all concepts before seeing six practice cases. Transfer testing consisted of correctly classifying and explaining 15 clinical cases involving near and far transfer. The outcome was ratings of quality of explanations on a 0-3 scale. The repeated measures analysis showed a significant near versus far by organ system interaction [F(1,38) = 3.4, p < 0.002] with practice with a single context showing lower far transfer scores than near transfer [0.58 (0.37)-0.83 (0.37)] compared to the two contexts which had similar far and near transfer scores [1.19 (0.50)-1.01 (0.38)]. Practicing with two organ contexts had a significant benefit for far transfer regardless of mixed or blocked practice; the single context mixed practice group had the lowest far transfer performance; this was a large effect size (Cohen's d = 0.81). Using only one practice context during practice significantly lowers performance even with the usually superior mixed practice mode. Novices should be exposed to multiple contexts and mixed practice to facilitate transfer.

What Indicates Competency in Systems Based Practice? An Analysis of Perspective Consistency among Healthcare Team Members

ERIC Educational Resources Information Center

Graham, Mark J.; Naqvi, Zoon; Encandela, John A.; Bylund, Carma L.; Dean, Randa; Calero-Breckheimer, Ayxa; Schmidt, Hilary J.

2009-01-01

In many parts of the world the practice of medicine and medical education increasingly focus on providing patient care within context of the larger healthcare system. Our purpose is to solicit perceptions of all professional stakeholders (e.g. nurses) of the system regarding the U.S. ACGME competency Systems Based Practice to uncover the extent to…

Cultivation mode research of practical application talents for optical engineering major

NASA Astrophysics Data System (ADS)

Liu, Zhiying

2017-08-01

The requirements on science and technology graduates are more and higher with modern science progress and society market economy development. Because optical engineering major is with very long practicality, practice should be paid more attention from analysis of optical engineering major and students' foundation. To play role of practice to a large amount, the practice need be systemic and correlation. It should be combination of foundation and profundity. Modern foundation professional knowledge is studied with traditional optical concept and technology at the same time. Systemic regularity and correlation should be embodied in the contents. Start from basic geometrical optics concept, the optical parameter of optical instrument is analyzed, the optical module is built and ray tracing is completed during geometrical optics practice. With foundation of primary aberration calculation, the optical system is further designed and evaluated during optical design practice course. With the optical model and given instrument functions and requirements, the optical-mechanism is matched. The accuracy is calculated, analyzed and distributed in every motion segment. And the mechanism should guarantee the alignment and adjustment. The optical mechanism is designed during the instrument and element design practice. When the optical and mechanism drawings are completed, the system is ready to be fabricated. Students can complete grinding, polishing and coating process by themselves through optical fabricating practice. With the optical and mechanical elements, the system can be assembled and aligned during the thesis practice. With a set of correlated and logical practices, the students can acquire the whole process knowledge about optical instrument. All details are contained in every practice process. These practical experiences provide students working ability. They do not need much adaption anymore when they go to work after graduation. It is favorable to both student talents and employer.

STP Position Paper: Recommended Practices for Sampling and Processing the Nervous System (Brain, Spinal Cord, Nerve, and Eye) during Nonclinical General Toxicity Studies

EPA Science Inventory

The Society of Toxicologic Pathology charged a Nervous System Sampling Working Group with devising recommended practices to routinely screen the central and peripheral nervous systems in Good Laboratory Practice-type nonclinical general toxicity studies. Brains should be trimmed ...

E-Learning System for Experiments Involving Construction of Practical Electronic Circuits

ERIC Educational Resources Information Center

Takemura, Atsushi

2013-01-01

This paper proposes a novel e-learning system for technical experiments involving the construction of practical electronic circuits; this system would meet the various demands of individual experimenters. This mixed mode is beneficial for practical use in that an experimenter who does not have sufficient circuit components for circuit making can…

Nineteenth-Century World's Fairs as Accountability Systems: Scopic Systems, Audit Practices and Educational Data

ERIC Educational Resources Information Center

Sobe, Noah W.; Boven, David T.

2014-01-01

Late-19th century World's Fairs constitute an important chapter in the history of educational accountability. International expositions allowed for educational systems and practices to be "audited" by lay and expert audiences. In this article we examine how World's Fair exhibitors sought to make visible educational practices and…

Current Faculty Development Practices for Alternative Delivery Systems in Christian Higher Education Institutions: A Qualitative Study

ERIC Educational Resources Information Center

Yates, Steven Lowell

2009-01-01

This research study was an investigation of current faculty development practices for alternative delivery systems. Attention was given to faculty development in general as well as specific facets of faculty development for alternative delivery systems. Future or intended faculty development practices were pursued, along with factors that…

Education System Reform in China after 1978: Some Practical Implications

ERIC Educational Resources Information Center

Sun, Miantao

2010-01-01

Purpose: This paper aims to provide an overview of education system reform in China since 1978, and its practical implications. Design/methodology/approach: Data were collected from literature review and interview. An overview of education system reform and its practical implications was found through data analysis. Findings: There has been two…

A sustainable primary care system: lessons from the Netherlands.

PubMed

Faber, Marjan J; Burgers, Jako S; Westert, Gert P

2012-01-01

The Dutch primary care system has drawn international attention, because of its high performance at low cost. Primary care practices are easily accessible during office hours and collaborate in a unique out-of-hours system. After the reforms in 2006, there are no copayments for patients receiving care in the primary care practice in which they are registered. Financial incentives support the transfer of care from hospital specialists to primary care physicians, and task delegation from primary care physicians to practice nurses. Regional collaborative care groups of primary care practices offer disease management programs. The quality assessment system and the electronic medical record system are predominantly driven by health care professionals. Bottom-up and top-down activities contributed to a successful Dutch primary care system.

Understanding the business of employed physician practices.

PubMed

Sanford, Kathleen D

2013-09-01

Health system leaders should understand issues related to finance, compliance, human resources, quality, and safety in their employed physician practices to better support the success of these practices. New business and payment models are driving operational changes in physician offices. Catholic Health Initiatives (CHI) has added new system roles and responsibilities to oversee physician practices.

An organizational cybernetics framework for achieving balance in evidence-based practice and practice-based evidence.

PubMed

Fitch, Dale

2014-01-01

This article applies the systems science of organizational cybernetics to the implementation of evidence-based practice (EBP) in the provision of social work services in a residential treatment center setting. It does so by systemically balancing EBP with practice-based evidence (PBE) with a focus on the organizational and information system infrastructures necessary to ensure successful implementation. This application is illustrated by discussing a residential treatment program that implemented evidence-based programming and evaluated the results; however, the systemic principles articulated can be applied to any human services organizational setting.

GN&C Engineering Best Practices for Human-Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2007-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

GN&C Engineering Best Practices for Human-Rated Spacecraft System

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2008-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

GN&C Engineering Best Practices For Human-Rated Spacecraft Systems

NASA Technical Reports Server (NTRS)

Dennehy, Cornelius J.; Lebsock, Kenneth; West, John

2007-01-01

The NASA Engineering and Safety Center (NESC) recently completed an in-depth assessment to identify a comprehensive set of engineering considerations for the Design, Development, Test and Evaluation (DDT&E) of safe and reliable human-rated spacecraft systems. Reliability subject matter experts, discipline experts, and systems engineering experts were brought together to synthesize the current "best practices" both at the spacecraft system and subsystems levels. The objective of this paper is to summarize, for the larger Community of Practice, the initial set of Guidance, Navigation and Control (GN&C) engineering Best Practices as identified by this NESC assessment process.

Relationship between quality of care and choice of clinical computing system: retrospective analysis of family practice performance under the UK's quality and outcomes framework

PubMed Central

Kontopantelis, Evangelos; Buchan, Iain; Reeves, David; Checkland, Kath; Doran, Tim

2013-01-01

Objectives To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system. Design Retrospective longitudinal study. Setting Data for 2007–2008 to 2010–2011, extracted from the clinical computer systems of general practices in England. Participants All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice. Main outcome measures Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement. Results Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels). Conclusions Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system. PMID:23913774

Increased Use of Care Management Processes and Expanded Health Information Technology Functions by Practice Ownership and Medicaid Revenue.

PubMed

Rodriguez, Hector P; McClellan, Sean R; Bibi, Salma; Casalino, Lawrence P; Ramsay, Patricia P; Shortell, Stephen M

2016-06-01

Practice ownership and Medicaid revenue may affect the use of care management processes (CMPs) for chronic conditions and expansion of health information technology (HIT). Using a national cohort of medical practices, we compared the use of CMPs and HIT from 2006/2008 to 2013 by practice ownership and level of Medicaid revenue. Poisson regression models estimated changes in CMP use, and linear regression estimated changes in HIT, by practice ownership and Medicaid patient revenue, controlling for other practice characteristics. Compared with physician-owned practices, system-owned practices adopted a greater number of CMPs and HIT functions over time (p < .001). High Medicaid revenue (≥30.0%) was associated with less adoption of CMPs (p < .001) and HIT (p < .01). System-owned practices (p < .001) and community health centers (p < .001) with high Medicaid revenue were more likely than physician-owned practices with high Medicaid revenue to adopt CMPs over time. System and community health center ownership appear to help high Medicaid practices overcome CMP adoption constraints. © The Author(s) 2015.

Assessment of the Orion-SLS Interface Management Process in Achieving the EIA 731.1 Systems Engineering Capability Model Generic Practices Level 3 Criteria

NASA Technical Reports Server (NTRS)

Jellicorse, John J.; Rahman, Shamin A.

2016-01-01

NASA is currently developing the next generation crewed spacecraft and launch vehicle for exploration beyond earth orbit including returning to the Moon and making the transit to Mars. Managing the design integration of major hardware elements of a space transportation system is critical for overcoming both the technical and programmatic challenges in taking a complex system from concept to space operations. An established method of accomplishing this is formal interface management. In this paper we set forth an argument that the interface management process implemented by NASA between the Orion Multi-Purpose Crew Vehicle (MPCV) and the Space Launch System (SLS) achieves the Level 3 tier of the EIA 731.1 System Engineering Capability Model (SECM) for Generic Practices. We describe the relevant NASA systems and associated organizations, and define the EIA SECM Level 3 Generic Practices. We then provide evidence for our compliance with those practices. This evidence includes discussions of: NASA Systems Engineering Interface (SE) Management standard process and best practices; the tailoring of that process for implementation on the Orion to SLS interface; changes made over time to improve the tailored process, and; the opportunities to take the resulting lessons learned and propose improvements to our institutional processes and best practices. We compare this evidence against the practices to form the rationale for the declared SECM maturity level.

Elementary Education Program for Engineering by Dual System of Workshop and Teaching Program with Practical Subject

NASA Astrophysics Data System (ADS)

Hara, Toshitsugu

Elementary education program for engineering by the dual system combined with workshop program and teaching program with practical subject was discussed. The dual system which consists of several workshop programs and fundamental subjects (such as mathematics, English and physics) with practical material has been performed for the freshmen. The elementary workshop program (primary course) has four workshops and the related lectures. Fundamental subjects are taught with the practical or engineering texts. English subjects are taught by specified teachers who have ever worked in engineering field with English. The dual system was supported by such systems as the center for success initiative and the English education center.

Integrating machine learning to achieve an automatic parameter prediction for practical continuous-variable quantum key distribution

NASA Astrophysics Data System (ADS)

Liu, Weiqi; Huang, Peng; Peng, Jinye; Fan, Jianping; Zeng, Guihua

2018-02-01

For supporting practical quantum key distribution (QKD), it is critical to stabilize the physical parameters of signals, e.g., the intensity, phase, and polarization of the laser signals, so that such QKD systems can achieve better performance and practical security. In this paper, an approach is developed by integrating a support vector regression (SVR) model to optimize the performance and practical security of the QKD system. First, a SVR model is learned to precisely predict the time-along evolutions of the physical parameters of signals. Second, such predicted time-along evolutions are employed as feedback to control the QKD system for achieving the optimal performance and practical security. Finally, our proposed approach is exemplified by using the intensity evolution of laser light and a local oscillator pulse in the Gaussian modulated coherent state QKD system. Our experimental results have demonstrated three significant benefits of our SVR-based approach: (1) it can allow the QKD system to achieve optimal performance and practical security, (2) it does not require any additional resources and any real-time monitoring module to support automatic prediction of the time-along evolutions of the physical parameters of signals, and (3) it is applicable to any measurable physical parameter of signals in the practical QKD system.

The Design of a Practical Enterprise Safety Management System

NASA Astrophysics Data System (ADS)

Gabbar, Hossam A.; Suzuki, Kazuhiko

This book presents design guidelines and implementation approaches for enterprise safety management system as integrated within enterprise integrated systems. It shows new model-based safety management where process design automation is integrated with enterprise business functions and components. It proposes new system engineering approach addressed to new generation chemical industry. It will help both the undergraduate and professional readers to build basic knowledge about issues and problems of designing practical enterprise safety management system, while presenting in clear way, the system and information engineering practices to design enterprise integrated solution.

Social Ecology of Asthma: Engaging Stakeholders in Integrating Health Behavior Theories and Practice-Based Evidence through Systems Mapping

ERIC Educational Resources Information Center

Gillen, Emily M.; Hassmiller Lich, Kristen; Yeatts, Karin B.; Hernandez, Michelle L.; Smith, Timothy W.; Lewis, Megan A.

2014-01-01

This article describes a process for integrating health behavior and social science theories with practice-based insights using participatory systems thinking and diagramming methods largely inspired by system dynamics methods. This integration can help close the gap between research and practice in health education and health behavior by offering…

Structural Decoupling between the VET and the Employment Systems: Challenges Manifested in Assessment of Practical Training

ERIC Educational Resources Information Center

Umarik, Meril; Loogma, Krista; Hinno, Krista

2010-01-01

This article aims to analyse how structural decoupling, which is an especially relevant problem for school-based vocational education and training (VET) systems, reveals itself in the assessment of practical training. Niklas Luhmann's social system theory has been applied to the analysis of assessment practices as a communication act between the…

40 CFR 141.553 - My system practices lime softening-is there any special provision regarding my combined filter...

Code of Federal Regulations, 2014 CFR

2014-07-01

... there any special provision regarding my combined filter effluent? 141.553 Section 141.553 Protection of... Filter Effluent Requirements § 141.553 My system practices lime softening—is there any special provision regarding my combined filter effluent? If your system practices lime softening, you may acidify...

40 CFR 141.553 - My system practices lime softening-is there any special provision regarding my combined filter...

Code of Federal Regulations, 2013 CFR

2013-07-01

... there any special provision regarding my combined filter effluent? 141.553 Section 141.553 Protection of... Filter Effluent Requirements § 141.553 My system practices lime softening—is there any special provision regarding my combined filter effluent? If your system practices lime softening, you may acidify...

40 CFR 141.553 - My system practices lime softening-is there any special provision regarding my combined filter...

Code of Federal Regulations, 2012 CFR

2012-07-01

... there any special provision regarding my combined filter effluent? 141.553 Section 141.553 Protection of... Filter Effluent Requirements § 141.553 My system practices lime softening—is there any special provision regarding my combined filter effluent? If your system practices lime softening, you may acidify...

40 CFR 141.553 - My system practices lime softening-is there any special provision regarding my combined filter...

Code of Federal Regulations, 2010 CFR

2010-07-01

... there any special provision regarding my combined filter effluent? 141.553 Section 141.553 Protection of... Filter Effluent Requirements § 141.553 My system practices lime softening—is there any special provision regarding my combined filter effluent? If your system practices lime softening, you may acidify...

40 CFR 141.553 - My system practices lime softening-is there any special provision regarding my combined filter...

Code of Federal Regulations, 2011 CFR

2011-07-01

... there any special provision regarding my combined filter effluent? 141.553 Section 141.553 Protection of... Filter Effluent Requirements § 141.553 My system practices lime softening—is there any special provision regarding my combined filter effluent? If your system practices lime softening, you may acidify...

Impact of a Generalizable Reminder System on Colorectal Cancer Screening in Diverse Primary Care Practices

PubMed Central

Nease, Donald E.; Ruffin, Mack T.; Klinkman, Michael S.; Jimbo, Masahito; Braun, Thomas M.; Underwood, Jennifer M.

2015-01-01

Background Computerized reminder systems (CRS) show promise for increasing preventive services such as colorectal cancer (CRC) screening. However, prior research has not evaluated a generalizable CRS across diverse, community primary care practices. We evaluated whether a generalizable CRS, ClinfoTracker, could improve screening rates for CRC in diverse primary care practices. Methods The study was a prospective trial to evaluate ClinfoTracker using historical control data in 12 Great Lakes Research In Practice Network community-based, primary care practices distributed from Southeast to Upper Peninsula Michigan. Our outcome measures were pre- and post-study practice-level CRC screening rates among patients seen during the 9-month study period. Ability to maintain the CRS was measured by days of reminder printing. Field notes were used to examine each practice’s cohesion and technology capabilities. Results All but one practice increased their CRC screening rates, ranging from 3.3% to 16.8% improvement. t tests adjusted for within practice correlation showed improvement in screening rates across all 12 practices, from 41.7% to 50.9%, P = 0.002. Technology capabilities impacted printing days (74% for high technology vs. 45% for low technology practices, P = 0.01), and cohesion demonstrated an impact trend for screening (15.3% rate change for high cohesion vs. 7.9% for low cohesion practices). Conclusions Implementing a generalizable CRS in diverse primary care practices yielded significant improvements in CRC screening rates. Technology capabilities are important in maintaining the system, but practice cohesion may have a greater influence on screening rates. This work has important implications for practices implementing reminder systems. PMID:18725836

A Constructive Reframing of Student Roles and Systems Learning in Medical Education Using a Communities of Practice Lens.

PubMed

Gonzalo, Jed D; Thompson, Britta M; Haidet, Paul; Mann, Karen; Wolpaw, Daniel R

2017-12-01

Health systems are in the midst of a transformation that is being driven by a variety of forces. This has important implications for medical educators because clinical practice environments play a key role in learning and professional development, and evolving health systems are beginning to demand that providers have "systems-ready" knowledge, attitudes, and skills. Such implications provide a clear mandate for medical schools to modify their goals and prepare physicians to practice flexibly within teams and effectively contribute to the improvement of health care delivery. In this context, the concepts of value-added medical education, authentic student roles, and health systems science are emerging as increasingly important. In this Article, the authors use a lens informed by communities of practice theory to explore these three concepts, examining the implications that the communities of practice theory has in the constructive reframing of educational practices-particularly common student roles and experiences-and charting future directions for medical education that better align with the needs of the health care system. The authors apply several key features of the communities of practice theory to current experiential roles for students, then propose a new approach to students' clinical experiences-value-added clinical systems learning roles-that provides students with opportunities to make meaningful contributions to patient care while learning health systems science at the patient and population level. Finally, the authors discuss implications for professional role formation and anticipated challenges to the design and implementation of value-added clinical systems learning roles.

Academy of Nutrition and Dietetics: Standards of professional performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Sustainable, Resilient, and Healthy Food and Water Systems.

PubMed

Tagtow, Angie; Robien, Kim; Bergquist, Erin; Bruening, Meg; Dierks, Lisa; Hartman, Barbara E; Robinson-O'Brien, Ramona; Steinitz, Tamara; Tahsin, Bettina; Underwood, Teri; Wilkins, Jennifer

2014-03-01

Sustainability is the ability of a system to be maintained over the long term. Resilience is the ability of a system to withstand disturbances and continue to function in a sustainable manner. Issues of sustainability and resilience apply to all aspects of nutrition and dietetics practice, can be practiced at both the program and systems level, and are broader than any one specific practice setting or individual intervention. Given an increasing need to apply principles of sustainability and resilience to nutrition and dietetics practice, as well as growing interest among the public and by Registered Dietitian Nutritionists of health issues related to food and water systems, the Hunger and Environmental Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Standards of Professional Performance as a tool for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems to assess their current skill levels and to identify areas for further professional development in this emerging practice area. This Standards of Professional Performance document covers six standards of professional performance: quality in practice, competence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources. Within each standard, specific indicators provide measurable action statements that illustrate how sustainable, resilient, and healthy food and water systems principles can be applied to practice. The indicators describe three skill levels (competent, proficient, and expert) for Registered Dietitian Nutritionists working in sustainable, resilient, and healthy food and water systems. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

A Framework of Working Across Disciplines in Early Design and R&D of Large Complex Engineered Systems

NASA Technical Reports Server (NTRS)

McGowan, Anna-Maria Rivas; Papalambros, Panos Y.; Baker, Wayne E.

2015-01-01

This paper examines four primary methods of working across disciplines during R&D and early design of large-scale complex engineered systems such as aerospace systems. A conceptualized framework, called the Combining System Elements framework, is presented to delineate several aspects of cross-discipline and system integration practice. The framework is derived from a theoretical and empirical analysis of current work practices in actual operational settings and is informed by theories from organization science and engineering. The explanatory framework may be used by teams to clarify assumptions and associated work practices, which may reduce ambiguity in understanding diverse approaches to early systems research, development and design. The framework also highlights that very different engineering results may be obtained depending on work practices, even when the goals for the engineered system are the same.

Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

ERIC Educational Resources Information Center

Margolis, Peter A.; DeWalt, Darren A.; Simon, Janet E.; Horowitz, Sheldon; Scoville, Richard; Kahn, Norman; Perelman, Robert; Bagley, Bruce; Miles, Paul

2010-01-01

Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and…

Ethical Tensions Related to Systemic Constraints: Occupational Alienation in Occupational Therapy Practice.

PubMed

Durocher, Evelyne; Kinsella, Elizabeth Anne; McCorquodale, Lisa; Phelan, Shanon

2016-09-03

Ethical tensions arise daily in health care practice and are frequently related to health care system structures or policies. Collective case study methodology was adopted to examine ethical tensions reported by occupational therapists practicing in different settings in Southwestern Ontario, Canada. Inductive analysis involving multiple layers of coding was conducted. This article focuses on tensions related to systemic constraints. Participants reported ethical tensions related to balancing client priorities with those of health care services. Four themes related to systemic constraints were identified including imposed practices, ineffective processes, resource limitations, and lack of services. Therapists' aims could be seen to align with an "ethic of care" and were seen to be in tension in light of systemic constraints. The findings raise issues related to occupational justice, particularly related to occupational alienation in occupational therapy practice, and open conversations related to neoliberalist health care agendas. © The Author(s) 2016.

Rail Transit System Maintenance Practices for Automatic Fare Collection Equipment

DOT National Transportation Integrated Search

1984-05-01

A review of rail transit system maintenance practices for automatic fare collection (AFC) equipment was performed. This study supports an UMTA sponsored program to improve the reliability of AFC equipment. The maintenance practices of the transit sys...

Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study.

PubMed

Kontopantelis, Evangelos; Stevens, Richard John; Helms, Peter J; Edwards, Duncan; Doran, Tim; Ashcroft, Darren M

2018-02-28

UK primary care databases (PCDs) are used by researchers worldwide to inform clinical practice. These databases have been primarily tied to single clinical computer systems, but little is known about the adoption of these systems by primary care practices or their geographical representativeness. We explore the spatial distribution of clinical computing systems and discuss the implications for the longevity and regional representativeness of these resources. Cross-sectional study. English primary care clinical computer systems. 7526 general practices in August 2016. Spatial mapping of family practices in England in 2016 by clinical computer system at two geographical levels, the lower Clinical Commissioning Group (CCG, 209 units) and the higher National Health Service regions (14 units). Data for practices included numbers of doctors, nurses and patients, and area deprivation. Of 7526 practices, Egton Medical Information Systems (EMIS) was used in 4199 (56%), SystmOne in 2552 (34%) and Vision in 636 (9%). Great regional variability was observed for all systems, with EMIS having a stronger presence in the West of England, London and the South; SystmOne in the East and some regions in the South; and Vision in London, the South, Greater Manchester and Birmingham. PCDs based on single clinical computer systems are geographically clustered in England. For example, Clinical Practice Research Datalink and The Health Improvement Network, the most popular primary care databases in terms of research outputs, are based on the Vision clinical computer system, used by <10% of practices and heavily concentrated in three major conurbations and the South. Researchers need to be aware of the analytical challenges posed by clustering, and barriers to accessing alternative PCDs need to be removed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Elaborating on systems thinking in health promotion practice.

PubMed

Naaldenberg, Jenneken; Vaandrager, Lenneke; Koelen, Maria; Wagemakers, Anne-Marie; Saan, Hans; de Hoog, Kees

2009-03-01

Health and well-being are the result of a series of complex processes in which an individual interacts with other people and the environment. A systematic approach ensures incorporation of individual, ecological, social and political factors. However, interactions between these factors can be overlooked within a systematical approach. A systemic approach can provide additional information by incorporating interactions and communication. The opportunities of a systems thinking perspective for health promotion were investigated for this paper. Although others have also made attempts to explore systems thinking in the field of health promotion, the implications of systems thinking in practice need attention. Other fields such as agricultural extension studies, organizational studies and development studies provide useful experiences with the use of a systems thinking perspective in practice. Building on experiences from these fields, we give a theoretical background in which processes of social learning and innovation play an important role. From this background, we derive an overview of important concepts for the practical application of a systems thinking perspective. These concepts are the structure of the system, meanings attached to actions, and power relations between actors. To make these concepts more explicit and reduce the theoretical character of systems thinking, we use an illustration to elaborate on these concepts in practice. For this purpose, we describe a health promotion partnership in The Netherlands using the concepts structure, meaning and power relations. We show how a systems perspective increases insight in the functioning of a partnership and how this can facilitate processes of social learning and innovation. This article concludes by identifying future opportunities and challenges in adopting systems thinking for health promotion practice. A systems perspective towards health promotion can help projects reaching a more integral and sustainable approach in which the complex nature of health promotion processes is supported. Practical applications of systems thinking are necessary to adapt this perspective.

An International Surgical Rotation as a Systems-Based Elective: The Botswana-University of Pennsylvania Surgical Experience.

PubMed

Cintolo-Gonzalez, Jessica A; Bedada, Alemayehu Ginbo; Morris, Jon; Azzie, Georges

2016-01-01

There is a growing need to address the global burden of surgical disease along with increasing interest in international surgical practice, necessitating an understanding of the challenges and issues that arise on a systems level when practicing abroad. This elective is a month-long rotation in which senior surgical residents participate in patient care as part of a surgical team in the main tertiary and teaching hospital in Gaborone, the capital city of Botswana. Clinical experience is combined with formal readings and educational sessions, with the attending surgeon supervising the program to develop a systems-based curriculum that contextualizes the clinical experience. A formal debriefing and written reflections by the residents at the conclusion of the rotation are used to qualitatively assess resident development and insight into systems-based international surgical practice. Princess Marina Hospital, Gaborone, Botswana. General surgery residents in their fourth clinical year of training. Our elective met important requirements outlined in the literature for foreign practice, including adequate supervision of the American trainees and care to not detract from local trainees' educational experience. Residents' debriefing and written reflections demonstrated an increased understanding of systems-based practice and awareness of issues important to successful international surgical practice and collaboration. Our global surgery elective with a focus on systems-based practice sensitizes residents to the challenges and issues they must be aware of when practicing internationally. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

The utility of an online diagnostic decision support system (Isabel) in general practice: a process evaluation.

PubMed

Henderson, Emily J; Rubin, Greg P

2013-05-01

To evaluate the utility of Isabel, an online diagnostic decision support system developed by Isabel Healthcare primarily for secondary medical care, in the general practice setting. Focus groups were conducted with clinicians to understand why and how they used the system. A modified online post-use survey asked practitioners about its impact on their decision-making. Normalization process theory (NPT) was used as a theoretical framework to determine whether the system could be incorporated into routine clinical practice. The system was introduced by NHS County Durham and Darlington in the UK in selected general practices as a three-month pilot. General practitioners and nurse practitioners who had access to Isabel as part of the Primary Care Trust's pilot. General practitioners' views, experiences and usage of the system. Seven general practices agreed to pilot Isabel. Two practices did not subsequently use it. The remaining five practices conducted searches on 16 patients. Post-use surveys (n = 10) indicated that Isabel had little impact on diagnostic decision-making. Focus group participants stated that, although the diagnoses produced by Isabel in general did not have an impact on their decision-making, they would find the tool useful if it were better tailored to the primary care setting. Our analysis concluded that normalization was not likely to occur in its current form. Isabel was of limited utility in this short pilot study and may need further modification for use in general practice.

21 CFR 26.1 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN... regulatory systems means that the systems are sufficiently comparable to assure that the process of... require that the respective regulatory systems have identical procedures. (c) Good Manufacturing Practices...

21 CFR 4.4 - How can I comply with these current good manufacturing practice requirements for a co-packaged or...

Code of Federal Regulations, 2014 CFR

2014-04-01

... practice operating system in accordance with paragraph (b) of this section, the following requirements..., and the current good manufacturing practice operating system has been shown to comply with the drug... operating system has been shown to comply with the QS regulation, the following provisions of the drug CGMPs...

21 CFR 4.4 - How can I comply with these current good manufacturing practice requirements for a co-packaged or...

Code of Federal Regulations, 2013 CFR

2013-04-01

... practice operating system in accordance with paragraph (b) of this section, the following requirements..., and the current good manufacturing practice operating system has been shown to comply with the drug... operating system has been shown to comply with the QS regulation, the following provisions of the drug CGMPs...

Developing a cost accounting system for a physician group practice.

PubMed

Mays, J; Gordon, G

1996-10-01

Physicians in group practices must gain a competitive edge to survive in a healthcare environment in which cost efficiency has become critical to success. One tool that can help them is a cost accounting system that yields reliable, detailed data on the costs of delivering care. Such a system not only can enable physicians and group administrators to manage their operations more cost-effectively, but also can help them accurately assess the potential profitability of prospective managed care plans. An otolaryngology practice located in Mississippi provides a model for developing a cost accounting system that can be applied to physician group practices.

A decision-support system for the analysis of clinical practice patterns.

PubMed

Balas, E A; Li, Z R; Mitchell, J A; Spencer, D C; Brent, E; Ewigman, B G

1994-01-01

Several studies documented substantial variation in medical practice patterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purpose of developing an expert system for the analysis of clinical practice patterns was to assist providers in analyzing and improving the process and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measurable quality improvement objectives. Based on objectives and actual clinical data, several measures can be calculated (utilization of procedures, annualized cost effect of using a particular procedure, and expected utilization based on peer-comparison and case-mix adjustment). The quality management rules help to detect important discrepancies among members of the selected provider group and compare performance with objectives. The system incorporates a variety of data and knowledge bases: (i) clinical data on actual practice patterns, (ii) frames of quality parameters derived from clinical practice guidelines, and (iii) rules of quality management for data analysis. An analysis of practice patterns of 12 family physicians in the management of urinary tract infections illustrates the use of the system.

Study of the Use of Data Systems to Increase Building Leader Capacity and Inform Principal Practice in K-12 Public Schools

ERIC Educational Resources Information Center

DeAngelo, Salvatore, Jr.

2013-01-01

The intention of this qualitative study was to explore the effects that instructional data systems have on a building level leader's capacity to evaluate student growth and inform principal practice. Principal leadership practices were examined through the lens of Kouzes and Postners' five practices of exemplary leadership (Kouzes & Posner,…

Are Characteristics of the Medical Home Associated with Diabetes Care Costs?

PubMed Central

Flottemesch, Thomas J.; Scholle, Sarah Hudson; O’Connor, Patrick J.; Solberg, Leif I.; Asche, Steve; Pawlson, L. Gregory

2015-01-01

Objective To examine the relationship between primary care medical home clinical practice systems (PCMH clinical practice systems) corresponding to the domains of the Chronic Care Model and diabetes-related healthcare costs incurred by members of a health plan who have diagnosed Type 2 diabetes and received care at one of 27 Minnesota-based medical groups over a 12-month period. Study Design Cross-sectional analysis of patient-level cost data in relation to the presence of PCMH clinical practice systems by Chronic Care Model domain using the Physician Practice Connections Readiness Survey (PPC-RS). Methods Multivariate regressions adjusting for patient demographics, health status and comorbidities estimated the relationship between the presence of PCMH clinical practice systems as measured by the PPC-RS and three outcomes: total diabetes-related healthcare costs, ambulatory care management costs, and potentially avoidable costs (e.g. unscheduled inpatient and emergency care). Results Two domains of PCMH clinical practice systems as measured by the PPC-RS were significantly associated with reductions in potentially avoidable costs. These were Health Care Organization (p=.04) and clinical reminder systems in the Decision Support domain (p=.01). Compared to medical groups with only quality improvement, those with improved Health Care Organization defined as performance measurement and individual provider feedback averaged $245/patient less. Similarly, medical groups with clinical reminders for counseling averaged $338/patient less. Conclusions PCMH clinical practice systems that correspond to some domains of the Chronic Care Model are related to reduced inpatient and emergency care costs. Further research is needed about how these systems impact costs over time. PMID:22710277

Systems Thinking: A New Lens for Old Problems

ERIC Educational Resources Information Center

Bierema, Laura L.

2003-01-01

This article introduces systems thinking and identifies its implications for practice-based learning and improvement. The article defines systems, identifies fundamental aspects of systems thinking, and provides strategies for creating more practice-based learning environments in medical contexts. (Contains 1 table.)

Navigating systems ideas for health practice: Towards a common learning device.

PubMed

Reynolds, Martin; Sarriot, Eric; Swanson, Robert Chad; Rusoja, Evan

2018-06-01

Systems thinking and reference to complexity science have gained currency in health sector practice and research. The extent to which such ideas might represent a mere passing fad or might more usefully be mobilized to tackle wicked problems in health systems is a concern underpinning this paper. Developing the usefulness of the systems idea requires appreciating how systems ideas are used essentially as constructs conceptually bounded by practitioners. Systems are used for purposes of understanding and engaging the reality of health issues, with the intent of transforming the reality into one that is more manageable, equitable, and sustainable. We examine some manifestations of the systems idea in health practice and the traditions of systems practice that variously make use of them. This provides a platform for proposing a systems thinking in (health) practice heuristic: a learning device supporting how different tools and methods can address "wicked problems" in health praxis. The device is built on the use of "conversation" as a metaphor to help practitioners use systems ideas in tandem with existing disciplinary and professional skills and methods. We consider how the application of the heuristic requires, and helps to develop, human characteristics of humility, empathy, and recognition of fallibility. © 2018 John Wiley & Sons, Ltd.

Best practices for implementing, testing and using a cloud-based communication system in a disaster situation.

PubMed

Makowski, Dale

2016-01-01

This paper sets out the basics for approaching the selection and implementation of a cloud-based communication system to support a business continuity programme, including: • consideration for how a cloud-based communication system can enhance a business continuity programme; • descriptions of some of the more popular features of a cloud-based communication system; • options to evaluate when selecting a cloud-based communication system; • considerations for how to design a system to be most effective for an organisation; • best practices for how to conduct the initial load of data to a cloud-based communication system; • best practices for how to conduct an initial validation of the data loaded to a cloud-based communication system; • considerations for how to keep contact information in the cloud-based communication system current and accurate; • best practices for conducting ongoing system testing; • considerations for how to conduct user training; • review of other potential uses of a cloud-based communication system; and • review of other tools and features many cloud-based communication systems may offer.

7 CFR 631.11 - Conservation practice maintenance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... resource management systems or conservation practices applied under the contract for the duration of the... contract. (b) If the life span of the practices or resource management systems extends beyond the period of....11 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES...

A resident conference for systems-based practice and practice-based learning.

PubMed

Sultana, Carmen J; Baxter, Jason K

2011-02-01

Improving patient safety and quality of care is part of systems-based practice and practice-based learning for residents. We expanded our obstetrics and gynecology department's regularly scheduled morbidity and mortality conferences to teach quality assurance concepts based on patient care on obstetrics and gynecology fourth-year resident rotations. Obstetrics and gynecology fourth-year residents on one of the two rotations each presented and analyzed a systems-based problem they encountered during patient care. They used an online learning module and proposed solutions, many of which were effectively implemented. Over 5 years, case presentations from 33 conferences were available with problems identified in emergency preparedness, coordination of care, scheduling and supervision, communication, medical practice, documentation, and lack of equipment or facilities. Twenty-two of the suggested solutions were partially or totally implemented. Barriers to implementation were identified. In conclusion, a conference presentation by fourth-year residents can identify patient safety problems, aid in their resolution, and suggest changes to patient care while teaching the principles of systems-based practice and practice-based learning.

75 FR 79345 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

... accounting system for health care billing practices. It shall assist military treatment facilities in the... accounting system for health care billing practices. It shall assist military treatment facilities in the...; System of Records AGENCY: Office of the Secretary of Defense, DoD. ACTION: Notice to Alter a System of...

16 CFR 1000.13 - Directives System.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Directives System. 1000.13 Section 1000.13 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.13 Directives System. The Commission maintains a Directives System which contains delegations of...

16 CFR 1000.13 - Directives System.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Directives System. 1000.13 Section 1000.13 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.13 Directives System. The Commission maintains a Directives System which contains delegations of...

16 CFR 1000.13 - Directives System.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Directives System. 1000.13 Section 1000.13 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.13 Directives System. The Commission maintains a Directives System which contains delegations of...

40 CFR 63.7926 - How do I demonstrate initial compliance with the emission limitations and work practice standards...

Code of Federal Regulations, 2011 CFR

2011-07-01

... work practice standards for carbon adsorption systems in § 63.7925(h) if you have submitted as part of... with each work practice standard that applies to your carbon adsorption system. (f) You must...

Principles and implementations of electrolysis systems for water splitting

DOE PAGES

Xiang, Chengxiang; Papadantonakis, Kimberly M.; Lewis, Nathan S.

2016-02-12

Efforts to develop renewable sources of carbon-neutral fuels have brought a renewed focus to research and development of sunlight-driven water-splitting systems. Electrolysis of water to produce H 2 and O 2 gases is the foundation of such systems, is conceptually and practically simple, and has been practiced both in the laboratory and industrially for many decades. In this Focus article, the fundamentals of water splitting and practices which distinguish commercial water-electrolysis systems from simple laboratory-scale demonstrations are described.

Practical implications of incentive systems are utilized by dental franchises.

PubMed

Yavner, S B

1989-01-01

The success of any dental practice depends, among other factors, on the critical role of staff employees. In order to encourage desired staff behaviors, incentive systems can be designed for employee dentists, assistants/hygienists and managers. A survey of dental franchises was conducted in 1987 for the purpose of examining their incentive control systems. The specific incentives employed by these dental franchises for their employees are analyzed. The implications of these incentive systems used by dental franchise organizations for all dental practices are then discussed.

Systems and complexity thinking in general practice: part 1 - clinical application.

PubMed

Sturmberg, Joachim P

2007-03-01

Many problems encountered in general practice cannot be sufficiently explained within the Newtonian reductionist paradigm. Systems and complexity thinking - already widely adopted in most nonmedical disciplines - describes and explores the contextual nature of questions posed in medicine, and in general practice in particular. This article briefly describes the framework underpinning systems and complexity sciences. A case study illustrates how systems and complexity thinking can help to better understand the contextual nature of patient presentations, and how different approaches will lead to different outcomes.

[ISMP-Spain questionnaire and strategy for improving good medication practices in the Andalusian health system].

PubMed

Padilla-Marín, V; Corral-Baena, S; Domínguez-Guerrero, F; Santos-Rubio, M D; Santana-López, V; Moreno-Campoy, E

2012-01-01

To describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. The strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. We found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. The self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values. Copyright © 2011 SEFH. Published by Elsevier Espana. All rights reserved.

Best Practices for Reduction of Uncertainty in CFD Results

NASA Technical Reports Server (NTRS)

Mendenhall, Michael R.; Childs, Robert E.; Morrison, Joseph H.

2003-01-01

This paper describes a proposed best-practices system that will present expert knowledge in the use of CFD. The best-practices system will include specific guidelines to assist the user in problem definition, input preparation, grid generation, code selection, parameter specification, and results interpretation. The goal of the system is to assist all CFD users in obtaining high quality CFD solutions with reduced uncertainty and at lower cost for a wide range of flow problems. The best-practices system will be implemented as a software product which includes an expert system made up of knowledge databases of expert information with specific guidelines for individual codes and algorithms. The process of acquiring expert knowledge is discussed, and help from the CFD community is solicited. Benefits and challenges associated with this project are examined.

Changing office practice and health care systems to facilitate diabetes self-management.

PubMed

Funnell, Martha M; Anderson, Robert M

2003-04-01

Diabetes is a self-managed disease for which patients provide 99% of their own care. For patients to succeed as diabetes self-managers, they need office practices and health care systems that can prepare and support them in their diabetes self-management efforts over the long term. In order to provide effective diabetes education and ongoing support, office practices and health care systems will have to fundamentally redefine the roles of health professionals and patients with diabetes, and redesign practices and systems to allow for effective long-term self-management education and support. Although it is difficult for both people and systems to change, change is essential if we are going to provide self-management support for the majority of patients suffering from this serious chronic disease.

Course Management Systems for Learning: Beyond Accidental Pedagogy

ERIC Educational Resources Information Center

McGee, Patricia; Carmean, Colleen; Jafari, Ali

2005-01-01

"Course Management Systems for Learning: Beyond Accidental Pedagogy" is a comprehensive overview of standards, practices and possibilities of course management systems in higher education. "Course Management Systems for Learning: Beyond Accidental Pedagogy" focuses on what the current knowledge is (in best practices, research, standards and…

Systemic accident analysis: examining the gap between research and practice.

PubMed

Underwood, Peter; Waterson, Patrick

2013-06-01

The systems approach is arguably the dominant concept within accident analysis research. Viewing accidents as a result of uncontrolled system interactions, it forms the theoretical basis of various systemic accident analysis (SAA) models and methods. Despite the proposed benefits of SAA, such as an improved description of accident causation, evidence within the scientific literature suggests that these techniques are not being used in practice and that a research-practice gap exists. The aim of this study was to explore the issues stemming from research and practice which could hinder the awareness, adoption and usage of SAA. To achieve this, semi-structured interviews were conducted with 42 safety experts from ten countries and a variety of industries, including rail, aviation and maritime. This study suggests that the research-practice gap should be closed and efforts to bridge the gap should focus on ensuring that systemic methods meet the needs of practitioners and improving the communication of SAA research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Exploring Adolescent Perceptions of Parental Beliefs and Practices Related to Friendships in Diverse Ethnic Communities

ERIC Educational Resources Information Center

Way, Niobe; Greene, Melissa L.; Mukherjee, Preetika Pandey

2007-01-01

It is important to examine both the belief systems and the practices of parents in regard to adolescent friendships. Belief systems inform parental practices and also reveal the full extent of cultural variations that exist within and across ethnic communities.

Activity Theory in Information Systems Research and Practice: Theoretical Underpinnings for an Information Systems Development Model

ERIC Educational Resources Information Center

Mursu, Anja; Luukkonen, Irmeli; Toivanen, Marika; Korpela, Mikko

2007-01-01

Introduction: The purpose of information systems is to facilitate work activities: here we consider how Activity Theory can be applied in information systems development. Method. The requirements for an analytical model for emancipatory, work-oriented information systems research and practice are specified. Previous research work in Activity…

Practical Approaches to Resolving Behaviour Problems. Selected Papers from the National Conference on Practical Approaches to Resolving Behaviour Problems (2nd, Sydney, New South Wales, Australia, July 1990). Programs Implementation and System Initiatives.

ERIC Educational Resources Information Center

Richardson, Susanna, Ed.; Izard, John, Ed.

This collection of papers focuses on practical approaches to resolving behavior problems in the Australian school system. The papers are divided into four general categories: perspectives on behavior problems, focusing on families, schools and system initiatives, and programs in special settings. The papers include: (1) "Beyond…

Evaluation of ecofriendly management practices of french beanrust (Uromyces appendiculatus) in organic farming system

NASA Astrophysics Data System (ADS)

Chhetry, G. K. N.; Mangang, H. C.

2012-09-01

Organic farming system emphasises on sustainable development of agriculture. The traditional agriculture system was much akin to the organic system but modernization of agriculture made a shift to this trend. The north east region of India is potential organic farming sites. Most of the farming systems are traditional and are organic by default; however crops in organic farming are prone to many fungal diseases. Hence for validation of the impact of organic practices on the disease development of plants, a study has been conducted for three years under natural environmental conditions on bean rust (Uromyces appendiculatus). Study includes ecofriendly practices like: plant extract treatment, intercropping of beans with maize, organic manure application, influence of cropping season and Trichoderma treatment. Rust is a major prevalent disease in the cultivation of beans as in other parts of the world. Detailed study of the disease in the organic environment and the impact of various treatments and agricultural agronomic practices would help in validation of the practices for the management of the disease in the organic farming system. In our study for three consecutive years it has been revealed that the practices of the traditional farmers likeplant extract application, intercropping, and manure application were found to have significant positive effects in reducing rust development in the bean fields. The treatment of farm yard manure resulted in development of lesser area under disease progress curve. The plant extract of Artemisia vulgaris has marked positive impact on reducing rust disease parameters. Foliar application of Trichoderma reduces the disease parameters of rust. This study would enhance information in understanding the impact of organic farming system on bean rust and would help in validitation of sustainable agricultural practices for use in organic farming system.

16 CFR § 1000.13 - Directives System.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Directives System. § 1000.13 Section § 1000.13 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL COMMISSION ORGANIZATION AND FUNCTIONS § 1000.13 Directives System. The Commission maintains a Directives System which contains...

A system management methodology for building successful resource management systems

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller; Willoughby, John K.

1989-01-01

This paper presents a system management methodology for building successful resource management systems that possess lifecycle effectiveness. This methodology is based on an analysis of the traditional practice of Systems Engineering Management as it applies to the development of resource management systems. The analysis produced fifteen significant findings presented as recommended adaptations to the traditional practice of Systems Engineering Management to accommodate system development when the requirements are incomplete, unquantifiable, ambiguous and dynamic. Ten recommended adaptations to achieve operational effectiveness when requirements are incomplete, unquantifiable or ambiguous are presented and discussed. Five recommended adaptations to achieve system extensibility when requirements are dynamic are also presented and discussed. The authors conclude that the recommended adaptations to the traditional practice of Systems Engineering Management should be implemented for future resource management systems and that the technology exists to build these systems extensibly.

Systems Thinking and Systems-Based Practice Across the Health Professions: An Inquiry Into Definitions, Teaching Practices, and Assessment.

PubMed

Plack, Margaret M; Goldman, Ellen F; Scott, Andrea R; Pintz, Christine; Herrmann, Debra; Kline, Kathleen; Thompson, Tracey; Brundage, Shelley B

2018-01-01

Phenomenon: Systems thinking is the cornerstone of systems-based practice (SBP) and a core competency in medicine and health sciences. Literature regarding how to teach or apply systems thinking in practice is limited. This study aimed to understand how educators in medicine, physical therapy, physician assistant, nursing, and speech-language pathology education programs teach and assess systems thinking and SBP. Twenty-six educators from seven different degree programs across the five professions were interviewed and program descriptions and relevant course syllabi were reviewed. Qualitative analysis was iterative and incorporated inductive and deductive methods as well as a constant comparison of units of data to identify patterns and themes. Six themes were identified: 1) participants described systems thinking as ranging across four major levels of healthcare (i.e., patient, care team, organization, and external environment); 2) participants associated systems thinking with a wide range of activities across the curriculum including quality improvement, Inter-professional education (IPE), error mitigation, and advocacy; 3) the need for healthcare professionals to understand systems thinking was primarily externally driven; 4) participants perceived that learning systems thinking occurred mainly informally and experientially rather than through formal didactic instruction; 5) participants characterized systems thinking content as interspersed across the curriculum and described a variety of strategies for teaching and assessing it; 6) participants indicated a structured framework and inter-professional approach may enhance teaching and assessment of systems thinking. Insights: Systems thinking means different things to different health professionals. Teaching and assessing systems thinking across the health professions will require further training and practice. Tools, techniques, taxonomies and expertise outside of healthcare may be used to enhance the teaching, assessment, and application of systems thinking and SBP to clinical practice; however, these would need to be adapted and refined for use in healthcare.

The impact of broiler production system practices on consumer perceptions of animal welfare.

PubMed

de Jonge, Janneke; van Trijp, Hans C M

2013-12-01

This research explores the extent to which different farm management practices influence the perceived animal friendliness of broiler production systems, and how this differs between individuals. Using a conjoint design with paired comparisons, respondents evaluated broiler production systems that were described on the basis of 7 animal welfare-related practices. It was found that practices in the area of outdoor access, stocking density, and day-night rhythm were overall perceived to have a larger impact on perceptions of animal friendliness than other practices, such as transport duration or the type of breed used. However, individuals differed regarding the extent to which they believed the different farm management practices influenced the animal friendliness of the production system. Differences between individuals regarding their knowledge about and familiarity with livestock farming, degree of anthropomorphism, and their moral beliefs regarding animal welfare partly explained the relative importance individuals attached to farm management practices. The obtained insight into which welfare-related farm management practices, in consumers' minds, most strongly contribute to animal welfare, and the existence of differences between consumers, can be helpful in the development of animal welfare-based certification schemes that are appealing to consumers, as well as the positioning of welfare concepts in the market.

78 FR 9908 - Notice of Availability of the Draft Issuance of the Small Municipal Separate Storm Sewer System...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

... significant factual, legal, methodological and policy questions considered in the development of the draft... maximum extent practicable, including management practices, control techniques, and system, design [[Page... that implementation of best management practices (BMPs) designed to control storm water runoff from the...

12 CFR 227.14 - Unfair or deceptive practices involving cosigners.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 3 2014-01-01 2014-01-01 false Unfair or deceptive practices involving cosigners. 227.14 Section 227.14 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit...

12 CFR 227.14 - Unfair or deceptive practices involving cosigners.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 3 2013-01-01 2013-01-01 false Unfair or deceptive practices involving cosigners. 227.14 Section 227.14 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit...

Resource depletion promotes automatic processing: implications for distribution of practice.

PubMed

Scheel, Matthew H

2010-12-01

Recent models of cognition include two processing systems: an automatic system that relies on associative learning, intuition, and heuristics, and a controlled system that relies on deliberate consideration. Automatic processing requires fewer resources and is more likely when resources are depleted. This study showed that prolonged practice on a resource-depleting mental arithmetic task promoted automatic processing on a subsequent problem-solving task, as evidenced by faster responding and more errors. Distribution of practice effects (0, 60, 120, or 180 sec. between problems) on rigidity also disappeared when groups had equal time on resource-depleting tasks. These results suggest that distribution of practice effects is reducible to resource availability. The discussion includes implications for interpreting discrepancies in the traditional distribution of practice effect.

21 CFR 26.20 - Alert system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Alert system. 26.20 Section 26.20 Food and Drugs... PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN... Provisions for Pharmaceutical Good Manufacturing Practices § 26.20 Alert system. (a) The details of an alert...

21 CFR 26.20 - Alert system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Alert system. 26.20 Section 26.20 Food and Drugs... PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN... Provisions for Pharmaceutical Good Manufacturing Practices § 26.20 Alert system. (a) The details of an alert...

21 CFR 26.20 - Alert system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... PHARMACEUTICAL GOOD MANUFACTURING PRACTICE REPORTS, MEDICAL DEVICE QUALITY SYSTEM AUDIT REPORTS, AND CERTAIN... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Alert system. 26.20 Section 26.20 Food and Drugs... Provisions for Pharmaceutical Good Manufacturing Practices § 26.20 Alert system. (a) The details of an alert...

7 CFR 58.220 - Drying systems.

Code of Federal Regulations, 2012 CFR

2012-01-01

... filter system shall comply with the applicable requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying Systems. The filtering system shall be cleaned or component parts replaced... shall comply with the requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying...

7 CFR 58.220 - Drying systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

... filter system shall comply with the applicable requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying Systems. The filtering system shall be cleaned or component parts replaced... shall comply with the requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying...

7 CFR 58.220 - Drying systems.

Code of Federal Regulations, 2013 CFR

2013-01-01

... filter system shall comply with the applicable requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying Systems. The filtering system shall be cleaned or component parts replaced... shall comply with the requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying...

7 CFR 58.220 - Drying systems.

Code of Federal Regulations, 2014 CFR

2014-01-01

... filter system shall comply with the applicable requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying Systems. The filtering system shall be cleaned or component parts replaced... shall comply with the requirements of the 3-A Accepted Practices for Milk and Milk Products Spray Drying...

The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice.

PubMed

Sparks, Jacqueline A; Duncan, Barry L

2018-03-09

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS' origins in everyday clinical practice. The authors contend that PCOMS represents "both/and," providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time-honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized. © 2018 Family Process Institute.

Large-Scale Linear Optimization through Machine Learning: From Theory to Practical System Design and Implementation

DTIC Science & Technology

2016-08-10

AFRL-AFOSR-JP-TR-2016-0073 Large-scale Linear Optimization through Machine Learning: From Theory to Practical System Design and Implementation ...2016 4.  TITLE AND SUBTITLE Large-scale Linear Optimization through Machine Learning: From Theory to Practical System Design and Implementation 5a...performances on various machine learning tasks and it naturally lends itself to fast parallel implementations . Despite this, very little work has been

Neuroscience nursing practice in a new millennium.

PubMed

Hickey, J V; Minton, M S

1999-09-01

Neuroscience nursing practice in the 21st century is considered from two perspectives: 1) scope of care and roles within a collaborative interdisciplinary model of care; and 2) patient-focused care within the challenging health care system. The implications of illness trends for neuroscience nursing practice are discussed, as are the developing changes in the health care delivery system driven by economics. The article focuses on the futuristic role of disease management in shaping practice and the models for practice which will prevail in this new health care environment.

Talent management best practices: how exemplary health care organizations create value in a down economy.

PubMed

Groves, Kevin S

2011-01-01

: Difficult economic conditions and powerful workforce trends pose significant challenges to managing talent in health care organizations. Although robust research evidence supports the many benefits of maintaining a strong commitment to talent management practices despite these challenges, many organizations compound the problem by resorting to workforce reductions and limiting or eliminating investments in talent management. : This study examines how nationwide health care systems address these challenges through best practice talent management systems. Addressing important gaps in talent management theory and practice, this study develops a best practice model of talent management that is grounded in the contextual challenges facing health care practitioners. : Utilizing a qualitative case study that examined 15 nationwide health care systems, data were collected through semistructured interviews with 30 executives and document analysis of talent management program materials submitted by each organization. : Exemplary health care organizations employ a multiphased talent management system composed of six sequential phases and associated success factors that drive effective implementation. Based on these findings, a model of talent management best practices in health care organizations is presented. : Health care practitioners may utilize the best practice model to assess and enhance their respective talent management systems by establishing the business case for talent management, defining, identifying, and developing high-potential leaders, carefully communicating high-potential designations, and evaluating talent management outcomes.

Software ``Best'' Practices: Agile Deconstructed

NASA Astrophysics Data System (ADS)

Fraser, Steven

Software “best” practices depend entirely on context - in terms of the problem domain, the system constructed, the software designers, and the “customers” ultimately deriving value from the system. Agile practices no longer have the luxury of “choosing” small non-mission critical projects with co-located teams. Project stakeholders are selecting and adapting practices based on a combina tion of interest, need and staffing. For example, growing product portfolios through a merger or the acquisition of a company exposes legacy systems to new staff, new software integration challenges, and new ideas. Innovation in communications (tools and processes) to span the growth and contraction of both information and organizations, while managing the adoption of changing software practices, is imperative for success. Traditional web-based tools such as web pages, document libraries, and forums are not suf ficient. A blend of tweeting, blogs, wikis, instant messaging, web-based confer encing, and telepresence creates a new dimension of communication “best” practices.

Signal systems asset management state-of-the-practice review

DOT National Transportation Integrated Search

2004-04-01

The purpose of this project is to obtain a better understanding of operations-level asset management by examining the specific case of signal systems. Key products will include: a synthesis of existing signal systems asset management practices; a gen...

Practice of clinical forensic medicine in Sri Lanka: does it need a new era?

PubMed

Kodikara, Sarathchandra

2012-07-01

Clinical forensic medicine is a sub-specialty of forensic medicine and is intimately associated with the justice system of a country. Practice of clinical forensic medicine is evolving, but deviates from one jurisdiction to another. Most English-speaking countries practice clinical forensic medicine and forensic pathology separately while most non-English-speaking countries practice forensic medicine which includes clinical forensic medicine and forensic pathology. Unlike the practice of forensic pathology, several countries have informal arrangements to deal with forensic patients and there are no international standards of practice or training in this discipline. Besides, this is rarely a topic of discussion. In the adversarial justice system in Sri Lanka, the designated Government Medical Officers practice both clinical forensic medicine and forensic pathology. Practice of clinical forensic medicine, and its teaching and training in Sri Lanka depicts unique features. However, this system has not undergone a significant revision for many decades. In this communication, the existing legal framework, current procedure of practice, examination for drunkenness, investigations, structure of referrals, reports, subsequent legal procedures, undergraduate, in-service, and postgraduate training are discussed with suggestions for reforms. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Technical Report: Guide Details Best Practices in Photovoltaic System

Science.gov Websites

Operations and Maintenance | Solar Research | NREL Guide Details Best Practices in Photovoltaic A best-practices report on photovoltaic (PV) operations and maintenance (O&M) released by NREL and the PV O&M Working Group provides valuable insights on improving the performance of PV systems

Practical Measurement and Productive Persistence: Strategies for Using Digital Learning System Data to Drive Improvement

ERIC Educational Resources Information Center

Krumm, Andrew E.; Beattie, Rachel; Takahashi, Sola; D'Angelo, Cynthia; Feng, Mingyu; Cheng, Britte

2016-01-01

This paper outlines the development of practical measures of productive persistence using digital learning system data. Practical measurement refers to data collection and analysis approaches originating from improvement science; productive persistence refers to the combination of academic and social mindsets as well as learning behaviours that…

Implementing online consultations in primary care: a mixed-method evaluation extending normalisation process theory through service co-production.

PubMed

Farr, Michelle; Banks, Jonathan; Edwards, Hannah B; Northstone, Kate; Bernard, Elly; Salisbury, Chris; Horwood, Jeremy

2018-03-19

To examine patient and staff views, experiences and acceptability of a UK primary care online consultation system and ask how the system and its implementation may be improved. Mixed-method evaluation of a primary care e-consultation system. Primary care practices in South West England. Qualitative interviews with 23 practice staff in six practices. Patient survey data for 756 e-consultations from 36 practices, with free-text survey comments from 512 patients, were analysed thematically. Anonymised patients' records were abstracted for 485 e-consultations from eight practices, including consultation types and outcomes. Descriptive statistics were used to analyse quantitative data. Analysis of implementation and the usage of the e-consultation system were informed by: (1) normalisation process theory, (2) a framework that illustrates how e-consultations were co-produced and (3) patients' and staff touchpoints. We found different expectations between patients and staff on how to use e-consultations 'appropriately'. While some patients used the system to try and save time for themselves and their general practitioners (GPs), some used e-consultations when they could not get a timely face-to-face appointment. Most e-consultations resulted in either follow-on phone (32%) or face-to-face appointments (38%) and GPs felt that this duplicated their workload. Patient satisfaction of the system was high, but a minority were dissatisfied with practice communication about their e-consultation. Where both patients and staff interact with technology, it is in effect 'co-implemented'. How patients used e-consultations impacted on practice staff's experiences and appraisal of the system. Overall, the e-consultation system studied could improve access for some patients, but in its current form, it was not perceived by practices as creating sufficient efficiencies to warrant financial investment. We illustrate how this e-consultation system and its implementation can be improved, through mapping the co-production of e-consultations through touchpoints. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Using Systems Thinking to Advance Global Health Engagement in Education and Practice.

PubMed

Phillips, Janet M; Stalter, Ann M

2018-04-01

The integration of global health into nursing practice within complex systems requires a strategic approach. The System-Level Awareness Model (SAM) can be used to guide the process of enhancing systems thinking for global health. The purpose of this article is to explain the SAM and how to use it for integrating systems thinking into nursing education in academic, professional development, and continuing education settings to promote global health across the nursing continuum. Tips are provided on how to teach systems thinking for global health in nursing education and practice, consistent with continuing education national learning competencies for health care professionals. J Contin Educ Nurs. 2018;49(4):154-156. Copyright 2018, SLACK Incorporated.

Using Interdisciplinary Workgroups to Educate Surgery Residents in Systems-Based Practice.

PubMed

Gillen, Jacob R; Ramirez, Adriana G; Farineau, Diane W; Hoke, Tracey R; Schirmer, Bruce D; Williams, Michael D; Lau, Christine L

Meaningful education of residents in systems-based practice is notoriously challenging, despite its recognition as 1 of the 6 Accreditation Council for Graduate Medical Education core competencies. To address this challenge, surgery residents and other members of the health care team were organized into interdisciplinary workgroups that were tasked with developing solutions to "systems issues" confronted on a daily basis. The project's goals included providing more meaningful, hands-on educational experience for residents in system-based practice, while also generating practical solutions to workflow issues through interprofessional collaboration. Project participants included all surgery residents at the University of Virginia in Charlottesville, VA, as well as surgical health care professionals across all disciplines. Participants were organized into workgroups. Over the course of 3 sessions, each of 1-hour, each workgroup identified commonly encountered systems issues, chose 1 issue to address, and determined an implementable solution for this issue. In total, 140 participants were divided among 13 workgroups. Workgroup topics ranged from improving paging etiquette to standardizing interdisciplinary communication. In total, 9 of the 13 proposals have been piloted or fully implemented as standard practice at our institution, either within a single unit or over the entire health system. This project demonstrates an innovative approach toward resident education in system-based practice, providing residents with a hands-on experience in problem solving from a systems perspective. These interdisciplinary workgroups generated effective solutions to issues that were meaningful to frontline health care providers. Interdisciplinary collaboration within the workgroups served as a valuable team-building exercise to improve relations between the disciplines. This project can serve as a model for other institutions desiring meaningful education in the Accreditation Council for Graduate Medical Education competency of systems-based practice. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Practice patterns when treating patients with low back pain: a survey of physical therapists.

PubMed

Davies, Claire; Nitz, Arthur J; Mattacola, Carl G; Kitzman, Patrick; Howell, Dana; Viele, Kert; Baxter, David; Brockopp, Dorothy

2014-08-01

Low back pain (LBP), is a common musculoskeletal problem, affecting 75-85% of adults in their lifetime. Direct costs of LBP in the USA were estimated over 85 billion dollars in 2005 resulting in a significant economic burden for the healthcare system. LBP classification systems and outcome measures are available to guide physical therapy assessments and intervention. However, little is known about which, if any, physical therapists use in clinical practice. The purpose of this study was to identify the use of and barriers to LBP classification systems and outcome measures among physical therapists in one state. A mixed methods study using a cross-sectional cohort design with descriptive qualitative methods was performed. A survey collected both quantitative and qualitative data relevant to classification systems and outcome measures used by physical therapists working with patients with LBP. Physical therapists responded using classification systems designed to direct treatment predominantly. The McKenzie method was the most frequent approach to classify LBP. Barriers to use of classification systems and outcome measures were lack of knowledge, too limiting and time. Classification systems are being used for decision-making in physical therapy practice for patients with LBP. Lack of knowledge and training seems to be the main barrier to the use of classification systems in practice. The Oswestry Disability Index and Numerical Pain Scale were the most commonly used outcome measures. The main barrier to their use was lack of time. Continuing education and reading the literature were identified as important tools to teach evidence-based practice to physical therapists in practice.

Institutional arrangements. [utilization of information derived from satellites

NASA Technical Reports Server (NTRS)

1975-01-01

The practical application of space systems is considered in terms of institutional arrangements. The evolution of space systems is examined along with examples of institutional arrangements for space systems uses or applications. An institutional framework developed to assure the widest practicable application of space system is proposed and described. Recommendations are included.

76 FR 57746 - Conference on the International Conference on Harmonisation Q10 Pharmaceutical Quality System: A...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-16

... ``Pharmaceutical Quality System (ICH Q10) Conference: A Practical Approach to Effective Life- Cycle Implementation... Pharmaceutical Quality System across the product life cycle according to the ICH Q10 model. These companies are...] Conference on the International Conference on Harmonisation Q10 Pharmaceutical Quality System: A Practical...

Describing Elementary Teachers' Operative Systems: A Case Study

ERIC Educational Resources Information Center

Dotger, Sharon; McQuitty, Vicki

2014-01-01

This case study introduces the notion of an operative system to describe elementary teachers' knowledge and practice. Drawing from complex systems theory, the operative system is defined as the network of knowledge and practices that constituted teachers' work within a lesson study cycle. Data were gathered throughout a lesson study cycle in which…

Best Practices for Teaming and Collaboration in the Interconnected Systems Framework

ERIC Educational Resources Information Center

Splett, Joni W.; Perales, Kelly; Halliday-Boykins, Colleen A.; Gilchrest, Callie E.; Gibson, Nicole; Weist, Mark D.

2017-01-01

The Interconnected Systems Framework (ISF) blends school mental health practices, systems, and resources into all levels of a multitiered system of supports (e.g., positive behavior interventions and supports). The ISF aims to improve mental health and school performance for all students by emphasizing effective school-wide promotion and…

Evidence-based practice for mere mortals: the role of informatics and health services research.

PubMed

Sim, Ida; Sanders, Gillian D; McDonald, Kathryn M

2002-04-01

The poor translation of evidence into practice is a well-known problem. Hopes are high that information technology can help make evidence-based practice feasible for mere mortal physicians. In this paper, we draw upon the methods and perspectives of clinical practice, medical informatics, and health services research to analyze the gap between evidence and action, and to argue that computing systems for bridging this gap should incorporate both informatics and health services research expertise. We discuss 2 illustrative systems--trial banks and a web-based system to develop and disseminate evidence-based guidelines (alchemist)--and conclude with a research and training agenda.

A practice course to cultivate students' comprehensive ability of photoelectricity

NASA Astrophysics Data System (ADS)

Lv, Yong; Liu, Yang; Niu, Chunhui; Liu, Lishuang

2017-08-01

After the studying of many theoretical courses, it's important and urgent for the students from specialty of optoelectronic information science and engineering to cultivate their comprehensive ability of photoelectricity. We set up a comprehensive practice course named "Integrated Design of Optoelectronic Information System" (IDOIS) for the purpose that students can integrate their knowledge of optics, electronics and computer programming to design, install and debug an optoelectronic system with independent functions. Eight years of practice shows that this practice course can train students' ability of analysis, design/development and debugging of photoelectric system, improve their ability in document retrieval, design proposal and summary report writing, teamwork, innovation consciousness and skill.

Quantum ergonomics: shifting the paradigm of the systems agenda.

PubMed

Walker, Guy H; Salmon, Paul M; Bedinger, Melissa; Stanton, Neville A

2017-02-01

A paradigm is an accepted world view. If we do not continually question our paradigm then wider trends and movements will overtake the discipline leaving it ill adapted to future challenges. This Special Issue is an opportunity to keep systems thinking at the forefront of ergonomics theory and practice. Systems thinking prompts us to ask whether ergonomics, as a discipline, has been too timid? Too preoccupied with the resolution of immediate problems with industrial-age methods when, approaching fast, are developments which could render these operating assumptions an irrelevance. Practical case studies are presented to show how abstract systems problems can be tackled head-on to deliver highly innovative and cost-effective insights. The strategic direction of the discipline foregrounds high-quality systems problems. These are something the discipline is well able to respond to provided that the appropriate operating paradigms are selected. Practitioner Summary: High-quality systems problems are the future of the discipline. How do we convert obtuse sounding systems concepts into practical interventions? In this paper, the essence of systems thinking is distilled and practical case studies used to demonstrate the benefits of this new paradigm.

Systems thinking and incivility in nursing practice: An integrative review.

PubMed

Phillips, Janet M; Stalter, Ann M; Winegardner, Sherri; Wiggs, Carol; Jauch, Amy

2018-01-23

There is a critical need for nurses and interprofessional healthcare providers to implement systems thinking (ST) across international borders, addressing incivility and its perilous effects on patient quality and safety. An estimated one million patients die in hospitals worldwide due to avoidable patient-related errors. Establishing safe and civil workplaces using ST is paramount to promoting clear, level-headed thinking from which patient-centered nursing actions can impact health systems. The purpose of the paper is to answer the research question, What ST evidence fosters the effect of workplace civility in practice settings? Whittemore and Knafl's integrative review method guided this study. The quality of articles was determined using Chu et al.'s Mixed Methods Assessment Tool. Thirty-eight studies were reviewed. Themes emerged describing antecedents and consequences of incivility as embedded within complex systems, suggesting improvements for civility and systems/ST in nursing practice. This integrative review provides information about worldwide incivility in nursing practice from a systems perspective. Several models are offered as a means of promoting civility in nursing practice to improve patient quality and safety. Further study is needed regarding incivility and resultant effects on patient quality and safety. © 2018 Wiley Periodicals, Inc.

A Global Assessment on Climate Research Engaging Indigenous Knowledge Systems and Recommendations for Quality Standards of Research Practice in Indigenous Communities

NASA Astrophysics Data System (ADS)

Davíd-Chavez, D. M.; Gavin, M. C.

2017-12-01

Indigenous communities worldwide have maintained their own knowledge systems for millennia informed through careful observation of dynamics of environmental changes. Withstanding centuries of challenges to their rights to maintain and practice these knowledge systems, Indigenous peoples continually speak to a need for quality standards for research in their communities. Although, international and Indigenous peoples' working groups emphasize Indigenous knowledge systems and the communities who hold them as critical resources for understanding and adapting to climate change, there has yet to be a comprehensive, evidence based analysis into how diverse knowledge systems are integrated in scientific studies. Do current research practices challenge or support Indigenous communities in their efforts to maintain and appropriately apply their knowledge systems? This study addresses this question using a systematic literature review and meta-analysis assessing levels of Indigenous community participation and decision-making in all stages of the research process (initiation, design, implementation, analysis, dissemination). Assessment is based on reported quality indicators such as: outputs that serve the community, ethical guidelines in practice (free, prior, and informed consent and intellectual property rights), and community access to findings. These indicators serve to identify patterns between levels of community participation and quality standards in practice. Meta-analysis indicates most climate studies practice an extractive model in which Indigenous knowledge systems are co-opted with minimal participation or decision-making authority from communities who hold them. Few studies report outputs that directly serve Indigenous communities, ethical guidelines in practice, or community access to findings. Studies reporting the most quality indicators were initiated in mutual agreement between Indigenous communities and outside researchers or by communities themselves. This study also draws from the researcher's experiences as an Indigenous scientist and includes recommendations for quality research practice. This global assessment provides an evidence base to inform our understanding of broader impacts related to research design.

ISYS-MD: A Surgeon's Influence on System Design

PubMed Central

Cavaye, Graham

1982-01-01

ISYS-MD, the Integrated SYStem in MUMPS for MD's, is a new design and a completely re-written system for a computerized medical record. It possesses the functionality of COSTAR combined with a comprehensive accountancy system. In addition, various ideas have been incorporated from the author's extensive experience in medical practice, making the system very practical in a clinical environment.

Structural and practical identifiability analysis of S-system.

PubMed

Zhan, Choujun; Li, Benjamin Yee Shing; Yeung, Lam Fat

2015-12-01

In the field of systems biology, biological reaction networks are usually modelled by ordinary differential equations. A sub-class, the S-systems representation, is a widely used form of modelling. Existing S-systems identification techniques assume that the system itself is always structurally identifiable. However, due to practical limitations, biological reaction networks are often only partially measured. In addition, the captured data only covers a limited trajectory, therefore data can only be considered as a local snapshot of the system responses with respect to the complete set of state trajectories over the entire state space. Hence the estimated model can only reflect partial system dynamics and may not be unique. To improve the identification quality, the structural and practical identifiablility of S-system are studied. The S-system is shown to be identifiable under a set of assumptions. Then, an application on yeast fermentation pathway was conducted. Two case studies were chosen; where the first case is based on a larger state trajectories and the second case is based on a smaller one. By expanding the dataset which span a relatively larger state space, the uncertainty of the estimated system can be reduced. The results indicated that initial concentration is related to the practical identifiablity.

Management Design Theories

NASA Astrophysics Data System (ADS)

Pries-Heje, Jan; Baskerville, Richard L.

This paper elaborates a design science approach for management planning anchored to the concept of a management design theory. Unlike the notions of design theories arising from information systems, management design theories can appear as a system of technological rules, much as a system of hypotheses or propositions can embody scientific theories. The paper illus trates this form of management design theories with three grounded cases. These grounded cases include a software process improvement study, a user involvement study, and an organizational change study. Collectively these studies demonstrate how design theories founded on technological rules can not only improve the design of information systems, but that these concepts have great practical value for improving the framing of strategic organi zational design decisions about such systems. Each case is either grounded in an empirical sense, that is to say, actual practice, or it is grounded to practices described extensively in the practical literature. Such design theories will help managers more easily approach complex, strategic decisions.

The past, present and future of cyber-physical systems: a focus on models.

PubMed

Lee, Edward A

2015-02-26

This paper is about better engineering of cyber-physical systems (CPSs) through better models. Deterministic models have historically proven extremely useful and arguably form the kingpin of the industrial revolution and the digital and information technology revolutions. Key deterministic models that have proven successful include differential equations, synchronous digital logic and single-threaded imperative programs. Cyber-physical systems, however, combine these models in such a way that determinism is not preserved. Two projects show that deterministic CPS models with faithful physical realizations are possible and practical. The first project is PRET, which shows that the timing precision of synchronous digital logic can be practically made available at the software level of abstraction. The second project is Ptides (programming temporally-integrated distributed embedded systems), which shows that deterministic models for distributed cyber-physical systems have practical faithful realizations. These projects are existence proofs that deterministic CPS models are possible and practical.

The Past, Present and Future of Cyber-Physical Systems: A Focus on Models

PubMed Central

Lee, Edward A.

2015-01-01

This paper is about better engineering of cyber-physical systems (CPSs) through better models. Deterministic models have historically proven extremely useful and arguably form the kingpin of the industrial revolution and the digital and information technology revolutions. Key deterministic models that have proven successful include differential equations, synchronous digital logic and single-threaded imperative programs. Cyber-physical systems, however, combine these models in such a way that determinism is not preserved. Two projects show that deterministic CPS models with faithful physical realizations are possible and practical. The first project is PRET, which shows that the timing precision of synchronous digital logic can be practically made available at the software level of abstraction. The second project is Ptides (programming temporally-integrated distributed embedded systems), which shows that deterministic models for distributed cyber-physical systems have practical faithful realizations. These projects are existence proofs that deterministic CPS models are possible and practical. PMID:25730486

Attacking a practical quantum-key-distribution system with wavelength-dependent beam-splitter and multiwavelength sources

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

Li, Hong-Wei; Zhengzhou Information Science and Technology Institute, Zhengzhou, 450004; Wang, Shuang

2011-12-15

It is well known that the unconditional security of quantum-key distribution (QKD) can be guaranteed by quantum mechanics. However, practical QKD systems have some imperfections, which can be controlled by the eavesdropper to attack the secret key. With current experimental technology, a realistic beam splitter, made by fused biconical technology, has a wavelength-dependent property. Based on this fatal security loophole, we propose a wavelength-dependent attacking protocol, which can be applied to all practical QKD systems with passive state modulation. Moreover, we experimentally attack a practical polarization encoding QKD system to obtain all the secret key information at the cost ofmore » only increasing the quantum bit error rate from 1.3 to 1.4%.« less

Laboratory medicine handoff gaps experienced by primary care practices: A report from the shared networks of collaborative ambulatory practices and partners (SNOCAP).

PubMed

West, David R; James, Katherine A; Fernald, Douglas H; Zelie, Claire; Smith, Maxwell L; Raab, Stephen S

2014-01-01

The majority of errors in laboratory medicine testing are thought to occur in the pre- and postanalytic testing phases, and a large proportion of these errors are secondary to failed handoffs. Because most laboratory tests originate in ambulatory primary care, understanding the gaps in handoff processes within and between laboratories and practices is imperative for patient safety. Therefore, the purpose of this study was to understand, based on information from primary care practice personnel, the perceived gaps in laboratory processes as a precursor to initiating process improvement activities. A survey was used to assess perceptions of clinicians, staff, and management personnel of gaps in handoffs between primary care practices and laboratories working in 21 Colorado primary care practices. Data were analyzed to determine statistically significant associations between categorical variables. In addition, qualitative analysis of responses to open-ended survey questions was conducted. Primary care practices consistently reported challenges and a desire/need to improve their efforts to systematically track laboratory test status, confirm receipt of laboratory results, and report results to patients. Automated tracking systems existed in roughly 61% of practices, and all but one of those had electronic health record-based tracking systems in place. One fourth of these electronic health record-enabled practices expressed sufficient mistrust in these systems to warrant the concurrent operation of an article-based tracking system as backup. Practices also reported 12 different procedures used to notify patients of test results, varying by test result type. The results highlight the lack of standardization and definition of roles in handoffs in primary care laboratory practices for test ordering, monitoring, and receiving and reporting test results. Results also identify high-priority gaps in processes and the perceptions by practice personnel that practice improvement in these areas is needed. Commonalities in these areas warrant the development and support of tools for use in primary care settings. © Copyright 2014 by the American Board of Family Medicine.

75 FR 28296 - Denso Manufacturing of Michigan Including On-Site Leased Workers From Adecco Employment Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-20

...., Anchor Staffing, Capitol Software Systems, Donohue Computer Services, Historic Northside Family Practice, Scripture and Associates, Summit Software Services DD, Tacworldwide Companies, Talent Trax, Tek Systems...., Anchor Staffing, Capitol Software Systems, Donohue Computer Services, Historic Northside Family Practice...

School Psychologists' Willingness to Implement RtI: The Role of Philosophical and Practical Readiness

ERIC Educational Resources Information Center

Fan, Chung-Hau; Denner, Peter R.; Bocanegra, Joel O.; Ding, Yi

2016-01-01

After the change in IDEIA, different models of response to intervention (RtI) have been practiced widely in American school systems. School psychologists are in an important position to facilitate RtI practice and provide professional development in order to help their school systems successfully undergo this transformation. However, there is a…

Instructional Systems of Practice: A Multidimensional Analysis of Math and Science Undergraduate Course Planning and Classroom Teaching

ERIC Educational Resources Information Center

Hora, Matthew Tadashi; Ferrare, Joseph J.

2013-01-01

Descriptions of faculty practice that illuminate nuances of how course planning and classroom instruction occur in specific contexts are important to inform pedagogical interventions. The study reported in this article draws on systems-of-practice theory to focus on the dynamic interplay among actors, artifacts, and tasks that constrains…

iSTART Therefore I Understand: But Metacognitive Supports Did Not Enhance Comprehension Gains

ERIC Educational Resources Information Center

McCarthy, Kathryn S.; Jacovina, Matthew E.; Snow, Erica L.; Guerrero, Tricia A.; McNamara, Danielle S.

2017-01-01

iSTART is an intelligent tutoring system designed to provide self-explanation instruction and practice to improve students' comprehension of complex, challenging text. This study examined the effects of extended game-based practice within the system as well as the effects of two metacognitive supports implemented within this practice. High school…

System level airworthiness tool: A comprehensive approach to small unmanned aircraft system airworthiness

NASA Astrophysics Data System (ADS)

Burke, David A.

One of the pillars of aviation safety is assuring sound engineering practices through airworthiness certification. As Unmanned Aircraft Systems (UAS) grow in popularity, the need for airworthiness standards and verification methods tailored for UAS becomes critical. While airworthiness practices for large UAS may be similar to manned aircraft, it is clear that small UAS require a paradigm shift from the airworthiness practices of manned aircraft. Although small in comparison to manned aircraft these aircraft are not merely remote controlled toys. Small UAS may be complex aircraft flying in the National Airspace System (NAS) over populated areas for extended durations and beyond line of sight of the operators. A comprehensive systems engineering framework for certifying small UAS at the system level is needed. This work presents a point based tool that evaluates small UAS by rewarding good engineering practices in design, analysis, and testing. The airworthiness requirements scale with vehicle size and operational area, while allowing flexibility for new technologies and unique configurations.

Resilient Practices in Maintaining Safety of Health Information Technologies

PubMed Central

Ash, Joan S.; Sittig, Dean F.; Singh, Hardeep

2014-01-01

Electronic health record systems (EHRs) can improve safety and reliability of health care, but they can also introduce new vulnerabilities by failing to accommodate changes within a dynamic EHR-enabled health care system. Continuous assessment and improvement is thus essential for achieving resilience in EHR-enabled health care systems. Given the rapid adoption of EHRs by many organizations that are still early in their experiences with EHR safety, it is important to understand practices for maintaining resilience used by organizations with a track record of success in EHR use. We conducted interviews about safety practices with 56 key informants (including information technology managers, chief medical information officers, physicians, and patient safety officers) at two large health care systems recognized as leaders in EHR use. We identified 156 references to resilience-related practices from 41 informants. Framework analysis generated five categories of resilient practices: (a) sensitivity to dynamics and interdependencies affecting risks, (b) basic monitoring and responding practices, (c) management of practices and resources for monitoring and responding, (d) sensitivity to risks beyond the horizon, and (e) reflecting on risks with the safety and quality control process itself. The categories reflect three functions that facilitate resilience: reflection, transcending boundaries, and involving sharp-end practitioners in safety management. PMID:25866492

Fact Sheet: Best Practices Handbook for the Collection and Use of Solar Energy Applications; Best Practices Handbook for the Collection and Use of Solar Energy Applications (Fact Sheet), Energy Systems Integration (ESI), NREL (National Renewable Energy Laboratory)

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

None

2015-06-01

This fact sheet presents highlights from the Best Practices Handbook for the Collection and Use of Solar Resource Data for Solar Energy Applications, which provides detailed information about solar resource data and the resulting data products needed for planning each stage of large concentrating solar power systems, from initial site selection to system operations.

Correlation Research of Medical Security Management System Network Platform in Medical Practice

NASA Astrophysics Data System (ADS)

Jie, Wang; Fan, Zhang; Jian, Hao; Li-nong, Yu; Jun, Fei; Ping, Hao; Ya-wei, Shen; Yue-jin, Chang

Objective-The related research of medical security management system network in medical practice. Methods-Establishing network platform of medical safety management system, medical security network host station, medical security management system(C/S), medical security management system of departments and sections, comprehensive query, medical security disposal and examination system. Results-In medical safety management, medical security management system can reflect the hospital medical security problem, and can achieve real-time detection and improve the medical security incident detection rate. Conclusion-The application of the research in the hospital management implementation, can find hospital medical security hidden danger and the problems of medical disputes, and can help in resolving medical disputes in time and achieve good work efficiency, which is worth applying in the hospital practice.

Advanced unambiguous state discrimination attack and countermeasure strategy in a practical B92 QKD system

NASA Astrophysics Data System (ADS)

Ko, Heasin; Choi, Byung-Seok; Choe, Joong-Seon; Youn, Chun Ju

2018-01-01

Even though unconditional security of B92 quantum key distribution (QKD) system is based on the assumption of perfect positive-operator-valued measures, practical B92 systems only utilize two projective measurements. Unfortunately, such implementation may degrade the security of the B92 QKD system due to Eve's potential attack exploiting the imperfection of system. In this paper, we propose an advanced attack strategy with an unambiguous state discrimination (USD) measurement which makes practical B92 QKD systems insecure even under a lossless channel. In addition, we propose an effective countermeasure against the advanced USD attack model by monitoring double-click events. We further address a fundamental approach to make the B92 QKD system tolerable to attack strategies with USD measurements using a multi-qubit scheme.

Rethinking Health Professions Education through the Lens of Interprofessional Practice and Education

ERIC Educational Resources Information Center

Brandt, Barbara F.

2018-01-01

Using adult learning principles, health professions educators are well positioned to create interprofessional learning systems for collaborative, team-based practice in the transforming health-care system.

Building chronic disease management capacity in General Practice: The South Australian GP Plus Practice Nurse Initiative.

PubMed

Fuller, Jeffrey; Koehne, Kristy; Verrall, Claire C; Szabo, Natalie; Bollen, Chris; Parker, Sharon

2015-01-01

This paper draws on the implementation experience of the South Australian GP Plus Practice Nurse Initiative in order to establish what is needed to support the development of the chronic disease management role of practice nurses. The Initiative was delivered between 2007 and 2010 to recruit, train and place 157 nurses across 147 General Practices in Adelaide. The purpose was to improve chronic disease management in General Practice, by equipping nurses to work as practice nurses who would coordinate care and establish chronic disease management systems. Secondary analysis of qualitative data contained in the Initiative evaluation report, specifically drawing on quarterly project records and four focus groups conducted with practice nurses, practice nurse coordinators and practice nurse mentors. As evidenced by the need to increase the amount of support provided during the implementation of the Initiative, nurses new to General Practice faced challenges in their new role. Nurses described a big learning curve as they dealt with role transition to a new work environment and learning a range of new skills while developing chronic disease management systems. Informants valued the skills development and support offered by the Initiative, however the ongoing difficulties in implementing the role suggested that change is also needed at the level of the Practice. While just over a half of the placement positions were retained, practice nurses expressed concern with having to negotiate the conditions of their employment. In order to advance the role of practice nurses as managers of chronic disease support is needed at two levels. At one level support is needed to assist practice nurses to build their own skills. At the level of the Practice, and in the wider health workforce system, support is also needed to ensure that Practices are organisationally ready to include the practice nurse within the practice team.

A whole-process progressive training mode to foster optoelectronic students' innovative practical ability

NASA Astrophysics Data System (ADS)

Zhong, Hairong; Xu, Wei; Hu, Haojun; Duan, Chengfang

2017-08-01

This article analyzes the features of fostering optoelectronic students' innovative practical ability based on the knowledge structure of optoelectronic disciplines, which not only reveals the common law of cultivating students' innovative practical ability, but also considers the characteristics of the major: (1) The basic theory is difficult, and the close combination of science and technology is obvious; (2)With the integration of optics, mechanics, electronics and computer, the system technology is comprehensive; (3) It has both leading-edge theory and practical applications, so the benefit of cultivating optoelectronic students is high ; (4) The equipment is precise and the practice is costly. Considering the concept and structural characteristics of innovative and practical ability, and adhering to the idea of running practice through the whole process, we put forward the construction of three-dimensional innovation and practice platform which consists of "Synthetically Teaching Laboratory + Innovation Practice Base + Scientific Research Laboratory + Major Practice Base + Joint Teaching and Training Base", and meanwhile build a whole-process progressive training mode to foster optoelectronic students' innovative practical ability, following the process of "basic experimental skills training - professional experimental skills training - system design - innovative practice - scientific research project training - expanded training - graduation project": (1) To create an in - class practical ability cultivation environment that has distinctive characteristics of the major, with the teaching laboratory as the basic platform; (2) To create an extra-curricular innovation practice activities cultivation environment that is closely linked to the practical application, with the innovation practice base as a platform for improvement; (3) To create an innovation practice training cultivation environment that leads the development of cutting-edge, with the scientific research laboratory as a platform to explore; (4) To create an out-campus expanded training environment of optoelectronic major practice and optoelectronic system teaching and training, with the major practice base as an expansion of the platform; (5) To break students' "pre-job training barriers" between school and work, with graduation design as the comprehensive training and testing link.

Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care.

PubMed

Quanbeck, Andrew; Brown, Randall T; E Zgierska, Aleksandra; A Johnson, Roberta; Robinson, James M; Jacobson, Nora

2016-01-27

Adoption of evidence-based practices takes place at a glacial place in healthcare. This research will pilot test an innovative implementation strategy - systems consultation -intended to speed the adoption of evidence-based practice in primary care. The strategy is based on tenets of systems engineering and has been extensively tested in addiction treatment. Three innovations have been included in the strategy - translation of a clinical practice guideline into a checklist-based implementation guide, the use of physician peer coaches ('systems consultants') to help clinics implement the guide, and a focus on reducing variation in practices across prescribers and clinics. The implementation strategy will be applied to improving opioid prescribing practices in primary care, which may help ultimately mitigate the increasing prevalence of opioid abuse and addiction. The pilot test will compare four intervention clinics to four control clinics in a matched-pairs design. A leading clinical guideline for opioid prescribing has been translated into a checklist-based implementation guide in a systematic process that involved experts who wrote the guideline in consultation with implementation experts and primary care physicians. Two physicians with expertise in family and addiction medicine are serving as the systems consultants. Each systems consultant will guide two intervention clinics, using two site visits and follow-up communication by phone and email, to implement the translated guideline. Mixed methods will be used to test the feasibility, acceptability, and preliminary effectiveness of the implementation strategy in an evaluation that meets standards for 'fully developed use' of the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). The clinic will be the primary unit of analysis. The systems consultation implementation strategy is intended to generalize to the adoption of other clinical guidelines. This pilot test is intended to prepare for a large randomized clinical trial that will test the strategy against other implementation strategies, such as audit/feedback and academic detailing, used to close the gap between knowledge and practice. The systems consultation approach has the potential to shorten the famously long time it takes to implement evidence-based practices and clinical guidelines in healthcare.

Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: a case study.

PubMed

Anwari, Zelaikha; Shukla, Mahesh; Maseed, Basir Ahmad; Wardak, Ghulam Farooq Mukhlis; Sardar, Sakhi; Matin, Javid; Rashed, Ghulam Sayed; Hamedi, Sayed Amin; Sahak, Hedayatullah; Aziz, Abdul Hakim; Boyd-Boffa, Mariah; Trasi, Reshma

2015-01-01

Previous studies show that health systems governance influences health system performance and health outcomes. However, there are few examples of how to implement and monitor good governing practices in fragile and conflict affected environments. Good governance has the potential to make the health system people-centered. More research is needed on implementing a people-centered governance approach in these environments. We piloted an intervention that placed a people-centred health systems governance approach in the hands of multi-stakeholder committees that govern provincial and district health systems. We report the results of this intervention from three provinces and eleven districts in Afghanistan over a six month period. This mixed-methods exploratory case study uses analysis of governance self-assessment scores, health management information system data on health system performance, and focus group discussions. The outcomes of interest are governance scores and health system performance indicators. We document the application of a people-centred health systems governance conceptual model based on applying four effective governing practices: cultivating accountability, engaging with stakeholders, setting a shared strategic direction, and stewarding resources responsibly. We present a participatory approach where health system leaders identify and act on opportunities for making themselves and their health systems more accountable and responsive to the needs of the communities they serve. We found that health systems governance can be improved in fragile and conflict affected environments, and that consistent application of the effective governing practices is key to improving governance. Intervention was associated with a 20% increase in antenatal care visit rate in pilot provinces. Focus group discussions showed improvements across the four governing practices, including: establishment of new sub-committees that oversee financial transparency and governance, collaboration with diverse stakeholders, sharper focus on community health needs, more frequent presentation of service delivery data, and increased use of data for decision making. Our findings have implications for policy and practice within and beyond Afghanistan. Governance is central to making health systems responsive to the needs of people who access and provide services. We provide a practical approach to improving health systems governance in fragile and conflict affected environments.

Development of an Interactive, Web-Delivered System to Increase Provider–Patient Engagement in Smoking Cessation

PubMed Central

Delaughter, Kathryn; Crenshaw, Katie; Sobko, Heather J; Williams, Jessica H; Coley, Heather L; Ray, Midge N; Ford, Daniel E; Allison, Jeroan J; Houston, Thomas K

2011-01-01

Background Patient self-management interventions for smoking cessation are effective but underused. Health care providers do not routinely refer smokers to these interventions. Objective The objective of our study was to uncover barriers and facilitators to the use of an e-referral system that will be evaluated in a community-based randomized trial. The e-referral system will allow providers to refer smokers to an online smoking intervention during routine clinical care. Methods We devised a four-step development and pilot testing process: (1) system conceptualization using Delphi to identify key functionalities that would overcome barriers in provider referrals for smoking cessation, (2) Web system programming using agile software development and best programming practices with usability refinement using think-aloud testing, (3) implementation planning using the nominal group technique for the effective integration of the system into the workflow of practices, and (4) pilot testing to identify practice recruitment and system-use barriers in real-world settings. Results Our Delphi process (step 1) conceptualized three key e-referral functions: (1) Refer Your Smokers, allowing providers to e-refer patients at the point of care by entering their emails directly into the system, (2) practice reports, providing feedback regarding referrals and impact of smoking-cessation counseling, and (3) secure messaging, facilitating provider–patient communication. Usability testing (step 2) suggested the system was easy to use, but implementation planning (step 3) suggested several important approaches to encourage use (eg, proactive email cues to encourage practices to participate). Pilot testing (step 4) in 5 practices had limited success, with only 2 patients referred; we uncovered important recruitment and system-use barriers (eg, lack of study champion, training, and motivation, registration difficulties, and forgetting to refer). Conclusions Implementing a system to be used in a clinical setting is complex, as several issues can affect system use. In our ongoing large randomized trial, preliminary analysis with the first 50 practices using the system for 3 months demonstrated that our rigorous preimplementation evaluation helped us successfully identify and overcome these barriers before the main trial. Trial Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/61feCfjCy) PMID:22011394

System hazards in managing laboratory test requests and results in primary care: medical protection database analysis and conceptual model.

PubMed

Bowie, Paul; Price, Julie; Hepworth, Neil; Dinwoodie, Mark; McKay, John

2015-11-27

To analyse a medical protection organisation's database to identify hazards related to general practice systems for ordering laboratory tests, managing test results and communicating test result outcomes to patients. To integrate these data with other published evidence sources to inform design of a systems-based conceptual model of related hazards. A retrospective database analysis. General practices in the UK and Ireland. 778 UK and Ireland general practices participating in a medical protection organisation's clinical risk self-assessment (CRSA) programme from January 2008 to December 2014. Proportion of practices with system risks; categorisation of identified hazards; most frequently occurring hazards; development of a conceptual model of hazards; and potential impacts on health, well-being and organisational performance. CRSA visits were undertaken to 778 UK and Ireland general practices of which a range of systems hazards were recorded across the laboratory test ordering and results management systems in 647 practices (83.2%). A total of 45 discrete hazard categories were identified with a mean of 3.6 per practice (SD=1.94). The most frequently occurring hazard was the inadequate process for matching test requests and results received (n=350, 54.1%). Of the 1604 instances where hazards were recorded, the most frequent was at the 'postanalytical test stage' (n=702, 43.8%), followed closely by 'communication outcomes issues' (n=628, 39.1%). Based on arguably the largest data set currently available on the subject matter, our study findings shed new light on the scale and nature of hazards related to test results handling systems, which can inform future efforts to research and improve the design and reliability of these systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Albert Einstein Distinguished Educator Fellowship: Bridging the Gap Between Policy and Practice

NASA Astrophysics Data System (ADS)

Milbourne, Jeff; Wheeler, Sam

2017-02-01

In an ideal world, education policy and practice would exist as parts of a coherent system. Effective practice would inform policy and that policy would, in turn, promote the tenets of effective practice at the local, state, and national levels. Policymakers and practitioners would collaborate and, by extension, have familiarity and respect for one another's perspective. Unfortunately, our current education system is a far cry from the ideal, a fact that we as practitioners know all too well.

The Emergence of Dominant Design(s) in Large Scale Cyber-Infrastructure Systems

ERIC Educational Resources Information Center

Diamanti, Eirini Ilana

2012-01-01

Cyber-infrastructure systems are integrated large-scale IT systems designed with the goal of transforming scientific practice by enabling multi-disciplinary, cross-institutional collaboration. Their large scale and socio-technical complexity make design decisions for their underlying architecture practically irreversible. Drawing on three…

30 CFR 250.802 - Design, installation, and operation of surface production-safety systems.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Production Platform Piping Systems (as incorporated by reference in § 250.198). (4) Electrical system... classified according to API RP 500, Recommended Practice for Classification of Locations for Electrical..., Recommended Practice for Classification of Locations for Electrical Installations at Petroleum Facilities...

30 CFR 250.802 - Design, installation, and operation of surface production-safety systems.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Production Platform Piping Systems (as incorporated by reference in § 250.198). (4) Electrical system... classified according to API RP 500, Recommended Practice for Classification of Locations for Electrical..., Recommended Practice for Classification of Locations for Electrical Installations at Petroleum Facilities...

30 CFR 250.802 - Design, installation, and operation of surface production-safety systems.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Production Platform Piping Systems (as incorporated by reference in § 250.198). (4) Electrical system... classified according to API RP 500, Recommended Practice for Classification of Locations for Electrical..., Recommended Practice for Classification of Locations for Electrical Installations at Petroleum Facilities...

Systemic Action and Learning in Public Services

ERIC Educational Resources Information Center

Rigg, Clare

2011-01-01

Complex, systemic issues continue to challenge public services without respect for organisational and professional boundaries. In practice, collaborative working with others who have differing professional cultural norms and systems confront members with the need to learn about each other's values, priorities and practices. This paper explores the…

Guidelines for Psychological Practice in Health Care Delivery Systems

ERIC Educational Resources Information Center

American Psychologist, 2013

2013-01-01

Psychologists practice in an increasingly diverse range of health care delivery systems. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts. These…

Traditional ecological knowledge and restoration practice

Treesearch

René Senos; Frank K. Lake; Nancy Turner; Dennis Martinez

2006-01-01

Ecological restoration is a process, a directed action aimed at repairing damage to ecocultural systems for which humans are responsible. Environmental degradation has impaired the functioning of both ecological and cultural systems and disrupted traditional practices that maintained these systems over several millennia. Indigenous and local peoples who depend...

Paradigm shifts: using a participatory leadership process to redesign health systems.

PubMed

Saleeby, Erin; Holschneider, Christine H; Singhal, Rita

2014-12-01

Physicians have increasingly given up private practices to become members of, and key stakeholders in, large healthcare systems. These systems are currently transforming to meet the Triple Aim: guaranteeing the equitable provision of high-quality, evidence-based care at a reasonable cost. Participatory leadership is an organizational change theory that engages key stakeholders as architects in the transformation process. This review highlights the utility of this leadership strategy in designing care for women's health. Our blueprint describing participatory leadership theory in women's health systems change is discussed in three case studies, highlighting what we call the six Ps of participatory leadership: participants, principles, purpose, process, and power. The 'sixth P', product, can then be substantially influential in changing the paradigm of care. Obstetrics and gynecology is increasingly practiced in large health systems responsible for the health of populations. Innovations in clinical practice impact care at the level of the individual. In order for advances in clinical practice to reach broad populations of women, they must be integrated into a delivery system. Physician engagement in leadership during this time of system transformation is of critical importance.

Scaling up Evidence-based Practices for Children and Families in New York State: Towards Evidence-based Policies on Implementation for State Mental Health Systems

PubMed Central

Hoagwood, Kimberly Eaton; Olin, S. Serene; Horwitz, Sarah; McKay, Mary; Cleek, Andrew; Gleacher, Alissa; Lewandowski, Eric; Nadeem, Erum; Acri, Mary; Chor, Ka Ho Brian; Kuppinger, Anne; Burton, Geraldine; Weiss, Dara; Frank, Samantha; Finnerty, Molly; Bradbury, Donna M.; Woodlock, Kristin M.; Hogan, Michael

2014-01-01

Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling-out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policy-makers, providers and family support specialists have worked in partnership since 2002 to redesign and evaluate the children’s mental health system. Five system strategies driven by empirically-based practices and organized within a state-supported infrastructure have been used in the child and family service system with over 2,000 providers: (a) business practices; (b) use of health information technologies in quality improvement; (c) specific clinical interventions targeted at common childhood disorders; (d) parent activation; and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems. PMID:24460518

Primary Care Practice: Uncertainty and Surprise

NASA Astrophysics Data System (ADS)

Crabtree, Benjamin F.

I will focus my comments on uncertainty and surprise in primary care practices. I am a medical anthropologist by training, and have been a full-time researcher in family medicine for close to twenty years. In this talk I want to look at primary care practices as complex systems, particularly taking the perspective of translating evidence into practice. I am going to discuss briefly the challenges we have in primary care, and in medicine in general, of translating new evidence into the everyday care of patients. To do this, I will look at two studies that we have conducted on family practices, then think about how practices can be best characterized as complex adaptive systems. Finally, I will focus on the implications of this portrayal for disseminating new knowledge into practice.

Practical security analysis of continuous-variable quantum key distribution with jitter in clock synchronization

NASA Astrophysics Data System (ADS)

Xie, Cailang; Guo, Ying; Liao, Qin; Zhao, Wei; Huang, Duan; Zhang, Ling; Zeng, Guihua

2018-03-01

How to narrow the gap of security between theory and practice has been a notoriously urgent problem in quantum cryptography. Here, we analyze and provide experimental evidence of the clock jitter effect on the practical continuous-variable quantum key distribution (CV-QKD) system. The clock jitter is a random noise which exists permanently in the clock synchronization in the practical CV-QKD system, it may compromise the system security because of its impact on data sampling and parameters estimation. In particular, the practical security of CV-QKD with different clock jitter against collective attack is analyzed theoretically based on different repetition frequencies, the numerical simulations indicate that the clock jitter has more impact on a high-speed scenario. Furthermore, a simplified experiment is designed to investigate the influence of the clock jitter.

Essential nurse practitioner business knowledge: An interprofessional perspective.

PubMed

LaFevers, David; Ward-Smith, Peggy; Wright, Wendy

2015-04-01

To describe business practice knowledge from the perspectives of nurse practitioners (NPs) who are practicing clinicians, academic instructors, and clinic managers. Using the eight domains of business practice attitudes identified by the Medical Group Management Associations Body of Knowledge (MGMA), which are supported by the American Association of Colleges of Nursing (AACN), a study-specific survey was developed. Data, which describe the knowledge and attitudes with respect to business practices, were obtained from 370 participants. Regardless of their job classification, these participants described (1) quality management, (2) risk management, and (3) patient care systems as critical business practice knowledge. Consensus was also achieved when ranking the content for business practice knowledge: (1) patient care systems, (2) business operation, and (3) financial management. These data identify gaps in business practice knowledge and content that should be included in educational programs. Business practice knowledge is essential for a successful clinical practice and should be a professional practice skill for the NP. ©2015 American Association of Nurse Practitioners.

Interprofessional practices of physiotherapists working with adults with low back pain in Québec’s private sector: results of a qualitative study

PubMed Central

2014-01-01

Background Collaboration and interprofessional practices are highly valued in health systems, because they are thought to improve outcomes of care for persons with complex health problems, such as low back pain. Physiotherapists, like all health providers, are encouraged to take part in interprofessional practices. However, little is known about these practices, especially for private sector physiotherapists. This study aimed to: 1) explore how physiotherapists working in the private sector with adults with low back pain describe their interprofessional practices, 2) identify factors that influence their interprofessional practices, and 3) identify their perceived effects. Methods Participants were 13 physiotherapists, 10 women/3 men, having between 3 and 21 years of professional experience. For this descriptive qualitative study, we used face-to-face semi-structured interviews and conducted content analysis encompassing data coding and thematic regrouping. Results Physiotherapists described interprofessional practices heterogeneously, including numerous processes such as sharing information and referring. Factors that influenced physiotherapists’ interprofessional practices were related to patients, providers, organizations, and wider systems (e.g. professional system). Physiotherapists mostly viewed positive effects of interprofessional practices, including elements such as gaining new knowledge as a provider and being valued in one’s own role, as well as improvements in overall treatment and outcome. Conclusions This qualitative study offers new insights into the interprofessional practices of physiotherapists working with adults with low back pain, as perceived by the physiotherapists’ themselves. Based on the results, the development of strategies aiming to increase interprofessionalism in the management of low back pain would most likely require taking into consideration factors associated with patients, providers, the organizations within which they work, and the wider systems. PMID:24884757

Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.

PubMed

Patel, Minal R; Vichich, Jennifer; Lang, Ian; Lin, Jessica; Zheng, Kai

2017-04-01

The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill "best" behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

[Practice marketing. Data analysis of a urological group practice].

PubMed

Schneider, T; Schneider, B; Eisenhardt, A; Sperling, H

2009-07-01

The urological practice setting in Germany has changed tremendously over the last years. Group practices with two or more urologists working together are becoming more and more popular. At the same time, marketing has become essential even for urologists. To evaluate the patient flow to our group practice, we asked all new patients to fill out a questionnaire (n=2112). We also evaluated the efficacy of our recall system. The analysis showed that patients were 18-93 years old (mean 57 years), 68% being male and 32% female. The largest age group consisted of 41-50-year-olds. The most important reasons for choosing our practice were recommendations by general practitioners in 38%, recommendations by specialists in 11%, and recommendations by friends and relatives in 27%. Five percent of the patients chose the practice because of the Internet home page and 10% because of entries in various phone books. Three percent of the patients came because of newspaper articles about the practice owners, and <1% had attended patient presentations. The Internet was used mainly by 31-40-year-old patients. Our recall system showed an efficacy of 59%. In summary, a good reputation in the medical society as well as in the neighbourhood is still the best advertising for a urological practice. Phone books are increasingly becoming less important, and the Internet is increasingly attractive to the younger population. Recall systems can also be useful for urological practices.

System for Collecting, Analyzing, and Using Information on Institutional Consumer Protection Practices: Accreditation User Guide. Improving The Consumer Protection Function in Postsecondary Education.

ERIC Educational Resources Information Center

Jung, Steven M.; And Others

This accreditation user guide describes: (1) a set of institutional conditions, policies, and practices that are potentially abusive to students, and (2) a system for collecting, analyzing, and using quantitative data on these conditions, policies, and practices. Possible uses include: (1) setting consumer protection standards and goals that…

A Grounded Theory Exploration of the North Carolina Educator Evaluation System and Its Effects on Teaching Practices and Teacher Leadership

ERIC Educational Resources Information Center

Wydo, Daniel A.

2016-01-01

This study examined the effects of the recently implemented North Carolina Educator Evaluator System (NCEES) on teaching practices and teacher leadership in a mostly rural county in the Piedmont region of North Carolina. NCEES is designed to improve teaching practices and teacher leadership through performance-based standards. This…

The Innovation and Sharing of Teaching Practices--II: Procedures for Stimulating Adoption and Adaptation of Selected Teaching Practices. Final Report.

ERIC Educational Resources Information Center

Fox, Robert A.; Lippitt, Ronald

A project was developed involving a state organization of teachers and teams of teachers in local school systems to demonstrate how selected teaching practices could be disseminated to interested teachers. The state organization provided the organizing link among the different school systems and established criteria. The members of the area teams…

Pathways Between Marriage and Parenting for Wives and Husbands: The Role of Coparenting1

PubMed Central

Morrill, Melinda

2016-01-01

As family systems research has expanded, so have investigations into how marital partners coparent together. Although coparenting research has increasingly found support for the influential role of coparenting on both marital relationships and parenting practices, coparenting has traditionally been investigated as part of an indirect system which begins with marital health, is mediated by coparenting processes, and then culminates in each partner's parenting. The field has not tested how this traditional model compares to the equally plausible alternative model in which coparenting simultaneously predicts both marital relationships and parenting practices. Furthermore, statistical and practical limitations have typically resulted in only one parent being analyzed in these models. This study used model-fitting analyses to include both wives and husbands in a test of these two alternative models of the role of coparenting in the family system. Our data suggested that both the traditional indirect model (marital health to coparenting to parenting practices), and the alternative predictor model where coparenting alliance directly and simultaneously predicts marital health and parenting practices, fit for both spouses. This suggests that dynamic and multiple roles may be played by coparenting in the overall family system, and raises important practical implications for family clinicians. PMID:20377635

76 FR 2123 - Agency Information Collection Activities; Announcement of Office of Management and Budget...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-12

...; Current Good Manufacturing Practice Quality System Regulation AGENCY: Food and Drug Administration, HHS... information entitled ``Current Good Manufacturing Practice Quality System Regulation'' has been approved by...

Remote Education Using Web Conference System in a Company of Coin Parking Business

NASA Astrophysics Data System (ADS)

Yoshioka, Yoshio; Mito, Hiroyuki; Azuma, Kouji

Maintenance jobs at coin parking places (CP) are very important for keeping trouble free operation. Such maintenance jobs include special inspection at the initiation of new CP and ordinal maintenance works. In order to level up the skill of maintenance people in the company, education of the basic knowlege of electricity, facility and maintenance skills are required. We made an original text for maintenance people, and practiced education by use of web conference system, because they are distributed in whole country, This paper describes a content of text on fundamental knowledge of electricity, facility of coin parking system and trouble experiences, and also a practice of remote education using web conference system. Problems of remote education which were found by practice and the future education plan of practical skill are also described.

Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant.

PubMed

Power, Thomas J; Michel, Jeremy; Mayne, Stephanie; Miller, Jeffrey; Blum, Nathan J; Grundmeier, Robert W; Guevara, James P; Fiks, Alexander G

2016-01-01

Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD Care Assistant, to facilitate the sharing of information between schools and primary care offices to promote the use of evidence-based practices for managing children with behavioral health conditions. A feasibility study was conducted across 19 diverse primary care practices with 105 participating providers. Across the practices, 67% of providers activated the system for at least one patient and 32% activated it for five or more cases. Care Assistant use was lower in practices with a relatively high percentage of Medicaid patients (≥ 25%). The article discusses challenges that have arisen among primary care providers, parents, and schools in using the Care Assistant, potential strategies for addressing the challenges, and directions for future research and practice.

Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach

PubMed Central

MONTANO, Diego

2016-01-01

The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach. PMID:26860787

Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach.

PubMed

Montano, Diego

2016-08-05

The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach.

Greenhouse gas emissions and management practices that impact them in US rice systems

USDA-ARS?s Scientific Manuscript database

Previous reviews have quantified factors affecting greenhouse gas (GHG) emissions from Asian rice (Oryza sativa L.) systems, but not from rice systems typical for the United States, which often vary considerably particularly in practices (i.e., water and carbon management) that affect emissions. Usi...

Wireless tracking of cotton modules Part II: automatic machine identification and system testing

USDA-ARS?s Scientific Manuscript database

Mapping the harvest location of cotton modules is essential to practical understanding and utilization of spatial-variability information in fiber quality. A wireless module-tracking system was recently developed, but automation of the system is required before it will find practical use on the far...

Natural Language Processing and Game-Based Practice in iSTART

ERIC Educational Resources Information Center

Jackson, Tanner; Boonthum-Denecke, Chutima; McNamara, Danielle

2015-01-01

Intelligent Tutoring Systems (ITSs) are situated in a potential struggle between effective pedagogy and system enjoyment and engagement. iSTART (Interactive Strategy Training for Active Reading and Thinking), a reading strategy tutoring system in which students practice generating self-explanations and using reading strategies, employs two devices…

Natural Language Processing and Game-Based Practice in iSTART

ERIC Educational Resources Information Center

Jackson, G. Tanner; Boonthum-Denecke, Chutima; McNamara, Danielle S.

2015-01-01

Intelligent Tutoring Systems (ITSs) are situated in a potential struggle between effective pedagogy and system enjoyment and engagement. iSTART, a reading strategy tutoring system in which students practice generating self-explanations and using reading strategies, employs two devices to engage the user. The first is natural language processing…

Exploratory Practice and Soft Systems Methodology

ERIC Educational Resources Information Center

Tajino, Akira; Smith, Craig

2005-01-01

This paper aims to demonstrate that Soft Systems Methodology (SSM), a soft systems approach developed in management studies (see Checkland, 1981), can be usefully linked with Exploratory Practice (EP), a form of practitioner research for language classrooms. Some compatible SSM and EP characteristics, in tandem, could enhance continual efforts to…

16 CFR Figure 8 to Part 1203 - Apparatus for Test of Retention System Strength

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Apparatus for Test of Retention System Strength 8 Figure 8 to Part 1203 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT...—Apparatus for Test of Retention System Strength ER10MR98.008 ...

16 CFR Figure 8 to Part 1203 - Apparatus for Test of Retention System Strength

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Apparatus for Test of Retention System Strength 8 Figure 8 to Part 1203 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT...—Apparatus for Test of Retention System Strength ER10MR98.008 ...

75 FR 22810 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-30

... System (EHRDS)--practice application and profile update system; Use: In 2008, the Secretary of the... new demonstration initiative using Medicare waiver authority to reward the delivery of high-quality... system was first developed with the intention of having practices applying to participate in Phase 2 of...

75 FR 41487 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-16

...: Electronic Health Records Demonstration System (EHRDS)--practice application and profile update system; Use... reward the delivery of high-quality care supported by the adoption and use of electronic health records... demonstration system was first developed with the intention of having practices applying to participate in Phase...

Primary care quality and safety systems in the English National Health Service: a case study of a new type of primary care provider.

PubMed

Baker, Richard; Willars, Janet; McNicol, Sarah; Dixon-Woods, Mary; McKee, Lorna

2014-01-01

Although the predominant model of general practice in the UK National Health Service (NHS) remains the small partnership owned and run by general practitioners (GPs), new types of provider are emerging. We sought to characterize the quality and safety systems and processes used in one large, privately owned company providing primary care through a chain of over 50 general practices in England. Senior staff with responsibility for policy on quality and safety were interviewed. We also undertook ethnographic observation in non-clinical areas and interviews with staff in three practices. A small senior executive team set policy and strategy on quality and safety, including a systematic incident reporting and investigation system and processes for disseminating learning with a strong emphasis on customer focus. Standardization of systems was possible because of the large number of practices. Policies appeared generally well implemented at practice level. However, there was some evidence of high staff turnover, particularly of GPs. This caused problems for continuity of care and challenges in inducting new GPs in the company's systems and procedures. A model of primary care delivery based on a corporate chain may be useful in standardizing policies and procedures, facilitating implementation of systems, and relieving clinical staff of administrative duties. However, the model also poses some risks, including those relating to stability. Provider forms that retain the long term, personal commitment of staff to their practices, such as federations or networks, should also be investigated; they may offer the benefits of a corporate chain combined with the greater continuity and stability of the more traditional general practice.

Auditing audits: use and development of the Oxfordshire Medical Audit Advisory Group rating system.

PubMed Central

Lawrence, M.; Griew, K.; Derry, J.; Anderson, J.; Humphreys, J.

1994-01-01

OBJECTIVES--To assess the value of the Oxfordshire Medical Audit Advisory Group rating system in monitoring and stimulating audit activity, and to implement a development of the system. DESIGN--Use of the rating system for assessment of practice audits on three annual visits in Oxfordshire; development and use of an "audit grid" as a refinement of the system; questionnaire to all medical audit advisory groups in England and Wales. SETTING--All 85 general practices in Oxfordshire; all 95 medical audit advisory groups in England and Wales. MAIN OUTCOME MEASURES--Level of practices' audit activity as measured by rating scale and grid. Use of scale nationally together with perceptions of strengths and weaknesses as perceived by chairs of medical audit advisory groups. RESULTS--After one year Oxfordshire practices more than attained the target standards set in 1991, with 72% doing audit involving setting target standards or implementing change; by 1993 this had risen to 78%. Most audits were confined to chronic disease management, preventive care, and appointments. 38 of 92 medical audit advisory groups used the Oxfordshire group's rating scale. Its main weaknesses were insensitivity in assessing the quality of audits and failure to measure team involvement. CONCLUSIONS--The rating system is effective educationally in helping practices improve and summatively for providing feedback to family health service authorities. The grid showed up weakness in the breadth of audit topics studied. IMPLICATIONS AND ACTION--Oxfordshire practices achieved targets set for 1991-2 but need to broaden the scope of their audits and the topics studied. The advisory group's targets for 1994-5 are for 50% of practices to achieve an audit in each of the areas of clinical care, access, communication, and professional values and for 80% of audits to include setting targets or implementing change. PMID:8086911

Perceptions of Indonesian general practitioners in maintaining standards of medical practice at a time of health reform.

PubMed

Syah, Nur A; Roberts, Chris; Jones, Alison; Trevena, Lyndal; Kumar, Koshila

2015-10-01

There is little research on how GPs experience the demands of maintaining standards of medical practice in developing countries and what strategies might improve their capability to provide high-quality primary health care (PHC). This study aims to explore the underlying factors, which shape GPs' experience within the Indonesian PHC system and impact on their experience of professional practice. A grounded theory approach was applied using semi-structured interviews of 25 purposively selected GPs in West Sumatra, Indonesia. The interviews were analysed inductively through an iterative process of the interplay between empirical data, emerging analysis and theory development. Three major health care systems attribute shaped GPs' experiences of professional practice, including (i) a restricted concept of the PHC system, (ii) lack of regulation of private primary care practice conducted by GPs, midwives, nurses and specialists and (iii) low coverage and inappropriate policy of the health insurance system. The findings indicate that a major revision of current health care system is required with a focus on promoting the concept of PHC services to the population, redefining the role of the GP to deliver recognised best practice within available resources, changing the way GPs are remunerated by the public health system and the health insurance industry, policing of the regulations related to the scope of practice of other health care professionals, particularly midwives and nurses, and regulation of prescribing. GPs can be the champions of the PHC service that Indonesia needs, but it requires sustained systematic change. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

PubMed Central

2013-01-01

Background A growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare? Discussion Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a ‘complex intervention’ (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem. Summary Answers to the complex problem of multi-morbidity won’t come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity. PMID:23919296

Generalist solutions to complex problems: generating practice-based evidence--the example of managing multi-morbidity.

PubMed

Reeve, Joanne; Blakeman, Tom; Freeman, George K; Green, Larry A; James, Paul A; Lucassen, Peter; Martin, Carmel M; Sturmberg, Joachim P; van Weel, Chris

2013-08-07

A growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare? Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a 'complex intervention' (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem. Answers to the complex problem of multi-morbidity won't come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity.

Expanding collaborative boundaries in nursing education and practice: The nurse practitioner-dentist model for primary care.

PubMed

Dolce, Maria C; Parker, Jessica L; Marshall, Chantelle; Riedy, Christine A; Simon, Lisa E; Barrow, Jane; Ramos, Catherine R; DaSilva, John D

The purpose of this paper is to describe the design and implementation of a novel interprofessional collaborative practice education program for nurse practitioner and dental students, the Nurse Practitioner-Dentist Model for Primary Care (NPD Program). The NPD Program expands collaborative boundaries in advanced practice nursing by integrating primary care within an academic dental practice. The dental practice is located in a large, urban city in the Northeast United States and provides comprehensive dental services to vulnerable and underserved patients across the age spectrum. The NPD Program is a hybrid curriculum comprised of online learning, interprofessional collaborative practice-based leadership and teamwork training, and clinical rotations focused on the oral-systemic health connection. Practice-based learning promotes the development of leadership and team-based competencies. Nurse practitioners emerge with the requisite interprofessional collaborative practice competencies to improve oral and systemic health outcomes. Copyright © 2017. Published by Elsevier Inc.

Drainpipe network management information system design based on GIS and SCADA technique

NASA Astrophysics Data System (ADS)

Gu, Ze-Yu; Zhao, De-An

2011-02-01

Achieving urban drainpipe network integration of geographical information system (GIS) and supervisory control and data acquisition (SCADA) technology is described in this paper. The system design's plans are put forward, which have realized GIS and SCADA system supplementary in the technology and strengthened the model visible analysis ability. It is verified by practical cases that the system has more practical values and a good prospect.

Systems Security Engineering

DTIC Science & Technology

2010-08-22

practice for information security management ( ISO /IEC 27002 ),” “Information technology — Security techniques — Information security management...systems —Requirements ( ISO /IEC 27002 ),”, “Information technology — Security techniques — Information security risk management ( ISO /IEC 27005).” from...associated practice aids. Perhaps the most germane discovery from this effort was a draft ISO standard on Systems and software engineering, Systems and

Integrated management of depression: improving system quality and creating effective interfaces.

PubMed

Myette, Thomas L

2008-04-01

Depression is a chronic recurrent condition and is a leading cause of work disability. Improving occupational outcomes for depression will require an integrated approach that incorporates best practices from the clinical, community, and workplace systems. This article briefly reviews recent quality improvement initiatives and promising practices in each system and then shifts to the importance of systems integration. An integrated chronic care model uses a sophisticated case management process to support essential relationships, facilitate key plans, and efficiently link the three systems to optimize clinical, economic, and occupational outcomes. An expanded role for employers and their agents in the management of depression and other chronic diseases is seen as fundamental to maintaining a healthy and productive workforce. To improve occupational outcomes for depression by integrating best practices from the clinical, community, and workplace systems. After a brief review of quality improvement initiatives and promising practices in each system, an integrated chronic care model is introduced. A case management process that links critical systems, supports essential relationships, and facilitates key plans is expected to result in improvements in clinical, economic, and occupational outcomes. Employers should be more engaged with clinical and community partners in the prevention and control of depression in affected employees.

DEVELOPMENT AND IMPLEMENTATION OF A PRACTICAL PUBLIC HEALTH TRAINING SYSTEM IN CHINA.

PubMed

Liu, Changjiang; Zhang, Junyue; Chen, Guoyuan; Yang, Kedi

2015-03-01

Public health education is becoming an increasing priority among educators of medicine. In China, little attention has been paid to public health education reform. A new public health training system was introduced in China in 2007. We conducted this study during 2006-2012 to evaluate the graduate core competencies under the new system. Data were collected from 231 graduates and 49 public health agencies. The 144 graduates who enrolled in 2006 and were trained under the old system constituted the control group; the 87 graduates who enrolled in 2007 and were trained under the new system constituted the experimental group. Surveys of graduate core competencies found analyzing and solving problems in the laboratory, conducting on-site practice and learning new technologies were the top three abilities most expected by public health agencies. After 5-year practical ability training, the graduates in the experimental group had better performance; on-site practical ability and laboratory practical ability increased significantly by 24.5% and 20.0%, respectively. Three other important competencies also improved: designing epidemiologic surveys, collecting information from the literature and doing statistical analyses. However, preventing and controlling common diseases and dealing with emergencies remained weak. These results show the new training system should be continued, but revisions are needed to improve this training system, especially in the areas of preventing and controlling common diseases and dealing with emergencies.

A Filing System for Medical Literature

PubMed Central

Cumming, Millie

1988-01-01

The author reviews the types of systems available for personal literature files and makes specific recommendations for filing systems for family physicians. A personal filing system can be an integral part of family practice, and need not require time out of proportion to the worth of the system. Because it is a personal system, different types will suit different users; some systems, however, are more reliable than others for use in family practice. (Can Fam Physician 1988; 34:425-433.) PMID:21253062

Is there a need for biomedical CBIR systems in clinical practice? Outcomes from a usability study

NASA Astrophysics Data System (ADS)

Antani, Sameer; Xue, Zhiyun; Long, L. Rodney; Bennett, Deborah; Ward, Sarah; Thoma, George R.

2011-03-01

Articles in the literature routinely describe advances in Content Based Image Retrieval (CBIR) and its potential for improving clinical practice, biomedical research and education. Several systems have been developed to address particular needs, however, surprisingly few are found to be in routine practical use. Our collaboration with the National Cancer Institute (NCI) has identified a need to develop tools to annotate and search a collection of over 100,000 cervigrams and related, anonymized patient data. One such tool developed for a projected need for retrieving similar patient images is the prototype CBIR system, called CervigramFinder, which retrieves images based on the visual similarity of particular regions on the cervix. In this article we report the outcomes from a usability study conducted at a primary meeting of practicing experts. We used the study to not only evaluate the system for software errors and ease of use, but also to explore its "user readiness", and to identify obstacles that hamper practical use of such systems, in general. Overall, the participants in the study found the technology interesting and bearing great potential; however, several challenges need to be addressed before the technology can be adopted.

Characteristics of Health Care Practices and Systems That Excel in Hypertension Control.

PubMed

Young, An; Ritchey, Matthew D; George, Mary G; Hannan, Judy; Wright, Janet

2018-06-07

Approximately 1 in 3 US adults has hypertension, but only half have their blood pressure controlled. We identified characteristics of health care practices and systems (hereinafter practices) effective in achieving control rates at or above 70% by using data collected via applications submitted from April through June 2017 for consideration in the Million Hearts Hypertension Control Challenge. We included 96 practices serving 635,000 patients with hypertension across 34 US states in the analysis. Mean hypertension control rate was 77.1%; 27.1% of practices had a control rate of 80% or greater. Although many practices served large populations with multiple risk factors for uncontrolled hypertension, high control rates were achieved with implementation of evidenced-based strategies.

The feminist/emotionally focused therapy practice model: an integrated approach for couple therapy.

PubMed

Vatcher, C A; Bogo, M

2001-01-01

Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.

40 CFR 63.7915 - What emissions limitations and work practice standards must I meet for transfer systems?

Code of Federal Regulations, 2012 CFR

2012-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS... Pollutants: Site Remediation Transfer Systems § 63.7915 What emissions limitations and work practice...

40 CFR 63.7915 - What emissions limitations and work practice standards must I meet for transfer systems?

Code of Federal Regulations, 2010 CFR

2010-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS... Pollutants: Site Remediation Transfer Systems § 63.7915 What emissions limitations and work practice...

40 CFR 63.7915 - What emissions limitations and work practice standards must I meet for transfer systems?

Code of Federal Regulations, 2014 CFR

2014-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS... Pollutants: Site Remediation Transfer Systems § 63.7915 What emissions limitations and work practice...

40 CFR 63.7915 - What emissions limitations and work practice standards must I meet for transfer systems?

Code of Federal Regulations, 2013 CFR

2013-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS... Pollutants: Site Remediation Transfer Systems § 63.7915 What emissions limitations and work practice...

40 CFR 63.7915 - What emissions limitations and work practice standards must I meet for transfer systems?

Code of Federal Regulations, 2011 CFR

2011-07-01

... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS... Pollutants: Site Remediation Transfer Systems § 63.7915 What emissions limitations and work practice...

Gaming science innovations to integrate health systems science into medical education and practice

PubMed Central

White, Earla J; Lewis, Joy H; McCoy, Lise

2018-01-01

Health systems science (HSS) is an emerging discipline addressing multiple, complex, interdependent variables that affect providers’ abilities to deliver patient care and influence population health. New perspectives and innovations are required as physician leaders and medical educators strive to accelerate changes in medical education and practice to meet the needs of evolving populations and systems. The purpose of this paper is to introduce gaming science as a lens to magnify HSS integration opportunities in the scope of medical education and practice. Evidence supports gaming science innovations as effective teaching and learning tools to promote learner engagement in scientific and systems thinking for decision making in complex scenarios. Valuable insights and lessons gained through the history of war games have resulted in strategic thinking to minimize risk and save lives. In health care, where decisions can affect patient and population outcomes, gaming science innovations have the potential to provide safe learning environments to practice crucial decision-making skills. Research of gaming science limitations, gaps, and strategies to maximize innovations to further advance HSS in medical education and practice is required. Gaming science holds promise to equip health care teams with HSS knowledge and skills required for transformative practice. The ultimate goals are to empower providers to work in complex systems to improve patient and population health outcomes and experiences, and to reduce costs and improve care team well-being.

Gaming science innovations to integrate health systems science into medical education and practice.

PubMed

White, Earla J; Lewis, Joy H; McCoy, Lise

2018-01-01

Health systems science (HSS) is an emerging discipline addressing multiple, complex, interdependent variables that affect providers' abilities to deliver patient care and influence population health. New perspectives and innovations are required as physician leaders and medical educators strive to accelerate changes in medical education and practice to meet the needs of evolving populations and systems. The purpose of this paper is to introduce gaming science as a lens to magnify HSS integration opportunities in the scope of medical education and practice. Evidence supports gaming science innovations as effective teaching and learning tools to promote learner engagement in scientific and systems thinking for decision making in complex scenarios. Valuable insights and lessons gained through the history of war games have resulted in strategic thinking to minimize risk and save lives. In health care, where decisions can affect patient and population outcomes, gaming science innovations have the potential to provide safe learning environments to practice crucial decision-making skills. Research of gaming science limitations, gaps, and strategies to maximize innovations to further advance HSS in medical education and practice is required. Gaming science holds promise to equip health care teams with HSS knowledge and skills required for transformative practice. The ultimate goals are to empower providers to work in complex systems to improve patient and population health outcomes and experiences, and to reduce costs and improve care team well-being.

Evidence-Based Practice in Psychology

ERIC Educational Resources Information Center

American Psychologist, 2006

2006-01-01

The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes…

A strategy for the implementation of a quality indicator system in German primary care.

PubMed

van den Heuvel, Henricus

2011-01-01

The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started. To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care. Literature review with a focus on the QOF and German quality indicator literature. There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes. For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.

Systems survivor: a program for house staff in systems-based practice.

PubMed

Turley, Christine B; Roach, Richard; Marx, Marilyn

2007-01-01

The Systems-Based Practice competency expanded the scope of graduate medical education. Innovative approaches are needed to teach this material. We have designed and implemented a rotation in Systems-Based Practice focused on the interrelationships of patient care, clinical revenue, and the physician's role within health care systems. Experiential learning occurs during a 5-day rotation through 26 areas encompassing the clinical revenue cycle, guided by "expert" staff. Using a reversal of the TV show Survivor, house staff begin conceptually "alone" and discover they are members of a large, dedicated team. Assessment results, including a system knowledge test and course evaluations, are presented. Twenty-five residents from four clinical departments participated in Year 1. An increase in pretest to posttest knowledge scores of 14.8% (p

Banana production systems: identification of alternative systems for more sustainable production.

PubMed

Bellamy, Angelina Sanderson

2013-04-01

Large-scale, monoculture production systems dependent on synthetic fertilizers and pesticides, increase yields, but are costly and have deleterious impacts on human health and the environment. This research investigates variations in banana production practices in Costa Rica, to identify alternative systems that combine high productivity and profitability, with reduced reliance on agrochemicals. Farm workers were observed during daily production activities; 39 banana producers and 8 extension workers/researchers were interviewed; and a review of field experiments conducted by the National Banana Corporation between 1997 and 2002 was made. Correspondence analysis showed that there is no structured variation in large-scale banana producers' practices, but two other banana production systems were identified: a small-scale organic system and a small-scale conventional coffee-banana intercropped system. Field-scale research may reveal ways that these practices can be scaled up to achieve a productive and profitable system producing high-quality export bananas with fewer or no pesticides.

Florence Nightingale and Irish nursing.

PubMed

McDonald, Lynn

2014-09-01

To challenge statements made about 'Careful Nursing' as a 'distinctive system' of nursing established by the Irish Sisters of Mercy, prior to Florence Nightingale, and which is said to have influenced her. Numerous publications have appeared claiming the emergence of a 'distinctive system' of nursing as 'Ireland's legacy to nursing', which, it is claimed, influenced Nightingale's system. One paper argues that the Irish system has its philosophical roots in Thomist philosophy. Several papers argue the ongoing relevance of the Irish system, not Nightingale's, for contemporary nursing theory and practice. Nightingale's influence on and legacy to Irish nursing are not acknowledged. A Discursive paper. Archival and published sources were used to compare the nursing systems of Florence Nightingale and the Irish Sisters of Mercy, with particular attention to nursing during the Crimean War. Claims were challenged of a 'distinctive system' of nursing established by the Irish Sisters of Mercy in the early nineteenth century, and of its stated influence on the nursing system of Florence Nightingale. The contention of great medical satisfaction with the 'distinctive' system is refuted with data showing that the death rate at the Koulali Hospital, where the Irish sisters nursed, was the highest of all the British war hospitals during the Crimean War. Profound differences between the two systems are outlined. Claims for a 'distinctive' Irish system of nursing fail for lack of evidence. Nightingale's principles and methods, as they evolved over the first decade of her school's work, remain central to nursing theory and practice. Nightingale's insistence on respect for patients and high ethical standards remains relevant to practice no less so as specific practices change with advances in medical knowledge and practice. © 2014 John Wiley & Sons Ltd.

Development of a health care systems curriculum.

PubMed

Pruitt, Zachary; Mhaskar, Rahul; Kane, Bryan G; Barraco, Robert D; DeWaay, Deborah J; Rosenau, Alex M; Bresnan, Kristin A; Greenberg, Marna Rayl

2017-01-01

There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution. This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys. To meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated they gained working knowledge of health systems by engaging in these sessions. The majority of the 2016 graduating students (88.24%) felt that the course content, overall, prepared them for their career. A health systems curriculum in undergraduate medical education using a problem-based learning approach is feasible. The majority of students learning health systems curriculum through this format reported being prepared to improve individual patient care and optimize the health system's value (better care and health for lower cost).

Software safety - A user's practical perspective

NASA Technical Reports Server (NTRS)

Dunn, William R.; Corliss, Lloyd D.

1990-01-01

Software safety assurance philosophy and practices at the NASA Ames are discussed. It is shown that, to be safe, software must be error-free. Software developments on two digital flight control systems and two ground facility systems are examined, including the overall system and software organization and function, the software-safety issues, and their resolution. The effectiveness of safety assurance methods is discussed, including conventional life-cycle practices, verification and validation testing, software safety analysis, and formal design methods. It is concluded (1) that a practical software safety technology does not yet exist, (2) that it is unlikely that a set of general-purpose analytical techniques can be developed for proving that software is safe, and (3) that successful software safety-assurance practices will have to take into account the detailed design processes employed and show that the software will execute correctly under all possible conditions.

The status of states' policies to support evidence-based practices in children's mental health.

PubMed

Cooper, Janice L; Aratani, Yumiko

2009-12-01

This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.

Mapping Farming Practices in Belgian Intensive Cropping Systems from Sentinel-1 SAR Time Series

NASA Astrophysics Data System (ADS)

Chome, G.; Baret, P. V.; Defourny, P.

2016-08-01

The environmental impact of the so-called conventional farming system calls for new farming practices reducing negative externalities. Emerging farming practices such as no-till and new inter-cropping management are promising tracks. The development of methods to characterize crop management across an entire region and to understand their spatial dimension offers opportunities to accompany the transition towards a more sustainable agriculture.This research takes advantage of the unmatched polarimetric and temporal resolutions of Sentinel-1 SAR C- band to develop a method to identify farming practices at the parcel level. To this end, the detection of changes in backscattering due to surface roughness modification (tillage, inter-crop cover destruction ...) is used to detect the farming management. The final results are compared to a reference dataset collected through an intensive field campaign. Finally, the performances are discussed in the perspective of practices monitoring of cropping systems through remote sensing.

Getting the most out of your practice--the Practice Health Atlas and business modelling opportunities.

PubMed

Del Fante, Peter; Allan, Don; Babidge, Elizabeth

2006-01-01

The Practice Health Atlas (PHA) is a decision support tool for general practice, designed by the Adelaide Western Division of General Practice (AWDGP). This article describes the features of the PHA and its potential role in enhancing health care. In developing the PHA, the AWDGP utilises a range of software tools and consults with a practice to understand its clinical data management approach. The PHA comprises three sections: epidemiology, business and clinical modelling systems, access to services. The objectives include developing a professional culture around quality health data and synthesis of aggregated de-identified general practice data at both practice and divisional level (and beyond) to assist with local health needs assessment, planning, and funding. Evaluation occurs through group feedback sessions and from the general practitioners and staff. It has demonstrated its potential to fulfill the objectives in outcome areas such as data quality and management, team based care, pro-active practice population health care, and business systems development, thereby contributing to improved patient health outcomes.

Transforming System Engineering through Model-Centric Engineering

DTIC Science & Technology

2015-11-18

best practices and provide computational technologies for real-time training within digital engineering environments  Multidisciplinary System...MBSE well due to continued training and practicing . While MBSE is a part of the MCE it does not encompass the full idea and enabling technologies of... practices against other Industry contractors and it was believed that ABC was trailing the others in the use of MDAO capabilities. They decided that

Improving access for patients – a practice manager questionnaire

PubMed Central

Meade, James G; Brown, James S

2006-01-01

Background The administrative and professional consequences of access targets for general practices, as detailed in the new GMS contract, are unknown. This study researched the effect of implementing the access targets of the new GP contract on general practice appointment systems, and practice manager satisfaction in a UK primary health care setting. Methods A four-part postal questionnaire was administered. The questionnaire was modified from previously validated questionnaires and the findings compared with data obtained from the Western Health and Social Services Board (WHSSB) in N Ireland. Practice managers from the 59 general practices in the WHSSB responded to the questionnaire. Results There was a 94.9% response rate. Practice managers were generally satisfied with the introduction of access targets for patients. Some 57.1% of responding practices, most in deprived areas (Odds ratio 3.13 -95% CI 1.01 – 9.80, p = 0.0256) had modified their appointment systems. Less booking flexibility was reported among group practices (p = 0.006), urban practices (p < 0.001) and those with above average patient list sizes (p < 0.001). Receptionists had not received training in patient appointment management in a quarter of practices. Practices with smaller list sizes were more likely than larger ones to utilise nurses in seeing extra patients (p = 0.007) or to undertake triage procedures (p = 0.062). Conclusion The findings demonstrated the ability of general practices within the WHSSB to adjust to a demanding component of the new GP contract. Issues relating to the flexibility of patient appointment booking systems, receptionists' training and the development of the primary care nursing role were highlighted by the study. PMID:16784530

Moving mountains together: strategic community leadership and systems change.

PubMed

Nissen, Laura Burney; Merrigan, Daniel M; Kraft, M Katherine

2005-01-01

Traditional leadership practice frameworks to guide systems change often fall short in today's practice environment. Reclaiming Futures is a national initiative to create an integrated, comprehensive, seamless system of care for teens with substance abuse problems involved in juvenile justice. It uses leadership and systems reform strategies to improve public health institutions. The premise is that interruption of the destructive cycle of drugs and delinquency can only be attained through the cultivation of shared strategic leadership. This article presents the limitations of traditional practice frameworks of leadership, describes the theory of this new approach to leadership development, and clarifies collaborative leadership and system change. The article includes an example of the framework in action, a discussion of lessons learned, and recommendations for community leadership development initiatives.

Use of information and communication technologies to support effective work practice innovation in the health sector: a multi-site study.

PubMed

Westbrook, Johanna I; Braithwaite, Jeffrey; Gibson, Kathryn; Paoloni, Richard; Callen, Joanne; Georgiou, Andrew; Creswick, Nerida; Robertson, Louise

2009-11-08

Widespread adoption of information and communication technologies (ICT) is a key strategy to meet the challenges facing health systems internationally of increasing demands, rising costs, limited resources and workforce shortages. Despite the rapid increase in ICT investment, uptake and acceptance has been slow and the benefits fewer than expected. Absent from the research literature has been a multi-site investigation of how ICT can support and drive innovative work practice. This Australian-based project will assess the factors that allow health service organisations to harness ICT, and the extent to which such systems drive the creation of new sustainable models of service delivery which increase capacity and provide rapid, safe, effective, affordable and sustainable health care. A multi-method approach will measure current ICT impact on workforce practices and develop and test new models of ICT use which support innovations in work practice. The research will focus on three large-scale commercial ICT systems being adopted in Australia and other countries: computerised ordering systems, ambulatory electronic medical record systems, and emergency medicine information systems. We will measure and analyse each system's role in supporting five key attributes of work practice innovation: changes in professionals' roles and responsibilities; integration of best practice into routine care; safe care practices; team-based care delivery; and active involvement of consumers in care. A socio-technical approach to the use of ICT will be adopted to examine and interpret the workforce and organisational complexities of the health sector. The project will also focus on ICT as a potentially disruptive innovation that challenges the way in which health care is delivered and consequently leads some health professionals to view it as a threat to traditional roles and responsibilities and a risk to existing models of care delivery. Such views have stifled debate as well as wider explorations of ICT's potential benefits, yet firm evidence of the effects of role changes on health service outcomes is limited. This project will provide important evidence about the role of ICT in supporting new models of care delivery across multiple healthcare organizations and about the ways in which innovative work practice change is diffused.

Teacher Evaluation Reform: Principals' Beliefs about Newly Adopted Teacher Evaluation Systems

ERIC Educational Resources Information Center

Young, Suzanne; Range, Bret G.; Hvidston, David; Mette, Ian M.

2015-01-01

Principals in one Western state were surveyed about teacher evaluation systems commonly used across the state. Findings suggest that principals' beliefs about aligning practice to performance expectations, about how much the view of professional practice is growth-oriented, and the degree to which systems use multiple measures are the variables…

40 CFR 141.564 - My system practices lime softening-is there any special provision regarding my individual filter...

Code of Federal Regulations, 2011 CFR

2011-07-01

... there any special provision regarding my individual filter turbidity monitoring? 141.564 Section 141.564... People Individual Filter Turbidity Requirements § 141.564 My system practices lime softening—is there any special provision regarding my individual filter turbidity monitoring? If your system utilizes lime...

40 CFR 141.564 - My system practices lime softening-is there any special provision regarding my individual filter...

Code of Federal Regulations, 2014 CFR

2014-07-01

... there any special provision regarding my individual filter turbidity monitoring? 141.564 Section 141.564... People Individual Filter Turbidity Requirements § 141.564 My system practices lime softening—is there any special provision regarding my individual filter turbidity monitoring? If your system utilizes lime...

40 CFR 141.564 - My system practices lime softening-is there any special provision regarding my individual filter...

Code of Federal Regulations, 2010 CFR

2010-07-01

... there any special provision regarding my individual filter turbidity monitoring? 141.564 Section 141.564... People Individual Filter Turbidity Requirements § 141.564 My system practices lime softening—is there any special provision regarding my individual filter turbidity monitoring? If your system utilizes lime...

40 CFR 141.564 - My system practices lime softening-is there any special provision regarding my individual filter...

Code of Federal Regulations, 2013 CFR

2013-07-01

... there any special provision regarding my individual filter turbidity monitoring? 141.564 Section 141.564... People Individual Filter Turbidity Requirements § 141.564 My system practices lime softening—is there any special provision regarding my individual filter turbidity monitoring? If your system utilizes lime...

23 CFR 971.212 - Federal lands safety management system (SMS).

Code of Federal Regulations, 2011 CFR

2011-04-01

.... (b) The SMS may be based on the guidance in “Safety Management Systems: Good Practices for Development and Implementation.”3 3 “Safety Management Systems: Good Practices for Development and... various levels of complexity depending on the nature of the facility and/or network involved. (e) The SMS...

23 CFR 971.212 - Federal lands safety management system (SMS).

Code of Federal Regulations, 2013 CFR

2013-04-01

.... (b) The SMS may be based on the guidance in “Safety Management Systems: Good Practices for Development and Implementation.”3 3 “Safety Management Systems: Good Practices for Development and... various levels of complexity depending on the nature of the facility and/or network involved. (e) The SMS...

23 CFR 971.212 - Federal lands safety management system (SMS).

Code of Federal Regulations, 2010 CFR

2010-04-01

.... (b) The SMS may be based on the guidance in “Safety Management Systems: Good Practices for Development and Implementation.”3 3 “Safety Management Systems: Good Practices for Development and... various levels of complexity depending on the nature of the facility and/or network involved. (e) The SMS...

23 CFR 971.212 - Federal lands safety management system (SMS).

Code of Federal Regulations, 2012 CFR

2012-04-01

.... (b) The SMS may be based on the guidance in “Safety Management Systems: Good Practices for Development and Implementation.”3 3 “Safety Management Systems: Good Practices for Development and... various levels of complexity depending on the nature of the facility and/or network involved. (e) The SMS...

23 CFR 971.212 - Federal lands safety management system (SMS).

Code of Federal Regulations, 2014 CFR

2014-04-01

.... (b) The SMS may be based on the guidance in “Safety Management Systems: Good Practices for Development and Implementation.”3 3 “Safety Management Systems: Good Practices for Development and... various levels of complexity depending on the nature of the facility and/or network involved. (e) The SMS...

40 CFR 141.564 - My system practices lime softening-is there any special provision regarding my individual filter...

Code of Federal Regulations, 2012 CFR

2012-07-01

... there any special provision regarding my individual filter turbidity monitoring? 141.564 Section 141.564... People Individual Filter Turbidity Requirements § 141.564 My system practices lime softening—is there any special provision regarding my individual filter turbidity monitoring? If your system utilizes lime...

Seeing the System: Dynamics and Complexity of Technology Integration in Secondary Schools

ERIC Educational Resources Information Center

Howard, Sarah K.; Thompson, Kate

2016-01-01

This paper introduces system dynamics modeling to understand, visualize and explore technology integration in schools, through the development of a theoretical model of technology-related change in teachers' practice. Technology integration is a dynamic social practice, within the social system of education. It is difficult, if not nearly…

Visualisation for System Learning in Supply Chains

ERIC Educational Resources Information Center

Lindskog, Magnus; Abrahamsson, Mats; Aronsson, Hakan

2007-01-01

Contemporary supply chains are vastly complex, and decisions made by actors have system-wide consequences that these might not be able to foresee. There are gaps between "best practice"-founded theory and actual practice in supply chains. To remedy this, we argue, the supply chain actors need to enhance systems knowledge. There is a need to…

System Leadership for School Improvement: A Developing Concept and Set of Practices

ERIC Educational Resources Information Center

Dimmock, Clive

2016-01-01

System leadership is a developing concept and practice increasingly seen as a tool for school improvement, as policymakers switch from traditional top-down reform to professional models of schools working collaboratively. System leadership is being championed by the Scottish College for Educational Leadership (SCEL), but is still in its infancy in…

Further Clarification Requested by States around the Application of FERPA to State Longitudinal Data Systems

ERIC Educational Resources Information Center

Data Quality Campaign, 2011

2011-01-01

Statewide Longitudinal Data Systems (SLDS) provide the information and tools needed to inform policies, practices and decisions at every level to improve student achievement and system performance. It is equally important that there are policies and practices to protect personally identifiable information and to ensure the confidentiality and…

Investigating Coherence among Turkish Elementary Science Teachers' Teaching Belief Systems, Pedagogical Content Knowledge and Practice

ERIC Educational Resources Information Center

Bahcivan, Eralp; Cobern, William W.

2016-01-01

This study investigated comprehensive science teaching belief systems and their relation to science teachers' pedagogical content knowledge and teaching practices. Rokeach's (1968) belief system was used as a framework for representing the hierarchy among in-service teachers' teaching beliefs. This study employed a multiple case study design with…

DESIGN OF THE DECISION SUPPORT SYSTEM FOR PLACEMENT AND SELECTION OF BEST MANAGEMENT PRACTICES (BMPS) FOR STORMWATER CONTROL IN URBAN WATERSHEDS

EPA Science Inventory

A decision support system for selection and placement of best management practices (BMPs) at strategic locations in urban watersheds is being developed. The primary objective of the system is to assist stormwater management practioners and decision makers in developing effective...

Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems.

PubMed

Decker, Sandra L; Jamoom, Eric W; Sisk, Jane E

2012-05-01

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices. Federal policies are specifically aimed at encouraging primary care providers and small practices to achieve widespread use of electronic health records. To achieve their nationwide adoption, federal policies may also have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of electronic record systems by practice size, physician age, and ownership status.

Electronic health record usage behaviors in primary care medical practices: A survey of family physicians in Canada.

PubMed

Paré, Guy; Raymond, Louis; Guinea, Ana Ortiz de; Poba-Nzaou, Placide; Trudel, Marie-Claude; Marsan, Josianne; Micheneau, Thomas

2015-10-01

The importance and potential value of office-based electronic health record (EHR) systems is being recognized internationally. We thus sought to better understand how EHRs are actually being used by family physicians and what they perceive to be the main performance outcomes for themselves and their medical practices. We conducted a survey of family physicians practicing in medical practices in Quebec, Canada (n =331). Bivariate and multivariate statistical analyses were conducted to characterize EHR usage behaviors and assess the perceived performance outcomes of these systems. EHR systems "as-used" vary substantively from one family physician to another in terms of the capabilities that are actually mobilized by them. Significant differences between "basic" and "advanced" users were observed in terms of the EHR system's characteristics and perceived performance outcomes. Physicians were also clustered under three profiles that could be clearly distinguished from one another, in terms of the extent to which their performance and their practice's performance was impacted by their EHR usage. Physicians that are "highly impacted" by their EHR system are those who have the longest usage experience and make the most extended use of their system's capabilities. Our study indicates that only a minority of family physicians in our sample use most of the features available in their EHR system. Consequently, few physicians perceive gaining significant performance improvements from such systems. Future research must identify the factors that motivate primary care physicians to assimilate EHR systems in a more extensive manner. Copyright © 2015. Published by Elsevier Ireland Ltd.

NASA Systems Engineering Handbook

NASA Technical Reports Server (NTRS)

Hirshorn, Steven R.; Voss, Linda D.; Bromley, Linda K.

2017-01-01

The update of this handbook continues the methodology of the previous revision: a top-down compatibility with higher level Agency policy and a bottom-up infusion of guidance from the NASA practitioners in the field. This approach provides the opportunity to obtain best practices from across NASA and bridge the information to the established NASA systems engineering processes and to communicate principles of good practice as well as alternative approaches rather than specify a particular way to accomplish a task. The result embodied in this handbook is a top-level implementation approach on the practice of systems engineering unique to NASA. Material used for updating this handbook has been drawn from many sources, including NPRs, Center systems engineering handbooks and processes, other Agency best practices, and external systems engineering textbooks and guides. This handbook consists of six chapters: (1) an introduction, (2) a systems engineering fundamentals discussion, (3) the NASA program project life cycles, (4) systems engineering processes to get from a concept to a design, (5) systems engineering processes to get from a design to a final product, and (6) crosscutting management processes in systems engineering. The chapters are supplemented by appendices that provide outlines, examples, and further information to illustrate topics in the chapters. The handbook makes extensive use of boxes and figures to define, refine, illustrate, and extend concepts in the chapters.

Stormwater Management Decision Support System for Using Low Impact Development Best Management Practices in Industrial Areas

DTIC Science & Technology

2015-05-30

particulates can be trapped in the inlet then washed into the drainage system in a large storm event...and P. Matin. 2005. Performance and Whole-Life Costs of Best Management Practices and Sustainable Urban Drainage Systems . Report #01CTS21TA. Water...subsurface drainage system consisting of a parallel perforated PVC pipe system in a stone bed that connects to the third chamber, which is the discharge

The State of the Practice of UAS Systems in Transportation

DOT National Transportation Integrated Search

2016-12-09

The objective of this research was to establish the state of the practice of unmanned aircraft system (UAS) applications in the transportation profession, with particular interest in understanding how other state departments of transportation across ...

It's there if you look. Get value out of technology to improve operations.

PubMed

Nelson, Rosemarie

2003-01-01

Is your group missing out on practice-management system functions critical to efficient operations and reduced overhead? Most practices don't maximize the capabilities of their office systems, hampering operational efficiency.

American Society of Neuroradiology

MedlinePlus

... Tumors of the Central Nervous System: A Practical Approach for Gliomas, Part 1. Basic Tumor Genetics The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Practical Approach for Gliomas, Part 2. Isocitrate Dehydrogenase Status—Imaging ...

Best Practices in Photovoltaic System Operations and Maintenance: 2nd Edition

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

Whaley, Cass

This best practices guide encourages high-quality system deployment and operation that improves lifetime project performance and energy production while reducing, or at least optimizing, costs to deliver an operation and maintenance program.

Road weather information systems : enabling proactive maintenance practices in Washington state

DOT National Transportation Integrated Search

2002-03-01

Washington State Department of Transportation's (WSDOT) rWeather program has significantly integrated and expanded the capabilities of road weather information systems (RWIS) in the state, enabling proactive winter maintenance practices and better-in...

A flight test of laminar flow control leading-edge systems

NASA Technical Reports Server (NTRS)

Fischer, M. C.; Wright, A. S., Jr.; Wagner, R. D.

1983-01-01

NASA's program for development of a laminar flow technology base for application to commercial transports has made significant progress since its inception in 1976. Current efforts are focused on development of practical reliable systems for the leading-edge region where the most difficult problems in applying laminar flow exist. Practical solutions to these problems will remove many concerns about the ultimate practicality of laminar flow. To address these issues, two contractors performed studies, conducted development tests, and designed and fabricated fully functional leading-edge test articles for installation on the NASA JetStar aircraft. Systems evaluation and performance testing will be conducted to thoroughly evaluate all system capabilities and characteristics. A simulated airline service flight test program will be performed to obtain the operational sensitivity, maintenance, and reliability data needed to establish that practical solutions exist for the difficult leading-edge area of a future commercial transport employing laminar flow control.

Adaptive Fault-Resistant Systems

DTIC Science & Technology

1994-10-01

An Architectural Overview of the Alpha Real-Time Distributed Kernel . In Proceeding., of the USEN[X Workshop on Microkernels and Other Kernel ...system and the controller are monolithic . We have noted earlier some of the problems of distributed systems-for exam- ple, the need to bound the...are monolithic . In practice, designers employ a layered structuring for their systems in order to manage complexity, and we expect that practical

Systemic Violence in Education: Promise Broken. SUNY Series, Education and Culture: Critical Factors in the Formation of Character and Community in American Life.

ERIC Educational Resources Information Center

Epp, Juanita Ross, Ed.; Watkinson, Ailsa M., Ed.

This collection illuminates some of the issues surrounding systemic violence in education, exposing the structures and processes of the schools and examining the effects of these structures on students. Part 1 concerns systemic violence in administrative practice; and Part 2 discusses systemic violence in pedagogical practice. Part 3 of the…

7th Annual CMMI Technology Conference Volume 3 Thursday Presentations

DTIC Science & Technology

2007-11-15

Inc. - US Corporate Research Effective Systems Engineering: What’s the Payoff for Program Performance?, NDIA Systems EngineeringsEffectiveness What’s...Inc. - US Corporate Research CMMI, Configuration Management, and Baseball – How to Score, Ms. Julie Schmarje, Raytheon Company Automated Systems for...Dr. Aldo Dagnino, ABB, Inc. US Corporate Research Systems Assurance – Practices Make Perfect – How Your Engineering and Management Practices Can Help

Assessing curriculum effectiveness: a survey of Uniformed Services University medical school graduates.

PubMed

Picho, Katherine; Gilliland, William R; Artino, Anthony R; DeZee, Kent J; Dong, Ting; McManigle, John E; Cruess, David F; Durning, Steven J

2015-04-01

This study assessed alumni perceptions of their preparedness for clinical practice using the Accreditation Council for Graduate Medical Education (ACGME) competencies. We hypothesized that our alumni's perception of preparedness would be highest for military-unique practice and professionalism and lowest for system-based practice and practice-based learning and improvement. 1,189 alumni who graduated from the Uniformed Services University (USU) between 1980 and 2001 completed a survey modeled to assess the ACGME competencies on a 5-point, Likert-type scale. Specifically, self-reports of competencies related to patient care, communication and interpersonal skills, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, and military-unique practice were evaluated. Consistent with our expectations as the nation's military medical school, our graduates were most confident in their preparedness for military-unique practice, which included items assessing military leadership (M = 4.30, SD = 0.65). USU graduates also indicated being well prepared for the challenges of residency education in the domain of professionalism (M = 4.02, SD = 0.72). Self-reports were also high for competencies related to patient care (M = 3.86, SD = 0.68), communication and interpersonal skills (M = 3.88, SD = 0.66), and medical knowledge (M = 3.78, SD = 0.73). Consistent with expectations, systems-based practice (M = 3.50, SD = 0.70) and practice-based learning and improvement (M = 3.57, SD = 0.62) were the lowest rated competencies, although self-reported preparedness was still quite high. Our findings suggest that, from the perspective of our graduates, USU is providing both an effective military-unique curriculum and is preparing trainees for residency training. Further, these results support the notion that graduates are prepared to lead and to practice medicine in austere environments. Compared to other competencies that were assessed, self-ratings for systems-based practice and practice-based learning and improvement were the lowest, which suggests the need to continue to improve USU education in these areas. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

A descriptive qualitative examination of knowledge translation practice among health researchers in Manitoba, Canada.

PubMed

Sibley, Kathryn M; Roche, Patricia L; Bell, Courtney P; Temple, Beverley; Wittmeier, Kristy D M

2017-09-06

The importance of effective translation of health research findings into action has been well recognized, but there is evidence to suggest that the practice of knowledge translation (KT) among health researchers is still evolving. Compared to research user stakeholders, researchers (knowledge producers) have been under-studied in this context. The goals of this study were to understand the experiences of health researchers in practicing KT in Manitoba, Canada, and identify their support needs to sustain and increase their participation in KT. Qualitative semi-structured interviews were conducted with 26 researchers studying in biomedical; clinical; health systems and services; and social, cultural, environmental and population health research. Interview questions were open-ended and probed participants' understanding of KT, their experiences in practicing KT, barriers and facilitators to practicing KT, and their needs for KT practice support. KT was broadly conceptualized across participants. Participants described a range of KT practice experiences, most of which related to dissemination. Participants also expressed a number of negative emotions associated with the practice of KT. Many individual, logistical, and systemic or organizational barriers to practicing KT were identified, which included a lack of institutional support for KT in both academic and non-academic systems. Participants described the presence of good relationships with stakeholders as a critical facilitator for practicing KT. The most commonly identified needs for supporting KT practice were access to education and training, and access to resources to increase awareness and promotion of KT. While there were few major variations in response trends across most areas of health research, the responses of biomedical researchers suggested a unique KT context, reflected by distinct conceptualizations of KT (such as commercialization as a core component), experiences (including frustration and lack of support), and barriers to practicing KT (for example, intellectual property concerns). The major findings of this study were the continued variations in conceptualization of KT, and persisting support needs that span basic individual to comprehensive systemic change. Expanding the study to additional regions of Canada will present opportunities to compare and contrast the state of KT practice and its influencing factors.

Enhancing implementation science by applying best principles of systems science.

PubMed

Northridge, Mary E; Metcalf, Sara S

2016-10-04

Implementation science holds promise for better ensuring that research is translated into evidence-based policy and practice, but interventions often fail or even worsen the problems they are intended to solve due to a lack of understanding of real world structures and dynamic complexity. While systems science alone cannot possibly solve the major challenges in public health, systems-based approaches may contribute to changing the language and methods for conceptualising and acting within complex systems. The overarching goal of this paper is to improve the modelling used in dissemination and implementation research by applying best principles of systems science. Best principles, as distinct from the more customary term 'best practices', are used to underscore the need to extract the core issues from the context in which they are embedded in order to better ensure that they are transferable across settings. Toward meaningfully grappling with the complex and challenging problems faced in adopting and integrating evidence-based health interventions and changing practice patterns within specific settings, we propose and illustrate four best principles derived from our systems science experience: (1) model the problem, not the system; (2) pay attention to what is important, not just what is quantifiable; (3) leverage the utility of models as boundary objects; and (4) adopt a portfolio approach to model building. To improve our mental models of the real world, system scientists have created methodologies such as system dynamics, agent-based modelling, geographic information science and social network simulation. To understand dynamic complexity, we need the ability to simulate. Otherwise, our understanding will be limited. The practice of dynamic systems modelling, as discussed herein, is the art and science of linking system structure to behaviour for the purpose of changing structure to improve behaviour. A useful computer model creates a knowledge repository and a virtual library for internally consistent exploration of alternative assumptions. Among the benefits of systems modelling are iterative practice, participatory potential and possibility thinking. We trust that the best principles proposed here will resonate with implementation scientists; applying them to the modelling process may abet the translation of research into effective policy and practice.

48 CFR 203.170 - Business practices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Business practices. 203..., DEPARTMENT OF DEFENSE GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Safeguards 203.170 Business practices. To ensure the separation of functions for oversight, source selection...

Improving System Engineering Excellence at NASA's Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Takada, Pamela Wallace; Newton, Steve; Gholston, Sampson; Thomas, Dale (Technical Monitor)

2001-01-01

NASA's Marshall Space Flight Center (MSFC) management feels that sound system engineering practices are essential for successful project management, NASA studies have concluded that recent project failures could be attributed in part to inadequate systems engineering. A recent survey of MSFC project managers and system engineers' resulted in the recognition of a need for training in Systems Engineering Practices, particularly as they relate to MSFC projects. In response to this survey, an internal pilot short-course was developed to reinforce accepted practices for system engineering at MSFC. The desire of the MSFC management is to begin with in-house training and offer additional educational opportunities to reinforce sound system engineering principles to the more than 800 professionals who are involved with system engineering and project management. A Systems Engineering Development Plan (SEDP) has been developed to address the longer-term systems engineering development needs of MSFC. This paper describes the survey conducted and the training course that was developed in response to that survey.

Clinical nurse specialist education: actualizing the systems leadership competency.

PubMed

Thompson, Cathy J; Nelson-Marten, Paula

2011-01-01

The purpose of this article was to show how sequenced educational strategies aid in the acquisition of systems leadership and change agent skills, as well as other essential skills for professional clinical nurse specialist (CNS) practice. Clinical nurse specialist education offers the graduate student both didactic and clinical experiences to help the student transition into the CNS role. Clinical nurse specialist faculty have a responsibility to prepare students for the realities of advanced practice. Systems leadership is an integral competency of CNS practice. The contemporary CNS is to be a leader in the translation of evidence into practice. To assist students to acquire this competency, all CNS students are expected to use research and other sources of evidence to identify, design, implement, and evaluate a specific practice change. Anecdotal comments from students completing the projects are offered. Student projects have been focused in acute and critical care, palliative care, and adult/gerontologic health clinical settings; community outreach has been the focus of a few change projects. Examples of student projects related to the systems leadership competency and correlated to the spheres of influence impacted are presented.

Practice, science and governance in interaction: European effort for the system-wide implementation of the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine.

PubMed

Stucki, Gerold; Zampolini, Mauro; Juocevicius, Alvydas; Negrini, Stefano; Christodoulou, Nicolas

2017-04-01

Since its launch in 2001, relevant international, regional and national PRM bodies have aimed to implement the International Classification of Functioning, Disability and Health (ICF) in Physical and Rehabilitation Medicine (PRM), whereby contributing to the development of suitable practical tools. These tools are available for implementing the ICF in day-to-day clinical practice, standardized reporting of functioning outcomes in quality management and research, and guiding evidence-informed policy. Educational efforts have reinforced PRM physicians' and other rehabilitation professionals' ICF knowledge, and numerous implementation projects have explored how the ICF is applied in clinical practice, research and policy. Largely lacking though is the system-wide implementation of ICF in day-to-day practice across all rehabilitation services of national health systems. In Europe, system-wide implementation of ICF requires the interaction between practice, science and governance. Considering its mandate, the UEMS PRM Section and Board have decided to lead a European effort towards system-wide ICF implementation in PRM, rehabilitation and health care at large, in interaction with governments, non-governmental actors and the private sector, and aligned with ISPRM's collaboration plan with WHO. In this paper we present the current PRM internal and external policy agenda towards system-wide ICF implementation and the corresponding implementation action plan, while highlighting priority action steps - promotion of ICF-based standardized reporting in national quality management and assurance programs, development of unambiguous rehabilitation service descriptions using the International Classification System for Service Organization in Health-related Rehabilitation, development of Clinical Assessment Schedules, qualitative linkage and quantitative mapping of data to the ICF, and the cultural adaptation of the ICF Clinical Data Collection Tool in European languages.

Best Practices for Reliable and Robust Spacecraft Structures

NASA Technical Reports Server (NTRS)

Raju, Ivatury S.; Murthy, P. L. N.; Patel, Naresh R.; Bonacuse, Peter J.; Elliott, Kenny B.; Gordon, S. A.; Gyekenyesi, J. P.; Daso, E. O.; Aggarwal, P.; Tillman, R. F.

2007-01-01

A study was undertaken to capture the best practices for the development of reliable and robust spacecraft structures for NASA s next generation cargo and crewed launch vehicles. In this study, the NASA heritage programs such as Mercury, Gemini, Apollo, and the Space Shuttle program were examined. A series of lessons learned during the NASA and DoD heritage programs are captured. The processes that "make the right structural system" are examined along with the processes to "make the structural system right". The impact of technology advancements in materials and analysis and testing methods on reliability and robustness of spacecraft structures is studied. The best practices and lessons learned are extracted from these studies. Since the first human space flight, the best practices for reliable and robust spacecraft structures appear to be well established, understood, and articulated by each generation of designers and engineers. However, these best practices apparently have not always been followed. When the best practices are ignored or short cuts are taken, risks accumulate, and reliability suffers. Thus program managers need to be vigilant of circumstances and situations that tend to violate best practices. Adherence to the best practices may help develop spacecraft systems with high reliability and robustness against certain anomalies and unforeseen events.

Towards Interactive Medical Content Delivery Between Simulated Body Sensor Networks and Practical Data Center.

PubMed

Shi, Xiaobo; Li, Wei; Song, Jeungeun; Hossain, M Shamim; Mizanur Rahman, Sk Md; Alelaiwi, Abdulhameed

2016-10-01

With the development of IoT (Internet of Thing), big data analysis and cloud computing, traditional medical information system integrates with these new technologies. The establishment of cloud-based smart healthcare application gets more and more attention. In this paper, semi-physical simulation technology is applied to cloud-based smart healthcare system. The Body sensor network (BSN) of system transmit has two ways of data collection and transmission. The one is using practical BSN to collect data and transmitting it to the data center. The other is transmitting real medical data to practical data center by simulating BSN. In order to transmit real medical data to practical data center by simulating BSN under semi-physical simulation environment, this paper designs an OPNET packet structure, defines a gateway node model between simulating BSN and practical data center and builds a custom protocol stack. Moreover, this paper conducts a large amount of simulation on the real data transmission through simulation network connecting with practical network. The simulation result can provides a reference for parameter settings of fully practical network and reduces the cost of devices and personnel involved.

Parental perceptions of the learner driver log book system in two Australian states.

PubMed

Bates, Lyndel; Watson, Barry; King, Mark Johann

2014-01-01

Though many jurisdictions internationally now require learner drivers to complete a specified number of hours of supervised driving practice before being able to drive unaccompanied, very few require learner drivers to complete a log book to record this practice and then present it to the licensing authority. Learner drivers in most Australian jurisdictions must complete a log book that records their practice, thereby confirming to the licensing authority that they have met the mandated hours of practice requirement. These log books facilitate the management and enforcement of minimum supervised hours of driving requirements. Parents of learner drivers in 2 Australian states, Queensland and New South Wales, completed an online survey assessing a range of factors, including their perceptions of the accuracy of their child's learner log book and the effectiveness of the log book system. The study indicates that the large majority of parents believe that their child's learner log book is accurate. However, they generally report that the log book system is only moderately effective as a system to measure the number of hours of supervised practice a learner driver has completed. The results of this study suggest the presence of a paradox, with many parents possibly believing that others are not as diligent in the use of log books as they are or that the system is too open to misuse. Given that many parents report that their child's log book is accurate, this study has important implications for the development and ongoing monitoring of hours of practice requirements in graduated driver licensing systems.

Trauma-informed juvenile justice systems: A systematic review of definitions and core components.

PubMed

Branson, Christopher Edward; Baetz, Carly Lyn; Horwitz, Sarah McCue; Hoagwood, Kimberly Eaton

2017-11-01

The U.S. Department of Justice has called for the creation of trauma-informed juvenile justice systems in order to combat the negative impact of trauma on youth offenders and frontline staff. Definitions of trauma-informed care have been proposed for various service systems, yet there is not currently a widely accepted definition for juvenile justice. The current systematic review examined published definitions of a trauma-informed juvenile justice system in an effort to identify the most commonly named core elements and specific interventions or policies. A systematic literature search was conducted in 10 databases to identify publications that defined trauma-informed care or recommended specific practices or policies for the juvenile justice system. We reviewed 950 unique records, of which 10 met criteria for inclusion. The 10 publications included 71 different recommended interventions or policies that reflected 10 core domains of trauma-informed practice. We found 8 specific practice or policy recommendations with relative consensus, including staff training on trauma and trauma-specific treatment, while most recommendations were included in 2 or less definitions. The extant literature offers relative consensus around the core domains of a trauma-informed juvenile justice system, but much less agreement on the specific practices and policies. A logical next step is a review of the empirical research to determine which practices or policies produce positive impacts on outcomes for youth, staff, and the broader agency environment, which will help refine the core definitional elements that comprise a unified theory of trauma-informed practice for juvenile justice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Test result communication in primary care: a survey of current practice

PubMed Central

Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

2015-01-01

Background The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. Methods We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Results Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. Conclusions The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the handling of samples and the reporting of results. Our findings will inform our continuing work with patients and staff to develop, implement and evaluate improvements to existing systems of managing the testing and result communication process. PMID:26243888

Practical Challenges of Systems Thinking and Modeling in Public Health

PubMed Central

Trochim, William M.; Cabrera, Derek A.; Milstein, Bobby; Gallagher, Richard S.; Leischow, Scott J.

2006-01-01

Objectives. Awareness of and support for systems thinking and modeling in the public health field are growing, yet there are many practical challenges to implementation. We sought to identify and describe these challenges from the perspectives of practicing public health professionals. Methods. A systems-based methodology, concept mapping, was used in a study of 133 participants from 2 systems-based public health initiatives (the Initiative for the Study and Implementation of Systems and the Syndemics Prevention Network). This method identified 100 key challenges to implementation of systems thinking and modeling in public health work. Results. The project resulted in a map identifying 8 categories of challenges and the dynamic interactions among them. Conclusions. Implementation by public health professionals of the 8 simple rules we derived from the clusters in the map identified here will help to address challenges and improve the organization of systems that protect the public’s health. PMID:16449581

48 CFR 503.570 - Advertising.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Advertising. 503.570 Section 503.570 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Other Improper Business Practices 503.570 Advertising. ...

48 CFR 503.570 - Advertising.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Advertising. 503.570 Section 503.570 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Other Improper Business Practices 503.570 Advertising. ...

48 CFR 503.570 - Advertising.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Advertising. 503.570 Section 503.570 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Other Improper Business Practices 503.570 Advertising. ...

48 CFR 503.570 - Advertising.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Advertising. 503.570 Section 503.570 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Other Improper Business Practices 503.570 Advertising. ...

48 CFR 503.570 - Advertising.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Advertising. 503.570 Section 503.570 Federal Acquisition Regulations System GENERAL SERVICES ADMINISTRATION GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Other Improper Business Practices 503.570 Advertising. ...

5 CFR 9701.517 - Unfair labor practices.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9701.517 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Labor-Management Relations § 9701.517 Unfair labor practices. (a) For the...

Administrators’ Perspectives on Changing Practice in End-of-Life Care in a State Prison System

PubMed Central

Penrod, Janice; Loeb, Susan J.; Smith, Carol A.

2013-01-01

Objective Sentencing trends have created a demographic shift in prison populations. Greater numbers of inmates are aging and dying in prison, creating a demand for enhanced end-of-life care. Changing practice to meet escalating care demands in corrections settings is complicated by economic constraints, attitudinal barriers, and organizational features. This study explored perspectives of end-of-life care held by administrators in a state prison system to reveal challenges to changing practice to meet the needs of inmates suffering advanced illness and dying in prison. Design and Sample Qualitative interviews were conducted with 12 administrators from the central office of a state department of corrections. Results Key influences impacting end-of-life care services included: local prison culture; treatment versus security focus; case-by-case consideration; public sentiment; budget neutral approaches; and conflicting views of service targets. Conclusions These findings revealed the organizational structures, attitudes, and beliefs held by the administrative echelon of a state prison system and were used to guide the derivation of discrete approaches to changing practice in this complex system. Contextual evaluation permitted a much deeper understanding of the influences on changing practice in this hierarchical bureaucracy. This type of preliminary evaluation is crucial to infusing new practice initiatives in complex organizations caring for stigmatized, at-risk populations. PMID:24588128

Does the North Staffordshire slot system control demand of orthopaedic referrals from primary care?

PubMed Central

Bridgman, Stephen; Li, Xuefang; Mackenzie, Gilbert; Dawes, Peter

2005-01-01

Background Attempts to manage general practice demand for orthopaedic outpatient consultations have been made in several areas of the NHS, with little robust evidence on whether or not they work. Aim To evaluate the effect of the North Staffordshire ‘orthopaedic slot system’ on the demand for general practice referrals to orthopaedic outpatients. Method A prospective study of 12 general practices in the slot system, 24 controls, and the 63 other general practices in North Staffordshire. Comparison periods were the baseline year (0); the first calendar year (1); and the first half of the second calendar year (2). A multifactor linear regression model was used. Results Mean referral rate decreased 22% in the slot group in period 1, and was maintained in period 2 (9.40, 7.29, 7.31 referrals per 10 000 population per month for periods 0, 1 and 2, respectively). The control and other groups showed a small decrease in period 1, but in period 2 higher referral rates were observed. The reduction in referrals of 20–40% in participating practices compared to other practices equates to 2–4 referrals per 10 000 patients per month. Conclusions Our study suggests that practices willing and able to take up an offer of a slot system for managing their orthopaedic referrals will be able to significantly reduce referral rates for their patients when compared to similar practices who do not. Further research on the generalisability, effectiveness and cost-effectiveness of such systems is warranted. PMID:16176738

The Vanderbilt Professional Nursing Practice Program: part 1: Growing and supporting professional nursing practice.

PubMed

Robinson, Karen; Eck, Carol; Keck, Becky; Wells, Nancy

2003-09-01

Professional practice programs are designed to attract, retain, and reward nurses. This three-part series will describe Vanderbilt's performance-based career advancement system, the Vanderbilt Professional Nursing Practice Program (VPNPP). Part 1 outlines the overall program's foundation, philosophical background, and basic structure. The VPNPP is built upon Benner's work, distinguishing among four levels of practice: novice, competent, proficient, and expert. Work by many in the organization identified the expected behaviors for nurses at each level, which were then used to develop clear process evaluation criteria. Part 2 will examine the performance measurement and evaluation system created to support the program. The process of advancing within the program will be described in part 3.

How treating the patient with diabetes can enhance your practice: recommendations for practice management.

PubMed

Levin, Roger P

2003-10-01

The ability of dental practices to remain productive and profitable over time depends on their capacity to serve patients comprehensively. The increasing diversity in the patient population demands that practices customize services to ensure exceptional care for all patients. This diversity is particularly prevalent in patient subpopulations with unique medical conditions and treatment needs, such as patients with diabetes. Proper and effective management of patients with diabetes requires that the practice evaluate all aspects of patient interaction. Systems need to be customized so that all procedures and patient communication scripts are implemented consistently to meet the distinct needs of patients with diabetes. A significant return on investment in customized systems can be realized if the practice implements effective marketing strategies to both attract this population of patients and brand the practice as a unique and specialized service provider.

The acceptability of computer applications to group practices.

PubMed

Zimmerman, J; Gordon, R S; Tao, D K; Boxerman, S B

1978-01-01

Of the 72 identified group practices in a midwest urban environment, 39 were found to use computers. The practices had been influenced strongly by vendors in their selection of an automated system or service, and had usually spent less than a work-month analyzing their needs and reviewing alternate ways in which those needs could be met. Ninety-seven percent of the practices had some financial applications and 64% had administrative applications, but only 2.5% had medical applications. For half the practices at least 2 months elapsed from the time the automated applications were put into operation until they were considered to be integrated into the office routine. Advantages experienced by at least a third of the practices using computers were that the work was done faster, information was more readily available, and costs were reduced. The most common disadvantage was inflexibility. Most (89%) of the practices believed that automation was preferable to their previous manual system.

Supporting shared decision making beyond consumer-prescriber interactions: Initial development of the CommonGround fidelity scale

PubMed Central

Fukui, Sadaaki; Salyers, Michelle P.; Rapp, Charlie; Goscha, Rick; Young, Leslie; Mabry, Ally

2015-01-01

Shared decision-making has become a central tenet of recovery-oriented, person-centered mental health care, yet the practice is not always transferred to the routine psychiatric visit. Supporting the practice at the system level, beyond the interactions of consumers and medication prescribers, is needed for successful adoption of shared decision-making. CommonGround is a systemic approach, intended to be part of a larger integration of shared decision-making tools and practices at the system level. We discuss the organizational components that CommonGround uses to facilitate shared decision-making, and we present a fidelity scale to assess how well the system is being implemented. PMID:28090194

Coordination of care by primary care practices: strategies, lessons and implications.

PubMed

O'Malley, Ann S; Tynan, Ann; Cohen, Genna R; Kemper, Nicole; Davis, Matthew M

2009-04-01

Despite calls from numerous organizations and payers to improve coordination of care, there are few published accounts of how care is coordinated in real-world primary care practices. This study by the Center for Studying Health System Change (HSC) documents strategies that a range of physician practices use to coordinate care for their patients. While there was no single recipe for coordination given the variety of patient, physician, practice and market factors, some cross-cutting lessons were identified, such as the value of a commitment to interpersonal continuity of care as a foundation for coordination. Respondents also identified the importance of system support for the standardization of office processes to foster care coordination. While larger practices may have more resources to invest, many of the innovations described could be scaled to smaller practices. Some coordination strategies resulted in improved efficiency over time for practices, but by and large, physician practices currently pursue these efforts at their own expense. In addition to sharing information on effective strategies among practices, the findings also provide policy makers with a snapshot of the current care coordination landscape and implications for initiatives to improve coordination. Efforts to provide technical support to practices to improve coordination, for example, through medical-home initiatives, need to consider the baseline more typical practices may be starting from and tailor their support to practices ranging widely in size, resources and presence of standardized care processes. If aligned with payment incentives, some of these strategies have the potential to increase quality and satisfaction among patients and providers by helping to move the health care delivery system toward better coordinated care.

Effect of different agronomic management practices on greenhouse gas emissions and nutrient cycling in a long-term field trial

NASA Astrophysics Data System (ADS)

Koal, Philipp; Schilling, Rolf; Gerl, Georg; Pritsch, Karin; Munch, Jean Charles

2015-04-01

In order to achieve a reduction of greenhouse gas emissions, modern agronomic management practices need to be established. Therefore, to assess the effect of different farming practices on greenhouse gas emissions, reliable data are required. The experiment covers and compares two main aspects of agricultural management for a better implementation of sustainable land use. The focus lies on the determination and interpretation of greenhouse gas emissions, however, regarding in each case a different agricultural management system, namely an organic farming system and an integrated farming system where the effect of diverse tillage systems and fertilisation practices are observed. In addition, with analysis of the alterable biological, physical and chemical soil properties a link between the impact of different management systems on greenhouse gas emissions and the observed cycle of matter in the soil, especially the nitrogen and carbon cycle, will be enabled. Measurements have been carried out on long-term field trials at the Research Farm Scheyern located in a Tertiary hilly landscape approximately 40 km north of Munich (South Germany). The long-term field trials of the organic and integrated farming system were started in 1992. Since then parcels of land (each around 0.2-0.4 ha) with a particular interior plot set-up have been conducted with the same crop rotation, tillage and fertilisation practice referring to organic and integrated farming management. Thus, the management impacts on the soil of more than 20 years are being examined. Fluxes of CH4, N2O and CO2 have been monitored since 2007 for the integrated farming system trial and since 2012 for the organic farming system trial using an automated system which consists of chambers (0.4 m2 area) with a motor-driven lid, an automated gas sampling unit, an on-line gas chromatographic analysis system, and a control and data logging unit. Precipitation and temperature data have been observed for each experimental field to include weather effects. The main outcomes are the analysis of temporal and spatial dynamics of greenhouse gas emissions influenced by management practice events (i.a. fertilisation, crop incorporation and tillage) and weather effects (drying-rewetting, freezing-thawing, intense rainfall and dry periods) and the creation of impact studies comparing the farming systems (organic vs integrated) and the management practices (minimum tillage vs conventional tillage; high vs low fertilisation). Physical, chemical and biological soil properties (i.a. texture, mineral nitrogen, soil organic carbon and microbial biomass) have been examined in short time intervals to aggregate the parameters and processes influencing the greenhouse gas emissions and to build a linkage between soil organic matter and greenhouse gas emissions. Moreover, with the comparison of the investigated similar long-term field experiments and the collected agronomic data (harvest, tillage and fertilisation practices) the study could contribute to a contemporary set of "best management practices" and could provide a help to create decision tools for stakeholders such as farmers.

WITHDRAWN: Nursing record systems: effects on nursing practice and healthcare outcomes.

PubMed

Urquhart, Christine; Currell, Rosemary; Grant, Maria J; Hardiker, Nicholas R

2018-05-15

A nursing record system is the record of care that was planned or given to individual patients and clients by qualified nurses or other caregivers under the direction of a qualified nurse. Nursing record systems may be an effective way of influencing nurse practice. To assess the effects of nursing record systems on nursing practice and patient outcomes. For the original version of this review in 2000, and updates in 2003 and 2008, we searched: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; MEDLINE, EMBASE, CINAHL, BNI, ISI Web of Knowledge, and ASLIB Index of Theses. We also handsearched: Computers, Informatics, Nursing (Computers in Nursing); Information Technology in Nursing; and the Journal of Nursing Administration. For this update, searches can be considered complete until the end of 2007. We checked reference lists of retrieved articles and other related reviews. Randomised controlled trials (RCTs), controlled before and after studies, and interrupted time series comparing one kind of nursing record system with another in hospital, community or primary care settings. The participants were qualified nurses, students or healthcare assistants working under the direction of a qualified nurse, and patients receiving care recorded or planned using nursing record systems. Two review authors (in two pairs) independently assessed trial quality and extracted data. We included nine trials (eight RCTs, one controlled before and after study) involving 1846 people. The studies that evaluated nursing record systems focusing on relatively discrete and focused problems, for example effective pain management in children, empowering pregnant women and parents, reducing loss of notes, reducing time spent on data entry of test results, reducing transcription errors, and reducing the number of pieces of paper in a record, all demonstrated some degree of success in achieving the desired results. Studies of nursing care planning systems and total nurse records demonstrated uncertain or equivocal results. We found some limited evidence of effects on practice attributable to changes in record systems. It is clear from the literature that it is possible to set up the randomised trials or other quasi-experimental designs needed to produce evidence for practice. Qualitative nursing research to explore the relationship between practice and information use could be used as a precursor to the design and testing of nursing information systems.

Best Development Practices: A Primer for Smart Growth

EPA Pesticide Factsheets

Best Development Practices: A Primer for Smart Growth lists specific practices to achieve development principles that mix land uses, support transportation options, protect natural systems, and provide housing choices.

Towards Evidence-Based, Quality-Controlled Health Promotion: The Dutch Recognition System for Health Promotion Interventions

ERIC Educational Resources Information Center

Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo

2010-01-01

Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and…

The Practical Relevance of Accountability Systems for School Improvement: A Descriptive Analysis of California Schools. CSE Report 713

ERIC Educational Resources Information Center

Mintrop, Heinrich; Trujillo, Tina

2007-01-01

In search for the practical relevance of accountability systems for school improvement, we ask whether practitioners traveling between the worlds of system-designated high and low-performing schools would detect tangible differences by observing concrete behaviors, looking at student work, or inquiring about teacher, administrator, or student…

Results from a Survey of Current Practices for Sampling of Nervous System in Rodents and Non-rodents in General Toxicity Studies

EPA Science Inventory

A survey of current practices for sampling and examination of the nervous system in rodents and non-rodents for general and neurotoxicity (NT) studies was conducted by the Nervous System Sampling Subcommittee of the STP. For general toxicity studies most of those surveyed (>63%) ...

40 CFR 141.542 - What must my system do if we are considering a significant change to disinfection practices?

Code of Federal Regulations, 2013 CFR

2013-07-01

... considering a significant change to disinfection practices? 141.542 Section 141.542 Protection of Environment... REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Benchmark § 141.542 What must my system do if we are considering a significant change to disinfection...

40 CFR 141.542 - What must my system do if we are considering a significant change to disinfection practices?

Code of Federal Regulations, 2014 CFR

2014-07-01

... considering a significant change to disinfection practices? 141.542 Section 141.542 Protection of Environment... REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection Benchmark § 141.542 What must my system do if we are considering a significant change to disinfection...

Practice Parameter on Child and Adolescent Mental Health Care in Community Systems of Care

ERIC Educational Resources Information Center

Journal of the American Academy of Child and Adolescent Psychiatry, 2007

2007-01-01

This parameter presents overarching principles and practices for child and adolescent mental health care in community systems of care. Community systems of care are defined broadly as comprising the wide array of child-serving agencies, programs, and practitioners (both public and private), in addition to natural community supports such as…

The new era of postgraduate certified general practice training in Japan.

PubMed

Takamura, Akiteru

2016-09-01

This paper describes the background to, and the recent evolution of general practice as a recognised medical specialism in Japan (2015), and the evolution of a system of training to support this development. We, the general practitioners (GPs) in Japan have not been recognised as one body of medical specialists and have been training in our own way. A new certified training system will commence in 2018, authorised by a new third organisation, the Japanese Medical Specialty Board. An effective educational system has been developed for medical graduates that have a career intention in general practice that is distinct from other basic medical fields, but collaborates with them. A challenge exists to provide clarity to the Japanese population about what the specialty of general practice is, and what professionals in general practice can do for them. Japan currently has approximately 500 certified GPs and it is unclear at present what numbers will eventually be required. This paper reviews some of the challenges facing the development of general practice from the perspective of the Japan Primary Care Association.

Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

PubMed Central

Martinez, Johanna; Phillips, Erica; Fein, Oliver

2013-01-01

Purpose The Accreditation Council for Graduate Medical Education restructured its accreditation system to be based on educational outcomes in six core competencies. Systems-based practice is one of the six core competencies. The purpose of this report is to describe Weill Cornell Medical College's Internal Medicine Residency program curriculum for systems-based practice (SBP) and its evaluation process. Methods To examine potential outcomes of the POCHS curriculum, an evaluation was conducted, examining participants': (1) knowledge gain; (2) course ratings; and (3) qualitative feedback. Results On average, there was a 19 percentage point increase in knowledge test scores for all three cohorts. The course was rated overall highly, receiving an average of 4.6 on a 1–5 scale. Lastly, the qualitative comments supported that the material is needed and valued. Conclusion The course, entitled Perspectives on the Changing Healthcare System (POCHS) and its evaluation process support that systems-based practice is crucial to residency education. The course is designed not only to educate residents about the current health care system but also to enable them to think critically about the risk and benefits of the changes. POCHS provides a framework for teaching and assessing this competency and can serve as a template for other residency programs looking to create or restructure their SBP curriculum. PMID:24001523

48 CFR 12.213 - Other commercial practices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Other commercial practices... ACQUISITION PLANNING ACQUISITION OF COMMERCIAL ITEMS Special Requirements for the Acquisition of Commercial Items 12.213 Other commercial practices. It is a common practice in the commercial marketplace for both...

An Architecture, System Engineering, and Acquisition Approach for Space System Software Resiliency

NASA Astrophysics Data System (ADS)

Phillips, Dewanne Marie

Software intensive space systems can harbor defects and vulnerabilities that may enable external adversaries or malicious insiders to disrupt or disable system functions, risking mission compromise or loss. Mitigating this risk demands a sustained focus on the security and resiliency of the system architecture including software, hardware, and other components. Robust software engineering practices contribute to the foundation of a resilient system so that the system "can take a hit to a critical component and recover in a known, bounded, and generally acceptable period of time". Software resiliency must be a priority and addressed early in the life cycle development to contribute a secure and dependable space system. Those who develop, implement, and operate software intensive space systems must determine the factors and systems engineering practices to address when investing in software resiliency. This dissertation offers methodical approaches for improving space system resiliency through software architecture design, system engineering, increased software security, thereby reducing the risk of latent software defects and vulnerabilities. By providing greater attention to the early life cycle phases of development, we can alter the engineering process to help detect, eliminate, and avoid vulnerabilities before space systems are delivered. To achieve this objective, this dissertation will identify knowledge, techniques, and tools that engineers and managers can utilize to help them recognize how vulnerabilities are produced and discovered so that they can learn to circumvent them in future efforts. We conducted a systematic review of existing architectural practices, standards, security and coding practices, various threats, defects, and vulnerabilities that impact space systems from hundreds of relevant publications and interviews of subject matter experts. We expanded on the system-level body of knowledge for resiliency and identified a new software architecture framework and acquisition methodology to improve the resiliency of space systems from a software perspective with an emphasis on the early phases of the systems engineering life cycle. This methodology involves seven steps: 1) Define technical resiliency requirements, 1a) Identify standards/policy for software resiliency, 2) Develop a request for proposal (RFP)/statement of work (SOW) for resilient space systems software, 3) Define software resiliency goals for space systems, 4) Establish software resiliency quality attributes, 5) Perform architectural tradeoffs and identify risks, 6) Conduct architecture assessments as part of the procurement process, and 7) Ascertain space system software architecture resiliency metrics. Data illustrates that software vulnerabilities can lead to opportunities for malicious cyber activities, which could degrade the space mission capability for the user community. Reducing the number of vulnerabilities by improving architecture and software system engineering practices can contribute to making space systems more resilient. Since cyber-attacks are enabled by shortfalls in software, robust software engineering practices and an architectural design are foundational to resiliency, which is a quality that allows the system to "take a hit to a critical component and recover in a known, bounded, and generally acceptable period of time". To achieve software resiliency for space systems, acquirers and suppliers must identify relevant factors and systems engineering practices to apply across the lifecycle, in software requirements analysis, architecture development, design, implementation, verification and validation, and maintenance phases.

Internal medicine residency graduates' perceptions of the systems-based practice and practice-based learning and improvement competencies.

PubMed

Didwania, Aashish; McGaghie, William C; Cohen, Elaine; Wayne, Diane B

2010-01-01

Resident education in Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI) is required but underemphasized. The objectives are to identify SBP and PBLI knowledge and skills with the most relevance to our graduates' practices and to determine how well they were prepared during residency training to address these issues. A survey was drafted based on Accreditation Council for Graduate Medical Education competency definitions and published literature on SBP and PBLI. Respondents indicated the extent to which each item is relevant to their practice and the adequacy of instruction received on a 5-point Likert scale. All topics had high perceived relevance to practice with most topics rated low for adequacy of training. Topics of practice management and health care economics contained the largest gaps between mean ratings of relevance and adequacy of training (p < .001). Few differences in ratings were seen based on graduate demographics. This survey has allowed us to prioritize SBP and PBLI curricula to meet the needs of our graduates.

A Practical Risk Assessment Methodology for Safety-Critical Train Control Systems

DOT National Transportation Integrated Search

2009-07-01

This project proposes a Practical Risk Assessment Methodology (PRAM) for analyzing railroad accident data and assessing the risk and benefit of safety-critical train control systems. This report documents in simple steps the algorithms and data input...

Report: Improvements Needed in EPA’s Network Traffic Management Practices

EPA Pesticide Factsheets

Report #11-P-0159, March 14, 2011. OEI does not have consistent, repeatable intrusion detection system monitoring practices in place, which inhibits EPA’s ability to monitor unusual network activity and thus protect Agency systems and associated data.

Choosing a silvicultural system

Treesearch

H. Clay Smith; Gary G. Naughton

1989-01-01

Landowners frequently have definite objectives and preferences that should influence the selection of a silvicultural system. Timber production is not the primary reason many landowners practice forestry, and silvicultural practices must be flexible enough to provide other "products" such as wildlife, esthetics, and recreation.

FRATIS concept of operations : assessment of relevant prior and ongoing research and industry practices.

DOT National Transportation Integrated Search

2012-08-01

This report summarizes the state of the practice in freight-related advanced traveler information systems (ATIS) and assesses their relevance to the development of a Freight Advanced Traveler Information System (FRATIS). The report includes relevant ...

[Quality system in cardiology: practical example to develop an organizational model for management certification without bureaucracy].

PubMed

Colonna, Paolo; Pasini, Evasio; Pitocchi, Oreste; Bovenzi, Francesco; Sorino, Margherita; de Luca, Italo

2003-04-01

It is a difficult task to define practical guidelines and a pragmatic achievement for the new document of the Italian Ministry of Health for structures of the national health system obtaining a quality system according to the ISO 9000 standard. The present article illustrates the different steps to accomplish the quality management in our cardiology department, recently internationally certified, and it gives several practical examples of the path followed in the different sections of the department to obtain the best management of all the Operative Units, identifying customer requests and measuring customer satisfaction.

Hybrid EEG-EOG brain-computer interface system for practical machine control.

PubMed

Punsawad, Yunyong; Wongsawat, Yodchanan; Parnichkun, Manukid

2010-01-01

Practical issues such as accuracy with various subjects, number of sensors, and time for training are important problems of existing brain-computer interface (BCI) systems. In this paper, we propose a hybrid framework for the BCI system that can make machine control more practical. The electrooculogram (EOG) is employed to control the machine in the left and right directions while the electroencephalogram (EEG) is employed to control the forword, no action, and complete stop motions of the machine. By using only 2-channel biosignals, the average classification accuracy of more than 95% can be achieved.

The experience of an information system for nursing practice: the importance of nursing records in the management of a care plan.

PubMed

Nunes, Sofia R T; Rego, Guilhermina; Nunes, Rui

2014-07-01

Health information systems are becoming common because they are important tools to support decision making and assist nurses in their daily interventions. The Information System for Nursing Practice promotes consistent nursing records, as it is directed to the nursing practice and process. The aims of this study were to identify and describe the most frequent type of nursing actions in the care plan for a patient after acute myocardial infarction, considering the seven-axis model of the International Classification of Nursing Practice and the rate of health education given to patients during hospitalization. A cross-sectional analysis was performed retrospectively by searching the computerized database of the Information System for Nursing Practice. We verified some gaps in information with regard to unidentified records of diagnoses and interventions. During hospitalization, the most used interventions were in the fields of observing (40%) and managing (23%). Interventions associated with management of signs and symptoms were more frequent and were performed in 84.9% of the patients. In the field of informing, health education in relation to diet was performed in 21.7% of the patients; exercise, in 16%; and tobacco, in 11.3%. The use of nursing records and information systems can improve nursing care coordination and care plan management.

Integrated weed management systems with herbicide-tolerant crops in the European Union: lessons learnt from home and abroad.

PubMed

Lamichhane, Jay Ram; Devos, Yann; Beckie, Hugh J; Owen, Micheal D K; Tillie, Pascal; Messéan, Antoine; Kudsk, Per

2017-06-01

Conventionally bred (CHT) and genetically modified herbicide-tolerant (GMHT) crops have changed weed management practices and made an important contribution to the global production of some commodity crops. However, a concern is that farm management practices associated with the cultivation of herbicide-tolerant (HT) crops further deplete farmland biodiversity and accelerate the evolution of herbicide-resistant (HR) weeds. Diversification in crop systems and weed management practices can enhance farmland biodiversity, and reduce the risk of weeds evolving herbicide resistance. Therefore, HT crops are most effective and sustainable as a component of an integrated weed management (IWM) system. IWM advocates the use of multiple effective strategies or tactics to manage weed populations in a manner that is economically and environmentally sound. In practice, however, the potential benefits of IWM with HT crops are seldom realized because a wide range of technical and socio-economic factors hamper the transition to IWM. Here, we discuss the major factors that limit the integration of HT crops and their associated farm management practices in IWM systems. Based on the experience gained in countries where CHT or GMHT crops are widely grown and the increased familiarity with their management, we propose five actions to facilitate the integration of HT crops in IWM systems within the European Union.

From scientific discovery to health outcomes: A synergistic model of doctoral nursing education.

PubMed

Michael, Melanie J; Clochesy, John M

2016-05-01

Across the globe, health system leaders and stakeholder are calling for system-level reforms in education, research, and practice to accelerate the uptake and application of new knowledge in practice and to improve health care delivery and health outcomes. An evolving bi-dimensional research-practice focused model of doctoral nursing education in the U.S. is creating unprecedented opportunities for collaborative translational and investigative efforts for nurse researchers and practitioners. The nursing academy must commit to a shared goal of preparing future generations of nurse scientists and practitioners with the capacity and motivation to work together to accelerate the translation of evidence into practice in order to place nursing at the forefront of health system improvement efforts and advance the profession. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Future of Pork Production in the World: Towards Sustainable, Welfare-Positive Systems

PubMed Central

McGlone, John J.

2013-01-01

Simple Summary More pork is eaten in the world than any other meat. Making production systems and practices more sustainable will benefit the animals, the planet and people. A system is presented by which production practices are evaluated using a sustainability matrix. The matrix shows why some practices are more common in some countries and regions and the impediments to more sustainable systems. This method can be used to assess the sustainability of production practices in the future where objective, science-based information is presented alongside ethical and economic information to make the most informed decisions. Finally, this paper points to current pork production practices that are more and less sustainable. Abstract Among land animals, more pork is eaten in the world than any other meat. The earth holds about one billion pigs who deliver over 100 mmt of pork to people for consumption. Systems of pork production changed from a forest-based to pasture-based to dirt lots and finally into specially-designed buildings. The world pork industry is variable and complex not just in production methods but in economics and cultural value. A systematic analysis of pork industry sustainability was performed. Sustainable production methods are considered at three levels using three examples in this paper: production system, penning system and for a production practice. A sustainability matrix was provided for each example. In a comparison of indoor vs. outdoor systems, the food safety/zoonoses concerns make current outdoor systems unsustainable. The choice of keeping pregnant sows in group pens or individual crates is complex in that the outcome of a sustainability assessment leads to the conclusion that group penning is more sustainable in the EU and certain USA states, but the individual crate is currently more sustainable in other USA states, Asia and Latin America. A comparison of conventional physical castration with immunological castration shows that the less-common immunological castration method is more sustainable (for a number of reasons). This paper provides a method to assess the sustainability of production systems and practices that take into account the best available science, human perception and culture, animal welfare, the environment, food safety, worker health and safety, and economics (including the cost of production and solving world hunger). This tool can be used in countries and regions where the table values of a sustainability matrix change based on local conditions. The sustainability matrix can be used to assess current systems and predict improved systems of the future. PMID:26487410

Practice acquisition: a due diligence checklist. HFMA Principles and Practices Board.

PubMed

1995-12-01

As healthcare executives act to form integrated healthcare systems that encompass entities such as physician-hospital organizations and medical group practices, they often discover that practical guidance on acquiring physician practices is scarce. To address the need for authoritative guidance on practice acquisition, HFMA's Principles and Practices Board has developed a detailed analysis of physician practices acquisition issues, Issues Analysis 95-1: Acquisition of Physician Practices. This analysis includes a detailed due diligence checklist developed to assist both healthcare financial managers involved in acquiring physician practices and physician owners interested in selling their practices.

The Ethics and Politics of the International Transfer of Educational Policy and Practice

ERIC Educational Resources Information Center

Bridges, David

2014-01-01

The focus of this paper is on a variety of practices associated with the transfer of educational policy and practice from one national education system to another--practices sometimes referred to as "policy borrowing". Its concern is with the ethical and political issues raised by these practices. In particular, it discusses concerns…

The Dynamics of Community Health Care Consolidation: Acquisition of Physician Practices

PubMed Central

Christianson, Jon B; Carlin, Caroline S; Warrick, Louise H

2014-01-01

Context Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. Methods We used key informant interviews, supplemented by document analysis. Findings The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. Conclusions In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. PMID:25199899

The dynamics of community health care consolidation: acquisition of physician practices.

PubMed

Christianson, Jon B; Carlin, Caroline S; Warrick, Louise H

2014-09-01

Health care delivery systems are becoming increasingly consolidated in urban areas of the United States. While this consolidation could increase efficiency and improve quality, it also could raise the cost of health care for payers. This article traces the consolidation trajectory in a single community, focusing on factors influencing recent acquisitions of physician practices by integrated delivery systems. We used key informant interviews, supplemented by document analysis. The acquisition of physician practices is a process that will be difficult to reverse in the current health care environment. Provider revenue uncertainty is a key factor driving consolidation, with public and private attempts to control health care costs contributing to that uncertainty. As these efforts will likely continue, and possibly intensify, community health care systems now are less consolidated than they will be in the future. Acquisitions of multispecialty and primary care practices by integrated delivery systems follow a common process, with relatively predictable issues relating to purchase agreements, employment contracts, and compensation. Acquisitions of single-specialty practices are less common, with motivations for acquisitions likely to vary by specialty type, group size, and market structure. Total cost of care contracting could be an important catalyst for practice acquisitions in the future. In the past, market and regulatory forces aimed at controlling costs have both encouraged and rewarded the consolidation of providers, with important new developments likely to create momentum for further consolidation, including acquisitions of physician practices. © 2014 Milbank Memorial Fund.

Neural practice effect during cross-modal selective attention: Supra-modal and modality-specific effects.

PubMed

Xia, Jing; Zhang, Wei; Jiang, Yizhou; Li, You; Chen, Qi

2018-05-16

Practice and experiences gradually shape the central nervous system, from the synaptic level to large-scale neural networks. In natural multisensory environment, even when inundated by streams of information from multiple sensory modalities, our brain does not give equal weight to different modalities. Rather, visual information more frequently receives preferential processing and eventually dominates consciousness and behavior, i.e., visual dominance. It remains unknown, however, the supra-modal and modality-specific practice effect during cross-modal selective attention, and moreover whether the practice effect shows similar modality preferences as the visual dominance effect in the multisensory environment. To answer the above two questions, we adopted a cross-modal selective attention paradigm in conjunction with the hybrid fMRI design. Behaviorally, visual performance significantly improved while auditory performance remained constant with practice, indicating that visual attention more flexibly adapted behavior with practice than auditory attention. At the neural level, the practice effect was associated with decreasing neural activity in the frontoparietal executive network and increasing activity in the default mode network, which occurred independently of the modality attended, i.e., the supra-modal mechanisms. On the other hand, functional decoupling between the auditory and the visual system was observed with the progress of practice, which varied as a function of the modality attended. The auditory system was functionally decoupled with both the dorsal and ventral visual stream during auditory attention while was decoupled only with the ventral visual stream during visual attention. To efficiently suppress the irrelevant visual information with practice, auditory attention needs to additionally decouple the auditory system from the dorsal visual stream. The modality-specific mechanisms, together with the behavioral effect, thus support the visual dominance model in terms of the practice effect during cross-modal selective attention. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder.

PubMed

Streeter, C C; Gerbarg, P L; Saper, R B; Ciraulo, D A; Brown, R P

2012-05-01

A theory is proposed to explain the benefits of yoga practices in diverse, frequently comorbid medical conditions based on the concept that yoga practices reduce allostatic load in stress response systems such that optimal homeostasis is restored. It is hypothesized that stress induces (1) imbalance of the autonomic nervous system (ANS) with decreased parasympathetic nervous system (PNS) and increased sympathetic nervous system (SNS) activity, (2) underactivity of the gamma amino-butyric acid (GABA) system, the primary inhibitory neurotransmitter system, and (3) increased allostatic load. It is further hypothesized that yoga-based practices (4) correct underactivity of the PNS and GABA systems in part through stimulation of the vagus nerves, the main peripheral pathway of the PNS, and (5) reduce allostatic load. Depression, epilepsy, post traumatic stress disorder (PTSD), and chronic pain exemplify medical conditions that are exacerbated by stress, have low heart rate variability (HRV) and low GABAergic activity, respond to pharmacologic agents that increase activity of the GABA system, and show symptom improvement in response to yoga-based interventions. The observation that treatment resistant cases of epilepsy and depression respond to vagal nerve stimulation corroborates the need to correct PNS underactivity as part of a successful treatment plan in some cases. According to the proposed theory, the decreased PNS and GABAergic activity that underlies stress-related disorders can be corrected by yoga practices resulting in amelioration of disease symptoms. This has far-reaching implications for the integration of yoga-based practices in the treatment of a broad array of disorders exacerbated by stress. Copyright © 2012 Elsevier Ltd. All rights reserved.

Advanced nursing practice.

PubMed

Carroll, Mark

Mark Carroll examines the concept of advanced nursing practice and highlights a number of the difficulties in assessing and defining different levels of practice. Some of the differences and similarities between advanced practice in the US and UK are compared and contrasted. Issues of élitism and the lack of correlation between the needs of the healthcare system and professional self-interest prevent the advancement of specialist roles in the UK. The continuing focus of local trusts on the medicalisation of roles to meet the demands of the healthcare system appears to ignore the need for nursing to expand from within the profession.

A Trial of Nursing Cost Accounting using Nursing Practice Data on a Hospital Information System.

PubMed

Miyahira, Akiko; Tada, Kazuko; Ishima, Masatoshi; Nagao, Hidenori; Miyamoto, Tadashi; Nakagawa, Yoshiaki; Takemura, Tadamasa

2015-01-01

Hospital administration is very important and many hospitals carry out activity-based costing under comprehensive medicine. However, nursing cost is unclear, because nursing practice is expanding both quantitatively and qualitatively and it is difficult to grasp all nursing practices, and nursing cost is calculated in many cases comprehensively. On the other hand, a nursing information system (NIS) is implemented in many hospitals in Japan and we are beginning to get nursing practical data. In this paper, we propose a nursing cost accounting model and we simulate a cost by nursing contribution using NIS data.

A systems engineering management approach to resource management applications

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller

1989-01-01

The author presents a program management response to the following question: How can the traditional practice of systems engineering management, including requirements specification, be adapted, enhanced, or modified to build future planning and scheduling systems for effective operations? The systems engineering management process, as traditionally practiced, is examined. Extensible resource management systems are discussed. It is concluded that extensible systems are a partial solution to problems presented by requirements that are incomplete, partially immeasurable, and often dynamic. There are positive indications that resource management systems have been characterized and modeled sufficiently to allow their implementation as extensible systems.

Maximizing User Satisfaction With Office Practice Data Processing Systems

PubMed Central

O'Flaherty, Thomas; Jussim, Judith

1980-01-01

Significant numbers of physicians are using data processing services and a large number of firms are offering an increasing variety of services. This paper quantifies user dissatisfaction with office practice data processing systems and analyzes factors affecting dissatisfaction in large group practices. Based on this analysis, a proposal is made for a more structured approach to obtaining data processing services in order to lower the risks and increase satisfaction with data processing.

Modeling systems-level dynamics: Understanding without mechanistic explanation in integrative systems biology.

PubMed

MacLeod, Miles; Nersessian, Nancy J

2015-02-01

In this paper we draw upon rich ethnographic data of two systems biology labs to explore the roles of explanation and understanding in large-scale systems modeling. We illustrate practices that depart from the goal of dynamic mechanistic explanation for the sake of more limited modeling goals. These processes use abstract mathematical formulations of bio-molecular interactions and data fitting techniques which we call top-down abstraction to trade away accurate mechanistic accounts of large-scale systems for specific information about aspects of those systems. We characterize these practices as pragmatic responses to the constraints many modelers of large-scale systems face, which in turn generate more limited pragmatic non-mechanistic forms of understanding of systems. These forms aim at knowledge of how to predict system responses in order to manipulate and control some aspects of them. We propose that this analysis of understanding provides a way to interpret what many systems biologists are aiming for in practice when they talk about the objective of a "systems-level understanding." Copyright © 2014 Elsevier Ltd. All rights reserved.

Development of a health care systems curriculum

PubMed Central

Pruitt, Zachary; Mhaskar, Rahul; Kane, Bryan G; Barraco, Robert D; DeWaay, Deborah J; Rosenau, Alex M; Bresnan, Kristin A; Greenberg, Marna Rayl

2017-01-01

Background There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution. Methods This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys. Results To meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated they gained working knowledge of health systems by engaging in these sessions. The majority of the 2016 graduating students (88.24%) felt that the course content, overall, prepared them for their career. Conclusion A health systems curriculum in undergraduate medical education using a problem-based learning approach is feasible. The majority of students learning health systems curriculum through this format reported being prepared to improve individual patient care and optimize the health system’s value (better care and health for lower cost). PMID:29138614

7 CFR 407.9 - Group risk plan common policy.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Provisions. Conventional farming practice. A system or process for producing an agricultural commodity, excluding organic farming practices, that is necessary to produce the crop that may be, but is not required... practice allows the crop to make normal progress toward maturity. Good farming practices. The production...

7 CFR 407.9 - Group risk plan common policy.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Provisions. Conventional farming practice. A system or process for producing an agricultural commodity, excluding organic farming practices, that is necessary to produce the crop that may be, but is not required... practice allows the crop to make normal progress toward maturity. Good farming practices. The production...

Research Making Its Way into Classroom Practice

ERIC Educational Resources Information Center

Johnston, Peter; Goatley, Virginia

2015-01-01

Identifying researchers whose work has influenced classroom practice, raises questions about the nature of research and its relationship with practice, and the means through which knowledge is distributed. We argue that normally, influence arises through lines of research more than individuals, that knowing-in-practice distribution systems should…

Feasibility, acceptability and effectiveness of an online alternative to face-to-face consultation in general practice: a mixed-methods study of webGP in six Devon practices

PubMed Central

Carter, Mary; Fletcher, Emily; Sansom, Anna; Warren, Fiona C; Campbell, John L

2018-01-01

Objectives To evaluate the feasibility, acceptability and effectiveness of webGP as piloted by six general practices. Methods Mixed-methods evaluation, including data extraction from practice databases, general practitioner (GP) completion of case reports, patient questionnaires and staff interviews. Setting General practices in NHS Northern, Eastern and Western Devon Clinical Commissioning Group’s area approximately 6 months after implementing webGP (February–July 2016). Participants Six practices provided consultations data; 20 GPs completed case reports (regarding 61 e-consults); 81 patients completed questionnaires; 5 GPs and 5 administrators were interviewed. Outcome measures Attitudes and experiences of practice staff and patients regarding webGP. Results WebGP uptake during the evaluation was small, showing no discernible impact on practice workload. The completeness of cross-sectional data on consultation workload varied between practices. GPs judged 41/61 (72%) of webGP requests to require a face-to-face or telephone consultation. Introducing webGP appeared to be associated with shifts in responsibility and workload between practice staff and between practices and patients. 81/231 patients completed a postal survey (35.1% response rate). E-Consulters were somewhat younger and more likely to be employed than face-to-face respondents. WebGP appeared broadly acceptable to patients regarding timeliness and quality/experience of care provided. Similar problems were presented by all respondents. Both groups appeared equally familiar with other practice online services; e-consulters were somewhat more likely to have used them. From semistructured staff interviews, it appeared that, while largely acceptable within practice, introducing e-consults had potential for adverse interactions with pre-existing practice systems. Conclusions There is potential to assess the impact of new systems on consultation patterns by extracting routine data from practice databases. Staff and patients noticed subtle changes to responsibilities associated with online options. Greater uptake requires good communication between practice and patients, and organisation of systems to avoid conflicts and misuse. Further research is required to evaluate the full potential of webGP in managing practice workload. PMID:29449293

A freely available real-time operating system well suited for astronomy and the physical sciences

NASA Astrophysics Data System (ADS)

Pedretti, Ettore; Monnier, John D.; Thureau, Nathalie D.; Berger, David H.

2006-06-01

This paper wants to be a practical example in building a real-time data-acquisition and control system from scratch using relatively non-expensive PC hardware and open-source software. The practical example of building the control system for the Michigan Infrared Combiner (MIRC) at the CHARA interferometer will be used to give the reader a 'hands-on' experience in installing and configuring the RTAI-Fusion real-time operating system and developing a complete control system with it.

Adaptive Systems Engineering: A Medical Paradigm for Practicing Systems Engineering

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

R. Douglas Hamelin; Ron D. Klingler; Christopher Dieckmann

2011-06-01

From its inception in the defense and aerospace industries, SE has applied holistic, interdisciplinary tools and work-process to improve the design and management of 'large, complex engineering projects.' The traditional scope of engineering in general embraces the design, development, production, and operation of physical systems, and SE, as originally conceived, falls within that scope. While this 'traditional' view has expanded over the years to embrace wider, more holistic applications, much of the literature and training currently available is still directed almost entirely at addressing the large, complex, NASA and defense-sized systems wherein the 'ideal' practice of SE provides the cradle-to-gravemore » foundation for system development and deployment. Under such scenarios, systems engineers are viewed as an integral part of the system and project life-cycle from conception to decommissioning. In far less 'ideal' applications, SE principles are equally applicable to a growing number of complex systems and projects that need to be 'rescued' from overwhelming challenges that threaten imminent failure. The medical profession provides a unique analogy for this latter concept and offers a useful paradigm for tailoring our 'practice' of SE to address the unexpected dynamics of applying SE in the real world. In short, we can be much more effective as systems engineers as we change some of the paradigms under which we teach and 'practice' SE.« less

Systems thinking perspectives applied to healthcare transition for youth with disabilities: a paradigm shift for practice, policy and research.

PubMed

Hamdani, Y; Jetha, A; Norman, C

2011-11-01

Healthcare transition (HCT) for youth with disabilities is a complex phenomenon influenced by multiple interacting factors, including health, personal and environmental factors. Current research on the transition to adulthood for disabled youth has primarily focused on identifying these multilevel factors to guide the development of interventions to improve the HCT process. However, little is known about how this complex array of factors interacts and contributes to successful HCT. Systems thinking provides a theoretically informed perspective that accounts for complexity and can contribute to enhanced understanding of the interactions among HCT factors. The objective of this paper is to introduce general concepts of systems thinking as applied to HCT practice and research. Several systems thinking concepts and principles are introduced and a discussion of HCT as a complex system is provided. Systems dynamics methodology is described as one systems method for conceptualizing HCT. A preliminary systems dynamics model is presented to facilitate discourse on the application of systems thinking principles to HCT practice, policy and research. An understanding of the complex interactions and patterns of relationships in HCT can assist health policy makers and practitioners in determining key areas of intervention, the impact of these interventions on the system and the potential intended and unintended consequences of change. This paper provides initial examination of applying systems thinking to inform future research and practice on HCT. © 2011 Blackwell Publishing Ltd.

Measuring primary care practice performance within an integrated delivery system: a case study.

PubMed

Stewart, Louis J; Greisler, David

2002-01-01

This article examines the use of an integrated performance measurement system to plan and control primary care service delivery within an integrated delivery system. We review a growing body of literature that focuses on the development and implementation of management reporting systems among healthcare providers. Our study extends the existing literature by examining the use of performance information generated by an integrated performance measurement system within a healthcare organization. We conduct our examination through a case study of the WMG Primary Care Medicine Group, the primary care medical group practice of WellSpan Health System. WellSpan Health System is an integrated delivery system that serves south central Pennsylvania and northern Maryland. Our study examines the linkage between WellSpan Health's strategic objectives and its primary care medicine group's integrated performance measurement system. The conceptual design of this integrated performance measurement system combines financial metrics with practice management and clinical operating metrics to provide a more complete picture of medical group performance. Our findings demonstrate that WellSpan Health was able to achieve superior financial results despite a weak linkage between its integrated performance measurement system and its strategic objectives. WellSpan Health achieved this objective for its primary care medicine group by linking clinical performance information to physician compensation and reporting practice management performance through the use of statistical process charts. They found that the combined mechanisms of integrated performance measurement and statistical process control charts improved organizational learning and communications between organizational stakeholders.

Canadian community pharmacists' use of digital health technologies in practice.

PubMed

Leung, Valerie; Tharmalingam, Sukirtha; Cooper, Janet; Charlebois, Maureen

2016-01-01

In 2010, a pan-Canadian study on the current state and benefits of provincial drug information systems (DIS) found that substantial benefits were being realized and that pharmacists perceived DIS to be a valuable tool in the evolving models of pharmacy practice. To understand changes in digital health and the impact on practice since that time, a survey of community pharmacists in Canada was conducted. In 2014, Canada Health Infoway (Infoway) and the Canadian Pharmacists Association (CPhA) invited community pharmacists to participate in a Web-based survey to understand their use and perceived benefits of digital health in practice. The survey was open from April 15 to May 12, 2014. Of the 447 survey responses, almost all used some form of digital health in practice. Those with access to DIS and provincial laboratory information systems (LIS) reported increased productivity and better quality of care. Those without access to these systems would overwhelmingly like access. There have been significant advances in digital health and community pharmacy practice over the past several years. In addition to digital health benefits in the areas of productivity and quality of care, pharmacists are also experiencing substantial benefits in areas related to recently expanded scope of practice activities such as ordering lab tests. Community pharmacists frequently use digital health in practice and recognize the benefits of these technologies. Digital health is, and will continue to be, a key enabler for practice transformation and improved quality of care. Can Pharm J (Ott) 2016;149:xx-xx.

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

Education, practical training and professional development for public health practitioners: a scoping review of the literature and insights for sustainable food system capacity-building.

PubMed

Wegener, Jessica; Fong, Debbie; Rocha, Cecilia

2018-06-01

Noting the upstream positioning of sustainable food systems (SFS) to multiple global crises, the present review described examples of emerging and promising practices to support SFS-oriented education, practical training (PT) and continuing professional development (CPD) among trainees and public health practitioners (PHP). A secondary objective was to compile the evidence into practical considerations for educators, supervising practitioners and professional associations. A scoping review of the literature published between 2007 and 2017 was conducted in May 2017 using four databases: CINAHL, MEDLINE, Scopus and HSSA, along with bibliography hand-searching and expert consultation. Articles were screened for relevance and specificity by independent raters. Nineteen articles were included for analysis. Two-thirds of the articles related to dietitians and public health nutritionists. Emerging practices included curriculum-based considerations, incorporation of 'sustainability' within professional competencies and self-reflection related to SFS. Descriptions of SFS-related education, PT and CPD practices appeared largely in the literature from developed countries. Articles converged on the need for ecosystems, food systems and sustainability considerations within and across practice to support current and future practitioners. There is growing interest in SFS but guidance to support educators and preceptors is lacking. Updates to dietary guidelines to reflect issues of sustainability are a timely prompt to examine the education, training and development needs of trainees and PHP. Practical examples of emerging practices can empower PHP to promote SFS in all areas of practice. More research is needed to address identified gaps in the literature and to improve SFS-specific education, PT and CPD.

The ABC's required for establishing a practical computerized plant engineering management data base system

NASA Technical Reports Server (NTRS)

Maiocco, F. R.; Hume, J. P.

1976-01-01

A system's approach is outlined in the paper to assist facility and Plant Engineers improve their organization's data management system. The six basic steps identified may appear somewhat simple; however, adequate planning, proper resources, and the involvement of management will determine the success of a computerized facility management data base. Helpful suggestions are noted throughout the paper to insure the development of a practical computerized data management system.

Concepts, requirements, and design approaches for building successful planning and scheduling systems

NASA Technical Reports Server (NTRS)

Hornstein, Rhoda Shaller; Willoughby, John K.

1991-01-01

Traditional practice of systems engineering management assumes requirements can be precisely determined and unambiguously defined prior to system design and implementation; practice further assumes requirements are held static during implementation. Human-computer decision support systems for service planning and scheduling applications do not conform well to these assumptions. Adaptation to the traditional practice of systems engineering management are required. Basic technology exists to support these adaptations. Additional innovations must be encouraged and nutured. Continued partnership between the programmatic and technical perspective assures proper balance of the impossible with the possible. Past problems have the following origins: not recognizing the unusual and perverse nature of the requirements for planning and scheduling; not recognizing the best starting point assumptions for the design; not understanding the type of system that being built; and not understanding the design consequences of the operations concept selected.

Update - Concept of Operations for Integrated Model-Centric Engineering at JPL

NASA Technical Reports Server (NTRS)

Bayer, Todd J.; Bennett, Matthew; Delp, Christopher L.; Dvorak, Daniel; Jenkins, Steven J.; Mandutianu, Sanda

2011-01-01

The increasingly ambitious requirements levied on JPL's space science missions, and the development pace of such missions, challenge our current engineering practices. All the engineering disciplines face this growth in complexity to some degree, but the challenges are greatest in systems engineering where numerous competing interests must be reconciled and where complex system level interactions must be identified and managed. Undesired system-level interactions are increasingly a major risk factor that cannot be reliably exposed by testing, and natural-language single-viewpoint specifications areinadequate to capture and expose system level interactions and characteristics. Systems engineering practices must improve to meet these challenges, and the most promising approach today is the movement toward a more integrated and model-centric approach to mission conception, design, implementation and operations. This approach elevates engineering models to a principal role in systems engineering, gradually replacing traditional document centric engineering practices.

AskFuse Origins: System Barriers to Providing the Research That Public Health Practice and Policy Partners Say They Need

ERIC Educational Resources Information Center

Rushmer, Rosemary; Shucksmith, Janet

2018-01-01

In this paper the development of askFuse is used as a case study to illustrate contextual and system barriers to universities providing useful, usable and timely research evidence in response to local practice and policy partners' stated public health research needs. Entrenched systems (research excellence framework, academic career pathways,…

40 CFR 141.203 - Tier 2 Public Notice-Form, manner, and frequency of notice.

Code of Federal Regulations, 2010 CFR

2010-07-01

... must provide the public notice as soon as practical, but no later than 30 days after the system learns... initial notice of up to three months from the date the system learns of the violation. It is not... as soon as practical but no later than 24 hours after the public water system learns of the violation...

Scaling the Pyramid Model across Complex Systems Providing Early Care for Preschoolers: Exploring How Models for Decision Making May Enhance Implementation Science

ERIC Educational Resources Information Center

Johnson, LeAnne D.

2017-01-01

Bringing effective practices to scale across large systems requires attending to how information and belief systems come together in decisions to adopt, implement, and sustain those practices. Statewide scaling of the Pyramid Model, a framework for positive behavior intervention and support, across different types of early childhood programs…

A System for Individualizing Instruction. Practical Answers to U-SAIL Implementation Questions. Monograph No. 4.

ERIC Educational Resources Information Center

Utah System Approach to Individualized Learning Project.

The U-SAIL system is a practical approach to individualization of instruction in which a problem-solving process is employed to install a program in logical sequential phases. U-SAIL is a nationally validated, successfully replicated, cost-feasible system for individualization of instruction which can be implemented in a variety of settings with…

40 CFR 141.203 - Tier 2 Public Notice-Form, manner, and frequency of notice.

Code of Federal Regulations, 2011 CFR

2011-07-01

... must provide the public notice as soon as practical, but no later than 30 days after the system learns... initial notice of up to three months from the date the system learns of the violation. It is not... as soon as practical but no later than 24 hours after the public water system learns of the violation...

Comparative Analysis of Educational Systems of American and Japanese Schools: Views and Visions

ERIC Educational Resources Information Center

Wieczorek, Craig C.

2008-01-01

Knowing the great impact education has on a nation, the author decided to investigate the education systems in America and Japan. The aim of the study was to answer how educational systems or practices in Japan and America differ, and how Japanese practices might improve those of American educators and administrators. Besides many similarities,…

Miller's best/enhanced practices for flour fortification at the flour mill.

PubMed

Johnson, Quentin W; Wesley, Annie S

2010-03-01

Cereal flour fortification has been identified as an effective mass fortification intervention as part of a national public health strategy to overcome micronutrient deficiencies and improve the health status of populations, especially women and children. The effectiveness of cereal flour fortification programs requires the use of micronutrient premixes that provide the desired health benefits. The Miller's Best/Enhanced Practices for Flour Fortification at the flour mill has been developed to provide specific guidance to millers and government officials to ensure that flour fortification practices are carried out in a way that results in the anticipated public health impact. The paper provides information specific to the use of micronutrient premixes, feeders, the fortification process, and quality control systems to ensure that both minimum and enhanced practices can be followed by the millers. Guidelines for basic and best/enhanced practices to be followed for each stage of the flour fortification process at the flour mill are presented. The paper is designed to be a companion to the Recommended Practices for the Production and Procurement of Premix used in Cereal Fortification Programs and supplementary to existing food quality manuals and systems, such as Good Manufacturing Practices, Food Quality Systems, and Hazard Analysis and Critical Control Points. Other stakeholders involved in flour fortification programs have the responsibility to follow best practices of their own to ensure optimum effectiveness.

Service Providers’ Experiences and Perspectives on Recovery-Oriented Mental Health System Reform

PubMed Central

Piat, Myra; Lal, Shalini

2016-01-01

Objective With the use of a qualitative approach, this study focuses on service providers’ experiences and perspectives on recovery-oriented reform. Methods Nine focus groups were conducted with a sample of 68 service providers recruited from three Canadian sites. Results Three major themes were identified: 1) positive attitudes towards recovery-oriented reform; 2) skepticism towards recovery-oriented reform; and 3) challenges associated with implementing recovery-oriented practice. These challenges pertained to conceptual uncertainty and consistency around the meanings of recovery; application of recovery-oriented practice with certain populations and in certain contexts; bureaucratization of recovery-oriented tools; limited leadership support; and, societal stigma and social exclusion of persons with mental illnesses. Conclusions and Implications for Practice The findings point towards challenges that might arise as system planners move ahead in their efforts toward implementing recovery within the mental health system. In this regard, we offer several recommendations for the planning of organizational and educational practices that support the implementation of recovery-oriented practice. PMID:22491368

From theory to practice: what drives the core business of public health?

PubMed

Smith, Tina Anderson; Minyard, Karen J; Parker, Christopher A; Van Valkenburg, Rachel Ferencik; Shoemaker, John A

2007-01-01

In 1994, the Public Health Functions Steering Committee proffered a description of the Essential Public Health Services (Essential Services). Questions remain, however, about the relationship between the roles defined therein and current public health practice at state and local levels. This case study describes the core business of public health in Georgia relative to the theoretical ideal and elucidates the primary drivers of the core business, thus providing data to inform future efforts to strengthen practice in the state. The principal finding was that public health in Georgia is not aligned with the Essential Services. Further analysis revealed that the primary drivers or determinants of public health practice are finance-related rather than based in need or strategy, precluding an integrated and intentional focus on health improvement. This case study provides a systems context for public health financing discussions, suggests leverage points for public health system change, and furthers the examination of applications for systems thinking relative to public health finance, practice, and policy.

Development of a Web-based resident profiling tool to support training in practice-based learning and improvement.

PubMed

Lyman, Jason A; Schorling, John; Nadkarni, Mohan; May, Natalie; Scully, Ken; Voss, John

2008-04-01

Multiple factors are driving residency programs to explicitly address practice-based learning and improvement (PBLI), yet few information systems exist to facilitate such training. We developed, implemented, and evaluated a Web-based tool that provides Internal Medicine residents at the University of Virginia Health System with population-based reports about their ambulatory clinical experiences. Residents use Systems and Practice Analysis for Resident Competencies (SPARC) to identify potential areas for practice improvement. Thirty-three (65%) of 51 residents completed a survey assessing SPARC's usefulness, with 94% agreeing that it was a useful educational tool. Twenty-six residents (51%) completed a before-after study indicating increased agreement (5-point Likert scale, with 5=strongly agree) with statements regarding confidence in ability to access population-based data about chronic disease management (mean [SD] 2.5 [1.2] vs. 4.5 [0.5], p < .001, sign test) and information comparing their practice style to that of their peers (2.2 [1.2] vs. 4.6 [0.5], p < .001).

Downstream approaches to phosphorus management in agricultural landscapes: regional applicability and use.

PubMed

Kröger, R; Dunne, E J; Novak, J; King, K W; McLellan, E; Smith, D R; Strock, J; Boomer, K; Tomer, M; Noe, G B

2013-01-01

This review provides a critical overview of conservation practices that are aimed at improving water quality by retaining phosphorus (P) downstream of runoff genesis. The review is structured around specific downstream practices that are prevalent in various parts of the United States. Specific practices that we discuss include the use of controlled drainage, chemical treatment of waters and soils, receiving ditch management, and wetlands. The review also focuses on the specific hydrology and biogeochemistry associated with each of those practices. The practices are structured sequentially along flowpaths as you move through the landscape, from the edge-of-field, to adjacent aquatic systems, and ultimately to downstream P retention. Often practices are region specific based on geology, cropping practices, and specific P related problems and thus require a right practice, and right place mentality to management. Each practice has fundamental P transport and retention processes by systems that can be optimized by management with the goal of reducing downstream P loading after P has left agricultural fields. The management of P requires a system-wide assessment of the stability of P in different biogeochemical forms (particulate vs. dissolved, organic vs. inorganic), in different storage pools (soil, sediment, streams etc.), and under varying biogeochemical and hydrological conditions that act to convert P from one form to another and promote its retention in or transport out of different landscape components. There is significant potential of hierarchically placing practices in the agricultural landscape and enhancing the associated P mitigation. But an understanding is needed of short- and long-term P retention mechanisms within a certain practice and incorporating maintenance schedules if necessary to improve P retention times and minimize exceeding retention capacity. Copyright © 2012 Elsevier B.V. All rights reserved.

Teaching medical management and operations engineering for systems-based practice to radiology residents.

PubMed

Brandon, Catherine J; Mullan, Patricia B

2013-03-01

To better prepare radiology residents for providing care within the context of the larger health care system, this study evaluated the feasibility and impact of a curriculum to enhance radiology residents' understanding and ability to apply concepts from medical management and industrial and operational engineering to systems-based practice problems in radiology practice. A multiprofessional team including radiology, medical education, and industrial and operational engineering professionals collaborated in developing a seven-module curriculum, including didactic lectures, interactive large-group analysis, and small-group discussions with case-based radiology examples, which illustrated real-life management issues and the roles physicians held. Residents and faculty participated in topic selection. Pre- and post-instruction formative assessments were administered, and results were shared with residents during teaching sessions. Attendance and participation in case-based scenario resolutions indicate the feasibility and impact of the interactive curriculum on residents' interest and ability to apply curricular concepts to systems-based practice in radiology. Paired t test analyses (P < .05) and effect sizes showed residents significantly increased their knowledge and ability to apply concepts to systems-based practice issues in radiology. Our iterative curriculum development and implementation process demonstrated need and support for a multiprofessional team approach to teach management and operational engineering concepts. Curriculum topics are congruent with Accreditation Council for Graduate Medical Education requirements for systems-based practice. The case-based curriculum using a mixed educational format of didactic lectures and small-group discussion and problem analysis could be adopted for other radiology programs, for both residents and continuing medical education applications. Copyright © 2013 AUR. Published by Elsevier Inc. All rights reserved.

Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya.

PubMed

Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan

2017-02-01

There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations of PSRA practices in case study hospitals over a period of 7 months. In this paper, we apply complex adaptive system (CAS) theory to examine the factors that influence PSRA practices. We found that PSRA practices in the case hospitals were influenced by, 1) inadequate financing level and poorly designed financing arrangements, 2) limited hospital autonomy and decision space, and 3) inadequate management and leadership capacity in the hospital. The case study hospitals exhibited properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in system 'hardware' (resource scarcity) and 'software' (including PSRA guidelines that reduced hospitals decision space, and poor leadership skills) led to the emergence of undesired properties. The capacity of hospitals to set priorities should be improved across these interacting aspects of the hospital organizational system. Interventions should however recognize that hospitals are CAS. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Overview of practice management in child and adolescent psychiatry.

PubMed

Schreter, Robert K

2010-01-01

The manager of a psychiatric practice must create and direct a clinical delivery system, design and oversee the administrative services necessary to support the system, and guide the business operations that contribute to its success. Regardless of the size of the practice, the psychiatrist administrator must handle seven core administrative responsibilities and oversee individual functions and capabilities within each domain. These responsibilities include practice development, clinical services management, medical office operations, clinical management, information management, business management, and risk management. This article provides a roadmap for creating and sustaining successful clinical and administrative endeavors. It can also be used by existing practices as an audit instrument to provide a snapshot of current capabilities so that strengths as well as opportunities for continued growth can be identified.

Randomness determines practical security of BB84 quantum key distribution.

PubMed

Li, Hong-Wei; Yin, Zhen-Qiang; Wang, Shuang; Qian, Yong-Jun; Chen, Wei; Guo, Guang-Can; Han, Zheng-Fu

2015-11-10

Unconditional security of the BB84 quantum key distribution protocol has been proved by exploiting the fundamental laws of quantum mechanics, but the practical quantum key distribution system maybe hacked by considering the imperfect state preparation and measurement respectively. Until now, different attacking schemes have been proposed by utilizing imperfect devices, but the general security analysis model against all of the practical attacking schemes has not been proposed. Here, we demonstrate that the general practical attacking schemes can be divided into the Trojan horse attack, strong randomness attack and weak randomness attack respectively. We prove security of BB84 protocol under randomness attacking models, and these results can be applied to guarantee the security of the practical quantum key distribution system.

Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.

PubMed

Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

2013-01-01

Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

Randomness determines practical security of BB84 quantum key distribution

PubMed Central

Li, Hong-Wei; Yin, Zhen-Qiang; Wang, Shuang; Qian, Yong-Jun; Chen, Wei; Guo, Guang-Can; Han, Zheng-Fu

2015-01-01

Unconditional security of the BB84 quantum key distribution protocol has been proved by exploiting the fundamental laws of quantum mechanics, but the practical quantum key distribution system maybe hacked by considering the imperfect state preparation and measurement respectively. Until now, different attacking schemes have been proposed by utilizing imperfect devices, but the general security analysis model against all of the practical attacking schemes has not been proposed. Here, we demonstrate that the general practical attacking schemes can be divided into the Trojan horse attack, strong randomness attack and weak randomness attack respectively. We prove security of BB84 protocol under randomness attacking models, and these results can be applied to guarantee the security of the practical quantum key distribution system. PMID:26552359

Randomness determines practical security of BB84 quantum key distribution

NASA Astrophysics Data System (ADS)

Li, Hong-Wei; Yin, Zhen-Qiang; Wang, Shuang; Qian, Yong-Jun; Chen, Wei; Guo, Guang-Can; Han, Zheng-Fu

2015-11-01

Unconditional security of the BB84 quantum key distribution protocol has been proved by exploiting the fundamental laws of quantum mechanics, but the practical quantum key distribution system maybe hacked by considering the imperfect state preparation and measurement respectively. Until now, different attacking schemes have been proposed by utilizing imperfect devices, but the general security analysis model against all of the practical attacking schemes has not been proposed. Here, we demonstrate that the general practical attacking schemes can be divided into the Trojan horse attack, strong randomness attack and weak randomness attack respectively. We prove security of BB84 protocol under randomness attacking models, and these results can be applied to guarantee the security of the practical quantum key distribution system.

Net Metering Policy Development and Distributed Solar Generation in Minnesota: Overview of Trends in Nationwide Policy Development and Implications of Increasing the Eligible System Size Cap

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

Doris, E.; Busche, S.; Hockett, S.

2009-12-01

The goal of the Minnesota net metering policy is to give the maximum possible encouragement to distributed generation assets, especially solar electric systems (MN 2008). However, according to a published set of best practices (NNEC 2008) that prioritize the maximum development of solar markets within states, the Minnesota policy does not incorporate many of the important best practices that may help other states transform their solar energy markets and increase the amount of grid-connected distributed solar generation assets. Reasons cited include the low system size limit of 40kW (the best practices document recommends a 2 MW limit) and a lackmore » of language protecting generators from additional utility fees. This study was conducted to compare Minnesota's policies to national best practices. It provides an overview of the current Minnesota policy in the context of these best practices and other jurisdictions' net metering policies, as well as a qualitative assessment of the impacts of raising the system size cap within the policy based on the experiences of other states.« less

Leadership development practices and hospital financial outcomes.

PubMed

Crowe, Daniel; Garman, Andrew N; Li, Chien-Ching; Helton, Jeff; Anderson, Matthew M; Butler, Peter

2017-08-01

Affordable Care Act legislation is requiring leaders in US health systems to adapt to new and very different approaches to improving operating performance. Research from other industries suggests leadership development can be a helpful component of organizational change strategies; however, there is currently very little healthcare-specific research available to guide design and deployment. The goal of this exploratory study is to examine potential relationships between specific leadership development practices and health system financial outcomes. Results from the National Center for Healthcare Leadership survey of leadership development practices were correlated with hospital and health system financial performance data from the 2013 Medicare Cost Reports. A general linear regression model, controlling for payer mix, case-mix index, and bed size, was used to assess possible relationships between leadership practices and three financial performance metrics: operating margin, days cash on hand, and debt to capitalization. Statistically significant associations were found between hospital-level operating margins and 5 of the 11 leadership practices as well as the composite score. Relationships at the health system level, however, were not statistically significant. Results provide preliminary evidence of an association between hospital financial performance and investments made in developing their leaders.

Data collection and information presentation for optimal decision making by clinical managers--the Autocontrol Project.

PubMed Central

Grant, A. M.; Richard, Y.; Deland, E.; Després, N.; de Lorenzi, F.; Dagenais, A.; Buteau, M.

1997-01-01

The Autocontrol methodology has been developed in order to support the optimisation of decision-making and the use of resources in the context of a clinical unit. The theoretical basis relates to quality assurance and information systems and is influenced by management and cognitive research in the health domain. The methodology uses population rather than individual decision making and because of its dynamic feedback design promises to have rapid and profound effect on practice. Most importantly the health care professional is the principle user of the Autocontrol system. In this methodology we distinguish three types of evidence necessary for practice change: practice based or internal evidence, best evidence derived from the literature or external evidence concerning the practice in question, and process based evidence on how to optimise the process of practice change. The software used by the system is of the executive decision support type which facilitates interrogation of large databases. The Autocontrol system is designed to interrogate the data of the patient medical record however the latter often lacks data on concomitant resource use and this must be supplemented. This paper reviews the Autocontrol methodology and gives examples from current studies. PMID:9357733

Data collection and information presentation for optimal decision making by clinical managers--the Autocontrol Project.

PubMed

Grant, A M; Richard, Y; Deland, E; Després, N; de Lorenzi, F; Dagenais, A; Buteau, M

1997-01-01

The Autocontrol methodology has been developed in order to support the optimisation of decision-making and the use of resources in the context of a clinical unit. The theoretical basis relates to quality assurance and information systems and is influenced by management and cognitive research in the health domain. The methodology uses population rather than individual decision making and because of its dynamic feedback design promises to have rapid and profound effect on practice. Most importantly the health care professional is the principle user of the Autocontrol system. In this methodology we distinguish three types of evidence necessary for practice change: practice based or internal evidence, best evidence derived from the literature or external evidence concerning the practice in question, and process based evidence on how to optimise the process of practice change. The software used by the system is of the executive decision support type which facilitates interrogation of large databases. The Autocontrol system is designed to interrogate the data of the patient medical record however the latter often lacks data on concomitant resource use and this must be supplemented. This paper reviews the Autocontrol methodology and gives examples from current studies.

The emperor's new clothes - Reflections on strategic environmental assessment (SEA) practice in South Africa

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

Retief, Francois; Jones, Carys; Jay, Stephen

This paper presents the results of research which evaluated the performance of strategic environmental assessment (SEA) practice in South Africa in order to develop understanding of how SEA functions within a developing country with a voluntary SEA system. The research applied a combination of methods in a mixed research strategy, including a macro level survey of the SEA system together with case study reviews exploring micro level application. Three main 'system features' emerged, namely expansion of voluntary practice, diversity in practice and general ineffectiveness. The results also highlight a number of 'application features' such as a lack of focus duemore » to an inability to deal with the concepts of 'sustainability' and 'significance', as well as poor understanding and integration with decision-making processes. Moreover, it emerged that none of the case studies seem to have conducted an 'assessment' per se, but rather provided a framework for strategic decision-making. The paper puts forward a number of interrelated explanations for these system and application features. In a parallel to the fable of the 'emperor's new clothes', SEA in South Africa appears to be regarded as the answer to all environmental problems, whilst being ineffective in practice.« less

48 CFR 9903.302-1 - Cost accounting practice.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., or measurement of cost. (a) Measurement of cost, as used in this part, encompasses accounting methods... practice. Examples of cost accounting practices which involve measurement of costs are— (1) The use of... 48 Federal Acquisition Regulations System 7 2010-10-01 2010-10-01 false Cost accounting practice...

Reflecting Reflective Practice

ERIC Educational Resources Information Center

Galea, Simone

2012-01-01

This paper demystifies reflective practice on teaching by focusing on the idea of reflection itself and how it has been conceived by two philosophers, Plato and Irigaray. It argues that reflective practice has become a standardized method of defining the teacher in teacher education and teacher accreditation systems. It explores how practices of…

Chinese L2 Literacy Practices: Material and Sociocultural Considerations

ERIC Educational Resources Information Center

Lo-Philip, Stephanie Wingyan

2014-01-01

Although there has been research on literacy as a sociocultural practice, L2 literacy researchers have yet to incorporate and consider how the material characteristics of a writing system interact with sociocultural factors in shaping literacy practices. Drawing on conceptions of literacy as a sociocultural practice, psycholinguistic and…

Co-Creating an Expansive Health Care Learning System.

PubMed

Cribb, Alan; Owens, John; Singh, Guddi

2017-11-01

How should practices of co-creation be integrated into health professions education? Although co-creation permits a variety of interpretations, we argue that realizing a transformative vision of co-creation-one that invites professionals to genuinely reconsider the purposes, relationships, norms, and priorities of health care systems through new forms of collaborative thought and practice-will require radically rethinking existing approaches to professional education. The meaningful enactment of co-creative roles and practices requires health professionals and students to negotiate competing traditions, pressures, and expectations. We therefore suggest that the development of what we call an "expansive health care learning system" is crucial for supporting learners in meeting the challenges of establishing genuinely co-creative health care systems. © 2017 American Medical Association. All Rights Reserved.

[Physiology in Relation to Anesthesia Practice: Preface and Comments].

PubMed

Yamada, Yoshitsugu

2016-05-01

It has been long recognized that anesthesia practice is profoundly based in physiology. With the advance of the technology of imaging, measurement and information, a serious gap has emerged between anesthesia mainly handling gross systemic parameters and molecular physiology. One of the main reasons is the lack of establishment of integration approach. This special series of reviews deals with systems physiology covering respiratory, cardiovascular, and nervous systems. It also includes metabolism, and fluid, acid-base, and electrolyte balance. Each review focuses on several physiological concepts in each area, explaining current understanding and limits of the concepts based on the new findings. They reaffirm the importance of applying physiological inference in anesthesia practice and underscore the needs of advancement of systems physiology.

The Scope of Practice of Occupational Therapy in U.S. Criminal Justice Settings.

PubMed

Muñoz, Jaime P; Moreton, Emily M; Sitterly, Audra M

2016-09-01

In the past 40 years, prison populations in the U.S. have nearly quadrupled while funding for rehabilitation, education and other programmes has been cut. Despite accounting for a small fraction of the world's population more than 20% of the worlds incarcerated population is in the U.S. and the rate of recidivism remains alarmingly high. Occupational therapists have the capability to play a significant role in addressing the needs of persons within the criminal justice system. However, the profession has been slow to delineate of the role occupational therapy within criminal justice settings. This study sought to provide a descriptive analysis of current occupational therapy roles and practices within the U.S. criminal justice system. Using survey research methods, the researchers collected data from respondents (N = 45; Response Rate + 51.7%) to establish a baseline of the scope of practices employed by occupational therapists working in the U.S. criminal justice system. U.S. practitioners work within institutional and community based criminal justice settings. Primary practice models, assessments and group interventions were catalogued. Respondents strongly valued the creation of networking to build the professions' presence within criminal justice settings. Occupational therapy in the criminal justice system remains an emerging practice arena. Understanding the current scope of practice in the U.S. and creating a mechanism for collaboration may help increase the depth, breadth and overall growth of the profession's role in these settings. The sampling method does not guarantee a representative sample of the population and is limited to practice within the United States. Survey design may not have allowed for respondents to fully describe their practice experiences. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Primary motor and premotor cortex in implicit sequence learning--evidence for competition between implicit and explicit human motor memory systems.

PubMed

Kantak, Shailesh S; Mummidisetty, Chaithanya K; Stinear, James W

2012-09-01

Implicit and explicit memory systems for motor skills compete with each other during and after motor practice. Primary motor cortex (M1) is known to be engaged during implicit motor learning, while dorsal premotor cortex (PMd) is critical for explicit learning. To elucidate the neural substrates underlying the interaction between implicit and explicit memory systems, adults underwent a randomized crossover experiment of anodal transcranial direct current stimulation (AtDCS) applied over M1, PMd or sham stimulation during implicit motor sequence (serial reaction time task, SRTT) practice. We hypothesized that M1-AtDCS during practice will enhance online performance and offline learning of the implicit motor sequence. In contrast, we also hypothesized that PMd-AtDCS will attenuate performance and retention of the implicit motor sequence. Implicit sequence performance was assessed at baseline, at the end of acquisition (EoA), and 24 h after practice (retention test, RET). M1-AtDCS during practice significantly improved practice performance and supported offline stabilization compared with Sham tDCS. Performance change from EoA to RET revealed that PMd-AtDCS during practice attenuated offline stabilization compared with M1-AtDCS and sham stimulation. The results support the role of M1 in implementing online performance gains and offline stabilization for implicit motor sequence learning. In contrast, enhancing the activity within explicit motor memory network nodes such as the PMd during practice may be detrimental to offline stabilization of the learned implicit motor sequence. These results support the notion of competition between implicit and explicit motor memory systems and identify underlying neural substrates that are engaged in this competition. © 2012 The Authors. European Journal of Neuroscience © 2012 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

Using the Systems-Practice Framework to Understand Food Allergen Management Practices at College Catering Operations: A Qualitative Study.

PubMed

Verstappen, Jennie; Mirosa, Miranda; Thomson, Carla

2018-03-01

The number of individuals with food allergies or intolerances attending catered university residential colleges is increasing, and safe dining options are required to minimize the risk of allergic reactions and food-induced death. This qualitative research study sought to advance professional knowledge of the factors affecting allergen management practices, particularly pertaining to college foodservices. Three catered residential colleges affiliated with a major university in New Zealand were selected as research sites. The study used an ethnographic approach and systems-practice theory as a framework for data collection and organizing results. Data collection techniques included document analyses (3 hours per site), observations (6 to 8 hours per site), focus groups with foodservice workers (30 to 45 minutes per site, n=16), and interviews with foodservice managers (45 to 90 minutes per interview, n=5). Notes and transcripts were coded through the process of thematic analysis using NVivo for Mac software, version 11.1.1, to identify factors affecting allergen management practices. The main factors affecting allergen management practices at college foodservices included information provided by residents about dietary requirements; communication between residents and foodservice staff; systems for allergen management; attitude of foodservice staff; and college size. Detailed dietary information, effective communication with residents, sufficient resources, clarification of responsibilities, and thorough systems are required for staff to perform safe allergen management practices. Ultimately, successful implementation was predominantly determined by staff attitude. Foodservice managers are advised to identify motivators and address barriers of staff attitudes toward allergen management practices to promote successful implementation. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

General practice integration in Australia. Primary health services provider and consumer perceptions of barriers and solutions.

PubMed

Appleby, N J; Dunt, D; Southern, D M; Young, D

1999-08-01

To identify practical examples of barriers and possible solutions to improve general practice integration with other health service providers. Twelve focus groups, including one conducted by teleconference, were held across Australia with GPs and non GP primary health service providers between May and September, 1996. Focus groups were embedded within concept mapping sessions, which were used to conceptually explore the meaning of integration in general practice. Data coding, organising and analysis were based on the techniques documented by Huberman and Miles. Barriers to integration were perceived to be principally due to the role and territory disputes between the different levels of government and their services, the manner in which the GP's role is currently defined, and the system of GP remuneration. Suggestions on ways to improve integration involved two types of strategies. The first involves initiatives implemented 'top down' through major government reform to service structures, including the expansion of the role of divisions of general practice, and structural changes to the GP remuneration systems. The second type of strategy suggested involves initiatives implemented from the 'bottom up' involving services such as hospitals (e.g. additional GP liaison positions) and the use of information technology to link services and share appropriate patient data. The findings support the need for further research and evaluation of initiatives aimed at achieving general practice integration at a systems level. There is little evidence to suggest which types of initiatives improve integration. However, general practice has been placed in the centre of the health care debate and is likely to remain central to the success of such initiatives. Clarification of the future role and authority of general practice will therefore be required if such integrative strategies are to be successful at a wider health system level.

Awareness and implementation of the 2000 United States public health service tobacco dependence treatment guideline in a public hospital system.

PubMed

Moody-Thomas, Sarah; Horswell, Ronald; Celestin, Michael D; Dellinger, Amy B; Kaiser, Michael; Butler, Michael

2011-04-01

The 2000 United States Public Health Service (USPHS) clinical practice guideline, "Treating Tobacco Use and Dependence," recommends systems interventions to integrate the treatment of tobacco into routine health care. The Tobacco Control Initiative employed a systems approach to integrate evidence-based treatment for tobacco use into patient care practices in Louisiana's safety net health care system. The purpose of this study was to assess changes in awareness and implementation of the USPHS clinical practice guideline. Surveys were administered to a purposive sample of hospital personnel from key departments in the Louisiana State University system of public hospitals in 2003 (n = 24) and 2007 (n = 44). Perceptions of implementation success improved for 50 of 59 distinct survey items. Rasch scaling was used to assess overall (scaled) change and showed substantial improvement from 2003 to 2007 (P < 0.001). Survey items also were grouped into 6 logical key concept sets. Improvement occurred in perceptions for all 6 key concepts; however, not uniformly. Results of the 2003 and 2007 surveys illustrate the potential effectiveness of using a systems approach to integrate the assessment and treatment of tobacco use into routine care practices in a public health care delivery system that serves medically vulnerable populations.

Effect of Tillage Practices on Soil Properties and Crop Productivity in Wheat-Mungbean-Rice Cropping System under Subtropical Climatic Conditions

PubMed Central

Islam, Md. Monirul; Hasanuzzaman, Mirza

2014-01-01

This study was conducted to know cropping cycles required to improve OM status in soil and to investigate the effects of medium-term tillage practices on soil properties and crop yields in Grey Terrace soil of Bangladesh under wheat-mungbean-T. aman cropping system. Four different tillage practices, namely, zero tillage (ZT), minimum tillage (MT), conventional tillage (CT), and deep tillage (DT), were studied in a randomized complete block (RCB) design with four replications. Tillage practices showed positive effects on soil properties and crop yields. After four cropping cycles, the highest OM accumulation, the maximum root mass density (0–15 cm soil depth), and the improved physical and chemical properties were recorded in the conservational tillage practices. Bulk and particle densities were decreased due to tillage practices, having the highest reduction of these properties and the highest increase of porosity and field capacity in zero tillage. The highest total N, P, K, and S in their available forms were recorded in zero tillage. All tillage practices showed similar yield after four years of cropping cycles. Therefore, we conclude that zero tillage with 20% residue retention was found to be suitable for soil health and achieving optimum yield under the cropping system in Grey Terrace soil (Aeric Albaquept). PMID:25197702

To fail is human: remediating remediation in medical education.

PubMed

Kalet, Adina; Chou, Calvin L; Ellaway, Rachel H

2017-12-01

Remediating failing medical learners has traditionally been a craft activity responding to individual learner and remediator circumstances. Although there have been moves towards more systematic approaches to remediation (at least at the institutional level), these changes have tended to focus on due process and defensibility rather than on educational principles. As remediation practice evolves, there is a growing need for common theoretical and systems-based perspectives to guide this work. This paper steps back from the practicalities of remediation practice to take a critical systems perspective on remediation in contemporary medical education. In doing so, the authors acknowledge the complex interactions between institutional, professional, and societal forces that are both facilitators of and barriers to effective remediation practices. The authors propose a model that situates remediation within the contexts of society as a whole, the medical profession, and medical education institutions. They also outline a number of recommendations to constructively align remediation principles and practices, support a continuum of remediation practices, destigmatize remediation, and develop institutional communities of practice in remediation. Medical educators must embrace a responsible and accountable systems-level approach to remediation if they are to meet their obligations to provide a safe and effective physician workforce.

The subtle body: an interoceptive map of central nervous system function and meditative mind-brain-body integration.

PubMed

Loizzo, Joseph J

2016-06-01

Meditation research has begun to clarify the brain effects and mechanisms of contemplative practices while generating a range of typologies and explanatory models to guide further study. This comparative review explores a neglected area relevant to current research: the validity of a traditional central nervous system (CNS) model that coevolved with the practices most studied today and that provides the first comprehensive neural-based typology and mechanistic framework of contemplative practices. The subtle body model, popularly known as the chakra system from Indian yoga, was and is used as a map of CNS function in traditional Indian and Tibetan medicine, neuropsychiatry, and neuropsychology. The study presented here, based on the Nalanda tradition, shows that the subtle body model can be cross-referenced with modern CNS maps and challenges modern brain maps with its embodied network model of CNS function. It also challenges meditation research by: (1) presenting a more rigorous, neural-based typology of contemplative practices; (2) offering a more refined and complete network model of the mechanisms of contemplative practices; and (3) serving as an embodied, interoceptive neurofeedback aid that is more user friendly and complete than current teaching aids for clinical and practical applications of contemplative practice. © 2016 New York Academy of Sciences.

Dynamics behind the scale up of evidence-based obesity prevention: protocol for a multi-site case study of an electronic implementation monitoring system in health promotion practice.

PubMed

Conte, Kathleen P; Groen, Sisse; Loblay, Victoria; Green, Amanda; Milat, Andrew; Persson, Lina; Innes-Hughes, Christine; Mitchell, Jo; Thackway, Sarah; Williams, Mandy; Hawe, Penelope

2017-12-06

The effectiveness of many interventions to promote health and prevent disease has been well established. The imperative has therefore shifted from amassing evidence about efficacy to scale-up to maximise population-level health gains. Electronic implementation monitoring, or 'e-monitoring', systems have been designed to assist and track the delivery of preventive policies and programs. However, there is little evidence on whether e-monitoring systems improve the dissemination, adoption, and ongoing delivery of evidence-based preventive programs. Also, given considerable difficulties with e-monitoring systems in the clinical sector, scholars have called for a more sophisticated re-examination of e-monitoring's role in enhancing implementation. In the state of New South Wales (NSW), Australia, the Population Health Information Management System (PHIMS) was created to support the dissemination of obesity prevention programs to 6000 childcare centres and elementary schools across all 15 local health districts. We have established a three-way university-policymaker-practice research partnership to investigate the impact of PHIMS on practice, how PHIMS is used, and how achievement of key performance indicators of program adoption may be associated with local contextual factors. Our methods encompass ethnographic observation, key informant interviews and participatory workshops for data interpretation at a state and local level. We use an on-line social network analysis of the collaborative relationships across local health district health promotion teams to explore the relationship between PHIMS use and the organisational structure of practice. Insights will be sensitised by institutional theory, practice theory and complex adaptive system thinking, among other theories which make sense of socio-technical action. Our working hypothesis is that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role they play in the on-going system of local relationships and multiple accountabilities. Data will be synthesised to produce a typology to characterise local context, PHIMS use and key performance indicator achievement (of program implementation) across the 15 local health districts. Results could be used to continuously align e-monitoring technologies within quality improvement processes to ensure that such technologies enhance practice and innovation. A partnership approach to knowledge production increases the likelihood that findings will be put into practice.

12 CFR 227.11 - [Reserved

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 3 2012-01-01 2012-01-01 false [Reserved] 227.11 Section 227.11 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule § 227.11 [Reserved] ...

12 CFR 227.11 - [Reserved

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 3 2011-01-01 2011-01-01 false [Reserved] 227.11 Section 227.11 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule § 227.11 [Reserved] ...

The Oral Health Care Delivery System in 2040: Executive Summary.

PubMed

Bailit, Howard L

2017-09-01

This executive summary for Section 4 of the "Advancing Dental Education in the 21 st Century" project examines the projected oral health care delivery system in 2040 and the likely impact of system changes on dental education. Dental care is at an early stage of major changes with the decline in solo practice and increase in large group practices. These groups are not consolidated at the state level, but further consolidation is expected as they try to increase their negotiating leverage with dental insurers. At this time, there is limited integration of medical and dental care in terms of financing, regulation, education, and delivery. This pattern may change as health maintenance organizations and integrated medical systems begin to offer dental care to their members. By 2040, it is expected that many dentists will be employed in large group practices and working with allied dental staff with expanded duties and other health professionals, and more dental graduates will seek formal postdoctoral training to obtain better positions in group practices.

Intersections of Critical Systems Thinking and Community Based Participatory Research: A Learning Organization Example with the Autistic Community

PubMed Central

Raymaker, Dora M

2016-01-01

Critical systems thinking (CST) and community based participatory research (CBPR) are distinct approaches to inquiry which share a primary commitment to holism and human emancipation, as well as common grounding in critical theory and emancipatory and pragmatic philosophy. This paper explores their intersections and complements on a historical, philosophical, and theoretical level, and then proposes a hybrid approach achieved by applying CBPR's principles and considerations for operationalizing emancipatory practice to traditional systems thinking frameworks and practices. This hybrid approach is illustrated in practice with examples drawn from of the implementation of the learning organization model in an action research setting with the Autistic community. Our experience of being able to actively attend to, and continuously equalize, power relations within an organizational framework that otherwise has great potential for reinforcing power inequity suggests CBPR's principles and considerations for operationalizing emancipatory practice could be useful in CST settings, and CST's vocabulary, methods, and clarity around systems thinking concepts could be valuable to CBPR practioners. PMID:27833398

Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education.

PubMed

Jones, Judith A; Snyder, John J; Gesko, David S; Helgeson, Michael J

2017-09-01

Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Intersections of Critical Systems Thinking and Community Based Participatory Research: A Learning Organization Example with the Autistic Community.

PubMed

Raymaker, Dora M

2016-10-01

Critical systems thinking (CST) and community based participatory research (CBPR) are distinct approaches to inquiry which share a primary commitment to holism and human emancipation, as well as common grounding in critical theory and emancipatory and pragmatic philosophy. This paper explores their intersections and complements on a historical, philosophical, and theoretical level, and then proposes a hybrid approach achieved by applying CBPR's principles and considerations for operationalizing emancipatory practice to traditional systems thinking frameworks and practices. This hybrid approach is illustrated in practice with examples drawn from of the implementation of the learning organization model in an action research setting with the Autistic community. Our experience of being able to actively attend to, and continuously equalize, power relations within an organizational framework that otherwise has great potential for reinforcing power inequity suggests CBPR's principles and considerations for operationalizing emancipatory practice could be useful in CST settings, and CST's vocabulary, methods, and clarity around systems thinking concepts could be valuable to CBPR practioners.

Feedback Control Systems Loop Shaping Design with Practical Considerations

NASA Technical Reports Server (NTRS)

Kopsakis, George

2007-01-01

This paper describes loop shaping control design in feedback control systems, primarily from a practical stand point that considers design specifications. Classical feedback control design theory, for linear systems where the plant transfer function is known, has been around for a long time. But it s still a challenge of how to translate the theory into practical and methodical design techniques that simultaneously satisfy a variety of performance requirements such as transient response, stability, and disturbance attenuation while taking into account the capabilities of the plant and its actuation system. This paper briefly addresses some relevant theory, first in layman s terms, so that it becomes easily understood and then it embarks into a practical and systematic design approach incorporating loop shaping design coupled with lead-lag control compensation design. The emphasis is in generating simple but rather powerful design techniques that will allow even designers with a layman s knowledge in controls to develop effective feedback control designs.

Systems and context modeling approach to requirements analysis

NASA Astrophysics Data System (ADS)

Ahuja, Amrit; Muralikrishna, G.; Patwari, Puneet; Subhrojyoti, C.; Swaminathan, N.; Vin, Harrick

2014-08-01

Ensuring completeness and correctness of the requirements for a complex system such as the SKA is challenging. Current system engineering practice includes developing a stakeholder needs definition, a concept of operations, and defining system requirements in terms of use cases and requirements statements. We present a method that enhances this current practice into a collection of system models with mutual consistency relationships. These include stakeholder goals, needs definition and system-of-interest models, together with a context model that participates in the consistency relationships among these models. We illustrate this approach by using it to analyze the SKA system requirements.

CSW Best Practices

NASA Technical Reports Server (NTRS)

Newman, Doug; Mitchell, Andrew

2016-01-01

During the development of the CMR (Common Metadata Repository) (CMR) for the Earth Observing System Data and Information System (EOSDIS), CSW (Catalog Service for the Web) a number of best practices came to light. Given that the ESIP (Earth Science Information Partners) Discovery Cluster is committed to interoperability and standards in earth data discovery this seemed like a convenient moment to provide Best Practices to the organization in the same way we did for OpenSearch for this widely-used standard.

Patients first! Engaging the hearts and minds of nurses with a patient-centered practice model.

PubMed

Small, Deborah C; Small, Robert M

2011-05-31

Like every healthcare system today, the Cleveland Clinic health system is a combination of medical hospitals, institutes, and services in which the implementation of uniform care methodologies faces significant barriers. The guiding principle of the Cleveland Clinic, 'Patients First,' focuses on the principle of patient- and family-centered care (PFCC) but deliberately lacks details due to the wide scope of care delivered by the organization. The Stanley Shalom Zielony Institute of Nursing Excellence (the Nursing Institute) at the Cleveland Clinic was charged with standardizing nursing practice across a system with 11,000 registered nurses and 800 advanced practice nurses. The challenge involved providing firm direction on delivering PFCC that was appropriate for all clinical disciplines and could be implemented quickly across existing practices and technologies. Successful implementation required full engagement in the concept of PFCC by what the Institute for Healthcare Improvement has termed the 'hearts and minds' of nurses. To achieve these ends, development of a systemwide nursing practice model was initiated. In this article the authors identify the essence of PFCC, consider barriers to PFCC, review their process of developing PFCC, and describe how the Cleveland Clinic health system has implemented a PFCC nursing practice model. In doing so the authors explore how the concept of 'Passion for Nursing' was used to stimulate nurse engagement in PFCC.

Using Interactive Patient Engagement Technology in Clinical Practice: A Qualitative Assessment of Nurses' Perceptions.

PubMed

Patmon, Frances L; Gee, Perry M; Rylee, Tina L; Readdy, Noriann L

2016-11-11

Research has shown patients who are more engaged in their care are likely to have better health outcomes and reduced health care costs. Health care organizations are now focusing their efforts in finding ways to improve patient engagement. At the forefront of this movement are patient engagement technology systems. In this paper, these emerging systems are described as interactive patient engagement technologies (iPET). The objective of this descriptive study was to gain an understanding of the perceptions of nurses who are integrating these iPET systems into their daily clinical practice. The research team interviewed 38 nurses from 2 California-based hospitals using a focused rapid ethnographic evaluation methodology to gather data. The study participants reported that using iPET systems may enhance clinical nursing practice. The 4 key findings of iPET were that it (1) is effective for distraction therapy, (2) has functionality that affects both patients and nurses, (3) has implications for clinical practice, and (4) may require additional training to improve usage. With sufficient training on the iPET system, nurses believed they could use these technologies as an enhancement to their clinical practice. Additionally, nurses perceived these systems served as distraction therapy for patients. Initial findings suggest that iPET is beneficial, but more research is required to examine the usefulness of iPET systems in the inpatient settings. ©Frances L Patmon, Perry M Gee, Tina L Rylee, Noriann L Readdy. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.11.2016.

MO-DE-BRA-02: From Teaching to Learning: Systems-Based-Practice and Practice-Based-Learning Innovations in Medical Physics Education Programs

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

Kapur, A

Purpose: The increasing complexity in the field of radiation medicine and concomitant rise in patient safety concerns call for enhanced systems-level training for future medical physicists and thus commensurate innovations in existing educational program curricula. In this work we report on the introduction of three learning opportunities to augment medical physics educational programs towards building systems-based practice and practice-based learning competencies. Methods: All initiatives were introduced for senior -level graduate students and physics residents in an institution with a newly established medical-physics graduate program and therapeutic-physics residency program. The first, centered on incident learning, was based on a spreadsheet toolmore » that incorporated the reporting structure of the Radiation Oncology-incident Learning System (ROILS), included 120 narratives of published incidents and enabled inter-rater variability calculations. The second, centered on best-practices, was a zero-credit seminar course, where students summarized select presentations from the AAPM virtual library on a weekly basis and moderated class discussions using a point/counterpoint approach. Presentation styles were critiqued. The third; centered on learning-by-teaching, required physics residents to regularly explain fundamental concepts in radiological physics from standard textbooks to board certified physics faculty members. Results: Use of the incident-learning system spreadsheet provided a platform to recast known accidents into the framework of ROILS, thereby increasing awareness of factors contributing to unsafe practice and appreciation for inter-rater variability. The seminar course enhanced awareness of best practices, the effectiveness of presentation styles and encouraged critical thinking. The learn-by-teaching rotation allowed residents to stay abreast of and deepen their knowledge of relevant subjects. Conclusion: The incorporation of systems-driven initiatives broadens comprehension of the wider systems context of medical physics, enhances awareness of resources for innovation, communication and sustained learning while maintaining a metric-driven focus on patient safety within the formative phase of student careers. The initiatives were well-received, feasible, and utilized available or shared-resources translatable across educational programs.« less

Organisational development in general practice: lessons from practice and professional development plans (PPDPs)

PubMed Central

Elwyn, Glyn; Hocking, Paul

2000-01-01

Background Improving the quality and effectiveness of clinical practice is becoming a key task within all health services. Primary medical care, as organised in the UK is composed of clinicians who work in independent partnerships (general practices) that collaborate with other health care professionals. Although many practices have successfully introduced innovations, there are no organisational development structures in place that support the evolution of primary medical care towards integrated care processes. Providing incentives for attendance at passive educational events and promoting 'teamwork' without first identifying organisational priorities are interventions that have proved to be ineffective at changing clinical processes. A practice and professional development plan feasibility study was evaluated in Wales and provided the experiential basis for a summary of the lessons learnt on how best to guide organisational development systems for primary medical care. Results Practice and professional development plans are hybrids produced by the combination of ideas from management (the applied behavioural science of organisational development) and education (self-directed adult learning theories) and, in conceptual terms, address the lack of effectiveness of passive educational strategies by making interventions relevant to identified system wide needs. In the intervention, each practice participated in a series of multidisciplinary workshops (minimum 4) where the process outcome was the production of a practice development plan and a set of personal portfolios, and the final outcome was a realised organisational change. It was apparent during the project that organisational admission to a process of developmental planning needed to be a stepwise process, where initial interest can lead to a fuller understanding, which subsequently develops into motivation and ownership, sufficient to complete the exercise. The advantages of introducing expert external facilitation were clear: evaluations of internal group processes were possible, strategic issues could be raised and explored and financial probity ensured. These areas are much more difficult to examine when only internal stakeholders are engaged in a planning process. Conclusions It is not possible to introduce practice and professional development plans (organisational development and organisational learning projects) in a publicly funded health care system without first addressing existing educational and management structures. Existing systems are based on educational credits for attendance and emerging accountability frameworks (criteria checklists) for clinical governance. Moving to systems that are less summative and more formative, and based on the philosophies of continual quality improvement, require changes to be made in the relevant support systems in order achieve policy proposals. PMID:11178111

An Adverse Drug Event and Medication Error Reporting System for Ambulatory Care (MEADERS)

PubMed Central

Zafar, Atif; Hickner, John; Pace, Wilson; Tierney, William

2008-01-01

The Institute of Medicine (IOM) has identified the mitigation of Adverse Drug Events (ADEs) and Medication Errors (MEs) as top national priorities. Currently available reporting tools are fraught with inefficiencies that prevent widespread adoption into busy primary care practices. Using expert panel input we designed and built a new reporting tool that could be used in these settings with a variety of information technology capabilities. We pilot tested the system in four Practice Based Research Networks (PBRNs) comprising 24 practices. Over 10 weeks we recorded 507 reports, of which 370 were MEs and 137 were ADEs. Clinicians found the system easy to use, with the average time to generating a report under 4 minutes. By using streamlined interface design techniques we were successfully able to improve reporting rates of ADEs and MEs in these practices. PMID:18999053

The future of health-system pharmacy: opportunities and challenges in practice model change.

PubMed

Zellmer, William A

2012-04-01

Key factors outside of health-system pharmacy that will shape this sector of the profession in the coming years are (1) the national economy, (2) national politics, (3) the debt of the federal government, (4) global megatrends (including terrorism and economic globalization), (5) health care reform, and (6) trends in the development and use of medicines. These factors will translate into payment cutbacks to hospitals, expanded mandates to improve the quality of health care, increased focus on patient-centered care, more team-based care, and a higher degree of integration across the range of health care settings and providers. In this environment, pharmacists in hospitals and other health systems will have rich opportunities to help improve patient care and institutional sustainability by continuing to move from order-fulfillment and product-preparation functions toward team leadership of drug therapy management. The American Society of Health-System Pharmacists Pharmacy Practice Model Initiative (PPMI) was created to encourage hospital and health-system practice leaders to examine how they deploy their resources (ie, pharmacist time, technician time, and technology) to ensure that the efforts of the pharmacy department are aligned with the most urgent needs of patients and institutions. Key recommendations of the PPMI and evidence about gaps in the provision of drug therapy management services are presented. It is important for every pharmacist and pharmacy technician in health-system practice to understand the imperatives for changing the profession's practice model and to actively pursue appropriate changes in that model.

Justice foundations for the Comprehensive Law Movement.

PubMed

Dewhurst, Dale

2010-01-01

Authors examining the developing dispute resolution alternatives to the adversarial system have identified nine converging "vectors" or alternatives in what has been termed the Comprehensive Law Movement. These authors have sought to understand how the developing vectors can remain separate and vibrant movements while sharing common ground. Some analyze these developments as being within law and legal practice, others see them as alternative approaches to law, and still others take a combined approach. It will be impossible to understand how these vectors have meaningful differences from law and legal practice if the search is limited to looking within law and legal practice. It will be impossible to understand how these vectors have meaningful commonalities with law and legal practice if the search is limited to looking external to law and legal practice. Instead of comparing the vectors with the adversarial system, higher order criteria are required. What is needed is a comprehensive and internally consistent super-system of norms; one that can be used to evaluate the adversarial system and the evolving vectors on an equal footing. An Aristotelian natural law virtue theory of justice can: (a) provide a functional guiding definition of justice; (b) serve as a comprehensive and internally consistent super-system of norms; and (c) provide the theoretical and evaluative foundation required to clarify the relationships among the adversarial system and the developing vectors. Finally, it will become clear why the Comprehensive Law Movement might be more appropriately conceptualized as the Comprehensive Justice Movement. Copyright © 2010 Elsevier Ltd. All rights reserved.

The Physiological Demands of Table Tennis: A Review

PubMed Central

Kondrič, Miran; Zagatto, Alessandro Moura; Sekulić, Damir

2013-01-01

Although table tennis has a tradition lasting more than 100 years, relatively little is known about players’ physiological requirements – especially during competition. In this review we discuss research studies that have led to our current understanding of how the body functions during table tennis training and competition and how this is altered by training. Match and practice analysis of the table tennis game indicates that during intense practice and competition it is predominantly the anaerobic alactic system that is called into play, while the endurance system is relied on to recovery the anaerobic stores used during such effort. It is thus important for coaches to keep in mind that, while the anaerobic alactic system is the most energetic system used during periods of exertion in a table tennis game, a strong capacity for endurance is what helps a player recover quicker for the following match and the next day of competition. This paper provides a review of specific studies that relate to competitive table tennis, and highlights the need for training and research programs tailored to table tennis. Key Points Match and practice analysis of the table tennis game indicates that during intense practice and competition it is predominantly the anaerobic alactic system that is called into play. The endurance system is relied on to recovery the anaerobic stores used during hard practice and competition effort. It is important for coaches to keep in mind that, while the anaerobic alactic system is the most energetic system used during periods of exertion in a table tennis game, a strong capacity for endurance is what helps a player recover quicker for the following match and the next day of competition. PMID:24149139

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

PubMed Central

Leykum, Luci K; McDaniel, Reuben R

2011-01-01

Objective Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Design Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. Measurements An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group—including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Results Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and respectful interaction, whereas practices that were furthest from achieving standardized EHR use exhibited low levels of mindfulness and respectful interaction. Conclusion Within-practice communication patterns provide a unique perspective for exploring the issue of standardization in EHR use. A major fallacy of setting homogeneous EHR use as the goal for practice-level EHR use is that practices with uniformly low EHR use could be considered successful. Achieving uniformly high EHR use across all users in a practice is more consistent with the goals of current EHR adoption and use efforts. It was found that some communication patterns among practice members may enable more standardized EHR use than others. Understanding the linkage between communication patterns and EHR use can inform understanding of the human element in EHR use and may provide key lessons for the implementation of EHRs and other health information technologies. PMID:21846780

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting.

PubMed

Lanham, Holly Jordan; Leykum, Luci K; McDaniel, Reuben R

2012-01-01

Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group-including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and respectful interaction, whereas practices that were furthest from achieving standardized EHR use exhibited low levels of mindfulness and respectful interaction. Within-practice communication patterns provide a unique perspective for exploring the issue of standardization in EHR use. A major fallacy of setting homogeneous EHR use as the goal for practice-level EHR use is that practices with uniformly low EHR use could be considered successful. Achieving uniformly high EHR use across all users in a practice is more consistent with the goals of current EHR adoption and use efforts. It was found that some communication patterns among practice members may enable more standardized EHR use than others. Understanding the linkage between communication patterns and EHR use can inform understanding of the human element in EHR use and may provide key lessons for the implementation of EHRs and other health information technologies.

Register-Recall Systems: Tools for Chronic Disease Management in General Practice.

PubMed

Georgiou, Andrew; Burns, Joan; Penn, Danielle; Infante, Fernando; Harris, Mark

2004-09-01

The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register-recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000-2002, an increase in the number of GPs using register-recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.

The current status of evidence-based practice in juvenile justice.

PubMed

McKee, Esther Chao; Rapp, Lisa

2014-01-01

The advent of evidence-based practice (EBP) has significantly changed the juvenile justice system while producing intense controversy. The intent of this article is to provide an update on the current status of EBP in the juvenile justice system. Specifically, this article will describe the evolution of juvenile justice philosophy as it has informed current juvenile justice policies and programs, discuss the scope of current juvenile justice research regarding EBP, identify barriers to implementing EBP, expound on the development of EBP in juvenile justice, discern the characteristics of evidence-based interventions in the juvenile justice system, and finally describe how to select and assess evidence-based practices and interventions.

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

PubMed Central

Kirby, J.; Rector, A. L.

1996-01-01

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

Integration of Evidence into a Detailed Clinical Model-based Electronic Nursing Record System

PubMed Central

Park, Hyeoun-Ae; Jeon, Eunjoo; Chung, Eunja

2012-01-01

Objectives The purpose of this study was to test the feasibility of an electronic nursing record system for perinatal care that is based on detailed clinical models and clinical practice guidelines in perinatal care. Methods This study was carried out in five phases: 1) generating nursing statements using detailed clinical models; 2) identifying the relevant evidence; 3) linking nursing statements with the evidence; 4) developing a prototype electronic nursing record system based on detailed clinical models and clinical practice guidelines; and 5) evaluating the prototype system. Results We first generated 799 nursing statements describing nursing assessments, diagnoses, interventions, and outcomes using entities, attributes, and value sets of detailed clinical models for perinatal care which we developed in a previous study. We then extracted 506 recommendations from nine clinical practice guidelines and created sets of nursing statements to be used for nursing documentation by grouping nursing statements according to these recommendations. Finally, we developed and evaluated a prototype electronic nursing record system that can provide nurses with recommendations for nursing practice and sets of nursing statements based on the recommendations for guiding nursing documentation. Conclusions The prototype system was found to be sufficiently complete, relevant, useful, and applicable in terms of content, and easy to use and useful in terms of system user interface. This study has revealed the feasibility of developing such an ENR system. PMID:22844649

Practicing governance towards equity in health systems: LMIC perspectives and experience.

PubMed

Gilson, Lucy; Lehmann, Uta; Schneider, Helen

2017-09-15

The unifying theme of the papers in this series is a concern for understanding the everyday practice of governance in low- and middle-income country (LMIC) health systems. Rather than seeing governance as a normative health system goal addressed through the architecture and design of accountability and regulatory frameworks, these papers provide insights into the real-world decision-making of health policy and system actors. Their multiple, routine decisions translate policy intentions into practice - and are filtered through relationships, underpinned by values and norms, influenced by organizational structures and resources, and embedded in historical and socio-political contexts. These decisions are also political acts - in that they influence who accesses benefits and whose voices are heard in decision-making, reinforcing or challenging existing institutional exclusion and power inequalities. In other words, the everyday practice of governance has direct impacts on health system equity.The papers in the series address governance through diverse health policy and system issues, consider actors located at multiple levels of the system and draw on multi-disciplinary perspectives. They present detailed examination of experiences in a range of African and Indian settings, led by authors who live and work in these settings. The overall purpose of the papers in this series is thus to provide an empirical and embedded research perspective on governance and equity in health systems.

Testing for a slope-based decoupling algorithm in a woofer-tweeter adaptive optics system.

PubMed

Cheng, Tao; Liu, WenJin; Yang, KangJian; He, Xin; Yang, Ping; Xu, Bing

2018-05-01

It is well known that using two or more deformable mirrors (DMs) can improve the compensation ability of an adaptive optics (AO) system. However, to keep the stability of an AO system, the correlation between the multiple DMs must be suppressed during the correction. In this paper, we proposed a slope-based decoupling algorithm to simultaneous control the multiple DMs. In order to examine the validity and practicality of this algorithm, a typical woofer-tweeter (W-T) AO system was set up. For the W-T system, a theory model was simulated and the results indicated in theory that the algorithm we presented can selectively make woofer and tweeter correct different spatial frequency aberration and suppress the cross coupling between the dual DMs. At the same time, the experimental results for the W-T AO system were consistent with the results of the simulation, which demonstrated in practice that this algorithm is practical for the AO system with dual DMs.

Using the PORS Problems to Examine Evolutionary Optimization of Multiscale Systems

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

Reinhart, Zachary; Molian, Vaelan; Bryden, Kenneth

2013-01-01

Nearly all systems of practical interest are composed of parts assembled across multiple scales. For example, an agrodynamic system is composed of flora and fauna on one scale; soil types, slope, and water runoff on another scale; and management practice and yield on another scale. Or consider an advanced coal-fired power plant: combustion and pollutant formation occurs on one scale, the plant components on another scale, and the overall performance of the power system is measured on another. In spite of this, there are few practical tools for the optimization of multiscale systems. This paper examines multiscale optimization of systemsmore » composed of discrete elements using the plus-one-recall-store (PORS) problem as a test case or study problem for multiscale systems. From this study, it is found that by recognizing the constraints and patterns present in discrete multiscale systems, the solution time can be significantly reduced and much more complex problems can be optimized.« less

Defense Acquisitions: Addressing Incentives is Key to Further Reform Efforts

DTIC Science & Technology

2014-04-30

championed sound management practices, such as realistic cost estimating, prototyping, and systems engineering . While some progress has been made...other reforms have championed sound management practices, such as realistic cost estimating, prototyping, and systems engineering . DOD’s declining...principles from disciplines such as systems engineering , as well as lessons learned and past reforms. The body of work we have done on benchmarking

Consortium for Robotics & Unmanned Systems Education & Research (CRUSER)

DTIC Science & Technology

2012-09-30

as facilities at Camp Roberts, Calif. and frequent experimentation events, the Many vs. Many ( MvM ) Autonomous Systems Testbed provides the...and expediently translate theory to practice. The MvM Testbed is designed to integrate technological advances in hardware (inexpensive, expendable...designed to leverage the MvM Autonomous Systems Testbed to explore practical and operationally relevant avenues to counter these “swarm” opponents, and

16 CFR Figures 3 and 4 to Part 1204 - High Voltage Test Facility and Antenna System Test Setup

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false High Voltage Test Facility and Antenna System Test Setup 3 Figures 3 and 4 to Part 1204 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... ANTENNAS Pt. 1204, Figs. 3, 4 Figures 3 and 4 to Part 1204—High Voltage Test Facility and Antenna System...

16 CFR Figures 3 and 4 to Part 1204 - High Voltage Test Facility and Antenna System Test Setup

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false High Voltage Test Facility and Antenna System Test Setup 3 Figures 3 and 4 to Part 1204 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... ANTENNAS Pt. 1204, Figs. 3, 4 Figures 3 and 4 to Part 1204—High Voltage Test Facility and Antenna System...

16 CFR Figures 3 and 4 to Part 1204 - High Voltage Test Facility and Antenna System Test Setup

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false High Voltage Test Facility and Antenna System Test Setup 3 Figures 3 and 4 to Part 1204 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... ANTENNAS Pt. 1204, Figs. 3, 4 Figures 3 and 4 to Part 1204—High Voltage Test Facility and Antenna System...

16 CFR Figures 3 and 4 to Part 1204 - High Voltage Test Facility and Antenna System Test Setup

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false High Voltage Test Facility and Antenna System Test Setup 3 Figures 3 and 4 to Part 1204 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION... ANTENNAS Pt. 1204, Figs. 3, 4 Figures 3 and 4 to Part 1204—High Voltage Test Facility and Antenna System...

Research on a practical telecom and CATV co-network transmission system

NASA Astrophysics Data System (ADS)

Mao, Youju

1998-12-01

A practical co-network transmission system of Telecom and CATV over installed Telecom network is designed. The system, making use of WDM and other technologies, has undergone experiments and performance tests on the Public Switched Telephone Network, which illustrate that optical fiber telecommunication network could be thereby transformed into a unified broadband network integrating VOICE, DATA, and VEDIO expeditiously and conveniently.

The Health Improvement Network (THIN)

Cancer.gov

The Health Improvement Network is a collaboration between Cegedim Strategic Data EPIC, an expert in the provision of UK primary care patient data that is used for medical research, and In Practice Systems (InPS), who continue to develop and supply the widely-used Vision general practice computer system.

Activity Theory and the Transformation of Pedagogic Practice

ERIC Educational Resources Information Center

Yamazumi, Katsuhiro

2006-01-01

Today, work and other societal practices are experiencing accelerating paradigm shifts from mass-production-based systems toward new systems based on networking between organizations, collaboration, and partnerships. This shift requires new paradigms in the fields of education, learning, and development. As human activity quickly changes to…

Rainwater harvesting in the United States: a survey of common system practices

EPA Science Inventory

Rainwater harvesting (RWH) systems in the United States vary in terms of design and operation. To better understand common practices in the RWH community and motivation for collecting harvested rainwater, an electronic survey was used to poll members of the American Rainwater Cat...

Reduction of suspended solid and nutrient loss from agricultural lands by tailwater recovery systems

USDA-ARS?s Scientific Manuscript database

Best management practices are being implemented throughout the Lower Mississippi River Alluvial Valley with the aim of alleviating pressures placed on downstream aquatic systems by sediment and nutrient losses from agricultural land; however, research evaluating the performance of one practice, tail...

Integrating walnut and other hardwoods into agroforestry practices

Treesearch

Shibu. Jose

2013-01-01

Agroforestry systems have been proposed as alternative, environmentally benign systems for agricultural production in temperate North America. Walnut and other hardwoods have been successfully integrated in most agroforestry practices include alley cropping, silvopastural, windbreaks, and riparian buffers. Because of walnuts relatively thin crowns and nut production,...

Family-School Socialization: Problems and Prospects.

ERIC Educational Resources Information Center

Case Western Reserve Univ., Cleveland, OH. Inst. on the Family and the Bureaucratic Society.

This document includes the proposal and implementation of a study focusing on the family's expectations, orientations, and cultural practices with regard to the educational system and the system's expectations, orientations and practices concerning the child and his family. The basic problem in this exploratory study is to describe analytically…

48 CFR 3.503-1 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Policy. 3.503-1 Section 3.503-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Other Improper Business Practices 3.503-1 Policy. 10 U.S.C...

48 CFR 3.503-1 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Policy. 3.503-1 Section 3.503-1 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Other Improper Business Practices 3.503-1 Policy. 10 U.S.C...

Assessment of runoff water quality for an integrated best-management practice system in an agricultural watershed

USDA-ARS?s Scientific Manuscript database

To better understand, implement and integrate best management practices (BMPs) in agricultural watersheds, critical information on their effectiveness is required. A representative agricultural watershed, Beasley Lake, was used to compare runoff water quality draining through an integrated system of...

Identifying Data-Driven Instructional Systems. Research to Practice Brief

ERIC Educational Resources Information Center

Lawrence, K. S.

2016-01-01

The study summarized in this research to practice brief, "Creating data-driven instructional systems in school: The new instructional leadership," Halverson, R., Grigg, J., Pritchett, R., & Thomas, C. (2015), "Journal of School Leadership," 25. 447-481, investigated whether student outcome improvements were linked to the…

Teller Training Module: Off-Line Banking System. High-Technology Training Module.

ERIC Educational Resources Information Center

Lund, Candyce J.

This teller training module on offline banking systems is intended to be part of a postsecondary financial applications course. The module contains the following sections: module objective; specific objective; content--electronic audit machine key functions, practice packet--sample bank transactions and practicing procedures, and…

12 CFR 227.11 - [Reserved

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 3 2013-01-01 2013-01-01 false [Reserved] 227.11 Section 227.11 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule § 227.11 [Reserved] ...

12 CFR 227.11 - [Reserved

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 3 2014-01-01 2014-01-01 false [Reserved] 227.11 Section 227.11 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule § 227.11 [Reserved] ...

Human factors systems approach to healthcare quality and patient safety

PubMed Central

Carayon, Pascale; Wetterneck, Tosha B.; Rivera-Rodriguez, A. Joy; Hundt, Ann Schoofs; Hoonakker, Peter; Holden, Richard; Gurses, Ayse P.

2013-01-01

Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety. PMID:23845724

Ecological impact of historical and future land-use patterns in Senegal

USGS Publications Warehouse

Parton, W.; Tappan, G. Gray; Ojima, D.; Tschakert, P.

2004-01-01

The CENTURY model was used to simulate changes in total system carbon resulting from land-use history (1850–2000), and impacts of climatic changes and improved land-use management practices in Senegal. Results show that 0.477 Gtons of carbon have been lost from 1850 to 2000. Improved management practices have the potential of increasing carbon levels by 0.116 Gtons from 2000 to 2100. Potential to store carbon exists for improved forest management and agriculture practices in southern Senegal. Potential climatic changes decrease plant production (30 percent), total system carbon (14 percent), and the potential to store carbon from improved management practices (31 percent).

Evidence-based Practice for Mere Mortals

PubMed Central

Sim, Ida; Sanders, Gillian D; McDonald, Kathryn M

2002-01-01

The poor translation of evidence into practice is a well-known problem. Hopes are high that information technology can help make evidence-based practice feasible for mere mortal physicians. In this paper, we draw upon the methods and perspectives of clinical practice, medical informatics, and health services research to analyze the gap between evidence and action, and to argue that computing systems for bridging this gap should incorporate both informatics and health services research expertise. We discuss 2 illustrative systems—trial banks and a web-based system to develop and disseminate evidence-based guidelines (alchemist)— and conclude with a research and training agenda. PMID:11972727

Investigation of the current requirements engineering practices among software developers at the Universiti Utara Malaysia Information Technology (UUMIT) centre

NASA Astrophysics Data System (ADS)

Hussain, Azham; Mkpojiogu, Emmanuel O. C.; Abdullah, Inam

2016-08-01

Requirements Engineering (RE) is a systemic and integrated process of eliciting, elaborating, negotiating, validating and managing of the requirements of a system in a software development project. UUM has been supported by various systems developed and maintained by the UUM Information Technology (UUMIT) Centre. The aim of this study was to assess the current requirements engineering practices at UUMIT. The main problem that prompted this research is the lack of studies that support software development activities at the UUMIT. The study is geared at helping UUMIT produce quality but time and cost saving software products by implementing cutting edge and state of the art requirements engineering practices. Also, the study contributes to UUM by identifying the activities needed for software development so that the management will be able to allocate budget to provide adequate and precise training for the software developers. Three variables were investigated: Requirement Description, Requirements Development (comprising: Requirements Elicitation, Requirements Analysis and Negotiation, Requirements Validation), and Requirement Management. The results from the study showed that the current practice of requirement engineering in UUMIT is encouraging, but still need further development and improvement because a few RE practices were seldom practiced.

Test result communication in primary care: a survey of current practice.

PubMed

Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

2015-11-01

The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the handling of samples and the reporting of results. Our findings will inform our continuing work with patients and staff to develop, implement and evaluate improvements to existing systems of managing the testing and result communication process. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Examining pedagogical practices in family systems nursing: intentionality, complexity, and doing well by families.

PubMed

Moules, Nancy J; Bell, Janice M; Paton, Brenda I; Morck, Angela C

2012-05-01

Teaching graduate family nursing students the important and delicate practice of entering into and mitigating families' illness suffering signifies an educational practice that is rigorous, intense, and contextual, yet not articulated as expounded knowledge. This study examined the pedagogical practices of the advanced practice of Family Systems Nursing (FSN) as taught to master's and doctoral nursing students at the Family Nursing Unit, University of Calgary, using observation of expert and novice clinical practice, live supervision, videotape review, presession hypothesizing, clinical documentation, and the writing of therapeutic letters to families. A triangulation of research methods and data collection strategies, interpretive ethnography, autoethnography, and hermeneutics, were used. Students reported an intensity of learning that had both useful and limiting consequences as they developed skills in therapeutic conversations with families experiencing illness. Faculty used an intentional pedagogical process to encourage growth in perceptual, conceptual, and executive knowledge and skills of working with families.

Flexibility First, Then Standardize: A Strategy for Growing Inter-Departmental Systems.

PubMed

á Torkilsheyggi, Arnvør

2015-01-01

Any attempt to use IT to standardize work practices faces the challenge of finding a balance between standardization and flexibility. In implementing electronic whiteboards with the goal of standardizing inter-departmental practices, a hospital in Denmark chose to follow the strategy of "flexibility first, then standardization." To improve the local grounding of the system, they first focused on flexibility by configuring the whiteboards to support intra-departmental practices. Subsequently, they focused on standardization by using the white-boards to negotiate standardization of inter-departmental practices. This paper investigates the chosen strategy and finds: that super users on many wards managed to configure the whiteboard to support intra-departmental practices; that initiatives to standardize inter-departmental practices improved coordination of certain processes; and that the chosen strategy posed a challenge for finding the right time and manner to shift the balance from flexibility to standardization.

Practical identifiability analysis of a minimal cardiovascular system model.

PubMed

Pironet, Antoine; Docherty, Paul D; Dauby, Pierre C; Chase, J Geoffrey; Desaive, Thomas

2017-01-17

Parameters of mathematical models of the cardiovascular system can be used to monitor cardiovascular state, such as total stressed blood volume status, vessel elastance and resistance. To do so, the model parameters have to be estimated from data collected at the patient's bedside. This work considers a seven-parameter model of the cardiovascular system and investigates whether these parameters can be uniquely determined using indices derived from measurements of arterial and venous pressures, and stroke volume. An error vector defined the residuals between the simulated and reference values of the seven clinically available haemodynamic indices. The sensitivity of this error vector to each model parameter was analysed, as well as the collinearity between parameters. To assess practical identifiability of the model parameters, profile-likelihood curves were constructed for each parameter. Four of the seven model parameters were found to be practically identifiable from the selected data. The remaining three parameters were practically non-identifiable. Among these non-identifiable parameters, one could be decreased as much as possible. The other two non-identifiable parameters were inversely correlated, which prevented their precise estimation. This work presented the practical identifiability analysis of a seven-parameter cardiovascular system model, from limited clinical data. The analysis showed that three of the seven parameters were practically non-identifiable, thus limiting the use of the model as a monitoring tool. Slight changes in the time-varying function modeling cardiac contraction and use of larger values for the reference range of venous pressure made the model fully practically identifiable. Copyright © 2017. Published by Elsevier B.V.

Changes in labile soil organic matter fractions following land use change from monocropping to poplar-based agroforestry systems in a semiarid region of Northeast China.

PubMed

Mao, Rong; Zeng, De-Hui; Li, Lu-Jun; Hu, Ya-Lin

2012-11-01

Labile fractions of soil organic matter (SOM) respond rapidly to land management practices and can be used as a sensitive indicator of changes in SOM. However, there is little information about the effect of agroforestry practices on labile SOM fractions in semiarid regions of China. In order to test the effects of land use change from monocropping to agroforestry systems on labile SOM fractions, we investigated soil microbial biomass C (MBC) and N, particulate organic matter C (POMC) and N (POMN), as well as total organic C (TOC) and total N (TN) in the 0- to 15-cm and the 15- to 30-cm layers in 4-year-old poplar-based agroforestry systems and adjoining monocropping systems with two different soil textures (sandy loam and sandy clay loam) in a semiarid region of Northeast China. Our results showed that poplar-based agroforestry practices affected soil MBC, POMC, and POMN, albeit there was no significant difference in TOC and TN. Agroforestry practices increased MBC, POMC, and POMN in sandy clay loam soils. However, in sandy loam soils, agroforestry practices only increased MBC and even decreased POMC and POMN at the 0- to 15-cm layer. Our results suggest that labile SOM fractions respond sensitively to poplar-based agroforestry practices and can provide early information about the changes in SOM in semiarid regions of Northeast China and highlight that the effects of agroforestry practices on labile SOM fractions vary with soil texture.

Prototypes for Content-Based Image Retrieval in Clinical Practice

PubMed Central

Depeursinge, Adrien; Fischer, Benedikt; Müller, Henning; Deserno, Thomas M

2011-01-01

Content-based image retrieval (CBIR) has been proposed as key technology for computer-aided diagnostics (CAD). This paper reviews the state of the art and future challenges in CBIR for CAD applied to clinical practice. We define applicability to clinical practice by having recently demonstrated the CBIR system on one of the CAD demonstration workshops held at international conferences, such as SPIE Medical Imaging, CARS, SIIM, RSNA, and IEEE ISBI. From 2009 to 2011, the programs of CADdemo@CARS and the CAD Demonstration Workshop at SPIE Medical Imaging were sought for the key word “retrieval” in the title. The systems identified were analyzed and compared according to the hierarchy of gaps for CBIR systems. In total, 70 software demonstrations were analyzed. 5 systems were identified meeting the criterions. The fields of application are (i) bone age assessment, (ii) bone fractures, (iii) interstitial lung diseases, and (iv) mammography. Bridging the particular gaps of semantics, feature extraction, feature structure, and evaluation have been addressed most frequently. In specific application domains, CBIR technology is available for clinical practice. While system development has mainly focused on bridging content and feature gaps, performance and usability have become increasingly important. The evaluation must be based on a larger set of reference data, and workflow integration must be achieved before CBIR-CAD is really established in clinical practice. PMID:21892374

"Getting the water-carrier to light the lamps": Discrepant role perceptions of traditional, complementary, and alternative medical practitioners in government health facilities in India.

PubMed

Josyula, K Lakshmi; Sheikh, Kabir; Nambiar, Devaki; Narayan, Venkatesh V; Sathyanarayana, T N; Porter, John D H

2016-10-01

The government of India has, over the past decade, implemented the "integration" of traditional, complementary and alternative medical (TCAM) practitioners, specifically practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-rigpa, and Homoeopathy (collectively known by the acronym AYUSH), in government health services. A range of operational and ethical challenges has manifested during this process of large health system reform. We explored the practices and perceptions of health system actors, in relation to AYUSH providers' roles in government health services in three Indian states - Kerala, Meghalaya, and Delhi. Research methods included 196 in-depth interviews with a range of health policy and system actors and beneficiaries, between February and October 2012, and review of national, state, and district-level policy documents relating to AYUSH integration. The thematic 'framework' approach was applied to analyze data from the interviews, and systematic content analysis performed on policy documents. We found that the roles of AYUSH providers are frequently ambiguously stated and variably interpreted, in relation to various aspects of their practice, such as outpatient care, prescribing rights, emergency duties, obstetric services, night duties, and referrals across systems of medicine. Work sharing is variously interpreted by different health system actors as complementing allopathic practice with AYUSH practice, or allopathic practice, by AYUSH providers to supplement the work of allopathic practitioners. Interactions among AYUSH practitioners and their health system colleagues frequently take place in a context of partial information, preconceived notions, power imbalances, and mistrust. In some notable instances, collegial relationships and apt divisions of responsibilities are observed. Widespread normative ambivalence around the roles of AYUSH providers, complicated by the logistical constraints prevalent in poorly resourced systems, has the potential to undermine the therapeutic practices and motivation of AYUSH providers, as well as the overall efficiency and performance of integrated health services. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study.

PubMed

Greenfield, S; Nelson, E C; Zubkoff, M; Manning, W; Rogers, W; Kravitz, R L; Keller, A; Tarlov, A R; Ware, J E

1992-03-25

To examine whether specialty and system of care exert independent effects on resource utilization. Cross-sectional analysis of just over 20,000 patients (greater than or equal to 18 years of age) who visited providers' offices during 9-day periods in 1986. Patient- and physician-provided information was obtained by self-administered questionnaires. Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo practices or small single-specialty group practices in three major US cities. Indicators of the intensity of resource utilization were examined among four medical specialties (family practice, general internal medicine, cardiology, and endocrinology) and five systems of care (health maintenance organization, multispecialty group-fee-for-service, multispecialty group-prepaid; solo practice and single-specialty group-fee-for-service, and solo practice and single-specialty group-prepaid) before and after controlling for the mix of patients seen in these offices. The indicators of resource utilization were hospitalizations, annual office visits, prescription drugs, and common tests and procedures, with rates estimated on both a per-visit and per-year basis. Variation in patient mix was a major determinant of the large variations in resource use. However, increased utilization was also independently related to specialty (cardiology and endocrinology), fee-for-service payment plan, and solo and single-specialty group practice arrangements. After adjusting for patient mix, solo practice/single-specialty groups-fee-for-service had 41% more hospitalizations than health maintenance organizations. General internists had utilization rates somewhat greater than family physicians on some indicators. Although variations in patient mix should be a major determinant of variations in resource use, the independent effects of specialty training, payment system, and practice organization on utilization rates need further explication. The 2- and 4-year outcomes now being analyzed will provide information critical to interpretation of the variations reported herein.

Validation of a real-time wireless telemedicine system, using bluetooth protocol and a mobile phone, for remote monitoring patient in medical practice.

PubMed

Yousef, Jasemian; Lars, A N

2005-06-22

This paper validates the integration of a generic real-time wireless telemedicine system utilising Global System for Mobile Communications (GSM), BLUETOOTH protocol and General Packet Radio Service (GPRS) for cellular network in clinical practice. In the first experiment, the system was tested on 24 pacemaker patients at Aalborg Hospital (Denmark), in order to see if the pacemaker implant would be affected by the system. I the second experiment, the system was tested on 15 non risky arrhythmia heart patients, in order to evaluate and validate the system application in clinical practice, for patient monitoring. Electrocardiograms were selected as the continuously monitored parameter in the present study. The results showed that the system had no negative effects on the pacemaker implants. The experiment results showed, that in a realistic environment for the patients, the system had 96.1 % up-time, 3.2 (kbps) throughput, 10(-3) (packet/s) Packet Error Rate and 10(-3) (packet/s) Packet Lost Rate. During 24 hours test the network did not respond for 57 minutes, from which 83.1 % was in the range of 0-3 minutes, 15.4 % was in the range of 3-5 minutes, and only 0.7 % of the down-time was > or = 5 and < or = 6 minutes. By a subjective evaluation, it was demonstrated that the system is applicable and the patients as well as the healthcare personals were highly confident with the system. Moreover, the patients had high degree of mobility and freedom, employing the system. In conclusion, this generic telemedicine system showed a high reliability, quality and performance, and the design can provide a basic principle for real-time wireless remote monitoring systems used in clinical practice.

Practice Makes Perfect?: Effective Practice Instruction in Large Ensembles

ERIC Educational Resources Information Center

Prichard, Stephanie

2012-01-01

Helping young musicians learn how to practice effectively is a challenge faced by all music educators. This article presents a system of individual music practice instruction that can be seamlessly integrated within large-ensemble rehearsals. Using a step-by-step approach, large-ensemble conductors can teach students to identify and isolate…

Timing Game-Based Practice in a Reading Comprehension Strategy Tutor

ERIC Educational Resources Information Center

Jacovina, Matthew E.; Jackson, G. Tanner; Snow, Erica L.; McNamara, Danielle S.

2016-01-01

Game-based practice within Intelligent Tutoring Systems (ITSs) can be optimized by examining how properties of practice activities influence learning outcomes and motivation. In the current study, we manipulated when game-based practice was available to students. All students (n = 149) first completed lesson videos in iSTART-2, an ITS focusing on…

Japanese Nursery and Kindergarten Teachers' Beliefs and Practices Regarding Developmentally Appropriate Practices

ERIC Educational Resources Information Center

Hegde, Archana V.; Sugita, Chisato; Crane-Mitchell, Linda; Averett, Paige

2014-01-01

This study explored Japanese day nursery and kindergarten teachers' beliefs and practices regarding developmentally appropriate practices. Data were collected using in-depth interviews. Teacher interviews provided insights into the merger of the childcare and education systems of Japan. Six themes emerged from the analysis of the day nursery and…

Sources of Principals' Leadership Practices and Areas Training Should Emphasize: Case Finland

ERIC Educational Resources Information Center

Shantal, Kakon Montua Ajua; Halttunen, Leena; Pekka, Kanervio

2014-01-01

Quality educational leadership preparation has positive influences on practices of graduates. In the Finnish decentralized education system, little is yet known about the sources of principals' practices. This research explores the sources of principals' self-assessed leadership practices in Central Finland and identifies areas for more emphasis.…

Teaching Research and Practice Evaluation Skills to Graduate Social Work Students

ERIC Educational Resources Information Center

Wong, Stephen E.; Vakharia, Sheila P.

2012-01-01

Objective: The authors examined outcomes of a graduate course on evaluating social work practice that required students to use published research, quantitative measures, and single-system designs in a simulated practice evaluation project. Method: Practice evaluation projects from a typical class were analyzed for the number of research references…

Safety management by walking around (SMBWA): a safety intervention program based on both peer and manager participation.

PubMed

Luria, Gil; Morag, Ido

2012-03-01

"Management by walking around" (MBWA) is a practice that has aroused much interest in management science and practice. The purpose of this study is to demonstrate adaptation of this practice to safety management. We describe a three-year long case study that collected empirical data in which a modified MBWA was practiced in order to improve safety in a semiconductor fabrication facility. The main modification involved integrating an information system with the MBWA in order to create a practice that would generate safety leadership development and an organizational safety learning mechanism, while promoting employee safety participation. The results of the case study demonstrate that the SMBWA practice facilitated thousands of tours in which safety leadership behaviors were practiced by managers and by employees (employees performed five times as many tours as managers). The information system collected information about safety behaviors and safety conditions that could not otherwise be obtained. Thus, this study presents a new organizational safety practice SMBWA, and demonstrates the ways in which SMBWA may improve safety in organizations. Copyright © 2011 Elsevier Ltd. All rights reserved.

Trojan horse attacks on counterfactual quantum key distribution

NASA Astrophysics Data System (ADS)

Yang, Xiuqing; Wei, Kejin; Ma, Haiqiang; Sun, Shihai; Du, Yungang; Wu, Lingan

2016-04-01

There has been much interest in ;counterfactual quantum cryptography; (T.-G. Noh, 2009 [10]). It seems that the counterfactual quantum key distribution protocol without any photon carrier through the quantum channel provides practical security advantages. However, we show that it is easy to break counterfactual quantum key distribution systems in practical situations. We introduce the two types of Trojan horse attacks that are available for the two-way protocol and become possible for practical counterfactual systems with our eavesdropping schemes.

High-performance work systems in health care management, part 1: development of an evidence-informed model.

PubMed

Garman, Andrew N; McAlearney, Ann Scheck; Harrison, Michael I; Song, Paula H; McHugh, Megan

2011-01-01

: Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.

Bridging the gap from values to actions: a family systems framework for family-centered AAC services.

PubMed

Mandak, Kelsey; O'Neill, Tara; Light, Janice; Fosco, Gregory M

2017-03-01

Despite the growing recognition of the importance of family involvement in augmentative and alternative communication (AAC) intervention, little guidance exists on how professionals can establish successful collaborative relationships with families. In this paper, we discuss family systems theory and ecological systems theory as a framework to guide family-centered AAC practice, review family-focused research in AAC, consider how AAC may impact the family system, and provide examples of the clinical implications of using the proposed family systems framework to improve family-centered AAC practice.

Enhanced early warning system impact on nursing practice: A phenomenological study.

PubMed

Burns, Kathleen A; Reber, Tracey; Theodore, Karen; Welch, Brenda; Roy, Debra; Siedlecki, Sandra L

2018-05-01

To determine how an enhanced early warning system has an impact on nursing practice. Early warning systems score physiologic measures and alert nurses to subtle changes in patient condition. Critics of early warning systems have expressed concern that nurses would rely on a score rather than assessment skills and critical thinking to determine the need for intervention. Enhancing early warning systems with innovative technology is still in its infancy, so the impact of an enhanced early warning system on nursing behaviours or practice has not yet been studied. Phenomenological design. Scripted, semistructured interviews were conducted in September 2015 with 25 medical/surgical nurses who used the enhanced early warning system. Data were analysed using thematic analysis techniques (coding and bracketing). Emerging themes were examined for relationships and a model describing the enhanced early warning system experience was developed. Nurses identified awareness leading to investigation and ease of prioritization as the enhanced early warning system's most important impact on their nursing practice. There was also an impact on organizational culture, with nurses reporting improved communication, increased collaboration, increased accountability and proactive responses to early changes in patient condition. Rather than hinder critical thinking, as many early warning systems' critics claim, nurses in this study found that the enhanced early warning system increased their awareness of changes in a patient's condition, resulting in earlier response and reassessment times. It also had an impact on the organization by improving communication and collaboration and supporting a culture of proactive rather than reactive response to early signs of deterioration. © 2017 John Wiley & Sons Ltd.

12 CFR 227.13 - Unfair credit contract provisions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Section 227.13 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule § 227.13 Unfair.... An executory waiver or a limitation of exemption from attachment, execution, or other process on real...

Tiered Systems of Support: Practical Considerations for School Districts. Issue Focus

ERIC Educational Resources Information Center

MDRC, 2017

2017-01-01

Students learn or progress at their own paces. How can schools make sure that they get the help they need--and only the help they need? Many are turning to multi-tiered systems of support. This brief provides some practical considerations for schools contemplating tiered approaches.

Constructing a Patient Education System: A Performance Technology Project

ERIC Educational Resources Information Center

Bell, Edith E.

2009-01-01

The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance…

The Many Forms of Research-Informed Practice: A Framework for Mapping Diversity

ERIC Educational Resources Information Center

Ostinelli, Giorgio

2016-01-01

This article investigates the interaction between educational research and practice in school systems, through a bi-dimensional framework. Forty-four papers were selected and analysed, and were grouped based on their pertinence to the categories: "system level" (macro-meso-micro) and "locus of need"…

Abstract: Using System Dynamics Analysis for Evaluating the Sustainability of “Complete Streets” Practices

EPA Science Inventory

Abstract: Using System Dynamics Analysis for Evaluating the Sustainability of “Complete Streets” Practices Primary Author: Nicholas R. Flanders 109 T.W. Alexander Drive Mail Code: E343-02 Research Triangle Park, NC 27709 919-541-3660 Flanders.nick@Epa.gov Topic categ...

Maternal Belief Systems: The Discourse of Cultural Practice as Evidence

ERIC Educational Resources Information Center

Mastergeorge, Ann M.

2007-01-01

Fully developed definitions of evidence-based practice incorporate evidence from family perspectives, as well as evidence from research on the effectiveness of particular interventions. Systems for appraising research evidence typically place qualitative analyses at lower levels. The argument in this article is that qualitative data offer a…

Community Interests and Indicator System Success

ERIC Educational Resources Information Center

Holden, Meg

2009-01-01

Testing the validity of indicator systems is a task almost always left to the scientific community, in standard practice and in keeping with the quest for objectivity prevalent in politics and in society as a whole. This paper calls for a reinvigorated agenda within indicators research to question this practice and develop alternative…

School Technology Leadership: Artifacts in Systems of Practice

ERIC Educational Resources Information Center

Dexter, Sara

2011-01-01

A cross-case analysis of five case studies of team-based technology leadership in middle schools with laptop programs identifies systems of practice that organize teams' distributed leadership. These cases suggest that successfully implementing a complex improvement effort warrants a team-based leadership approach, especially for an improvement…

77 FR 9714 - Self-Regulatory Organizations; EDGX Exchange, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

... practices and display execution and trading systems. While the Series 56 examination is primarily dedicated to topics related to proprietary trading, the Series 56 examination also covers some general concepts... Practices and Prohibited Acts, 50 questions; and Display, Execution, and Trading Systems, 13 questions...

40 CFR 141.542 - What must my system do if we are considering a significant change to disinfection practices?

Code of Federal Regulations, 2010 CFR

2010-07-01

... considering a significant change to disinfection practices? 141.542 Section 141.542 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER REGULATIONS Enhanced Filtration and Disinfection-Systems Serving Fewer Than 10,000 People Disinfection...

Complex Teacher Evaluation Systems Can Produce Negative Perceptions

ERIC Educational Resources Information Center

Schumacher, Gary

2010-01-01

The purpose of this study was to determine teacher perceptions of the impact on instructional practice when using a complex, standards-based performance evaluation system. The study used expectancy theory to investigate teacher expectancy (did they believe they could enhance their practice to the identified program standards?), instrumentality…

Low input and intensified crop production systems effects on soil health and environment

USDA-ARS?s Scientific Manuscript database

The material in this chapter covers the concepts of "low-input" and "intensified" production systems in the context of input intensity and sustainability. Research-based case studies are presented that draw out the practicalities of implementing production practices on an input intensity gradient fr...

12 CFR 227.12 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 3 2013-01-01 2013-01-01 false Definitions. 227.12 Section 227.12 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM (CONTINUED) UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule § 227.12 Definitions. For the...

12 CFR 227.16 - State exemptions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 3 2011-01-01 2011-01-01 false State exemptions. 227.16 Section 227.16 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM UNFAIR OR DECEPTIVE ACTS OR PRACTICES (REGULATION AA) Credit Practices Rule § 227.16 State exemptions. (a...