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.

An orthogonal wavelet division multiple-access processor architecture for LTE-advanced wireless/radio-over-fiber systems over heterogeneous networks

NASA Astrophysics Data System (ADS)

Mahapatra, Chinmaya; Leung, Victor CM; Stouraitis, Thanos

2014-12-01

The increase in internet traffic, number of users, and availability of mobile devices poses a challenge to wireless technologies. In long-term evolution (LTE) advanced system, heterogeneous networks (HetNet) using centralized coordinated multipoint (CoMP) transmitting radio over optical fibers (LTE A-ROF) have provided a feasible way of satisfying user demands. In this paper, an orthogonal wavelet division multiple-access (OWDMA) processor architecture is proposed, which is shown to be better suited to LTE advanced systems as compared to orthogonal frequency division multiple access (OFDMA) as in LTE systems 3GPP rel.8 (3GPP, http://www.3gpp.org/DynaReport/36300.htm). ROF systems are a viable alternative to satisfy large data demands; hence, the performance in ROF systems is also evaluated. To validate the architecture, the circuit is designed and synthesized on a Xilinx vertex-6 field-programmable gate array (FPGA). The synthesis results show that the circuit performs with a clock period as short as 7.036 ns (i.e., a maximum clock frequency of 142.13 MHz) for transform size of 512. A pipelined version of the architecture reduces the power consumption by approximately 89%. We compare our architecture with similar available architectures for resource utilization and timing and provide performance comparison with OFDMA systems for various quality metrics of communication systems. The OWDMA architecture is found to perform better than OFDMA for bit error rate (BER) performance versus signal-to-noise ratio (SNR) in wireless channel as well as ROF media. It also gives higher throughput and mitigates the bad effect of peak-to-average-power ratio (PAPR).

An Architecture for Enabling Migration of Tactical Networks to Future Flexible Ad Hoc WBWF

DTIC Science & Technology

2010-09-01

Requirements Several multiple access schemes TDMA OFDMA SC-OFDMA, FH- CDMA , DS - CDMA , hybrid access schemes, transitions between them Dynamic...parameters algorithms depend on the multiple access scheme If DS - CDMA : handling of macro-diversity (linked to cooperative routing) TDMA and/of OFDMA...Transport format Ciphering @MAC/RLC level : SCM Physical layer (PHY) : signal processing (mod, FEC, etc) CDMA : macro-diversity CDMA , OFDMA

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.

MAI-free performance of PMU-OFDM transceiver in time-variant environment

NASA Astrophysics Data System (ADS)

Tadjpour, Layla; Tsai, Shang-Ho; Kuo, C.-C. J.

2005-06-01

An approximately multi-user OFDM transceiver was introduced to reduce the multi-access interference (MAI ) due to the carrier frequency offset (CFO) to a negligible amount via precoding by Tsai, Lin and Kuo. In this work, we investigate the performance of this precoded multi-user (PMU) OFDM system in a time-variant channel environment. We analyze and compare the MAI effect caused by time-variant channels in the PMU-OFDM and the OFDMA systems. Generally speaking, the MAI effect consists of two parts. The first part is due to the loss of orthogonality among subchannels for all users while the second part is due to the CFO effect caused by the Doppler shift. Simulation results show that, although OFDMA outperforms the PMU-OFDM transceiver in a fast time-variant environment without CFO, PMU-OFDM outperforms OFDMA in a slow time-variant channel via the use of M/2 symmetric or anti-symmetric codewords of M Hadamard-Walsh codes.

Hermitian symmetry free optical-single-carrier frequency division multiple access for visible light communication

NASA Astrophysics Data System (ADS)

Azim, Ali W.; Le Guennec, Yannis; Maury, Ghislaine

2018-05-01

Optical-orthogonal frequency division multiplexing (O-OFDM) is an effective scheme for visible light communications (VLC), offering a candid extension to multiple access (MA) scenarios, i.e., O-OFDMA. However, O-OFDMA exhibits high peak-to-average power ratio (PAPR), which exacerbates the non-linear distortions from the light emitting diode (LED). To overcome high PAPR while sustaining MA, optical-single-carrier frequency-division multiple access (O-SCFDMA) is used. For both O-OFDMA and O-SCFDMA, Hermitian symmetry (HS) constraint is imposed in frequency-domain (FD) to obtain a real-valued time-domain (TD) signal for intensity modulation-direct detection (IM-DD) implementation of VLC. Howbeit, HS results in an increase of PAPR for O-SCFDMA. In this regard, we propose HS free (HSF) O-SCFDMA (HSFO-SCFDMA). We compare HSFO-SCFDMA with several approaches in key parameters, such as, bit error rate (BER), optical power penalty, PAPR, quantization, electrical power efficiency and system complexity. BER performance and optical power penalty is evaluated considering multipath VLC channel and taking into account the bandwidth limitation of LED in combination with its optimized driver. It is illustrated that HSFO-SCFDMA outperforms other alternatives.

Tunable optical frequency comb enabled scalable and cost-effective multiuser orthogonal frequency-division multiple access passive optical network with source-free optical network units.

PubMed

Chen, Chen; Zhang, Chongfu; Liu, Deming; Qiu, Kun; Liu, Shuang

2012-10-01

We propose and experimentally demonstrate a multiuser orthogonal frequency-division multiple access passive optical network (OFDMA-PON) with source-free optical network units (ONUs), enabled by tunable optical frequency comb generation technology. By cascading a phase modulator (PM) and an intensity modulator and dynamically controlling the peak-to-peak voltage of a PM driven signal, a tunable optical frequency comb source can be generated. It is utilized to assist the configuration of a multiple source-free ONUs enhanced OFDMA-PON where simultaneous and interference-free multiuser upstream transmission over a single wavelength can be efficiently supported. The proposed multiuser OFDMA-PON is scalable and cost effective, and its feasibility is successfully verified by experiment.

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.

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

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.

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.

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.

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

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

Epilogue: Systems Approaches and Systems Practice

NASA Astrophysics Data System (ADS)

Reynolds, Martin; Holwell, Sue

Each of the five systems approaches discussed in this volume: system dynamics (SD), the viable systems model (VSM), strategic options development and analysis (SODA), soft systems methodology (SSM) and critical systems heuristics (CSH) has a pedigree. Not in the sense of the sometimes absurd spectacle of animals paraded at dog shows. Rather, their pedigree derives from their systems foundations, their capacity to evolve and their flexibility in use. None of the five approaches has developed out of use in restricted and controlled contexts of either low or high levels of complicatedness. Neither has any one of them evolved as a consequence of being applied only to situations with either presumed stakeholder agreement on purpose, or courteous disagreement amongst stakeholders, or stakeholder coercion. The compilation is not a celebration of abstract ‘methodologies', but of theoretically robust approaches that have a genuine pedigree in practice.

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

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…

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…

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.

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.

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 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 Systems Survivor" is successful in providing an innovative opportunity to explore complex health care systems and is an effective curriculum.

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.

Practical Applications of Space Systems.

ERIC Educational Resources Information Center

National Academy of Sciences - National Research Council, Washington, DC. Assembly of Engineering.

This report gives an overview of a study conducted by the Space Applications Board (SAB) on the practical applications of space systems. In this study, the SAB considered how the nation's space capability might be used to solve problems such as the shortage of food and energy; the improvement of the physical environment; inventorying and…

Selecting practice management information systems.

PubMed

Worley, R; Ciotti, V

1997-01-01

Despite enormous advances in information systems, the process by which most medical practices select them has remained virtually unchanged for decades: the request for proposal (RFP). Unfortunately, vendors have learned ways to minimize the value of RFP checklists to where purchasers now learn little about the system functionality. The authors describe a selection methodology that replaces the RFP with scored demos, reviews of vendor user manuals and mathematically structured reference checking. In a recent selection process at a major medical center, these techniques yielded greater user buy-in and favorable contract terms as well.

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…

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.

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.

Practical Application of Sociology in Systems Engineering

NASA Technical Reports Server (NTRS)

Watson, Michael D.; Andrews, James G.; Eckley, Jeri Cassel; Culver, Michael L.

2017-01-01

Systems engineering involves both the integration of the system and the integration of the disciplines which develop and operate the system. Integrating the disciplines is a sociological effort to bring together different groups, who often have different terminology, to achieve a common goal, the system. The focus for the systems engineer is information flow through the organization, between the disciplines, to ensure the system is developed and operated will all relevant information informing system decisions. The practical application of the sociology in systems engineering brings in various organizational development concepts including the principles of planned renegotiation and the application of principles to address information barriers created by organizational culture. Concepts such as specification of ignorance, consistent terminology, opportunity structures, role-sets, and the reclama (reconsideration) process are all important sociological approaches that help address the organizational social structure (culture). In bringing the disciplines together, the systems engineer must also be wary of social ambivalence, social anomie, social dysfunction, and insider-outsider behavior. Unintended consequences can result when these social issues are present. These issues can occur when localized subcultures shift from the overarching organizational culture, or when the organizational culture prevents achievement of system goals. These sociological principles provide the systems engineer with key approaches to manage the information flow through the organization as the disciplines are integrated and share their information and provides key sociological barriers to information flow through the organization. This paper will discuss the practical application of sociological principles to systems engineering.

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.

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…

Advancing the practice of systems engineering at JPL

NASA Technical Reports Server (NTRS)

Jansma, Patti A.; Jones, Ross M.

2006-01-01

In FY 2004, JPL launched an initiative to improve the way it practices systems engineering. The Lab's senior management formed the Systems Engineering Advancement (SEA) Project in order to "significantly advance the practice and organizational capabilities of systems engineering at JPL on flight projects and ground support tasks." The scope of the SEA Project includes the systems engineering work performed in all three dimensions of a program, project, or task: 1. the full life-cycle, i.e., concept through end of operations 2. the full depth, i.e., Program, Project, System, Subsystem, Element (SE Levels 1 to 5) 3. the full technical scope, e.g., the flight, ground and launch systems, avionics, power, propulsion, telecommunications, thermal, etc. The initial focus of their efforts defined the following basic systems engineering functions at JPL: systems architecture, requirements management, interface definition, technical resource management, system design and analysis, system verification and validation, risk management, technical peer reviews, design process management and systems engineering task management, They also developed a list of highly valued personal behaviors of systems engineers, and are working to inculcate those behaviors into members of their systems engineering community. The SEA Project is developing products, services, and training to support managers and practitioners throughout the entire system lifecycle. As these are developed, each one needs to be systematically deployed. Hence, the SEA Project developed a deployment process that includes four aspects: infrastructure and operations, communication and outreach, education and training, and consulting support. In addition, the SEA Project has taken a proactive approach to organizational change management and customer relationship management - both concepts and approaches not usually invoked in an engineering environment. This paper'3 describes JPL's approach to advancing the practice of

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.

Human Systems Integration in Practice: Constellation Lessons Learned

NASA Technical Reports Server (NTRS)

Zumbado, Jennifer Rochlis

2012-01-01

NASA's Constellation program provided a unique testbed for Human Systems Integration (HSI) as a fundamental element of the Systems Engineering process. Constellation was the first major program to have HSI mandated by NASA's Human Rating document. Proper HSI is critical to the success of any project that relies on humans to function as operators, maintainers, or controllers of a system. HSI improves mission, system and human performance, significantly reduces lifecycle costs, lowers risk and minimizes re-design. Successful HSI begins with sufficient project schedule dedicated to the generation of human systems requirements, but is by no means solely a requirements management process. A top-down systems engineering process that recognizes throughout the organization, human factors as a technical discipline equal to traditional engineering disciplines with authority for the overall system. This partners with a bottoms-up mechanism for human-centered design and technical issue resolution. The Constellation Human Systems Integration Group (HSIG) was a part of the Systems Engineering and Integration (SE&I) organization within the program office, and existed alongside similar groups such as Flight Performance, Environments & Constraints, and Integrated Loads, Structures and Mechanisms. While the HSIG successfully managed, via influence leadership, a down-and-in Community of Practice to facilitate technical integration and issue resolution, it lacked parallel top-down authority to drive integrated design. This presentation will discuss how HSI was applied to Constellation, the lessons learned and best practices it revealed, and recommendations to future NASA program and project managers. This presentation will discuss how Human Systems Integration (HSI) was applied to NASA's Constellation program, the lessons learned and best practices it revealed, and recommendations to future NASA program and project managers on how to accomplish this critical function.

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.

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.

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.

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

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.

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

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.

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.

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.

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.

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

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…

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.

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...

Development and practice of a Telehealthcare Expert System (TES).

PubMed

Lin, Hanjun; Hsu, Yeh-Liang; Hsu, Ming-Shinn; Cheng, Chih-Ming

2013-07-01

Expert systems have been widely used in medical and healthcare practice for various purposes. In addition to vital sign data, important concerns in telehealthcare include the compliance with the measurement prescription, the accuracy of vital sign measurements, and the functioning of vital sign meters and home gateways. However, few expert system applications are found in the telehealthcare domain to address these issues. This article presents an expert system application for one of the largest commercialized telehealthcare practices in Taiwan by Min-Sheng General Hospital. The main function of the Telehealthcare Expert System (TES) developed in this research is to detect and classify events based on the measurement data transmitted to the database at the call center, including abnormality of vital signs, violation of vital sign measurement prescriptions, and malfunction of hardware devices (home gateway and vital sign meter). When the expert system detects an abnormal event, it assigns an "urgent degree" and alerts the nursing team in the call center to take action, such as phoning the patient for counseling or to urge the patient to return to the hospital for further tests. During 2 years of clinical practice, from 2009 to 2011, 19,182 patients were served by the expert system. The expert system detected 41,755 events, of which 22.9% indicated abnormality of vital signs, 75.2% indicated violation of measurement prescription, and 1.9% indicated malfunction of devices. On average, the expert system reduced by 76.5% the time that the nursing team in the call center spent in handling the events. The expert system helped to reduce cost and improve quality of the telehealthcare service.

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

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

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…

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...

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.

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.

A decision-supported outpatient practice system.

PubMed Central

Barrows, R. C.; Allen, B. A.; Smith, K. C.; Arni, V. V.; Sherman, E.

1996-01-01

We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed. PMID:8947774

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

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.

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.

Choosing a New Telephone System for Your Medical Practice.

PubMed

Metherell, Brian

2016-01-01

E-mail may rule the world in other types of businesses, but for medical practices, the telephone remains the primary mode of communication with patients, specialists, and pharmacies. From making appointments to calling in prescriptions, telephones are essential to patient care. With technology changing very quickly and new capabilities coming into the medical practice, such as telemedicine and Skype, you need to know your options when choosing a new telephone system. The possibilities include on-site, cloud, and hybrid networked solutions. A wide variety of features and capabilities are available, from dozens of vendors. Of course, no matter what telephone solution you choose, you must meet regulatory compliance, particularly HIPAA, and Payment Card Industry Data Security Standard if you take credit cards. And it has to be affordable, reliable, and long lasting. This article explores what medical practices need to know when choosing a new business telephone system in order to find the right solutions for their businesses.

Resident Front Office Experience: A Systems-Based Practice Activity

PubMed Central

Sutkin, Gary; Aronoff, Christine K.

2008-01-01

Purpose: We set out to create and evaluate a systems-based practice experience designed to introduce residents to front office responsibilities and stimulate suggestions for front office improvements. Methods: On two occasions in 2002 and 2006, each resident in the Obstetrics and Gynecology Department was trained by a front office staff member for one day. The residents completed pre- and post-experience surveys, answered open-ended questions about their experience, and volunteered suggestions for improving the front office staff, and were evaluated by their precepting staff member. Results: All but two of 23 particpating residents participated enthusiastically. These residents perceived experiencing the staff as vital to the success of the practice, reported an increased sense of appreciation for the training of staff personnel, and were evaluated favorably. Conclusion: This program gave our residents an appreciation for the training and responsibilities of pivotal office staff and an opportunity to suggest improvements. This program also satisfied ACGME resident education requirements regarding systems-based practice. PMID:20165536

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…

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.

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

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

Expanded Guidance for NASA Systems Engineering. Volume 1: Systems Engineering Practices

NASA Technical Reports Server (NTRS)

Hirshorn, Steven R.

2016-01-01

This document is intended to provide general guidance and information on systems engineering that will be useful to the NASA community. It provides a generic description of Systems Engineering (SE) as it should be applied throughout NASA. A goal of the expanded guidance is to increase awareness and consistency across the Agency and advance the practice of SE. This guidance provides perspectives relevant to NASA and data particular to NASA. This expanded guidance should be used as a companion for implementing NPR 7123.1, Systems Engineering Processes and Requirements, the Rev 2 version of SP-6105, and the Center-specific handbooks and directives developed for implementing systems engineering at NASA. It provides a companion reference book for the various systems engineering-related training being offered under NASA's auspices.

Toxicovigilance Systems and Practices in Africa

PubMed Central

Bertrand, Pouokam Guy; Ahmed, Hatem Abdel Moniem; Ngwafor, Randolph; Frazzoli, Chiara

2016-01-01

African consumers and citizens are growingly aware of the wide range of toxic poisoning scenarios from different products and hazards. Recurrent episodes on poisoning that have been reported in Africa include toxic hazards in consumers’ products ranging from food to herbal medicine, drugs, and cosmetics. Chemical poisoning remains an issue that is overlooked by public health stakeholders in Africa. Available information on toxicovigilance systems and practices in African countries is reviewed in terms of increasing development, organization and articulation levels. Less than nine out of 54 African countries have a legally recognized toxicovigilance system. Of these, the majority have created toxicovigilance systems recently, and are facing many challenges in developing them, at regional and country levels. Basic structures for a good toxicovigilance system include a phone line service (available 24/7), and hospital facilities. Pesticides emerge as the hazard recognized by all of the toxicovigilance systems, and may represent a prototypic toxicant towards a toxicovigilance system that is inclusive of a wider spectrum of toxicological hazards for the protection of community health. Toxicovigilance today is more reactive than preventive in Africa, but some milestones are present that constitute some promising seminal efforts. PMID:29051419

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.

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.

Thinking strategically: academic-practice relationships: one health system's experience.

PubMed

Wurmser, Teri; Bliss-Holtz, Jane

2011-01-01

Strategic planning and joint leverage of the strengths inherent in the academic and practice arenas of nursing are imperative to confront the challenges facing the profession of nursing and its place within the healthcare team of the future. This article presents a description and discussion of the implementation of several academic-practice partnership initiatives by Meridian Health, a health system located in central New Jersey. Included in the strategies discussed are creation of a support program for nonprofessional employees to become registered nurses; active partnership in the development of an accelerated BSN program; construction of support systems and academic partnerships for staff participation in RN-to-BSN programs; construction of on-site clinical simulation laboratories to foster interprofessional learning; and the implementation of a new BSN program, the first and only generic BSN program in two counties of the state. Outcomes of these academic-practice partnerships also are presented, including number of participants; graduation and NCLEX-RN pass rates; MH nurse vacancy rates; and nurse retention rates after first employment. Copyright © 2011 Elsevier Inc. All rights reserved.

[The use of an opect optic system in neurosurgical practice].

PubMed

Kalinovskiy, A V; Rzaev, D A; Yoshimitsu, K

2018-01-01

Modern neurosurgical practice is impossible without access to various information sources. The use of MRI and MSCT data during surgery is an integral part of the neurosurgeon's daily practice. Devices capable of managing an image viewer system without direct contact with equipment simplify working in the operating room. To test operation of a non-contact MRI and MSCT image viewer system in the operating room and to evaluate the system effectiveness. An Opect non-contact image management system developed at the Tokyo Women's Medical University was installed in one of the operating rooms of the Novosibirsk Federal Center of Neurosurgery in 2014. In 2015, the Opect system was used by operating surgeons in 73 surgeries performed in the same operating room. The system effectiveness was analyzed based on a survey of surgeons. The non-contact image viewer system occurred to be easy-to-learn for the personnel to operate this system, easy-to-manage it, and easy-to-present visual information during surgery. Application of the Opect system simplifies work with neuroimaging data during surgery. The surgeon can independently view series of relevant MRI and MSCT scans without any assistance.

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.

Systems-based practice: the sixth core competency.

PubMed

Dyne, Pamela L; Strauss, Robert W; Rinnert, Stephan

2002-11-01

Systems-Based Practice (SBP) is the sixth competency defined by the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project. Specifically, SBP requires "Residents [to] demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value." This competency can be divided into four subcompetencies, all of which are integral to training emergency medicine (EM) physicians: resources, providers, and systems; cost-appropriate care; delivery systems; and patient advocacy. In March 2002, the Council of Emergency Medicine Residency Directors (CORD-EM) convened a consensus conference to assist residency directors in modifying the SBP competency specific for EM. The Consensus Group modified the broad ACGME definition for SBP into EM-specific goals and objectives for residency training in SBP. The primary assessment methods from the Toolbox of Assessment Methods were also identified for SBP. They are direct observation, global ratings, 360-degree evaluations, portfolio assessment, and testing by both oral and written exams. The physician tasks from the Model of the Clinical Practice of Emergency Medicine that are most relevant to SBP are out-of-hospital care, modifying factors, legal/professional issues, diagnostic studies, consultation and disposition, prevention and education, multitasking, and team management. Suggested EM residency curriculum components for SBP are already in place in most residency programs, so no additional resources would be required for their implementation. These include: emergency medical services and administrative rotations, directed reading, various interdisciplinary and hospital committee participation, continuous quality improvement project participation, evidence-based medicine instruction, and various didactic experiences, including follow-up, interdisciplinary, and case conferences. With appropriate

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.

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.

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…

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.

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.

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…

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.

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.

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.

Exploring extended scope of practice in dietetics: A systems approach.

PubMed

Ryan, Dominique; Pelly, Fiona; Purcell, Elizabeth

2017-09-01

The aim of this study was to explore health professionals' perceptions of an extended scope of a practice clinic, and develop a framework using a systems approach to facilitate extended scope models across various health settings. A qualitative investigation using semi-structured interviews with four health professionals involved in an extended scope dietitian-led gastroenterology clinic in a hospital in regional Queensland was conducted. A case study design was utilised to investigate interviewees' perceptions of the clinic. Participants were conveniently, purposively sampled. Transcript analysis involved a descriptive analytical approach. Interviewee responses were coded and categorised into themes, and investigator triangulation was used to ensure consistency between individual analyses. A secondary interpretative analysis was conducted where relationships between key themes were mapped to the Systems Engineering Initiative for Patient Safety work system model. Interviewees identified various factors as vital inputs to the work system. These were categorised into the four key elements: stakeholder support, resources, planning and the dietitian. Clinic outcomes were categorised into the impact on four key groups: patients, the dietitian, the multidisciplinary team and the health system. Mapping of the relationships between inputs and outcomes resulted in an implementation framework for extended scope of practice. Extended scope of practice in dietetics may provide positive outcomes for various stakeholders. However, further development of extended scope roles for dietitians requires increased advocacy and support from governments, professional bodies, training institutions and dietitians. We have developed an implementation framework which can be utilised by health professionals interested in embracing an extended scope model of care. © 2016 Dietitians Association of Australia.

Information systems: the key to evidence-based health practice.

PubMed Central

Rodrigues, R. J.

2000-01-01

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195

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...

IAU resolutions on reference systems and time scales in practice

NASA Astrophysics Data System (ADS)

Brumberg, V. A.; Groten, E.

2001-03-01

To be consistent with IAU/IUGG (1991) resolutions ICRS and ITRS should be treated as four-dimensional reference systems with TCB and TCG time scales, respectively, interrelated by a four-dimensional general relativistic transformation. This two-way transformation is given in the form adapted for actual application. The use of TB and TT instead of TCB and TCG, respectively, involves scaling factors complicating the use of this transformation in practice. New IAU B1 (2000) resolution is commented taking in mind some points of possible confusion in its practical application. The problem of the relationship of the theory of reference systems with the parameters of common relevance to astronomy, geodesy and geodynamics is briefly outlined.

Identification and Classification of Orthogonal Frequency Division Multiple Access (OFDMA) Signals Used in Next Generation Wireless Systems

DTIC Science & Technology

2012-03-01

advanced antenna systems AMC adaptive modulation and coding AWGN additive white Gaussian noise BPSK binary phase shift keying BS base station BTC ...QAM-16, and QAM-64, and coding types include convolutional coding (CC), convolutional turbo coding (CTC), block turbo coding ( BTC ), zero-terminating

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…

Leading Instructional Practices in a Performance-Based System

ERIC Educational Resources Information Center

Kauble, Anna; Wise, Donald

2015-01-01

Given the shift to Common Core, educational leaders are challenged to see new directions in teaching and learning. The purpose of this study was to investigate the instructional practices which may be related to the effectiveness of a performance-based system (PBS) and their impact on student achievement, as part of a thematic set of dissertations…

Practical system for generating digital mixed reality video holograms.

PubMed

Song, Joongseok; Kim, Changseob; Park, Hanhoon; Park, Jong-Il

2016-07-10

We propose a practical system that can effectively mix the depth data of real and virtual objects by using a Z buffer and can quickly generate digital mixed reality video holograms by using multiple graphic processing units (GPUs). In an experiment, we verify that real objects and virtual objects can be merged naturally in free viewing angles, and the occlusion problem is well handled. Furthermore, we demonstrate that the proposed system can generate mixed reality video holograms at 7.6 frames per second. Finally, the system performance is objectively verified by users' subjective evaluations.

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.

New Best-Practices Guide for Photovoltaic System Operations and Maintenance

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

Fact sheet summarizing technical report TP-7A40-67553. As solar photovoltaic (PV) systems have continued their transition from niche applications into large, mature markets in the United States, their potential as financial investments has risen accordingly. Mainstream investors, however, need to feel confident about the risk and return of solar photovoltaic (PV) systems before committing funds. A major influence on risk and return for PV is operations and maintenance (O&M) - but O&M practices and costs vary widely across the United States, making these variables difficult for investors to predict. To address this barrier to continued PV investment, the PV O&M Workingmore » Group has developed a new best-practices guide for PV O&M.« less

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…

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.

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...

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.

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.

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

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 ...

Development of Quality Management Systems for Clinical Practice Guidelines in Korea.

PubMed

Jo, Heui-Sug; Kim, Dong Ik; Chang, Sung-Goo; Shin, Ein-Soon; Oh, Moo-Kyung

2015-11-01

This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers.

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.

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.

Complex adaptive systems: A new approach for understanding health practices.

PubMed

Gomersall, Tim

2018-06-22

This article explores the potential of complex adaptive systems theory to inform behaviour change research. A complex adaptive system describes a collection of heterogeneous agents interacting within a particular context, adapting to each other's actions. In practical terms, this implies that behaviour change is 1) socially and culturally situated; 2) highly sensitive to small baseline differences in individuals, groups, and intervention components; and 3) determined by multiple components interacting "chaotically". Two approaches to studying complex adaptive systems are briefly reviewed. Agent-based modelling is a computer simulation technique that allows researchers to investigate "what if" questions in a virtual environment. Applied qualitative research techniques, on the other hand, offer a way to examine what happens when an intervention is pursued in real-time, and to identify the sorts of rules and assumptions governing social action. Although these represent very different approaches to complexity, there may be scope for mixing these methods - for example, by grounding models in insights derived from qualitative fieldwork. Finally, I will argue that the concept of complex adaptive systems offers one opportunity to gain a deepened understanding of health-related practices, and to examine the social psychological processes that produce health-promoting or damaging actions.

[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.

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

People-centred science: strengthening the practice of health policy and systems research.

PubMed

Sheikh, Kabir; George, Asha; Gilson, Lucy

2014-04-17

Health policy and systems research (HPSR) is a transdisciplinary field of global importance, with its own emerging standards for creating, evaluating, and utilizing knowledge, and distinguished by a particular orientation towards influencing policy and wider action to strengthen health systems. In this commentary, we argue that the ability of the HPSR field to influence real world change hinges on its becoming more people-centred. We see people-centredness as recognizing the field of enquiry as one of social construction, requiring those conducting HPSR to locate their own position in the system, and conduct and publish research in a manner that foregrounds human agency attributes and values, and is acutely attentive to policy context. Change occurs at many layers of a health system, shaped by social, political, and economic forces, and brought about by different groups of people who make up the system, including service users and communities. The seeds of transformative practice in HPSR lie in amplifying the breadth and depth of dialogue across health system actors in the conduct of research - recognizing that these actors are all generators, sources, and users of knowledge about the system. While building such a dialogic practice, those conducting HPSR must strive to protect the autonomy and integrity of their ideas and actions, and also clearly explain their own positions and the value-basis of their work. We conclude with a set of questions that health policy and systems researchers may wish to consider in making their practice more people-centred, and hence more oriented toward real-world change.

People-centred science: strengthening the practice of health policy and systems research

PubMed Central

2014-01-01

Health policy and systems research (HPSR) is a transdisciplinary field of global importance, with its own emerging standards for creating, evaluating, and utilizing knowledge, and distinguished by a particular orientation towards influencing policy and wider action to strengthen health systems. In this commentary, we argue that the ability of the HPSR field to influence real world change hinges on its becoming more people-centred. We see people-centredness as recognizing the field of enquiry as one of social construction, requiring those conducting HPSR to locate their own position in the system, and conduct and publish research in a manner that foregrounds human agency attributes and values, and is acutely attentive to policy context. Change occurs at many layers of a health system, shaped by social, political, and economic forces, and brought about by different groups of people who make up the system, including service users and communities. The seeds of transformative practice in HPSR lie in amplifying the breadth and depth of dialogue across health system actors in the conduct of research – recognizing that these actors are all generators, sources, and users of knowledge about the system. While building such a dialogic practice, those conducting HPSR must strive to protect the autonomy and integrity of their ideas and actions, and also clearly explain their own positions and the value-basis of their work. We conclude with a set of questions that health policy and systems researchers may wish to consider in making their practice more people-centred, and hence more oriented toward real-world change. PMID:24739525

Nursing record systems: effects on nursing practice and health care outcomes.

PubMed

Currell, R; Wainwright, P; Urquhart, C

2000-01-01

A nursing record system is the record of care planned and/or given to individual patients/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. We searched The Cochrane Library, MEDLINE, Cinahl, Sigle, and databases of the Royal College of Nursing, King's Fund, the NHS Centre for Reviews and Dissemination, and the Institute of Electrical Engineers up to August 1999; and OCLC First Search, Department of Health database, NHS Register of Computer Applications and the Health Visitors' Association database up to the end of 1995. We hand searched the Journal of Nursing Administration (1971-1999), Computers in Nursing (1984-1999), Information Technology in Nursing (1989-1999) and reference lists of articles. We also hand searched the major health informatics conference proceedings. We contacted experts in the field of nursing informatics, suppliers of nursing computer systems, and relevant Internet groups. Randomised trials, 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 health care assistants working under the direction of a qualified nurse and patients receiving care recorded and/or planned using nursing record systems. Two reviewers independently assessed trial quality and extracted data. Six trials involving 1407 people were included. In three studies of client held records, there were no overall positive or negative effects, although some administrative benefits through fewer missing notes were suggested. A paediatric pain management sheet study showed a positive effect on the children's pain intensity. A computerised nursing care planning study showed a negative effect on documented nursing

A dynamic family practice information system for enhanced financial management.

PubMed

Hofman, M N; Hughes, R L

1982-08-01

The definition of the fiscal unit/family structure has enabled users of the FMIS, or family practices in Colorado and Wyoming, to maintain accurate, ongoing financial information on their patients. In turn, this structure has been a major incentive for maintaining accurate family information, and a distinct benefit to FMIS users. This article has presented the rationale, design, and method of implementation of the fiscal unit structure, with the intention of presenting this concept to others for use in other information systems used in maintaining family-oriented financial and medical information for medical practices.

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.

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.

"The mirror" and "the village": a new method for teaching practice-based learning and improvement and systems-based practice.

PubMed

Ziegelstein, Roy C; Fiebach, Nicholas H

2004-01-01

Practice-based learning and improvement (PBLI) and systems-based practice (SBP) may be conceptually difficult for both residents and faculty. Methods for introducing these concepts are needed if PBLI and SBP are to be incorporated into education and practice. In 2001, PBLI and SBP were introduced at Johns Hopkins Bayview Medical Center in Baltimore, Maryland, using the metaphors "the mirror" and "the village." PBLI was likened to residents' holding up a mirror to document, assess, and improve their practice. Specific tools for residents (e.g., weekly morbidity and mortality morning reports, continuity clinic chart self-audits, and resident learning portfolios) became the mirrors. SBP was introduced through specific training activities (e.g., multidisciplinary patient care rounds, nursing evaluations, and quality assessment-systems improvement exercises) using the metaphor of the village made famous by Hillary Clinton in the phrase: "It takes a village to raise a child." Residents completed a questionnaire in which they rated these initiatives' impact on their training. The majority of residents who participated in specific activities agreed that quality assessment-systems improvement exercises (92.9%), multidisciplinary rounds (92.1%), morbidity and mortality morning reports (86.8%), clinic chart self-audits (76.4%), and nursing evaluations (52.8%) helped to improve their proficiency in specific aspects of PBLI and SBP. Residents' retrospective self-assessments of their PBLI abilities demonstrated significant improvement after the introduction of specific training activities. PBLI and SBP can be introduced effectively in residency training by incorporating specific activities that use the metaphors of the mirror and the village.

Practical considerations for a second-order directional hearing aid microphone system

NASA Astrophysics Data System (ADS)

Thompson, Stephen C.

2003-04-01

First-order directional microphone systems for hearing aids have been available for several years. Such a system uses two microphones and has a theoretical maximum free-field directivity index (DI) of 6.0 dB. A second-order microphone system using three microphones could provide a theoretical increase in free-field DI to 9.5 dB. These theoretical maximum DI values assume that the microphones have exactly matched sensitivities at all frequencies of interest. In practice, the individual microphones in the hearing aid always have slightly different sensitivities. For the small microphone separation necessary to fit in a hearing aid, these sensitivity matching errors degrade the directivity from the theoretical values, especially at low frequencies. This paper shows that, for first-order systems the directivity degradation due to sensitivity errors is relatively small. However, for second-order systems with practical microphone sensitivity matching specifications, the directivity degradation below 1 kHz is not tolerable. A hybrid order directive system is proposed that uses first-order processing at low frequencies and second-order directive processing at higher frequencies. This hybrid system is suggested as an alternative that could provide improved directivity index in the frequency regions that are important to speech intelligibility.

Systems-based practice in graduate medical education: systems thinking as the missing foundational construct.

PubMed

Colbert, Colleen Y; Ogden, Paul E; Ownby, Allison R; Bowe, Constance

2011-04-01

Since 2001, residencies have struggled with teaching and assessing systems-based practice (SBP). One major obstacle may be that the competency alone is not sufficient to support assessment. We believe the foundational construct underlying SBP is systems thinking, absent from the current Accreditation Council for Graduate Medical Education competency language. Systems thinking is defined as the ability to analyze systems as a whole. The purpose of this article is to describe psychometric issues that constrain assessment of SBP and elucidate the role of systems thinking in teaching and assessing SBP. Residency programs should incorporate systems thinking models into their curricula. Trainees should be taught to understand systems at an abstract level, in order to analyze their own healthcare systems, and participate in quality and patient safety activities. We suggest that a developmental trajectory for systems thinking be developed, similar to the model described by Dreyfus and Dreyfus.

Towards an evaluation framework for information quality management (IQM) practices for health information systems--evaluation criteria for effective IQM practices.

PubMed

Mohammed, Siti Asma; Yusof, Maryati Mohd

2013-04-01

Poor information quality (IQ) must be understood as a business problem rather than systems problem. In health care organization, what is required is an effective quality management that continuously manages and reviews the factors influencing IQ in health information systems (HIS) so as to achieve the desired outcomes. Hence, in order to understand the issues of information quality management (IQM) practices in health care organizations, a more holistic evaluation study should be undertaken to investigate the IQM practices in health care organizations. It is the aim of this paper to identify the significant evaluation criteria that influence the production of good IQ in HIS. Six selected frameworks and best practices both from health informatics and information systems literature have been reviewed to identify the evaluation criteria from the perspective of human, organizational and technological factors. From the review, it was found that human and organization factors are of greater significance in influencing HIS IQ. Our review depicts that there is still shortage in finding a comprehensive IQM evaluation framework. Thus, the criteria from the frameworks reviewed can be used in combination for more comprehensive evaluation criteria. Integrated IQM evaluation criteria for HIS are then proposed in this study. Poor IQ is the result of complex interdependency within sociotechnical factors in health care organization and lack of formal and structured IQM practices. Thus, a feedback mechanism such as evaluation is needed to understand the issues in depth in the future. © 2012 Blackwell Publishing Ltd.

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.

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.

A prototype system to support evidence-based practice.

PubMed

Demner-Fushman, Dina; Seckman, Charlotte; Fisher, Cheryl; Hauser, Susan E; Clayton, Jennifer; Thoma, George R

2008-11-06

Translating evidence into clinical practice is a complex process that depends on the availability of evidence, the environment into which the research evidence is translated, and the system that facilitates the translation. This paper presents InfoBot, a system designed for automatic delivery of patient-specific information from evidence-based resources. A prototype system has been implemented to support development of individualized patient care plans. The prototype explores possibilities to automatically extract patients problems from the interdisciplinary team notes and query evidence-based resources using the extracted terms. Using 4,335 de-identified interdisciplinary team notes for 525 patients, the system automatically extracted biomedical terminology from 4,219 notes and linked resources to 260 patient records. Sixty of those records (15 each for Pediatrics, Oncology & Hematology, Medical & Surgical, and Behavioral Health units) have been selected for an ongoing evaluation of the quality of automatically proactively delivered evidence and its usefulness in development of care plans.

A Prototype System to Support Evidence-based Practice

PubMed Central

Demner-Fushman, Dina; Seckman, Charlotte; Fisher, Cheryl; Hauser, Susan E.; Clayton, Jennifer; Thoma, George R.

2008-01-01

Translating evidence into clinical practice is a complex process that depends on the availability of evidence, the environment into which the research evidence is translated, and the system that facilitates the translation. This paper presents InfoBot, a system designed for automatic delivery of patient-specific information from evidence-based resources. A prototype system has been implemented to support development of individualized patient care plans. The prototype explores possibilities to automatically extract patients’ problems from the interdisciplinary team notes and query evidence-based resources using the extracted terms. Using 4,335 de-identified interdisciplinary team notes for 525 patients, the system automatically extracted biomedical terminology from 4,219 notes and linked resources to 260 patient records. Sixty of those records (15 each for Pediatrics, Oncology & Hematology, Medical & Surgical, and Behavioral Health units) have been selected for an ongoing evaluation of the quality of automatically proactively delivered evidence and its usefulness in development of care plans. PMID:18998835

Physician practice management companies: implications for hospital-based integrated delivery systems.

PubMed

Burns, L R; Robinson, J C

1997-01-01

Physician practice management companies (PPMCs) are one of the most visible entrants into the industry of managing physician practices, and anywhere from 100-150 are already in operation. Although PPMCs and hospital-based integrated delivery systems (IDSs) differ from each other in many ways, they share a number of common features, including the pursuit of capitation contracts from payors. As a result, PPMCs pose a growing, direct threat to hospital systems in competing for managed care contracts that cover physician service. PPMCs also provide an alternative to hospital-based IDSs at the local market level for physician group consolidation. This article looks at the structure, operation, and strategy of PPMCs and examines what implications their growth will have for hospital-based IDSs.

A Practical and Portable Solids-State Electronic Terahertz Imaging System

PubMed Central

Smart, Ken; Du, Jia; Li, Li; Wang, David; Leslie, Keith; Ji, Fan; Li, Xiang Dong; Zeng, Da Zhang

2016-01-01

A practical compact solid-state terahertz imaging system is presented. Various beam guiding architectures were explored and hardware performance assessed to improve its compactness, robustness, multi-functionality and simplicity of operation. The system performance in terms of image resolution, signal-to-noise ratio, the electronic signal modulation versus optical chopper, is evaluated and discussed. The system can be conveniently switched between transmission and reflection mode according to the application. A range of imaging application scenarios was explored and images of high visual quality were obtained in both transmission and reflection mode. PMID:27110791

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.

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.

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…

A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education.

PubMed

Varkey, Prathibha; Karlapudi, Sudhakar; Rose, Steven; Nelson, Roger; Warner, Mark

2009-03-01

The Accreditation Council for Graduate Medical Education (ACGME) initiated its Outcome Project to better prepare physicians-in-training to practice in the rapidly changing medical environment and mandated assessment of competency in six outcomes, including Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). Before the initiation of the Outcome Project, these competencies were not an explicit element of most graduate medical education training programs. Since 1999, directors of ACGME-accredited programs nationwide have been challenged to teach and assess these competencies. The authors describe an institution-wide curriculum intended to facilitate the teaching and assessment of PBLI and SBP competencies in the 115 ACGME-accredited residency and fellowship programs (serving 1,327 trainees) sponsored by Mayo School of Graduate Medical Education. Strategies to establish the curriculum in 2005 included development of a Quality Improvement (QI) curriculum Web site, one-on-one consultations with program directors, a three-hour program director workshop, and didactic sessions for residents and fellows on core topics. An interim program director self-assessment survey revealed a 13% increase in perceived ability to measure competency in SBP, no change in their perceived ability to measure competence in PBLI, a 15% increase in their ability to provide written documentation of competence in PBLI, and a 35% increase in their ability to provide written documentation of competence in SBP between 2005 and 2007. Nearly 70% of the programs had trainees participating in QI projects. Further research is needed to evaluate the cost-effectiveness of such a program and to measure its impact on learner knowledge, skills, and attitudes and, ultimately, on patient outcomes.

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...

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.

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…

Nursing record systems: effects on nursing practice and health care outcomes.

PubMed

Currell, R; Urquhart, C

2003-01-01

A nursing record system is the record of care planned and/or given to individual patients/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. We searched The Cochrane Library, the EPOC trial register (October 2002), MEDLINE, Cinahl, Sigle, and databases of the Royal College of Nursing, King's Fund, the NHS Centre for Reviews and Dissemination, and the Institute of Electrical Engineers up to August 1999; and OCLC First Search, Department of Health database, NHS Register of Computer Applications and the Health Visitors' Association database up to the end of 1995. We hand searched the Journal of Nursing Administration (1971-1999), Computers in Nursing (1984-1999), Information Technology in Nursing (1989-1999) and reference lists of articles. We also hand searched the major health informatics conference proceedings. We contacted experts in the field of nursing informatics, suppliers of nursing computer systems, and relevant Internet groups. To update the review the Medline, Cinahl, British Nursing Index, Aslib Index to Theses databases were all searched from 1998 to 2002. The Journal of Nursing Administration, Computers in Nursing, Information Technology in Nursing were all hand searched up to 2002. The searches of the other databases and grey literature included in the original review, were not updated (except for Health Care Computing Conference and Med Info) as the original searches produced little relevant material. Randomised trials, 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 health care assistants working under the direction of a qualified nurse and patients receiving care recorded

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.

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.

Web-based education in systems-based practice: a randomized trial.

PubMed

Kerfoot, B Price; Conlin, Paul R; Travison, Thomas; McMahon, Graham T

2007-02-26

All accredited US residency programs are expected to offer curricula and evaluate their residents in 6 general competencies. Medical schools are now adopting similar competency frameworks. We investigated whether a Web-based program could effectively teach and assess elements of systems-based practice. We enrolled 276 medical students and 417 residents in the fields of surgery, medicine, obstetrics-gynecology, and emergency medicine in a 9-week randomized, controlled, crossover educational trial. Participants were asked to sequentially complete validated Web-based modules on patient safety and the US health care system. The primary outcome measure was performance on a 26-item validated online test administered before, between, and after the participants completed the modules. Six hundred forty (92.4%) of the 693 enrollees participated in the study; 512 (80.0%) of the participants completed all 3 tests. Participants' test scores improved significantly after completion of the first module (P<.001). Overall learning from the 9-week Web-based program, as measured by the increase in scores (posttest scores minus pretest scores), was 16 percentage points (95% confidence interval, 14-17 percentage points; P<.001) in public safety topics and 22 percentage points (95% confidence interval, 20-23 percentage points; P<.001) in US health care system topics. A Web-based educational program on systems-based practice competencies generated significant and durable learning across a broad range of medical students and residents.

Documentation of Nursing Practice Using a Computerized Medical Information System

PubMed Central

Romano, Carol

1981-01-01

This paper discusses a definition of the content of the computerized nursing data base developed by the Nursing Department for the Clinical Center Medical Information System at the National Institutes of Health in Bethesda, Maryland. The author describes the theoretical framework for the content and presents a model to describe the organization of the nursing data components in relation to the process of nursing care delivery. Nursing documentation requirements of Nurse Practice Acts, American Nurses Association Standards of Practice and the Joint Commission on Accreditation of Hospitals are also addressed as they relate to this data base. The advantages and disadvantages of such an approach to computerized documentation are discussed.

The Practical Implementation of Non-Contacting Laser Strain Measurements Systems

NASA Technical Reports Server (NTRS)

Yunis, Isam; Quinn, roger D.; Kadambi, Jaikrishnan R.

2000-01-01

Measurement of stress and strain in rotating turbomachinery is critical to many industries. The search for a non-contacting, non-interfering, non-degrading measurement system is on going and extensive. While several methods seem promising in theory, implementation has proven troublesome. This work uncovers and quantifies these implementation issues in the context of a laser measurement system. Both a Laser Doppler Velocimeter system and a displacement laser system are utilized. It is found that the key issues are signal to noise ratio, rigid body compensation, measurement location, and conversion of intermittent measurements to a continuous signal. Accounting for these factors leads to successful measurements. These results should lead to better ideas and more practical solutions to the non-contacting, non-degrading, non-interfering strain measurement system problem.

Using Gunshot Detection Systems to Fight Explosive Fishing Practices

NASA Astrophysics Data System (ADS)

Showen, R. L.; Dunson, J. C.; Woodman, G.; Christopher, S.; Wilson, S.

2015-12-01

Blast fishing (using explosives to catch fish) causes extensive damage to coral reefs, especially in the Coral Triangle in Southeast Asia. Subsistence fishermen and larger consortiums, often with criminal links, throw an explosive into a school of fish, killing all sea life within range. This unsustainable practice is becoming more prevalent, and threatens the protein supply of as many as a billion people. Ending blast fishing will require combined technical and societal methods aimed at both deterring the practice, and catching those responsible. Our work aims to significantly improve enforcement. We are re-purposing SST's ShotSpotter gunshot detection system, (trusted and valued by police around the world), substituting hydrophones for the present microphones. Using multilateration and trained human reviewers, the system can give prompt blast alerts, location data, and acoustic waveforms to law enforcement officials. We hope to establish a prototype system in Malaysia in 2015, and have already secured governmental approvals for installation and tests with local law enforcement. The Scubazoo media firm in Malaysia is working with resorts, dive operations, and celebrity sponsors, and is planning to produce videos to illustrate the severity of the problem to both governments and the public. Because there is little hard data concerning the prevalence of blast fishing in either marine protected areas or open waters, the system can also indicate to the world the actual blast rates and patterns of use. The Teng Hoi environmental NGO in Hong Kong showed in 2004 that acoustic waves from typical bombs propagate on the order of 20 km, so an underwater locator system with a small number of sensors can feasibly cover a sizable coral region. Our present plans are to mount sensors on piers, buoys, and boats, but if possible we would also like to integrate with other existing acoustic arrays to strengthen the fight against blast fishing.

Coliform Bacteria Monitoring in Fish Systems: Current Practices in Public Aquaria.

PubMed

Culpepper, Erin E; Clayton, Leigh A; Hadfield, Catherine A; Arnold, Jill E; Bourbon, Holly M

2016-06-01

Public aquaria evaluate coliform indicator bacteria levels in fish systems, but the purpose of testing, testing methods, and management responses are not standardized, unlike with the coliform bacteria testing for marine mammal enclosures required by the U.S. Department of Agriculture. An online survey was sent to selected aquaria to document current testing and management practices in fish systems without marine mammals. The information collected included indicator bacteria species, the size and type of systems monitored, the primary purpose of testing, sampling frequency, test methods, the criteria for interpreting results, corrective actions, and management changes to limit human exposure. Of the 25 institutions to which surveys were sent, 19 (76%) responded. Fourteen reported testing for fecal indicator bacteria in fish systems. The most commonly tested indicator species were total (86%) and fecal (79%) coliform bacteria, which were detected by means of the membrane filtration method (64%). Multiple types and sizes of systems were tested, and the guidelines for testing and corrective actions were highly variable. Only three institutions performed additional tests to confirm the identification of indicator organisms. The results from this study can be used to compare bacterial monitoring practices and protocols in fish systems, as an aid to discussions relating to the accuracy and reliability of test results, and to help implement appropriate management responses. Received August 23, 2015; accepted December 29, 2015.

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…

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...

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

Resilient Control Systems Practical Metrics Basis for Defining Mission Impact

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

Craig G. Rieger

"Resilience” describes how systems operate at an acceptable level of normalcy despite disturbances or threats. In this paper we first consider the cognitive, cyber-physical interdependencies inherent in critical infrastructure systems and how resilience differs from reliability to mitigate these risks. Terminology and metrics basis are provided to integrate the cognitive, cyber-physical aspects that should be considered when defining solutions for resilience. A practical approach is taken to roll this metrics basis up to system integrity and business case metrics that establish “proper operation” and “impact.” A notional chemical processing plant is the use case for demonstrating how the system integritymore » metrics can be applied to establish performance, and« less

Does an activity based remuneration system attract young doctors to general practice?

PubMed Central

2012-01-01

Background The use of increasingly complex payment schemes in primary care may represent a barrier to recruiting general practitioners (GP). The existing Norwegian remuneration system is fully activity based - 2/3 fee-for-service and 1/3 capitation. Given that the system has been designed and revised in close collaborations with the medical association, it is likely to correspond - at least to some degree - with the preferences of current GPs (men in majority). The objective of this paper was to study which preferences that young doctors (women in majority), who are the potential entrants to general practice have for activity based vs. salary based payment systems. Methods In November-December 2010 all last year medical students and all interns in Norway (n = 1.562) were invited to participate in an online survey. The respondents were asked their opinion on systems of remuneration for GPs; inclination to work as a GP; risk attitude; income preferences; work pace tolerance. The data was analysed using one-way ANOVA and multinomial logistic regression analysis. Results A total of 831 (53%) responded. Nearly half the sample (47%) did not consider the remuneration system to be important for their inclination to work as GP; 36% considered the current system to make general practice more attractive, while 17% considered it to make general practice less attractive. Those who are attracted by the existing system were men and those who think high income is important, while those who are deterred by the system are risk averse and less happy with a high work pace. On the question of preferred remuneration system, half the sample preferred a mix of salary and activity based remuneration (the median respondent would prefer a 50/50 mix). Only 20% preferred a fully activity based system like the existing one. A salary system was preferred by women, and those less concerned with high income, while a fully activity based system was preferred by men, and those happy with a high work

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…

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.

Risk Modeling of Interdependent Complex Systems of Systems: Theory and Practice.

PubMed

Haimes, Yacov Y

2018-01-01

The emergence of the complexity characterizing our systems of systems (SoS) requires a reevaluation of the way we model, assess, manage, communicate, and analyze the risk thereto. Current models for risk analysis of emergent complex SoS are insufficient because too often they rely on the same risk functions and models used for single systems. These models commonly fail to incorporate the complexity derived from the networks of interdependencies and interconnectedness (I-I) characterizing SoS. There is a need to reevaluate currently practiced risk analysis to respond to this reality by examining, and thus comprehending, what makes emergent SoS complex. The key to evaluating the risk to SoS lies in understanding the genesis of characterizing I-I of systems manifested through shared states and other essential entities within and among the systems that constitute SoS. The term "essential entities" includes shared decisions, resources, functions, policies, decisionmakers, stakeholders, organizational setups, and others. This undertaking can be accomplished by building on state-space theory, which is fundamental to systems engineering and process control. This article presents a theoretical and analytical framework for modeling the risk to SoS with two case studies performed with the MITRE Corporation and demonstrates the pivotal contributions made by shared states and other essential entities to modeling and analysis of the risk to complex SoS. A third case study highlights the multifarious representations of SoS, which require harmonizing the risk analysis process currently applied to single systems when applied to complex SoS. © 2017 Society for Risk Analysis.

Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry.

PubMed

Wilper, Andrew P; Smith, Curtis Scott; Weppner, William

2013-09-16

The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. CONTEXT AND SETTING: We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects' feasibility, impact, and appropriateness. The 'Curriculum of Inquiry' generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and improvement. Residents gain knowledge and skills though this enterprise

Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry

PubMed Central

Wilper, Andrew P.; Smith, Curtis Scott; Weppner, William

2013-01-01

Background The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. Context and setting We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Methods Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. Outcomes We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects’ feasibility, impact, and appropriateness. The ‘Curriculum of Inquiry’ generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. Conclusions A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and improvement. Residents gain

Instituting systems-based practice and practice-based learning and improvement: a curriculum of inquiry.

PubMed

Wilper, Andrew P; Smith, Curtis Scott; Weppner, William

2013-01-01

Background The Accreditation Council for Graduate Medical Education (ACGME) requires that training programs integrate system-based practice (SBP) and practice-based learning and improvement (PBLI) into internal medicine residency curricula. Context and setting We instituted a seminar series and year-long-mentored curriculum designed to engage internal medicine residents in these competencies. Methods Residents participate in a seminar series that includes assigned reading and structured discussion with faculty who assist in the development of quality improvement or research projects. Residents pursue projects over the remainder of the year. Monthly works in progress meetings, protected time for inquiry, and continued faculty mentorship guide the residents in their project development. Trainees present their work at hospital-wide grand rounds at the end of the academic year. We performed a survey of residents to assess their self-reported knowledge, attitudes and skills in SBP and PBLI. In addition, blinded faculty scored projects for appropriateness, impact, and feasibility. Outcomes We measured resident self-reported knowledge, attitudes, and skills at the end of the academic year. We found evidence that participants improved their understanding of the context in which they were practicing, and that their ability to engage in quality improvement projects increased. Blinded faculty reviewers favorably ranked the projects' feasibility, impact, and appropriateness. The 'Curriculum of Inquiry' generated 11 quality improvement and research projects during the study period. Barriers to the ongoing work include a limited supply of mentors and delays due to Institutional Review Board approval. Hospital leadership recognizes the importance of the curriculum, and our accreditation manager now cites our ongoing work. Conclusions A structured residency-based curriculum facilitates resident demonstration of SBP and practice-based learning and improvement. Residents gain

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…

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…

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

Managing Systemic Change: Future Roles for Social Learning Systems and Communities of Practice?

NASA Astrophysics Data System (ADS)

Blackmore, Chris

The Open University course that prompted this book, and for which it is part of the required reading, focuses on managing systemic change. The course is designed for people who want to develop their skills and understanding in systems thinking and practice, to be used in a range of different domains. Most of the examples in the course come from work-based settings. The idea of managing in this context is mainly about appreciating situations with others, recognising what actions are desirable and feasible and for whom, and getting organised, in order to affect or respond to change in a positive way. It has little to do with control. As Vickers (1978, p. 81) said 'I do not think it too much to hope that an understanding of systemic relations may bring us a better understanding of our limitations and even our possibilities.'

Public Health Information Systems: Priorities and Practices for Successful Deployments.

PubMed

Pearce, Martin

2016-01-01

A fast paced workshop designed for senior public health decision makers and clinical leaders implementing information systems to support delivery of public health programs. The tutorial will introduce public health information systems and provide best practices for implementing solutions related to immunization, communicable disease case management and outbreak management. Using a combination of formats, the tutorial will: • Highlight key functionality of public health information systems. • Review global crises currently exposing gaps and deficiencies in public health information. • Examine governance, planning, and implementation priorities. • Highlight considerations supporting implementations nationally and in special populations. • Provide real, actionable lessons learned to take away and apply in the real world.

Modeling Speed-Accuracy Tradeoff in Adaptive System for Practicing Estimation

ERIC Educational Resources Information Center

Nižnan, Juraj

2015-01-01

Estimation is useful in situations where an exact answer is not as important as a quick answer that is good enough. A web-based adaptive system for practicing estimates is currently being developed. We propose a simple model for estimating student's latent skill of estimation. This model combines a continuous measure of correctness and response…

Spontaneous Raman Scattering Diagnostics: Applications in Practical Combustion Systems. Chapter 5

NASA Technical Reports Server (NTRS)

Kojima, Jun; Viet-Nguyen, Quang; Lackner, Maximilian (Editor); Winter, Franz (Editor); Agarwal, Avinash (Editor)

2010-01-01

In this chapter, the recent advancements and practical aspects of laser SRS diagnostics have been reviewed wi til regards to applications in practical combustion systems. Clearly, SRS represents a theoretically and experimentally mature diagnostic technology that has become an essential tool for multiscalar measurements in turbulent combustion at elevated pressures. Today, time-, space-, spectrally, and even polarization-resolved S RS diagnostics is at hand, with aid from recent innovations in theoretical and technological developments on electro-optical or electromechanical devices. Whilst a linear increase in SRS signals can be expected in high-pressure systems (this is perhaps one of the most important advantages for using SRS in high-pressure systems), there are practical (often severe) restrictions associated with pressurized vessels, due mainly to the limited degree of optical access. This narrows ti,e available choice of diagnostics that can be employed at any given time. Point-wise SRS diagnostics provides the highest accuracy on the chemical species and temperature measurements, and will continue to remain a vital approach for the study in such harsh environments. The practical design considerations and hands-on set-up guide for SRS diagnostics provided in this chapter are rarely presented elsewhere. Although the second-harmonic Nd:YAG pulsed laser (532 nm), combined with pulse-stretching optics or the recently introduced White Cell-based laser, seems to be the most favored excitation source of choice by the research community, UV excitation will undoubtedly continue to be used on many occasions, and especially in sooting flames. Detection methods may be divided into ICCD-based nanosecond-gate detection or a rotary-chopper electromechanical shutter-based CCD array detection, and the levels of background flame emission in individual cases would determine this critical design choice. Here, a process of Raman signal calibration based on ti,e crosstalk matrix

The Clinical Health Economics System Simulation (CHESS): a teaching tool for systems- and practice-based learning.

PubMed

Voss, John D; Nadkarni, Mohan M; Schectman, Joel M

2005-02-01

Academic medical centers face barriers to training physicians in systems- and practice-based learning competencies needed to function in the changing health care environment. To address these problems, at the University of Virginia School of Medicine the authors developed the Clinical Health Economics System Simulation (CHESS), a computerized team-based quasi-competitive simulator to teach the principles and practical application of health economics. CHESS simulates treatment costs to patients and society as well as physician reimbursement. It is scenario based with residents grouped into three teams, each team playing CHESS using differing (fee-for-service or capitated) reimbursement models. Teams view scenarios and select from two or three treatment options that are medically justifiable yet have different potential cost implications. CHESS displays physician reimbursement and patient and societal costs for each scenario as well as costs and income summarized across all scenarios extrapolated to a physician's entire patient panel. The learners are asked to explain these findings and may change treatment options and other variables such as panel size and case mix to conduct sensitivity analyses in real time. Evaluations completed in 2003 by 68 (94%) CHESS resident and faculty participants at 19 U.S. residency programs preferred CHESS to a traditional lecture-and-discussion format to learn about medical decision making, physician reimbursement, patient costs, and societal costs. Ninety-eight percent reported increased knowledge of health economics after viewing the simulation. CHESS demonstrates the potential of computer simulation to teach health economics and other key elements of practice- and systems-based competencies.

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.

Implementing Effective Mission Systems Engineering Practices During Early Project Formulation Phases

NASA Technical Reports Server (NTRS)

Moton, Tryshanda

2016-01-01

Developing and implementing a plan for a NASA space mission can be a complicated process. The needs, goals, and objectives of any proposed mission or technology must be assessed early in the Project Life Cycle. The key to successful development of a space mission or flight project is the inclusion of systems engineering in early project formulation, namely during Pre-phase A, Phase A, and Phase B of the NASA Project Life Cycle. When a space mission or new technology is in pre-development, or "pre-Formulation", feasibility must be determined based on cost, schedule, and risk. Inclusion of system engineering during project formulation is key because in addition to assessing feasibility, design concepts are developed and alternatives to design concepts are evaluated. Lack of systems engineering involvement early in the project formulation can result in increased risks later in the implementation and operations phases of the project. One proven method for effective systems engineering practice during the pre-Formulation Phase is the use of a mission conceptual design or technology development laboratory, such as the Mission Design Lab (MDL) at NASA's Goddard Space Flight Center (GSFC). This paper will review the engineering process practiced routinely in the MDL for successful mission or project development during the pre-Formulation Phase.

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

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.

Creating financial transparency in public health: examining best practices of system partners.

PubMed

Honoré, Peggy A; Clarke, Richard L; Mead, Dean Michael; Menditto, Susan M

2007-01-01

Financial transparency is based on concepts for valid, standardized information that is readily accessible and routinely disseminated to stakeholders. While Congress and others continuously ask for an accounting of public health investments, transparency remains an ignored concept. The objective of this study was to examine financial transparency practices in other industries considered as part of the public health system. Key informants, regarded as financial experts on the operations of hospitals, school systems, and higher education, were a primary source of information. Principal findings were that system partners have espoused some concepts for financial transparency beginning in the early 20th century--signifying an 80-year implementation gap for public health. Critical features that promote accountability included standardized data collection methods and infrastructures, uniform practices for quantitative analysis of financial performance, and credentialing of the financial management workforce. Recommendations are offered on the basis of these findings to aid public health to close this gap by framing a movement toward transparency.

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...

Implementing AORN recommended practices for selection and use of packaging systems for sterilization.

PubMed

Morton, Paula J; Conner, Ramona

2014-04-01

The delivery of sterile products to the sterile field is essential to perioperative practice. The use of protective packaging for sterilized items is crucial to helping ensure that patients receive sterile items for surgical procedures. AORN's "Recommended practices for selection and use of packaging systems for sterilization" offers guidance to perioperative team members in evaluating, selecting, and using packaging systems that permit sterilization of the contents, prevent contamination of sterilized items until the package is opened for use, protect the items from damage during transport and storage, and permit aseptic delivery of the items to the sterile field. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

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.

A Pathophysiological Model-Driven Communication for Dynamic Distributed Medical Best Practice Guidance Systems.

PubMed

Hosseini, Mohammad; Jiang, Yu; Wu, Poliang; Berlin, Richard B; Ren, Shangping; Sha, Lui

2016-11-01

There is a great divide between rural and urban areas, particularly in medical emergency care. Although medical best practice guidelines exist and are in hospital handbooks, they are often lengthy and difficult to apply clinically. The challenges are exaggerated for doctors in rural areas and emergency medical technicians (EMT) during patient transport. In this paper, we propose the concept of distributed executable medical best practice guidance systems to assist adherence to best practice from the time that a patient first presents at a rural hospital, through diagnosis and ambulance transfer to arrival and treatment at a regional tertiary hospital center. We codify complex medical knowledge in the form of simplified distributed executable disease automata, from the thin automata at rural hospitals to the rich automata in the regional center hospitals. However, a main challenge is how to efficiently and safely synchronize distributed best practice models as the communication among medical facilities, devices, and professionals generates a large number of messages. This complex problem of patient diagnosis and transport from rural to center facility is also fraught with many uncertainties and changes resulting in a high degree of dynamism. A critically ill patient's medical conditions can change abruptly in addition to changes in the wireless bandwidth during the ambulance transfer. Such dynamics have yet to be addressed in existing literature on telemedicine. To address this situation, we propose a pathophysiological model-driven message exchange communication architecture that ensures the real-time and dynamic requirements of synchronization among distributed emergency best practice models are met in a reliable and safe manner. Taking the signs, symptoms, and progress of stroke patients transported across a geographically distributed healthcare network as the motivating use case, we implement our communication system and apply it to our developed best practice

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.

Ethical and legal issues in cross-system practice in India: Past, present and future.

PubMed

Math, Suresh Bada; Moirangthem, Sydney; Kumar, Naveen C; Nirmala, Maria Christine

2015-01-01

Recent changes in policies allowing practitioners of Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) to integrate into the mainstream of healthcare and also allowing practitioners of Ayurveda and Homoeopathy to perform medical termination of pregnancy (MTP) under the proposed amendment to the MTP bill have brought crosssystem practice into the limelight. We evaluate cross-system practice from its legal and ethical perspectives. Across judgments, the judiciary has held that cross-system practice is a form of medical negligence; however, it is permitted only in those states where the concerned governments have authorized it by a general or special order. Further, though a state government may authorize an alternative medicine doctor to prescribe allopathic medicines (or vice versa), it does not condone the prescription of wrong medicines or wrong diagnosis. Courts have also stated that prescribing allopathic medicines and misrepresenting these as traditional medicines is an unfair trade practice and not explaining the side-effects of a prescribed allopathic medicine amounts to medical negligence. Finally, the Supreme Court has cautioned that employing traditional medical practitioners who do not possess the required skill and competence to give allopathic treatment in hospitals and to let an emergency patient be treated by them is gross negligence. In the event of an unwanted outcome, the responsibility is completely on the hospital authorities. Therefore, there is an urgent need to abolish cross-system practice, invest in healthcare, and bring radical changes in health legislations to make right to healthcare a reality. Copyright 2015, NMJI.

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.

A Practical Millimeter-Wave Holographic Imaging System with Tunable IF Attenuator

NASA Astrophysics Data System (ADS)

Zhu, Yu-Kun; Yang, Ming-Hui; Wu, Liang; Sun, Yun; Sun, Xiao-Wei

2017-10-01

A practical millimeter-wave (mmw) holographic imaging system with tunable intermediate frequency (IF) attenuator has been developed. It can be used for the detection of concealed weapons at security checkpoints, especially the airport. The system is utilized to scan the passenger and detect the weapons hidden in the clothes. To reconstruct the three dimensions (3-D) image, a holographic mmw imaging algorithm based on aperture synthesis and back scattering is presented. The system is active and works at 28-33 GHz. Tunable IF attenuator is applied to compensate the intensity and phase differences between multi-channels and multi-frequencies.

Strategy for an Extensible Microcomputer-Based Mumps System for Private Practice

PubMed Central

Walters, Richard F.; Johnson, Stephen L.

1979-01-01

A macro expander technique has been adopted to generate a machine independent single user version of ANSI Standard MUMPS running on an 8080 Microcomputer. This approach makes it possible to have the medically oriented MUMPS language available on inexpensive systems suitable for small group practice settings. Substitution of another macro expansion set allows the same interpreter to be implemented on another computer, thereby providing compatibility with comparable or larger scale systems. Furthermore, since the global file handler can be separated from the interpreter, this approach permits development of a distributed MUMPS system with no change in applications software.

Practical solutions to implementing "Born Semantic" data systems

NASA Astrophysics Data System (ADS)

Leadbetter, A.; Buck, J. J. H.; Stacey, P.

2015-12-01

The concept of data being "Born Semantic" has been proposed in recent years as a Semantic Web analogue to the idea of data being "born digital"[1], [2]. Within the "Born Semantic" concept, data are captured digitally and at a point close to the time of creation are annotated with markup terms from semantic web resources (controlled vocabularies, thesauri or ontologies). This allows heterogeneous data to be more easily ingested and amalgamated in near real-time due to the standards compliant annotation of the data. In taking the "Born Semantic" proposal from concept to operation, a number of difficulties have been encountered. For example, although there are recognised methods such as Header, Dictionary, Triples [3] for the compression, publication and dissemination of large volumes of triples these systems are not practical to deploy in the field on low-powered (both electrically and computationally) devices. Similarly, it is not practical for instruments to output fully formed semantically annotated data files if they are designed to be plugged into a modular system and the data to be centrally logged in the field as is the case on Argo floats and oceanographic gliders where internal bandwidth becomes an issue [2]. In light of these issues, this presentation will concentrate on pragmatic solutions being developed to the problem of generating Linked Data in near real-time systems. Specific examples from the European Commission SenseOCEAN project where Linked Data systems are being developed for autonomous underwater platforms, and from work being undertaken in the streaming of data from the Irish Galway Bay Cable Observatory initiative will be highlighted. Further, developments of a set of tools for the LogStash-ElasticSearch software ecosystem to allow the storing and retrieval of Linked Data will be introduced. References[1] A. Leadbetter & J. Fredericks, We have "born digital" - now what about "born semantic"?, European Geophysical Union General Assembly, 2014

Applications of complex systems theory in nursing education, research, and practice.

PubMed

Clancy, Thomas R; Effken, Judith A; Pesut, Daniel

2008-01-01

The clinical and administrative processes in today's healthcare environment are becoming increasingly complex. Multiple providers, new technology, competition, and the growing ubiquity of information all contribute to the notion of health care as a complex system. A complex system (CS) is characterized by a highly connected network of entities (e.g., physical objects, people or groups of people) from which higher order behavior emerges. Research in the transdisciplinary field of CS has focused on the use of computational modeling and simulation as a methodology for analyzing CS behavior. The creation of virtual worlds through computer simulation allows researchers to analyze multiple variables simultaneously and begin to understand behaviors that are common regardless of the discipline. The application of CS principles, mediated through computer simulation, informs nursing practice of the benefits and drawbacks of new procedures, protocols and practices before having to actually implement them. The inclusion of new computational tools and their applications in nursing education is also gaining attention. For example, education in CSs and applied computational applications has been endorsed by The Institute of Medicine, the American Organization of Nurse Executives and the American Association of Colleges of Nursing as essential training of nurse leaders. The purpose of this article is to review current research literature regarding CS science within the context of expert practice and implications for the education of nurse leadership roles. The article focuses on 3 broad areas: CS defined, literature review and exemplars from CS research and applications of CS theory in nursing leadership education. The article also highlights the key role nursing informaticists play in integrating emerging computational tools in the analysis of complex nursing systems.

Satellite-instrument system engineering best practices and lessons

NASA Astrophysics Data System (ADS)

Schueler, Carl F.

2009-08-01

This paper focuses on system engineering development issues driving satellite remote sensing instrumentation cost and schedule. A key best practice is early assessment of mission and instrumentation requirements priorities driving performance trades among major instrumentation measurements: Radiometry, spatial field of view and image quality, and spectral performance. Key lessons include attention to technology availability and applicability to prioritized requirements, care in applying heritage, approaching fixed-price and cost-plus contracts with appropriate attention to risk, and assessing design options with attention to customer preference as well as design performance, and development cost and schedule. A key element of success either in contract competition or execution is team experience. Perhaps the most crucial aspect of success, however, is thorough requirements analysis and flowdown to specifications driving design performance with sufficient parameter margin to allow for mistakes or oversights - the province of system engineering from design inception to development, test and delivery.

Elevating pharmacists' scope of practice through a health-system clinical privileging process.

PubMed

Jordan, Trisha A; Hennenfent, Joel A; Lewin, John J; Nesbit, Todd W; Weber, Robert

2016-09-15

The privileging of pharmacists for clinical activities and the impact that privileging has on enhancing the scope of pharmacy practice in health systems are reviewed. Health-system pharmacists or pharmacy leaders must gain a thorough understanding of the credentialing and privileging process as they broaden their scope of practice. Clinical privileging affords an expanded scope of practice that is recognized at the institutional level and formally elevates the pharmacist to that of a nonphysician provider. The installation of privileging processes is expected to take many months to complete for individual institutions and should begin now in anticipation of provider status. Model institutions, including Truman Medical Centers, Johns Hopkins Hospital, and The Ohio State University Wexner Medical Center, are highlighted in this article and provide their individual approach to clinical privileging that can be applied to other institutions. The development and evaluation of these programs have given valuable insight into how this individual approach translates to health systems across the country and how the pharmacy profession can continue to unite to convey the value of pharmacists in improving patient care. In preparation for the potential approval of pharmacist provider status across the United States, it is essential that pharmacists are privileged by the medical staff at their respective institution. Clinical privileges must be strategically developed with a focus on cost and quality aims and meeting the needs of patients. Implementation and maintenance of high-performing pharmacy privileging programs require both successful leadership and management skills and an understanding of the interprofessional nature of healthcare. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Developing a Web-Based Nursing Practice and Research Information Management System: A Pilot Study.

PubMed

Choi, Jeeyae; Lapp, Cathi; Hagle, Mary E

2015-09-01

Many hospital information systems have been developed and implemented to collect clinical data from the bedside and have used the information to improve patient care. Because of a growing awareness that the use of clinical information improves quality of care and patient outcomes, measuring tools (electronic and paper based) have been developed, but most of them require multiple steps of data collection and analysis. This necessitated the development of a Web-based Nursing Practice and Research Information Management System that processes clinical nursing data to measure nurses' delivery of care and its impact on patient outcomes and provides useful information to clinicians, administrators, researchers, and policy makers at the point of care. This pilot study developed a computer algorithm based on a falls prevention protocol and programmed the prototype Web-based Nursing Practice and Research Information Management System. It successfully measured performance of nursing care delivered and its impact on patient outcomes successfully using clinical nursing data from the study site. Although Nursing Practice and Research Information Management System was tested with small data sets, results of study revealed that it has the potential to measure nurses' delivery of care and its impact on patient outcomes, while pinpointing components of nursing process in need of improvement.

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

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…

Recommended Practice: Creating Cyber Forensics Plans for Control Systems

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

Eric Cornelius; Mark Fabro

these issues and to accommodate for the diversity in both system and architecture types, a framework based in recommended practices to address forensics in the control systems domain is required. This framework must be fully flexible to allow for deployment into any control systems environment regardless of technologies used. Moreover, the framework and practices must provide for direction on the integration of modern network security technologies with traditionally closed systems, the result being a true defense-in-depth strategy for control systems architectures. This document takes the traditional concepts of cyber forensics and forensics engineering and provides direction regarding augmentation for control systems operational environments. The goal is to provide guidance to the reader with specifics relating to the complexity of cyber forensics for control systems, guidance to allow organizations to create a self-sustaining cyber forensics program, and guidance to support the maintenance and evolution of such programs. As the current control systems cyber security community of interest is without any specific direction on how to proceed with forensics in control systems environments, this information product is intended to be a first step.« less

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.

Features of computerized clinical decision support systems supportive of nursing practice: a literature review.

PubMed

Lee, Seonah

2013-10-01

This study aimed to organize the system features of decision support technologies targeted at nursing practice into assessment, problem identification, care plans, implementation, and outcome evaluation. It also aimed to identify the range of the five stage-related sequential decision supports that computerized clinical decision support systems provided. MEDLINE, CINAHL, and EMBASE were searched. A total of 27 studies were reviewed. The system features collected represented the characteristics of each category from patient assessment to outcome evaluation. Several features were common across the reviewed systems. For the sequential decision support, all of the reviewed systems provided decision support in sequence for patient assessment and care plans. Fewer than half of the systems included problem identification. There were only three systems operating in an implementation stage and four systems in outcome evaluation. Consequently, the key steps for sequential decision support functions were initial patient assessment, problem identification, care plan, and outcome evaluation. Providing decision support in such a full scope will effectively help nurses' clinical decision making. By organizing the system features, a comprehensive picture of nursing practice-oriented computerized decision support systems was obtained; however, the development of a guideline for better systems should go beyond the scope of a literature review.

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

A preliminary comparison of speech recognition functionality in dental practice management systems.

PubMed

Irwin, Jeannie Y; Schleyer, Titus

2008-11-06

In this study, we examined speech recognition functionality in four leading dental practice management systems. Twenty dental students used voice to chart a simulated patient with 18 findings in each system. Results show it can take over a minute to chart one finding and that users frequently have to repeat commands. Limited functionality, poor usability and a high error rate appear to retard adoption of speech recognition in dentistry.

The Action Research Program: Experiential Learning in Systems-Based Practice for First-Year Medical Students.

PubMed

Ackerman, Sara L; Boscardin, Christy; Karliner, Leah; Handley, Margaret A; Cheng, Sarah; Gaither, Thomas W; Hagey, Jill; Hennein, Lauren; Malik, Faizan; Shaw, Brian; Trinidad, Norver; Zahner, Greg; Gonzales, Ralph

2016-01-01

Systems-based practice focuses on the organization, financing, and delivery of medical services. The American Association of Medical Colleges has recommended that systems-based practice be incorporated into medical schools' curricula. However, experiential learning in systems-based practice, including practical strategies to improve the quality and efficiency of clinical care, is often absent from or inconsistently included in medical education. A multidisciplinary clinician and nonclinician faculty team partnered with a cardiology outpatient clinic to design a 9-month clerkship for 1st-year medical students focused on systems-based practice, delivery of clinical care, and strategies to improve the quality and efficiency of clinical operations. The clerkship was called the Action Research Program. In 2013-2014, 8 trainees participated in educational seminars, research activities, and 9-week clinic rotations. A qualitative process and outcome evaluation drew on interviews with students, clinic staff, and supervising physicians, as well as students' detailed field notes. The Action Research Program was developed and implemented at the University of California, San Francisco, an academic medical center in the United States. All educational activities took place at the university's medical school and at the medical center's cardiology outpatient clinic. Students reported and demonstrated increased understanding of how care delivery systems work, improved clinical skills, growing confidence in interactions with patients, and appreciation for patients' experiences. Clinicians reported increased efficiency at the clinic level and improved performance and job satisfaction among medical assistants as a result of their unprecedented mentoring role with students. Some clinicians felt burdened when students shadowed them and asked questions during interactions with patients. Most student-led improvement projects were not fully implemented. The Action Research Program is a

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...

Amalgamation of management information system into anaesthesiology practice: A boon for the modern anaesthesiologists

PubMed Central

Bajwa, Sukhminder Jit Singh

2014-01-01

Over the years, traditional anaesthesia record keeping system has been the backbone of anaesthesiology ever since its introduction in the 1890s by Dr. Harvey Cushing and Dr. Ernest A. Codman. Besides providing the important information regarding patients’ vital physiologic parameters, paper records had been a reliable source for various clinical research activities. The introduction of electronic monitoring gadgets and electronic record keeping systems has revolutionised the anaesthesiology practice to a large extent. Recently, the introduction of anaesthesia information management system (AIMS), which incorporates all the features of monitoring gadgets, such as electronic storage of large accurate data, quality assurance in anaesthesia, enhancing patient safety, ensuring legal protection, improved billing services and effecting an organisational change, is almost a revolution in modern-day anaesthesiology practice. The clinical research activities that are responsible for taking anaesthesiology discipline to higher peaks have also been boosted by the amalgamation of AIMS, enabling multicenter studies and sharing of clinical data. Barring few concerns in its installation, cost factors and functional aspects, the future of AIMS seems to be bright and will definitely prove to be a boon for modern-day anaesthesiology practice. PMID:24963173

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...

Physician Practice Audit Targets Now Become Hospital and Health System Compliance Risks.

PubMed

Hirsch, Ronald L

2015-01-01

In 2013, 22% of the federal budget was spent on Medicare and Medicaid. The Medicare Trust Fund is forecast to be depleted in 2030. More than 12% of Medicare fee-for-service payments in 2014 were made in error. These factors have led Congress to apply more pressure to reduce improper payments. Although hospitals were the initial targets because of their higher reimbursement, recent efforts have shifted to physician billing. Hospitals and health systems continue to acquire physician practices, making them liable for the billing activities of physicians. And for physicians who remain independent, the cost and effort required to respond to audits and denials can be financially devastating, further demonstrating the importance of prevention. This article addresses some of the common audit targets and mistakes made by physicians and provides strategies for physician practices and health systems to respond to and, ultimately, avoid these denials.

Practical Performance Analysis for Multiple Information Fusion Based Scalable Localization System Using Wireless Sensor Networks.

PubMed

Zhao, Yubin; Li, Xiaofan; Zhang, Sha; Meng, Tianhui; Zhang, Yiwen

2016-08-23

In practical localization system design, researchers need to consider several aspects to make the positioning efficiently and effectively, e.g., the available auxiliary information, sensing devices, equipment deployment and the environment. Then, these practical concerns turn out to be the technical problems, e.g., the sequential position state propagation, the target-anchor geometry effect, the Non-line-of-sight (NLOS) identification and the related prior information. It is necessary to construct an efficient framework that can exploit multiple available information and guide the system design. In this paper, we propose a scalable method to analyze system performance based on the Cramér-Rao lower bound (CRLB), which can fuse all of the information adaptively. Firstly, we use an abstract function to represent all of the wireless localization system model. Then, the unknown vector of the CRLB consists of two parts: the first part is the estimated vector, and the second part is the auxiliary vector, which helps improve the estimation accuracy. Accordingly, the Fisher information matrix is divided into two parts: the state matrix and the auxiliary matrix. Unlike the theoretical analysis, our CRLB can be a practical fundamental limit to denote the system that fuses multiple information in the complicated environment, e.g., recursive Bayesian estimation based on the hidden Markov model, the map matching method and the NLOS identification and mitigation methods. Thus, the theoretical results are approaching the real case more. In addition, our method is more adaptable than other CRLBs when considering more unknown important factors. We use the proposed method to analyze the wireless sensor network-based indoor localization system. The influence of the hybrid LOS/NLOS channels, the building layout information and the relative height differences between the target and anchors are analyzed. It is demonstrated that our method exploits all of the available information for

A qualitative analysis of how advanced practice nurses use clinical decision support systems.

PubMed

Weber, Scott

2007-12-01

The purpose of this study was to generate a grounded theory that will reflect the experiences of advanced practice nurses (APNs) working as critical care nurse practitioners (NPs) and clinical nurse specialists (CNS) with computer-based decision-making systems. A study design using grounded theory qualitative research methods and convenience sampling was employed in this study. Twenty-three APNs (13 CNS and 10 NPs) were recruited from 16 critical care units located in six large urban medical centers in the U.S. Midwest. Single-structured in-depth interviews with open-ended audio-taped questions were conducted with each APN. Through this process, APNs defined what they consider to be relevant themes and patterns of clinical decision system use in their critical care practices, and they identified the interrelatedness of the conceptual categories that emerged from the results. Data were analyzed using the constant comparative analysis method of qualitative research. APN participants were predominantly female, white/non-Hispanic, had a history of access to the clinical decision system used in their critical care settings for an average of 14 months, and had attended a formal training program to learn how to use clinical decision systems. "Forecasting decision outcomes," which was defined as the voluntary process employed to forecast the outcomes of patient care decisions in critical care prior to actual decision making, was the core variable describing system use that emerged from the responses. This variable consisted of four user constructs or components: (a) users' perceptions of their initial system learning experience, (b) users' sense of how well they understand how system technology works, (c) users' understanding of how system inferences are created or derived, and (d) users' relative trust of system-derived data. Each of these categories was further described through the grounded theory research process, and the relationships between the categories were

Implementation of an attack scheme on a practical QKD system

NASA Astrophysics Data System (ADS)

Lamas-Linares, Antia; Liu, Qin; Gerhardt, Ilja; Makarov, Vadim; Kurtsiefer, Christian

2010-03-01

We report on an experimental implementation of an attack of a practical quantum key distribution system [1], based on a vulnerability of single photon detectors [2]. An intercept/resend-like attack has been carried out which revealed 100% of the raw key generated between the legitimate communication partners. No increase of the error ratio was observed, which is usually considered a reliable witness for any eavesdropping attempt. We also present an experiment which shows that this attack is not revealed by key distribution protocols probing for eavesdroppers by testing a Bell inequality [3], and discuss implications for practical quantum key distribution.[4pt] [1] I. Marcikic, A. Lamas-Linares, C. Kurtsiefer, Appl. Phys. Lett. 89, 101122 (2006); [2] V. Makarov, New J. Phys. 11, 065003 (2009); [3] A. Ling et al., Phys. Rev. A 78, 020301(R), (2008)

Knowing for Nursing Practice: Patterns of Knowledge and Their Emulation in Expert Systems

PubMed Central

Abraham, Ivo L.; Fitzpatrick, Joyce J.

1987-01-01

This paper addresses the issue of clinical knowledge in nursing, and the feasibility of emulating this knowledge into expert system technology. The perspective on patterns of knowing for nursing practice, advanced by Carper (1978), serves as point of departure. The four patterns of knowing -- empirics, esthetics, ethics, personal knowledge -- are evaluated as to the extent to which they can be emulated in clinical expert systems, given constraints imposed by the current technology of these systems.

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…

Attacks on practical quantum key distribution systems (and how to prevent them)

NASA Astrophysics Data System (ADS)

Jain, Nitin; Stiller, Birgit; Khan, Imran; Elser, Dominique; Marquardt, Christoph; Leuchs, Gerd

2016-07-01

With the emergence of an information society, the idea of protecting sensitive data is steadily gaining importance. Conventional encryption methods may not be sufficient to guarantee data protection in the future. Quantum key distribution (QKD) is an emerging technology that exploits fundamental physical properties to guarantee perfect security in theory. However, it is not easy to ensure in practice that the implementations of QKD systems are exactly in line with the theoretical specifications. Such theory-practice deviations can open loopholes and compromise security. Several such loopholes have been discovered and investigated in the last decade. These activities have motivated the proposal and implementation of appropriate countermeasures, thereby preventing future attacks and enhancing the practical security of QKD. This article introduces the so-called field of quantum hacking by summarising a variety of attacks and their prevention mechanisms.

Quantum and classical noise in practical quantum-cryptography systems based on polarization-entangled photons

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

Castelletto, S.; Degiovanni, I.P.; Rastello, M.L.

2003-02-01

Quantum-cryptography key distribution (QCKD) experiments have been recently reported using polarization-entangled photons. However, in any practical realization, quantum systems suffer from either unwanted or induced interactions with the environment and the quantum measurement system, showing up as quantum and, ultimately, statistical noise. In this paper, we investigate how an ideal polarization entanglement in spontaneous parametric down-conversion (SPDC) suffers quantum noise in its practical implementation as a secure quantum system, yielding errors in the transmitted bit sequence. Since all SPDC-based QCKD schemes rely on the measurement of coincidence to assert the bit transmission between the two parties, we bundle up themore » overall quantum and statistical noise in an exhaustive model to calculate the accidental coincidences. This model predicts the quantum-bit error rate and the sifted key and allows comparisons between different security criteria of the hitherto proposed QCKD protocols, resulting in an objective assessment of performances and advantages of different systems.« less

[Practical experience about the compatibility of PDF converter in ECG information system].

PubMed

Yang, Gang; Lu, Weishi; Zhou, Jiacheng

2009-11-01

To find a way to view ECG from different manufacturers in electrocardiogram information system. Different format ECG data were transmitted to ECG center by different ways. Corresponding analysis software was used to make the diagnosis reports in the center. Then we use PDF convert to change all ECG reports into PDF format. The electrocardiogram information system manage these PDF format ECG data for clinic user. The ECG reports form several major ECG manufacturers were transformed to PDF format successfully. In the electrocardiogram information system it is freely to view the ECG figure. PDF format ECG report is a practicable way to solve the compatibility problem in electrocardiogram information system.

Using Simulation to Improve Systems-Based Practices.

PubMed

Gardner, Aimee K; Johnston, Maximilian; Korndorffer, James R; Haque, Imad; Paige, John T

2017-09-01

Ensuring the safe, effective management of patients requires efficient processes of care within a smoothly operating system in which highly reliable teams of talented, skilled health care providers are able to use the vast array of high-technology resources and intensive care techniques available. Simulation can play a unique role in exploring and improving the complex perioperative system by proactively identifying latent safety threats and mitigating their damage to ensure that all those who work in this critical health care environment can provide optimal levels of patient care. A panel of five experts from a wide range of institutions was brought together to discuss the added value of simulation-based training for improving systems-based aspects of the perioperative service line. Panelists shared the way in which simulation was demonstrated at their institutions. The themes discussed by each panel member were delineated into four avenues through which simulation-based techniques have been used. Simulation-based techniques are being used in (1) testing new clinical workspaces and facilities before they open to identify potential latent conditions; (2) practicing how to identify the deteriorating patient and escalate care in an effective manner; (3) performing prospective root cause analyses to address system weaknesses leading to sentinel events; and (4) evaluating the efficiency and effectiveness of the electronic health record in the perioperative setting. This focused review of simulation-based interventions to test and improve components of the perioperative microsystem, which includes literature that has emerged since the panel's presentation, highlights the broad-based utility of simulation-based technologies in health care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Morbidity and process of care in urban Malaysian general practice: the impact of payment system.

PubMed

Teng, C L; Aljunid, S M; Cheah, Molly; Leong, K C; Kwa, S K

2003-08-01

The majority of primary care consultations in Malaysia occur in the general practice clinics. To date, there is no comprehensive documentation of the morbidity and practice activities in this setting. We reported the reasons for encounter, diagnoses and process of care in urban general practice and the influence of payment system on the morbidity and practice activities. 115 clinics in Kuala Lumpur, Ipoh and Penang participated in this study. General practitioners in these clinics completed a 2-page questionnaire for each of the 30 consecutive patients. The questionnaire requested for the following information: demographic data, reasons for encounter, important physical findings, diagnoses, investigations ordered, outpatient procedures performed, medical certificate given, medication prescribed and referral made. The morbidity (reasons for encounter and diagnoses) was coded using ICPC-2 and the medication data was coded using MIMS Classification Index. During 3481 encounters, 5300 RFEs (152 RFEs per 100 encounters) and 3342 diagnoses (96 diagnoses per 100 encounters) were recorded. The majority of the RFEs and diagnoses are in the following ICPC Chapters: Respiratory, General and unspecified, Digestive, Neurological, Musculoskeletal and Skin. The frequencies of selected aspects of the process of care (rate per 100 encounters) were: laboratory investigations 14.7, outpatient procedures 2.4, sick certification 26.9, referral 2.4, and medication prescription 244. Consultation for chronic diseases and acute infections were influenced more by demographic variables (age, employment) rather than payment system. Cash-paying patients were more likely to receive laboratory investigations and injections. This study demonstrated the breadth of clinical care in the general practice. Relatively fewer patients consulted specifically for preventive care and treatment of chronic diseases. The frequencies of outpatient procedures and referrals appeared to be low. Payment system

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.

Practice-audit-publish: A practice reflection.

PubMed

Ferrari, Robert

2016-12-01

Practice audits are useful opportunities to improve practice efficiency and effectiveness, reduce clinical errors, demonstrate quality care to stakeholders, promote high standards of practice, lower the risk of liability, and foster practice change. However, a benefit that is usually overlooked is the possibility of publication of the results of a practice audit. Publication (research) has a number of benefits for the clinician, including skill development as a scholar, communicator, professional, and collaborator. A practice audit is beneficial to an individual physician; furthermore, publication of the audit results could be beneficial for many others such as health care providers, patients, and other stakeholders in a health care system. The problem is that practice audits often begin without a clear plan. The important steps in planning and carrying out a practice audit can be captured by thinking about how a research publication evolves. Thus, a good researcher is a good practice auditor. This paper reviews the author's experience and provides examples and directions of the process of practice-audit-publish.

Practice-audit-publish: A practice reflection

PubMed Central

Ferrari, Robert

2016-01-01

Practice audits are useful opportunities to improve practice efficiency and effectiveness, reduce clinical errors, demonstrate quality care to stakeholders, promote high standards of practice, lower the risk of liability, and foster practice change. However, a benefit that is usually overlooked is the possibility of publication of the results of a practice audit. Publication (research) has a number of benefits for the clinician, including skill development as a scholar, communicator, professional, and collaborator. A practice audit is beneficial to an individual physician; furthermore, publication of the audit results could be beneficial for many others such as health care providers, patients, and other stakeholders in a health care system. The problem is that practice audits often begin without a clear plan. The important steps in planning and carrying out a practice audit can be captured by thinking about how a research publication evolves. Thus, a good researcher is a good practice auditor. This paper reviews the author’s experience and provides examples and directions of the process of practice-audit-publish. PMID:28149662

Practical tolerancing and performance implications for XUV projection lithography reduction systems (Poster Paper)

NASA Astrophysics Data System (ADS)

Viswanathan, Vriddhachalam K.

1992-07-01

Practical considerations that will strongly affect the imaging capabilities of reflecting systems for extreme-ultraviolet (XUV) projection lithography include manufacturing tolerances and thermal distortion of the mirror surfaces due to absorption of a fraction of the incident radiation beam. We have analyzed the potential magnitudes of these effects for two types of reflective projection optical designs. We find that concentric, symmetric two-mirror systems are less sensitive to manufacturing errors and thermal distortion than off-axis, four-mirror systems.

Practical Entanglement Estimation for Spin-System Quantum Simulators.

PubMed

Marty, O; Cramer, M; Plenio, M B

2016-03-11

We present practical methods to measure entanglement for quantum simulators that can be realized with trapped ions, cold atoms, and superconducting qubits. Focusing on long- and short-range Ising-type Hamiltonians, we introduce schemes that are applicable under realistic experimental conditions including mixedness due to, e.g., noise or temperature. In particular, we identify a single observable whose expectation value serves as a lower bound to entanglement and that may be obtained by a simple quantum circuit. As such circuits are not (yet) available for every platform, we investigate the performance of routinely measured observables as quantitative entanglement witnesses. Possible applications include experimental studies of entanglement scaling in critical systems and the reliable benchmarking of quantum simulators.

Impact of same-day appointments on patient satisfaction with general practice appointment systems.

PubMed

Sampson, Fiona; Pickin, Mark; O'Cathain, Alicia; Goodall, Stephen; Salisbury, Chris

2008-09-01

Following recent concerns about patients' inability to book appointments in advance, this study examined the relationship between the proportion of GP appointments reserved for same-day booking, and patient satisfaction with appointment systems. In a survey of 12,825 patients in 47 practices, it was found that a 10% increase in the proportion of same-day appointments was associated with an 8% reduction in the proportion of patients satisfied. Practices should be wary of increasing the level of same-day appointments to meet access targets.

Are Earth System model software engineering practices fit for purpose? A case study.

NASA Astrophysics Data System (ADS)

Easterbrook, S. M.; Johns, T. C.

2009-04-01

We present some analysis and conclusions from a case study of the culture and practices of scientists at the Met Office and Hadley Centre working on the development of software for climate and Earth System models using the MetUM infrastructure. The study examined how scientists think about software correctness, prioritize their requirements in making changes, and develop a shared understanding of the resulting models. We conclude that highly customized techniques driven strongly by scientific research goals have evolved for verification and validation of such models. In a formal software engineering context these represents costly, but invaluable, software integration tests with considerable benefits. The software engineering practices seen also exhibit recognisable features of both agile and open source software development projects - self-organisation of teams consistent with a meritocracy rather than top-down organisation, extensive use of informal communication channels, and software developers who are generally also users and science domain experts. We draw some general conclusions on whether these practices work well, and what new software engineering challenges may lie ahead as Earth System models become ever more complex and petascale computing becomes the norm.

[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.

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…

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

The utility of an automated electronic system to monitor and audit transfusion practice.

PubMed

Grey, D E; Smith, V; Villanueva, G; Richards, B; Augustson, B; Erber, W N

2006-05-01

Transfusion laboratories with transfusion committees have a responsibility to monitor transfusion practice and generate improvements in clinical decision-making and red cell usage. However, this can be problematic and expensive because data cannot be readily extracted from most laboratory information systems. To overcome this problem, we developed and introduced a system to electronically extract and collate extensive amounts of data from two laboratory information systems and to link it with ICD10 clinical codes in a new database using standard information technology. Three data files were generated from two laboratory information systems, ULTRA (version 3.2) and TM, using standard information technology scripts. These were patient pre- and post-transfusion haemoglobin, blood group and antibody screen, and cross match and transfusion data. These data together with ICD10 codes for surgical cases were imported into an MS ACCESS database and linked by means of a unique laboratory number. Queries were then run to extract the relevant information and processed in Microsoft Excel for graphical presentation. We assessed the utility of this data extraction system to audit transfusion practice in a 600-bed adult tertiary hospital over an 18-month period. A total of 52 MB of data were extracted from the two laboratory information systems for the 18-month period and together with 2.0 MB theatre ICD10 data enabled case-specific transfusion information to be generated. The audit evaluated 15,992 blood group and antibody screens, 25,344 cross-matched red cell units and 15,455 transfused red cell units. Data evaluated included cross-matched to transfusion ratios and pre- and post-transfusion haemoglobin levels for a range of clinical diagnoses. Data showed significant differences between clinical units and by ICD10 code. This method to electronically extract large amounts of data and linkage with clinical databases has provided a powerful and sustainable tool for monitoring

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.

Centering Pregnancy: practical tips for your practice.

PubMed

DeCesare, Julie Z; Jackson, Jessica R

2015-03-01

With increased access to care, current health delivery systems will need expansion to meet higher demands and needs. To define Centering Pregnancy and practical tips for implementation into both private and academic practices. Evidence was gathered through literature reviews. It was found that Centering Pregnancy offers a patient-centered, evidence-based approach to helping with access issues, as well as improving outcomes. This article describes the benefits of Centering Pregnancy to the practice, the provider, and the patient. Practical implementation tips will be offered, with suggestions for negating common implementation barriers.

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

Educating fellows in practice-based learning and improvement and systems-based practice: The value of quality improvement in clinical practice.

PubMed

Carey, William A; Colby, Christopher E

2013-02-01

In 1999, the Accreditation Council for Graduate Medical Education identified 6 general competencies in which all residents must receive training. In the decade since these requirements went into effect, practice-based learning and improvement (PBLI) and systems-based practice (SBP) have proven to be the most challenging competencies to teach and assess. Because PBLI and SBP both are related to quality improvement (QI) principles and processes, we developed a QI-based curriculum to teach these competencies to our fellows. This experiential curriculum engaged our fellows in our neonatal intensive care unit's (NICU's) structured QI process. After identifying specific patient outcomes in need of improvement, our fellows applied validated QI methods to develop evidence-based treatment protocols for our neonatal intensive care unit. These projects led to immediate and meaningful improvements in patient care and also afforded our fellows various means by which to demonstrate their competence in PBLI and SBP. Our use of portfolios enabled us to document our fellows' performance in these competencies quite easily and comprehensively. Given the clinical and educational structures common to most intensive care unit-based training programs, we believe that a QI-based curriculum such as ours could be adapted by others to teach and assess PBLI and SBP. Copyright © 2013 Elsevier Inc. All rights reserved.

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.

Clinical practice guidelines for the treatment of systemic lupus erythematosus by the Mexican College of Rheumatology.

PubMed

Xibillé-Friedmann, Daniel; Pérez-Rodríguez, Marcela; Carrillo-Vázquez, Sandra; Álvarez-Hernández, Everardo; Aceves, Francisco Javier; Ocampo-Torres, Mario C; García-García, Conrado; García-Figueroa, José Luis; Merayo-Chalico, Javier; Barrera-Vargas, Ana; Portela-Hernández, Margarita; Sicsik, Sandra; Andrade-Ortega, Lilia; Rosales-Don Pablo, Víctor Manuel; Martínez, Aline; Prieto-Seyffert, Pilar; Pérez-Cristóbal, Mario; Saavedra, Miguel Ángel; Castro-Colín, Zully; Ramos, Azucena; Huerta-Sil, Gabriela; Hernández-Cabrera, María Fernanda; Jara, Luis Javier; Limón-Camacho, Leonardo; Tinajero-Nieto, Lizbet; Barile-Fabris, Leonor A

2018-05-04

There are national and international clinical practice guidelines for systemic lupus erythematosus treatment. Nonetheless, most of them are not designed for the Mexican population or are devoted only to the treatment of certain disease manifestations, like lupus nephritis, or are designed for some physiological state like pregnancy. The Mexican College of Rheumatology aimed to create clinical practice guidelines that included the majority of the manifestations of systemic lupus erythematosus, and also incorporated guidelines in controversial situations like vaccination and the perioperative period. The present document introduces the «Clinical Practice Guidelines for the Treatment of Systemic Lupus Erythematosus» proposed by the Mexican College of Rheumatology, which could be useful mostly for non-rheumatologist physicians who need to treat patients with systemic lupus erythematosus without having the appropriate training in the field of rheumatology. In these guidelines, the reader will find recommendations on the management of general, articular, kidney, cardiovascular, pulmonary, neurological, hematologic and gastrointestinal manifestations, and recommendations on vaccination and treatment management during the perioperative period. Copyright © 2018 Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. Publicado por Elsevier España, S.L.U. All rights reserved.

A model of formative assessment practice in secondary science classrooms using an audience response system

NASA Astrophysics Data System (ADS)

Shirley, Melissa L.

Formative assessment involves the probing of students' ideas to determine their level of understanding during the instructional sequence. Often conceptualized as a cycle, formative assessment consists of the teacher posing an instructional task to students, collecting data about student understanding, and engaging in follow-up strategies such as clarifying student understanding and adjusting instruction to meet learning needs. Despite having been shown to increase student achievement in a variety of classroom settings, formative assessment remains a relative weak area of teacher practice. Methods that enhance formative assessment strategies may therefore have a positive effect on student achievement. Audience response systems comprise a broad category of technologies that support richer classroom interaction and have the potential to facilitate formative assessment. Results from a large national research study, Classroom Connectivity in Promoting Mathematics and Science Achievement (CCMS), show that students in algebra classrooms where the teacher has implemented a type of audience response system experience significantly higher achievement gains compared to a control group. This suggests a role for audience response systems in promoting rich formative assessment. The importance of incorporating formative assessment strategies into regular classroom practice is widely recognized. However, it remains challenging to identify whether rich formative assessment is occurring during a particular class session. This dissertation uses teacher interviews and classroom observations to develop a fine-grained model of formative assessment in secondary science classrooms employing a type of audience response system. This model can be used by researchers and practitioners to characterize components of formative assessment practice in classrooms. A major component of formative assessment practice is the collection and aggregation of evidence of student learning. This dissertation

Benchmarking transportation logistics practices for effective system planning

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

Thrower, A.W.; Dravo, A.N.; Keister, M.

2007-07-01

This paper presents preliminary findings of an Office of Civilian Radioactive Waste Management (OCRWM) benchmarking project to identify best practices for logistics enterprises. The results will help OCRWM's Office of Logistics Management (OLM) design and implement a system to move spent nuclear fuel (SNF) and high-level radioactive waste (HLW) to the Yucca Mountain repository for disposal when that facility is licensed and built. This report suggests topics for additional study. The project team looked at three Federal radioactive material logistics operations that are widely viewed to be successful: (1) the Waste Isolation Pilot Plant (WIPP) in Carlsbad, New Mexico; (2)more » the Naval Nuclear Propulsion Program (NNPP); and (3) domestic and foreign research reactor (FRR) SNF acceptance programs. (authors)« less

[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.

A practical implementation of free viewpoint video system for soccer games

NASA Astrophysics Data System (ADS)

Suenaga, Ryo; Suzuki, Kazuyoshi; Tezuka, Tomoyuki; Panahpour Tehrani, Mehrdad; Takahashi, Keita; Fujii, Toshiaki

2015-03-01

In this paper, we present a free viewpoint video generation system with billboard representation for soccer games. Free viewpoint video generation is a technology that enables users to watch 3-D objects from their desired viewpoints. Practical implementation of free viewpoint video for sports events is highly demanded. However, a commercially acceptable system has not yet been developed. The main obstacles are insufficient user-end quality of the synthesized images and highly complex procedures that sometimes require manual operations. In this work, we aim to develop a commercially acceptable free viewpoint video system with a billboard representation. A supposed scenario is that soccer games during the day can be broadcasted in 3-D, even in the evening of the same day. Our work is still ongoing. However, we have already developed several techniques to support our goal. First, we captured an actual soccer game at an official stadium where we used 20 full-HD professional cameras. Second, we have implemented several tools for free viewpoint video generation as follow. In order to facilitate free viewpoint video generation, all cameras should be calibrated. We calibrated all cameras using checker board images and feature points on the field (cross points of the soccer field lines). We extract each player region from captured images manually. The background region is estimated by observing chrominance changes of each pixel in temporal domain (automatically). Additionally, we have developed a user interface for visualizing free viewpoint video generation using a graphic library (OpenGL), which is suitable for not only commercialized TV sets but also devices such as smartphones. However, practical system has not yet been completed and our study is still ongoing.

Discourse versus practice: are traditional practices and beliefs in pregnancy and childbirth included or excluded in the Ecuadorian health care system?

PubMed

Gallegos, Carlos Andres; Waters, William F; Kuhlmann, Anne Sebert

2017-03-01

Traditional beliefs, knowledge and practices are formally integrated into the Ecuadorian health system. We sought to understand whether they are integrated in practice. Qualitative data were collected in two rural parishes in the central highlands of Ecuador through four focus group discussions (30 participants), eight key informant interviews, three participatory exercises (24 participants), structured observations of health facilities and analysis of official documents. We found different levels of integration, coexistence, tolerance, and intolerance of traditional health beliefs and practices in health facilities. One parish has undergone dramatic social and cultural transformation, and the role of traditional birth attendants is limited. In the other parish, traditional indigenous norms and values persist, and traditional birth attendants are sought during pregnancy and childbirth. The degree to which traditional birth attendants, indigenous women and their families are included or excluded from public health services depends largely on decisions taken by local health professionals. Formal policies in Ecuador stipulate that health care should be intercultural, but the role of traditional birth attendants is not necessarily incorporated in practice. The integration of culturally-informed beliefs and practices is critical for providing appropriate health services to members of vulnerable populations. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Applying a family systems lens to proxy decision making in clinical practice and research.

PubMed

Rolland, John S; Emanuel, Linda L; Torke, Alexia M

2017-03-01

When patients are incapacitated and face serious illness, family members must make medical decisions for the patient. Medical decision sciences give only modest attention to the relationships among patients and their family members, including impact that these relationships have on the decision-making process. A review of the literature reveals little effort to systematically apply a theoretical framework to the role of family interactions in proxy decision making. A family systems perspective can provide a useful lens through which to understand the dynamics of proxy decision making. This article considers the mutual impact of family systems on the processes and outcomes of proxy decision making. The article first reviews medical decision science's evolution and focus on proxy decision making and then reviews a family systems approach, giving particular attention to Rolland's Family Systems Illness Model. A case illustrates how clinical practice and how research would benefit from bringing family systems thinking to proxy decisions. We recommend including a family systems approach in medical decision science research and clinical practices around proxy decisions making. We propose that clinical decisions could be less conflicted and less emotionally troubling for families and clinicians if family systems approaches were included. This perspective opens new directions for research and novel approaches to clinical care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Introduction of hospital information system and anesthesia information management system into the perianesthetic practice at Osaka City University Hospital].

PubMed

Shimizu, Motoko; Tanaka, Katsuaki; Hagiwara, Chie; Ikenaga, Kazutake; Yoshioka, Miwako; Asada, Akira

2011-06-01

Recently, the hospital information systems (HIS) and anesthesia information management systems (AIMS) have been rapidly improved and have been introduced into the clinical practice in Japan drastically; however, few reports have detailed their influences on clinical practice. We here report our experience. We introduced HIS (EGMAIN-EX, Fujitsu Co., Ltd.) in our preoperative evaluation clinic and in the postoperative care unit. AIMS (ORSYS, Philips Electronics Japan) was introduced almost only to the intraoperative management. It became easy for us to acquire patient's information and to share it with the medical staffs in the other departments. However, we had to invest large human resources for the introduction and maintenance of the HIS and the AIMS. Though AIMS is more useful in anesthetic management than HIS, it seems to be more suitable for coordination with the medical staffs in the other departments to use HIS for perioperative management than to use AIMS.

Energy information systems (EIS): Technology costs, benefit, and best practice uses

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

Granderson, Jessica; Lin, Guanjing; Piette, Mary Ann

2013-11-26

Energy information systems are the web-based software, data acquisition hardware, and communication systems used to store, analyze, and display building energy data. They often include analysis methods such as baselining, benchmarking, load profiling, and energy anomaly detection. This report documents a large-scale assessment of energy information system (EIS) uses, costs, and energy benefits, based on a series of focused case study investigations that are synthesized into generalizable findings. The overall objective is to provide organizational decision makers with the information they need to make informed choices as to whether or not to invest in an EIS--a promising technology that canmore » enable up to 20 percent site energy savings, quick payback, and persistent low-energy performance when implemented as part of best-practice energy management programs.« less

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.

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

Tubing misconnections--a systems failure with human factors: lessons for nursing practice.

PubMed

Simmons, Debora; Graves, Krisanne

2008-12-01

In a neonatal unit, an experienced nurse inadvertently connected a feeding tube to an intravenous catheter. An analysis of this error, including the historical perspective, reveals that this threat to safety has been documented since 1972. Implications for nursing practice include the redesign of systems to accommodate human factors science and a change in health care's view of vigilance.

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…

Proposal for research and education: joint lectures and practicals on central nervous system anatomy and physiology.

PubMed

Kageyama, Ikuo; Yoshimura, Ken; Satoh, Yoshihide; Nanayakkara, Chinthani D; Pallegama, Ranjith W; Iwasaki, Shin-Ichi

2016-07-01

We coordinated anatomy and physiology lectures and practicals to facilitate an integrated understanding of morphology and function in a basic medical science program for dental students and to reduce the time spent on basic science education. This method is a means to provide the essential information and skills in less time. The overall impression was that the practice of joint central nervous system lectures and practicals was an efficient method for students, which suggests that joint lectures might also be useful for clinical subjects. About two-thirds of students felt that the joint anatomy and physiology lecture on the central nervous system was useful and necessary in understanding the relationship between morphology and function, at least for this subject. One-third of students were neutral on the effectiveness of this method. However, the survey results suggest that improvements are needed in the method and timing of joint lectures and practicals. The present teaching approach can be further improved by conducting combined lectures in which the form and function of anatomic structures are presented by the relevant departments during the same lecture. Finally, joint lecturers and practicals offer an opportunity to increase student understanding of the importance of new research findings by the present authors and other researchers.

Conservation Agriculture Practices in Rainfed Uplands of India Improve Maize-Based System Productivity and Profitability

PubMed Central

Pradhan, Aliza; Idol, Travis; Roul, Pravat K.

2016-01-01

Traditional agriculture in rainfed uplands of India has been experiencing low agricultural productivity as the lands suffer from poor soil fertility, susceptibility to water erosion and other external pressures of development and climate change. A shift toward more sustainable cropping systems such as conservation agriculture production systems (CAPSs) may help in maintaining soil quality as well as improving crop production and farmer’s net economic benefit. This research assessed the effects over 3 years (2011–2014) of reduced tillage, intercropping, and cover cropping practices customized for maize-based production systems in upland areas of Odisha, India. The study focused on crop yield, system productivity and profitability through maize equivalent yield and dominance analysis. Results showed that maize grain yield did not differ significantly over time or among CAPS treatments while cowpea yield was considered as an additional yield in intercropping systems. Mustard and horsegram grown in plots after maize cowpea intercropping recorded higher grain yields of 25 and 37%, respectively, as compared to those without intercropping. Overall, the full CAPS implementation, i.e., minimum tillage, maize–cowpea intercropping and mustard residue retention had significantly higher system productivity and net benefits than traditional farmer practices, i.e., conventional tillage, sole maize cropping, and no mustard residue retention. The dominance analysis demonstrated increasing benefits of combining conservation practices that exceeded thresholds for farmer adoption. Given the use of familiar crops and technologies and the magnitude of yield and income improvements, these types of CAPS should be acceptable and attractive for smallholder farmers in the area. This in turn should support a move toward sustainable intensification of crop production to meet future household income and nutritional needs. PMID:27471508

Conservation Agriculture Practices in Rainfed Uplands of India Improve Maize-Based System Productivity and Profitability.

PubMed

Pradhan, Aliza; Idol, Travis; Roul, Pravat K

2016-01-01

Traditional agriculture in rainfed uplands of India has been experiencing low agricultural productivity as the lands suffer from poor soil fertility, susceptibility to water erosion and other external pressures of development and climate change. A shift toward more sustainable cropping systems such as conservation agriculture production systems (CAPSs) may help in maintaining soil quality as well as improving crop production and farmer's net economic benefit. This research assessed the effects over 3 years (2011-2014) of reduced tillage, intercropping, and cover cropping practices customized for maize-based production systems in upland areas of Odisha, India. The study focused on crop yield, system productivity and profitability through maize equivalent yield and dominance analysis. Results showed that maize grain yield did not differ significantly over time or among CAPS treatments while cowpea yield was considered as an additional yield in intercropping systems. Mustard and horsegram grown in plots after maize cowpea intercropping recorded higher grain yields of 25 and 37%, respectively, as compared to those without intercropping. Overall, the full CAPS implementation, i.e., minimum tillage, maize-cowpea intercropping and mustard residue retention had significantly higher system productivity and net benefits than traditional farmer practices, i.e., conventional tillage, sole maize cropping, and no mustard residue retention. The dominance analysis demonstrated increasing benefits of combining conservation practices that exceeded thresholds for farmer adoption. Given the use of familiar crops and technologies and the magnitude of yield and income improvements, these types of CAPS should be acceptable and attractive for smallholder farmers in the area. This in turn should support a move toward sustainable intensification of crop production to meet future household income and nutritional needs.

Investigation of practical and theoretical accuracy of wireless indoor-positioning system UBISENSE

NASA Astrophysics Data System (ADS)

Wozniak, Marek; Odziemczyk, Waldemar; Nagorski, Kamil

2013-04-01

The development of Real Time Locating Systems has become an important add-on to many existing location aware systems. While Global Navigation Satelite System has solved most of the outdoor problems, it fails to repeat this success indoors. Wireless indoor positioning systems have become very popular in recent years. One of them is UBISENSE system. This system requires to carry an identity tag that is detected by sensors, which typically use triangulation to determine location. This paper presents the results of the investigation of accuracy of tag position using precise geodetic measurements and geometric analysis. Experimental measurements were carried out on the field polygon using precise tacheometer TCRP 1201+ and complete equipment of Ubisense. Results of experimental measurements were analyzed and presented graphically using Surfer 8. The paper presents the results of the investigation the teoretical and practical positioning accuracy according to the various working conditions.

Energy Efficiency Maximization of Practical Wireless Communication Systems

NASA Astrophysics Data System (ADS)

Eraslan, Eren

Energy consumption of the modern wireless communication systems is rapidly growing due to the ever-increasing data demand and the advanced solutions employed in order to address this demand, such as multiple-input multiple-output (MIMO) and orthogonal frequency division multiplexing (OFDM) techniques. These MIMO systems are power hungry, however, they are capable of changing the transmission parameters, such as number of spatial streams, number of transmitter/receiver antennas, modulation, code rate, and transmit power. They can thus choose the best mode out of possibly thousands of modes in order to optimize an objective function. This problem is referred to as the link adaptation problem. In this work, we focus on the link adaptation for energy efficiency maximization problem, which is defined as choosing the optimal transmission mode to maximize the number of successfully transmitted bits per unit energy consumed by the link. We model the energy consumption and throughput performances of a MIMO-OFDM link and develop a practical link adaptation protocol, which senses the channel conditions and changes its transmission mode in real-time. It turns out that the brute force search, which is usually assumed in previous works, is prohibitively complex, especially when there are large numbers of transmit power levels to choose from. We analyze the relationship between the energy efficiency and transmit power, and prove that energy efficiency of a link is a single-peaked quasiconcave function of transmit power. This leads us to develop a low-complexity algorithm that finds a near-optimal transmit power and take this dimension out of the search space. We further prune the search space by analyzing the singular value decomposition of the channel and excluding the modes that use higher number of spatial streams than the channel can support. These algorithms and our novel formulations provide simpler computations and limit the search space into a much smaller set; hence

Passive Faraday-mirror attack in a practical two-way quantum-key-distribution system

NASA Astrophysics Data System (ADS)

Sun, Shi-Hai; Jiang, Mu-Sheng; Liang, Lin-Mei

2011-06-01

The Faraday mirror (FM) plays a very important role in maintaining the stability of two-way plug-and-play quantum key distribution (QKD) systems. However, the practical FM is imperfect, which will not only introduce an additional quantum bit error rate (QBER) but also leave a loophole for Eve to spy the secret key. In this paper we propose a passive Faraday mirror attack in two-way QKD system based on the imperfection of FM. Our analysis shows that if the FM is imperfect, the dimension of Hilbert space spanned by the four states sent by Alice is three instead of two. Thus Eve can distinguish these states with a set of Positive Operator Valued Measure (POVM) operators belonging to three-dimension space, which will reduce the QBER induced by her attack. Furthermore, a relationship between the degree of the imperfection of FM and the transmittance of the practical QKD system is obtained. The results show that the probability that Eve loads her attack successfully depends on the degree of the imperfection of FM rapidly, but the QBER induced by Eve’s attack changes slightly with the degree of the FM imperfection.

[Practical implementation of a quality management system in a radiological department].

PubMed

Huber, S; Zech, C J

2011-10-01

This article describes the architecture of a project aiming to implement a DIN EN ISO 9001 quality management system in a radiological department. It is intended to be a practical guide to demonstrate each step of the project leading to certification of the system. In a planning phase resources for the implementation of the project have to be identified and a quality management (QM) group as core team has to be formed. In the first project phase all available documents have to be checked and compiled in the QM manual. Moreover all relevant processes of the department have to be described in so-called process descriptions. In a second step responsibilities for the project are identified. Customer and employee surveys have to be carried out and a nonconformity management system has to be implemented. In this phase internal audits are also needed to check the new QM system, which is finally tested in the external certification audit with reference to its conformity with the standards.

Comprehensive and Practical Vision System for Self-Driving Vehicle Lane-Level Localization.

PubMed

Du, Xinxin; Tan, Kok Kiong

2016-05-01

Vehicle lane-level localization is a fundamental technology in autonomous driving. To achieve accurate and consistent performance, a common approach is to use the LIDAR technology. However, it is expensive and computational demanding, and thus not a practical solution in many situations. This paper proposes a stereovision system, which is of low cost, yet also able to achieve high accuracy and consistency. It integrates a new lane line detection algorithm with other lane marking detectors to effectively identify the correct lane line markings. It also fits multiple road models to improve accuracy. An effective stereo 3D reconstruction method is proposed to estimate vehicle localization. The estimation consistency is further guaranteed by a new particle filter framework, which takes vehicle dynamics into account. Experiment results based on image sequences taken under different visual conditions showed that the proposed system can identify the lane line markings with 98.6% accuracy. The maximum estimation error of the vehicle distance to lane lines is 16 cm in daytime and 26 cm at night, and the maximum estimation error of its moving direction with respect to the road tangent is 0.06 rad in daytime and 0.12 rad at night. Due to its high accuracy and consistency, the proposed system can be implemented in autonomous driving vehicles as a practical solution to vehicle lane-level localization.

Content Design and System Implementation of a Teleophthalmology System for Eye Disease Diagnosis and Treatment and Its Preliminary Practice in Guangdong, China.

PubMed

Xiao, Di; Vignarajan, Janardhan; Chen, Tingting; Ye, Tiantian; Xiao, Baixiang; Congdon, Nathan; Kanagasingam, Yogessan

2017-12-01

We have developed a new telemedicine system for comprehensive eye examination, diabetic retinopathy (DR) screening, and eye disease diagnosis and treatment. The novel points of the system include a tablet application for facilitating doctor's examination and diagnosis process, a comprehensive eye examination component, and integrated treatment planning and recording. The system provided a new service model through one ophthalmological center linking with multiple remote and rural hospitals for eye care in Guangdong province, China. The early stage of the project study also undertook the responsibility of educations for remote-area doctors and image graders for DR grading and glaucoma grading and research on the effectiveness of short message service (SMS) reminder for patient revisit. Some other research, such as the comparison of the accuracy of graders' DR grading with the gold standard, and doctor's tentative diagnosis with final diagnosis and related statistical information, has been implemented in the system. In the preliminary practice, we summarized the outcomes related to presenting system performance and made an initial analysis. From the practice, the project has shown the telemedicine system and associated contents have satisfied our initial goal and demonstrated their effectiveness and efficiency.

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…

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…

Improving Professional Development System through Quality Assurance Practices in the Universities of Pakistan

ERIC Educational Resources Information Center

Shabbir, Muhammad; Khalid, M. Ibrahim; Bakhsh, Khuda; Mohsin, Muhammad Naeem; Rasool, Shafqat; Mohsin, M. Saleem

2016-01-01

The rationalization of this research was to investigate about improving professional development system through Quality Assurance Practices (QAP) in the Universities of Pakistan pertaining to the opinions of students, teachers and Directors of Quality Enhancement Cells (QECs) and to differentiate the ideas of students, teachers and Directors of…

Commercial Impact and Optimum Capacity Determination of Pumped Storage Hydro Plant for a Practical Power System

NASA Astrophysics Data System (ADS)

Latha, P. G.; Anand, S. R.; Imthias, Ahamed T. P.; Sreejith, P. S., Dr.

2013-06-01

This paper attempts to study the commercial impact of pumped storage hydro plant on the operation of a stressed power system. The paper further attempts to compute the optimum capacity of the pumped storage scheme that can be provided on commercial basis for a practical power system. Unlike the analysis of commercial aspects of pumped storage scheme attempted in several papers, this paper is presented from the point of view of power system management of a practical system considering the impact of the scheme on the economic operation of the system. A realistic case study is presented as the many factors that influence the pumped storage operation vary widely from one system to another. The suitability of pumped storage for the particular generation mix of a system is well explored in the paper. To substantiate the economic impact of pumped storage on the system, the problem is formulated as a short-term hydrothermal scheduling problem involving power purchase which optimizes the quantum of power to be scheduled and the duration of operation. The optimization model is formulated using an algebraic modeling language, AMPL, which is then solved using the advanced MILP solver CPLEX.

[Experience of the Mexican National Health System in the development of clinical practice guidelines].

PubMed

Sosa-García, Jesús Ojino; Nieves-Hernández, Pedro; Puentes-Rosas, Esteban; Pineda-Pérez, Dayana; Viniegra-Osorio, Arturo; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Barragán-Padilla, Sergio Baltazar; Díaz-González, Ruth; Chávez-Valdez, Lizbeth; Ramírez-López, Juan Carlos

2016-01-01

Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence. The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico. The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination. The Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health. The result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines' development and update. Master catalogue guidelines' integration, diffusion and implantation improve quality of attention and security of the users of the National Health System. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Motivating medical information system performance by system quality, service quality, and job satisfaction for evidence-based practice.

PubMed

Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

2012-11-21

No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems.

Practical optimal flight control system design for helicopter aircraft. Volume 2: Software user's guide

NASA Technical Reports Server (NTRS)

Riedel, S. A.

1979-01-01

A method by which modern and classical control theory techniques may be integrated in a synergistic fashion and used in the design of practical flight control systems is presented. A general procedure is developed, and several illustrative examples are included. Emphasis is placed not only on the synthesis of the design, but on the assessment of the results as well. The first step is to establish the differences, distinguishing characteristics and connections between the modern and classical control theory approaches. Ultimately, this uncovers a relationship between bandwidth goals familiar in classical control and cost function weights in the equivalent optimal system. In order to obtain a practical optimal solution, it is also necessary to formulate the problem very carefully, and each choice of state, measurement and output variable must be judiciously considered. Once design goals are established and problem formulation completed, the control system is synthesized in a straightforward manner. Three steps are involved: filter-observer solution, regulator solution, and the combination of those two into the controller. Assessment of the controller permits and examination and expansion of the synthesis results.

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

Influences of Family-Systems Intervention Practices on Parent-Child Interactions and Child Development

ERIC Educational Resources Information Center

Trivette, Carol M.; Dunst, Carl J.; Hamby, Deborah W.

2010-01-01

The extent to which the influences of family-systems intervention practices could be traced to variations in parent-child interactions and child development was investigated by meta-analytic structural equation modeling (MASEM). MASEM is a procedure for producing a weighted pooled correlation matrix and fitting a structural equation model to the…

Practical Side of the Bibliographic Information Retrieval System in the National Museum of Ethnology

NASA Astrophysics Data System (ADS)

Kondo, Katsuichi

The information retrieval system of the National Museum of Ethnology made its debut in 1979 and now enables us to search the books not only in the Museum but in the country and abroad by means of JAPAN MARC & LC MARC. The author presents the outline and the development of the information managing system including the above briefly and secondly the practical case of using our retrieval system in particular. The problems to be solved in the course of the future plan are also mentioned.

Partnering with health care systems to assess tobacco treatment practices and beliefs among clinicians: evaluating the process.

PubMed

Celestin, Michael D; Hart, Alton; Moody-Thomas, Sarah

2014-05-29

Tobacco is a major cause of preventable illness and death. However, clinician use of an evidence-based guideline for treatment of tobacco use is low. This case study describes the process for conducting a pre-intervention assessment of clinician practices and beliefs regarding treatment of tobacco use. Louisiana State University Health System, one of the largest safety-net public hospital systems in the United States, consists of 10 facilities in population centers across the state of Louisiana. The system serves a large proportion of the state's underinsured and uninsured, low-income, and racial/ethnic minority populations, groups that have high rates of tobacco use. Activities included 1) partnering with hospital administrators to generate support for conducting a clinician assessment, 2) identifying and adapting a survey tool to assess clinicians' practices and beliefs regarding treatment of tobacco use, 3) developing a survey protocol and obtaining approval from the institutional review board, and 4) administering the survey electronically, using the hospital's e-mail system. Existing partnerships and system resources aided survey administration. Use of the hospital's internal e-mail system and distribution of an online survey were effective means to engage clinicians. Following notification, 43.6% of 4,508 clinicians opened their e-mail containing the invitation letter with a Web link to the survey; of these, 83.1% (1,634) completed the survey. Partnering with stakeholders and using existing resources within the health care system are essential to successful implementation of a system-wide survey of clinician practices and beliefs regarding treatment of tobacco use.

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

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

Development of superconducting high gradient magnetic separation system for highly viscous fluid for practical use

NASA Astrophysics Data System (ADS)

Hayashi, S.; Mishima, F.; Akiyama, Y.; Nishijima, S.

2011-11-01

In the industrial plants processing highly viscous fluid such as foods or industrial products, it is necessary to remove the metallic wear debris originating from pipe in manufacturing line which triggers quality loss. In this study, we developed a high gradient magnetic separation (HGMS) system which consists of superconducting magnet to remove the metallic wear debris. The magnetic separation experiment and the particle trajectory simulation were conducted with polyvinyl alcohol (PVA) as a model material (viscosity coefficient was 10 Pa s, which is 10,000 times higher than that in water). In order to develop a magnetic separation system for practical use, the particle trajectory simulation by using solenoidal superconducting magnet was conducted, and the possibility of the magnetic separation for removing ferromagnetic stainless steel (SUS) particles in highly viscous fluid of 10 Pa s was indicated. Based on the results, the number of filters to obtain required separation efficiency was examined to design the practical separation system.

[Economic Evaluation of Integrated Care Systems - Scientific Standard Specifications, Challenges, Best Practice Model].

PubMed

Pimperl, A; Schreyögg, J; Rothgang, H; Busse, R; Glaeske, G; Hildebrandt, H

2015-12-01

 Transparency of economic performance of integrated care systems (IV) is a basic requirement for the acceptance and further development of integrated care. Diverse evaluation methods are used but are seldom openly discussed because of the proprietary nature of the different business models. The aim of this article is to develop a generic model for measuring economic performance of IV interventions.  A catalogue of five quality criteria is used to discuss different evaluation methods -(uncontrolled before-after-studies, control group-based approaches, regression models). On this -basis a best practice model is proposed.  A regression model based on the German morbidity-based risk structure equalisation scheme (MorbiRSA) has some benefits in comparison to the other methods mentioned. In particular it requires less resources to be implemented and offers advantages concerning the relia-bility and the transparency of the method (=important for acceptance). Also validity is sound. Although RCTs and - also to a lesser -extent - complex difference-in-difference matching approaches can lead to a higher validity of the results, their feasibility in real life settings is limited due to economic and practical reasons. That is why central criticisms of a MorbiRSA-based model were addressed, adaptions proposed and incorporated in a best practice model: Population-oriented morbidity adjusted margin improvement model (P-DBV(MRSA)).  The P-DBV(MRSA) approach may be used as a standardised best practice model for the economic evaluation of IV. Parallel to the proposed approach for measuring economic performance a balanced, quality-oriented performance measurement system should be introduced. This should prevent incentivising IV-players to undertake short-term cost cutting at the expense of quality. © Georg Thieme Verlag KG Stuttgart · New York.

78 FR 59725 - Construction Fall Protection Systems Criteria and Practices, and Training Requirements; Extension...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-27

...- 1648. Mail, hand delivery, express mail, messenger, or courier service: When using this method, you... DEPARTMENT OF LABOR Occupational Safety and Health Administration [Docket No. OSHA-2010-0008] Construction Fall Protection Systems Criteria and Practices, and Training Requirements; Extension of the Office...

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...

A practically unconditionally gradient stable scheme for the N-component Cahn-Hilliard system

NASA Astrophysics Data System (ADS)

Lee, Hyun Geun; Choi, Jeong-Whan; Kim, Junseok

2012-02-01

We present a practically unconditionally gradient stable conservative nonlinear numerical scheme for the N-component Cahn-Hilliard system modeling the phase separation of an N-component mixture. The scheme is based on a nonlinear splitting method and is solved by an efficient and accurate nonlinear multigrid method. The scheme allows us to convert the N-component Cahn-Hilliard system into a system of N-1 binary Cahn-Hilliard equations and significantly reduces the required computer memory and CPU time. We observe that our numerical solutions are consistent with the linear stability analysis results. We also demonstrate the efficiency of the proposed scheme with various numerical experiments.

Managing health and safety risks: Implications for tailoring health and safety management system practices.

PubMed

Willmer, D R; Haas, E J

2016-01-01

As national and international health and safety management system (HSMS) standards are voluntarily accepted or regulated into practice, organizations are making an effort to modify and integrate strategic elements of a connected management system into their daily risk management practices. In high-risk industries such as mining, that effort takes on added importance. The mining industry has long recognized the importance of a more integrated approach to recognizing and responding to site-specific risks, encouraging the adoption of a risk-based management framework. Recently, the U.S. National Mining Association led the development of an industry-specific HSMS built on the strategic frameworks of ANSI: Z10, OHSAS 18001, The American Chemistry Council's Responsible Care, and ILO-OSH 2001. All of these standards provide strategic guidance and focus on how to incorporate a plan-do-check-act cycle into the identification, management and evaluation of worksite risks. This paper details an exploratory study into whether practices associated with executing a risk-based management framework are visible through the actions of an organization's site-level management of health and safety risks. The results of this study show ways that site-level leaders manage day-to-day risk at their operations that can be characterized according to practices associated with a risk-based management framework. Having tangible operational examples of day-to-day risk management can serve as a starting point for evaluating field-level risk assessment efforts and their alignment to overall company efforts at effective risk mitigation through a HSMS or other processes.

Development and clinical trial of a practical vessel imaging system for vessel punctures in children

NASA Astrophysics Data System (ADS)

Cuper, Natasha J.; Verdaasdonk, Rudolf M.; de Roode, Rowland; Septer, Erica

2008-02-01

Venipunctures to draw blood for diagnostics can be cumbersome. Multiple puncture attempts are distressing, painful and traumatic, especially for small children. Drawing blood from babies, in particular, is a problem, due to the cutaneous baby fat, tiny veins and, worst case, a pigmented skin. We developed a practical vein viewing system based on IR translumination that, contrary to commercial systems available, has the advantage of: a) low cost, b) easily implemented in routine practice, c) normal and IR image simultaneously available, d) small add-on, e) child friendly IR illuminator and f) efficient IR light coupling. Before introducing the vessel viewer for clinical application in the children's department, parameters were measured in 194 patients (age 0-17 yrs): time to draw blood, number of attempts, skin characteristics, discomfort of patient, and experience of nurse. In this control group, time to draw blood increases significantly with decreasing age of the children. The instant feedback from the nurses has been valuable for the improvements of especially the illumination sources. A clinical trial has been performed in 125 patients (age 0-6 yrs) to prove effectivity of the system in the blood withdrawal procedure. There was a significant decrease from 13% to 2% in failure rate. Also time needed to search for a vein was significantly decreased. A practical and accessible vein viewing system has been developed and is being introduced for clinical application. Although the concept of patient friendliness is already accepted, measurements need to show the effectiveness for particular groups of patients.

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.

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…

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.

Integrating Public Health Policy, Practice, Evaluation, Surveillance, and Research: The School Health Action Planning and Evaluation System

PubMed Central

Cameron, Roy; Manske, Stephen; Brown, K. Stephen; Jolin, Mari Alice; Murnaghan, Donna; Lovato, Chris

2007-01-01

The Canadian Cancer Society and the National Cancer Institute of Canada have charged their Centre for Behavioral Research and Program Evaluation with contributing to the development of the country’s systemic capacity to link research, policy, and practice related to population-level interventions. Local data collection and feedback systems are integral to this capacity. Canada’s School Health Action Planning and Evaluation System (SHAPES) allows data to be collected from all of a school’s students, and these data are used to produce computer-generated school “health profiles.” SHAPES is being used for intervention planning, evaluation, surveillance, and research across Canada. Strong demand and multipartner investment suggest that SHAPES is adding value in all of these domains. Such systems can contribute substantially to evidence-informed public health practice, public engagement, participatory action research, and relevant, timely population intervention research. PMID:17329662

Motivating medical information system performance by system quality, service quality, and job satisfaction for evidence-based practice

PubMed Central

2012-01-01

Background No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. Methods The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. Results The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. Conclusions It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems. PMID:23171394

When practice transformation impedes practice improvement.

PubMed

Bujold, Edward

2015-01-01

I lead a small practice in rural western North Carolina. We have embraced the patient-centered medical home model and other practice-improvement initiatives, and I have seen our practice transformed in many positive ways. But in the past year alone, my staff and I have spent hundreds of hours studying for and taking exams, certifying for numerous programs, and updating our electronic health records system (EHR) to meet new national requirements and then relearning our EHR. Seeing patients used to be the hardest part of my job. It is now the easiest by far. I am considering walking away from the time-intensive PCMH certification even though it would cause financial hardship. We have more important business at hand-taking excellent care of patients, improving our practice, and meaningfully engaging with our patients. © 2015 Annals of Family Medicine, Inc.

Best practices: the Utah Youth Suicide Study: best practices for suicide prevention through the juvenile court system.

PubMed

Gray, Doug; Dawson, Kristin L; Grey, Todd C; McMahon, William M

2011-12-01

Utah is among a group of Western Mountain states in which suicide rates among youths are consistently high. The Utah Youth Suicide Study incorporated data from every government agency in Utah, utilizing a statewide Office of the Medical Examiner. A key finding was that 63% of suicide decedents had contact with the juvenile courts. The group developed a best practices model within the juvenile court system for early mental health intervention. Significant cost savings were demonstrated. The model includes screening at-risk teenagers with the Youth Outcome Questionnaire. Treatment includes both psychiatric care and in-home behavioral intervention. Services were effectively delivered on a large scale.

Registered Dietitian Nutritionists' Perspectives on Integrating Food and Water System Issues into Professional Practice.

PubMed

Heidelberger, Lindsay; Smith, Chery; Robinson-O'Brien, Ramona; Earthman, Carrie; Robien, Kim

2017-02-01

Sustainable agriculture encompasses economic, environmental, and social aspects of the food system. Members of the Academy of Nutrition and Dietetics (Academy) play an important role in promoting sustainable agriculture because they work in areas where they can influence the food purchasing decisions of foodservice operations and the public. To investigate behavior of registered dietitian nutritionists (RDNs) toward incorporating sustainable agriculture principles into professional practice using the Theory of Planned Behavior. This cross-sectional study surveyed RDNs nationwide about their perspectives on incorporating sustainable agriculture issues into practice. The survey questions were based on a survey originally administered to Minnesota RDNs during 2002. The sample (N=626) was drawn from a randomly selected, national sample of Academy members. Data were analyzed using descriptive statistics, independent t tests, Pearson correlations, and stepwise regression. The sample was mostly white, female, and the average age was 45.4±12.2 years. Almost half of Academy RDNs (47%) reported incorporating environmental issues into their practice. All four Theory of Planned Behavior variables (intention, attitude, perceived behavior control, and subjective norm) were predictive of behavior to include sustainable agriculture issues into practice. Barriers to incorporating this topic into practice included lack of knowledge, ability, time, and employer support. This study found that most of the RDN respondents had heard of sustainable agriculture and nearly half reported including this topic in their professional practice. To integrate this topic into practice more consistently, RDNs need more knowledge, time, and employer support. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Practical optimal flight control system design for helicopter aircraft. Volume 1: Technical Report

NASA Technical Reports Server (NTRS)

Hofmann, L. G.; Riedel, S. A.; Mcruer, D.

1980-01-01

A method by which modern and classical theory techniques may be integrated in a synergistic fashion and used in the design of practical flight control systems is presented. A general procedure is developed, and several illustrative examples are included. Emphasis is placed not only on the synthesis of the design, but on the assessment of the results as well.

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.

The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.

PubMed

Coulam, Robert; Kralewski, John; Dowd, Bryan; Gans, David

2016-01-01

Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators. To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States. We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues. Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare's PQRS reports impeded use of the data by administrators to support quality management. Group practice administrators are playing a prominent role in activities related to the quality of patient care--they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results. More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if

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.

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

Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system.

PubMed

Kalogeropoulos, Dimitris A; Carson, Ewart R; Collinson, Paul O

2003-09-01

Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.

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…

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.

Dermatology practice management assures practice development and efficiency.

PubMed

Wagener, D L

2000-09-01

This article provides an overview of the disciplines involved in managing a dermatology practice today. Several key management processes, including strategic planning, financial analysis, advertising and public relations, information systems management, and compliance program development and monitoring are addressed. This article explores several possible tactics that can be used to help guide your practice in the right direction without overtaxing your resources. Also offered are possible solutions for creating an organization that is poised for success, and a management team capable of steering the practice through the sea of change ahead.

Managing soil microbial communities in grain production systems through cropping practices

NASA Astrophysics Data System (ADS)

Gupta, Vadakattu

2013-04-01

Cropping practices can significantly influence the composition and activity of soil microbial communities with consequences to plant growth and production. Plant type can affect functional capacity of different groups of biota in the soil surrounding their roots, rhizosphere, influencing plant nutrition, beneficial symbioses, pests and diseases and overall plant health and crop production. The interaction between different players in the rhizosphere is due to the plethora of carbon and nutritional compounds, root-specific chemical signals and growth regulators that originate from the plant and are modulated by the physico-chemical properties of soils. A number of plant and environmental factors and management practices can influence the quantity and quality of rhizodeposition and in turn affect the composition of rhizosphere biota communities, microbe-fauna interactions and biological processes. Some of the examples of rhizosphere interactions that are currently considered important are: proliferation of plant and variety specific genera or groups of microbiota, induction of genes involved in symbiosis and virulence, promoter activity in biocontrol agents and genes correlated with root adhesion and border cell quality and quantity. The observation of variety-based differences in rhizodeposition and associated changes in rhizosphere microbial diversity and function suggests the possibility for the development of varieties with specific root-microbe interactions targeted for soil type and environment i.e. designer rhizospheres. Spatial location of microorganisms in the heterogeneous field soil matrix can have significant impacts on biological processes. Therefore, for rhizosphere research to be effective in variable seasonal climate and soil conditions, it must be evaluated in the field and within a farming systems context. With the current focus on security of food to feed the growing global populations through sustainable agricultural production systems there is a

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.

Religious Diversity and Inclusion: Policy and Accommodation Practices in British Columbia's Secular School System

ERIC Educational Resources Information Center

Jacquet, Marianne; D'Amico, Laura

2016-01-01

The religious diversity of students and staff within a secular school system may sometimes create tensions. To better understand the possible issues generated by and practical accommodations made with respect to these tensions, interviews were conducted at the district level with key administrators in metropolitan school districts in British…

Evaluating the Strength of School Tobacco Policies: The Development of a Practical Rating System

ERIC Educational Resources Information Center

Boyce, Jennifer C.; Mueller, Nancy B.; Hogan-Watts, Melissa; Luke, Douglas A.

2009-01-01

Background: School tobacco control policies vary widely in their strength, extensiveness, and enforcement. Currently, no standardized method exists to assess the comprehensiveness of school tobacco policies. The purpose of this study was to develop a new practical rating system for school tobacco policies, assess its reliability, and present…

Army Job Training Development and Testing Practices Compared to the Instructional Systems Development Model.

ERIC Educational Resources Information Center

Oxford-Carpenter, Rebecca L.; And Others

This paper presents an evaluation of Army job training development and testing practices, with a focus on Advanced Individual Testing. Information comes from intensive interviews with school instructors and from observations in the schools. Results indicate that some aspects of the Instructional Systems Development (ISD) model have been…

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.

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.

Organizational technologies of chronic disease management programs in large rural multispecialty group practice systems.

PubMed

Gamm, Larry; Bolin, Jane Nelson; Kash, Bita A

2005-01-01

Four large rural multispecialty group practice systems employ a mix of organizational technologies to provide chronic disease management with measurable impacts on their patient populations and costs. Four technologies-administrative, clinical, information, and social-are proposed as key dimensions for examining disease management programs. The benefits of disease management are recognized by these systems despite marked variability in the organization of the programs. Committees spanning health plans and clinics in the 4 systems and electronic medical records and/or other disease management information systems are important coordinating mechanisms. Increased reliance on nurses for patient education and care coordination in all 4 systems reflects significant extension of clinical and social technologies in the management of patient care. The promise of disease management as offered by these systems and other auspices are considered.

Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R; Sklar, Marisa

2014-01-01

There has been a growing impetus to bridge the gap between basic science discovery, development of evidence-based practices (EBPs), and the availability and delivery of EBPs in order to improve the public health impact of such practices. To capitalize on factors that support implementation and sustainment of EBPs, it is important to consider that health care is delivered within the outer context of public health systems and the inner context of health care organizations and work groups. Leaders play a key role in determining the nature of system and organizational contexts. This article addresses the role of leadership and actions that leaders can take at and across levels in developing a strategic climate for EBP implementation within the outer (i.e., system) and inner (i.e., organization, work group) contexts of health care. Within the framework of Edgar Schein's "climate embedding mechanisms," we describe strategies that leaders at the system, organization, and work group levels can consider and apply to develop strategic climates that support the implementation and sustainment of EBP in health care and allied health care settings.

Aligning Leadership Across Systems and Organizations to Develop Strategic Climate to for Evidence-Based Practice Implementation

PubMed Central

Aarons, Gregory A.; Farahnak, Lauren R.; Ehrhart, Mark G.; Sklar, Marisa

2015-01-01

There has been a growing impetus to bridge the gap between basic science discovery, development of evidence-based practices (EBPs) and their availability and delivery in order to improve public health impact of such practices. In seeking to capitalize on factors that support implementation and sustainment of EBPs, it is important to consider that healthcare is delivered within the outer context of public health systems, and the inner context of healthcare organizations and workgroups. Leaders have a key role in determining the nature of system and organizational context. This article will addresses the role of leadership across levels in developing strategic climate for EBP implementation within the outer (i.e., system) and inner (i.e., organization, work group) contexts of healthcare. Within the framework of Edgar Schein’s “climate embedding mechanisms,” we describe strategies that leaders at the system, organization, and work group levels can consider and apply to develop a strategic climates that support the implementation and sustainment of EBP in healthcare and allied healthcare settings. PMID:24641560

The 'Practice Entrepreneur' - An Australian case study of a systems thinking inspired health promotion initiative.

PubMed

Joyce, A; Green, C; Carey, G; Malbon, E

2017-01-23

The potential of systems science concepts to inform approaches for addressing complex public health problems, such as obesity prevention, has been attracting significant attention over the last decade. Despite its recent popularity, there are very few studies examining the application of systems science concepts, termed systems thinking, in practice and whether (if at all) it influences the implementation of health promotion in real world settings and in what ways. Healthy Together Victoria (HTV) was based on a systems thinking approach to address obesity prevention alongside other chronic health problems and was implemented across 14 local government areas. This paper examines the experience of practitioners from one of those intervention sites. In-depth interviews with eight practitioners revealed that there was a rigidity with which they had experienced previous health promotion jobs relative to the flexibility and fluidity of HTV. While the health promotion literature does not indicate that health promotion should be overly prescriptive, the experience of these practitioners suggests it is being applied as such in real world settings. Within HTV, asking people to work with 'systems thinking', without giving a prescription about what systems thinking is, enabled practitioners to be 'practice entrepreneurs' by choosing from a variety of systems thinking methods (mapping, reflection) to engage actively in their positions. This highlights the importance of understanding how key concepts, both traditional planning approaches and systems science concepts, are interpreted and then implemented in real world settings. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Decision support systems for clinical radiological practice — towards the next generation

PubMed Central

Stivaros, S M; Gledson, A; Nenadic, G; Zeng, X-J; Keane, J; Jackson, A

2010-01-01

The huge amount of information that needs to be assimilated in order to keep pace with the continued advances in modern medical practice can form an insurmountable obstacle to the individual clinician. Within radiology, the recent development of quantitative imaging techniques, such as perfusion imaging, and the development of imaging-based biomarkers in modern therapeutic assessment has highlighted the need for computer systems to provide the radiological community with support for academic as well as clinical/translational applications. This article provides an overview of the underlying design and functionality of radiological decision support systems with examples tracing the development and evolution of such systems over the past 40 years. More importantly, we discuss the specific design, performance and usage characteristics that previous systems have highlighted as being necessary for clinical uptake and routine use. Additionally, we have identified particular failings in our current methodologies for data dissemination within the medical domain that must be overcome if the next generation of decision support systems is to be implemented successfully. PMID:20965900

Reliability Prediction Analysis: Airborne System Results and Best Practices

NASA Astrophysics Data System (ADS)

Silva, Nuno; Lopes, Rui

2013-09-01

This article presents the results of several reliability prediction analysis for aerospace components, made by both methodologies, the 217F and the 217Plus. Supporting and complementary activities are described, as well as the differences concerning the results and the applications of both methodologies that are summarized in a set of lessons learned that are very useful for RAMS and Safety Prediction practitioners.The effort that is required for these activities is also an important point that is discussed, as is the end result and their interpretation/impact on the system design.The article concludes while positioning these activities and methodologies in an overall process for space and aeronautics equipment/components certification, and highlighting their advantages. Some good practices have also been summarized and some reuse rules have been laid down.

Facilitation Skills: The Catalyst for Increased Effectiveness in Consultant Practice and Clinical Systems Leadership

ERIC Educational Resources Information Center

Manley, Kim; Titchen, Angie

2017-01-01

Consultant practitioner is the pinnacle of the clinical career ladder for all health care disciplines in the United Kingdom. Consultant nurse, midwife and health visitor roles build on the clinical credibility and expertise characteristic of advanced level practice, but also possess expertise in: clinical systems leadership and the facilitation of…

The classification systems of nursing practice--the historical and practical perspective.

PubMed

Górajek-Jóźwik, Jolanta

2003-01-01

The contribution into activities connected with the development of the quality of nursing care is closely combined with the process of systematic recording of accumulated data, of undertaken activities and achieved results. This in turn constitutes the essence of the 31st Aim of WHO which speaks not only about the need to continue the rational contribution towards the increase in the nursing care quality but also the application of adequate computer technologies to improve this quality. The aim of this work is to demonstrate the scope and character of the activities that have been over years undertaken by the nursing community towards the development of the classification systems which are comparable with those used in medicine. The focus has been specifically put on the taxonomy of diagnosis used by the North American Nursing Diagnosis Association (NANDA) and the European International Classification of Nursing Practice (ICNP). The analysis of the reference sources constitutes the methodological foundation applied in this work. It has allowed to show the pioneering contribution of the American Nursing Association (ANA) into the process of recording and coding of the data that are essential in care delivery as well as their value for the development of ICNP. The latter one is a systematic and multi-axial structure which uses unified terminology and numeric codes for the three categories of variables: the recognized conditions, the undertaken activities and the achieved results.

Concepts and practices used to develop functional PLGA-based nanoparticulate systems.

PubMed

Sah, Hongkee; Thoma, Laura A; Desu, Hari R; Sah, Edel; Wood, George C

2013-01-01

The functionality of bare polylactide-co-glycolide (PLGA) nanoparticles is limited to drug depot or drug solubilization in their hard cores. They have inherent weaknesses as a drug-delivery system. For instance, when administered intravenously, the nanoparticles undergo rapid clearance from systemic circulation before reaching the site of action. Furthermore, plain PLGA nanoparticles cannot distinguish between different cell types. Recent research shows that surface functionalization of nanoparticles and development of new nanoparticulate dosage forms help overcome these delivery challenges and improve in vivo performance. Immense research efforts have propelled the development of diverse functional PLGA-based nanoparticulate delivery systems. Representative examples include PEGylated micelles/nanoparticles (PEG, polyethylene glycol), polyplexes, polymersomes, core-shell-type lipid-PLGA hybrids, cell-PLGA hybrids, receptor-specific ligand-PLGA conjugates, and theranostics. Each PLGA-based nanoparticulate dosage form has specific features that distinguish it from other nanoparticulate systems. This review focuses on fundamental concepts and practices that are used in the development of various functional nanoparticulate dosage forms. We describe how the attributes of these functional nanoparticulate forms might contribute to achievement of desired therapeutic effects that are not attainable using conventional therapies. Functional PLGA-based nanoparticulate systems are expected to deliver chemotherapeutic, diagnostic, and imaging agents in a highly selective and effective manner.

Concepts and practices used to develop functional PLGA-based nanoparticulate systems

PubMed Central

Sah, Hongkee; Thoma, Laura A; Desu, Hari R; Sah, Edel; Wood, George C

2013-01-01

The functionality of bare polylactide-co-glycolide (PLGA) nanoparticles is limited to drug depot or drug solubilization in their hard cores. They have inherent weaknesses as a drug-delivery system. For instance, when administered intravenously, the nanoparticles undergo rapid clearance from systemic circulation before reaching the site of action. Furthermore, plain PLGA nanoparticles cannot distinguish between different cell types. Recent research shows that surface functionalization of nanoparticles and development of new nanoparticulate dosage forms help overcome these delivery challenges and improve in vivo performance. Immense research efforts have propelled the development of diverse functional PLGA-based nanoparticulate delivery systems. Representative examples include PEGylated micelles/nanoparticles (PEG, polyethylene glycol), polyplexes, polymersomes, core-shell–type lipid-PLGA hybrids, cell-PLGA hybrids, receptor-specific ligand-PLGA conjugates, and theranostics. Each PLGA-based nanoparticulate dosage form has specific features that distinguish it from other nanoparticulate systems. This review focuses on fundamental concepts and practices that are used in the development of various functional nanoparticulate dosage forms. We describe how the attributes of these functional nanoparticulate forms might contribute to achievement of desired therapeutic effects that are not attainable using conventional therapies. Functional PLGA-based nanoparticulate systems are expected to deliver chemotherapeutic, diagnostic, and imaging agents in a highly selective and effective manner. PMID:23459088

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.

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 ...

Development of a Technical Practice for Roll Stabilization System Selection. Phase I

DTIC Science & Technology

1974-10-01

the roll motions, velocity, acceleration and in some cases the lift on the fin. The fin is actuated by a hydraulic system which in most cases can...Technical Report 7401.06-1 I. 00VT ACCESSION NO 4. TITLI fantf S«M<(I*> ■ PHASE I REPORT ON THE (DEVELOPMENT OF A TECHNICAL PRACTICE FOR ROLL...ship rolling, for a given application, is considered. The Influence of human effectiveness and subsystem performance on this determination is

Supervision--growing and building a sustainable general practice supervisor system.

PubMed

Thomson, Jennifer S; Anderson, Katrina J; Mara, Paul R; Stevenson, Alexander D

2011-06-06

This article explores various models and ideas for future sustainable general practice vocational training supervision in Australia. The general practitioner supervisor in the clinical practice setting is currently central to training the future general practice workforce. Finding ways to recruit, retain and motivate both new and experienced GP teachers is discussed, as is the creation of career paths for such teachers. Some of the newer methods of practice-based teaching are considered for further development, including vertically integrated teaching, e-learning, wave consulting and teaching on the run, teaching teams and remote teaching. Approaches to supporting and resourcing teaching and the required infrastructure are also considered. Further research into sustaining the practice-based general practice supervision model will be required.

An academic practice partnership: Building capacity to meet sexual health education policy requirements of a public school system.

PubMed

Cygan, Heide R; McNaughton, Diane; Reising, Virginia; Reid, Bianca

2018-06-19

The purpose of this clinical concepts paper is to describe the development, implementation, and evaluation of a formal academic-practice partnership between a large, urban, public school system and a college of nursing, based on the American Association of Colleges of Nursing's Guiding Principles to Academic-Practice Partnerships. The overarching goal of the partnership was to increase the school district's capacity to meet sexual health education policy requirements while providing graduate nursing students with an opportunity to work with a diverse population of youth during a public health nursing practicum course. As a result of the partnership, over 2,000 public school students (grades 5-12) have received comprehensive sexual health education and increased their knowledge by an average of 19.7-32.7%. In addition, 79 prelicensure, graduate nursing students have been placed at the public school system for public health nursing practicum and 100% have met all clinical objectives. As with any partnership, successes and lessons learned were identified. Discussion of both is included in this paper and may benefit other organizations considering entering into similar partnerships. Ultimately, academic-practice partnerships are an important mechanism to simultaneously meet the growing needs of community practice partners and nursing education programs, while strengthening public health nursing practice. © 2018 Wiley Periodicals, Inc.

Promoting Evidence-Based Practices: The Adoption of a Prevention Support System in Community Settings

ERIC Educational Resources Information Center

Hunter, Sarah B.; Paddock, Susan M.; Ebener, Patricia; Burkhart, A. K.; Chinman, Matthew

2009-01-01

Prevention support systems (PSSs) are designed to help communities implement evidence-based practices (EBPs). Little is known about the factors that influence their adoption. In this article, we examined adoption of a PSS for substance abuse prevention called Getting To Outcomes (GTO)[R] among staff in two community coalitions with varying levels…

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

Indicators for assessing socioeconomic sustainability of bioenergy systems. A short list of practical measures

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

Dale, Virginia H.; Efroymson, Rebecca Ann; Kline, Keith L.

2012-10-16

Indicators are needed to assess both socioeconomic and environmental sustainability of bioenergy systems. Effective indicators can help to identify and quantify the sustainability attributes of bioenergy options. We identify 16 socioeconomic indicators that fall into the categories of social well-being, energy security, trade, profitability, resource conservation, and social acceptability. The suite of indicators is predicated on the existence of basic institutional frameworks to provide governance, legal, regulatory and enforcement services. Indicators were selected to be practical, sensitive to stresses, unambiguous, anticipatory, predictive, calibrated with known variability, and sufficient when considered collectively. The utility of each indicator, methods for its measurement,more » and applications appropriate for the context of particular bioenergy systems are described along with future research needs. Together, this suite of indicators is hypothesized to reflect major socioeconomic effects of the full supply chain for bioenergy, including feedstock production and logistics, conversion to biofuels, biofuel logistics and biofuel end uses. Ten of those 16 indicators are proposed to be the minimum list of practical measures of socioeconomic aspects of bioenergy sustainability. Coupled with locally-prioritized environmental indicators, we propose that these socioeconomic indicators can provide a basis to quantify and evaluate sustainability of bioenergy systems across many regions in which they will be deployed.« less

Moving science into state child and adolescent mental health systems: Illinois' evidence-informed practice initiative.

PubMed

Starin, Amy C; Atkins, Marc S; Wehrmann, Kathryn C; Mehta, Tara; Hesson-McInnis, Matthew S; Marinez-Lora, A; Mehlinger, Renee

2014-01-01

In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

Evaluating professionalism, practice-based learning and improvement, and systems-based practice: utilization of a compliance form and correlation with conflict styles.

PubMed

Ogunyemi, Dotun; Eno, Michelle; Rad, Steve; Fong, Alex; Alexander, Carolyn; Azziz, Ricardo

2010-09-01

The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Our analysis of 18 residents for academic year 2007-2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies. Postgraduate year, behavior, and conflict styles

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,…

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...

Two management systems in a nursing private practice group.

PubMed

Zahourek, R P

1979-09-01

Entry into private practice can be rewarding for nurses who are willing to risk personal, financial, and professional security. Among the problems faced by the nurse in this new role is the administration of the practice, since few, if any, adequate models exist. This article describes the struggle of nurses in one private nursing practice, Creative Health Services, to meet their needs for individual freedom within an organization that is regulated sufficiently to maintain its viability.

Introducing Advanced Practice Nurses / Nurse Practitioners in health care systems: a framework for reflection and analysis.

PubMed

De Geest, Sabina; Moons, Philip; Callens, Betty; Gut, Chris; Lindpaintner, Lyn; Spirig, Rebecca

2008-11-01

An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context. Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented. Argumentation developed using data based papers and policy reports on Advanced Practice Nursing. The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role. Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.

Application of Recommended Design Practices for Conceptual Nuclear Fusion Space Propulsion Systems

NASA Technical Reports Server (NTRS)

Williams, Craig H.

2004-01-01

An AIAA Special Project Report was recently produced by AIAA's Nuclear and Future Flight Propulsion Technical Committee and is currently in peer review. The Report provides recommended design practices for conceptual engineering studies of nuclear fusion space propulsion systems. Discussion and recommendations are made on key topics including design reference missions, degree of technological extrapolation and concomitant risk, thoroughness in calculating mass properties (nominal mass properties, weight-growth contingency and propellant margins, and specific impulse), and thoroughness in calculating power generation and usage (power-flow, power contingencies, specific power). The report represents a general consensus of the nuclear fusion space propulsion system conceptual design community and proposes 15 recommendations. This paper expands on the Report by providing specific examples illustrating how to apply each of the recommendations.

A self-instructional model to teach systems-based practice and practice-based learning and improvement.

PubMed

Peters, Antoinette S; Kimura, Joe; Ladden, Maryjoan D; March, Elizabeth; Moore, Gordon T

2008-07-01

When mandated as resident competencies in 1999, systems-based practice (SBP) and practice-based learning and improvement (PBLI) were new concepts to many. To describe and evaluate a 4-week clinical elective (Achieving Competence Today-ACT) to teach residents SBP and PBLI. ACT consisted of a four-week active learning course and follow-up teaching experience, guided and supported by web-based materials. The curriculum included readings, scheduled activities, work products including an improvement project, and weekly meetings with a non-expert preceptor. The evaluation used a before-after cross-comparison of ACT residents and their peers. Seventy-eight residents and 42 faculty in 18 US Internal Medicine residency programs participated between 2003 and 2005. RESULTS AND MAIN MEASUREMENTS: All residents and faculty preceptors responded to a knowledge test, survey of attitudes, and self-assessment of competency to do 15 tasks related to SBP/PBLI. All measures were normalized to a 100-point scale. Each program's principal investigator (PI) identified aspects of ACT that were most and least effective in enhancing resident learning. ACT residents' gains in knowledge (4.4 on a 100-point scale) and self-assessed competency (11.3) were greater than controls' (-1.9, -8.0), but changes in attitudes were not significantly different. Faculty preceptors' knowledge scores did not change, but their attitudes became more positive (15.8). PIs found a ready-to-use curriculum effective (rated 8.5 on a 10-point scale). ACT increased residents' knowledge and self-assessment of their own competency and raised faculty's assessment of the importance of residents' learning SBP/PBLI. Faculty content expertise is not required for residents to learn SBP/PBLI.

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.

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.

Translating Addictions Research into Evidence-based Practice: the Polaris CD Outcomes Management System

PubMed Central

Toche-Manley, L.; Grissom, G.; Dietzen, L.; Sangsland, S.

2011-01-01

Converting the findings from addictions studies into information actionable by (non-research) treatment programs is important to improving program outcomes. This paper describes the translation of the findings of studies on Patient-Services matching, prediction of patient response to treatment (Expected Treatment Response) and prediction of dropout to provide evidence-based decision support in routine treatment. The findings of the studies and their application to the development of an outcomes management system are described. Implementation issues in a network of addictions treatment programs are discussed. The work illustrates how outcomes management systems can play an important role in translating research into practice. PMID:21324606

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.

Assessing experience in the deliberate practice of running using a fuzzy decision-support system

PubMed Central

Roveri, Maria Isabel; Manoel, Edison de Jesus; Onodera, Andrea Naomi; Ortega, Neli R. S.; Tessutti, Vitor Daniel; Vilela, Emerson; Evêncio, Nelson

2017-01-01

The judgement of skill experience and its levels is ambiguous though it is crucial for decision-making in sport sciences studies. We developed a fuzzy decision support system to classify experience of non-elite distance runners. Two Mamdani subsystems were developed based on expert running coaches’ knowledge. In the first subsystem, the linguistic variables of training frequency and volume were combined and the output defined the quality of running practice. The second subsystem yielded the level of running experience from the combination of the first subsystem output with the number of competitions and practice time. The model results were highly consistent with the judgment of three expert running coaches (r>0.88, p<0.001) and also with five other expert running coaches (r>0.86, p<0.001). From the expert’s knowledge and the fuzzy model, running experience is beyond the so-called "10-year rule" and depends not only on practice time, but on the quality of practice (training volume and frequency) and participation in competitions. The fuzzy rule-based model was very reliable, valid, deals with the marked ambiguities inherent in the judgment of experience and has potential applications in research, sports training, and clinical settings. PMID:28817655

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

PubMed Central

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

2015-01-01

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

[Trial to stimulate learning motivation of medical students in the dissection practice "teaching assistant system"].

PubMed

Kawashiro, Yukiko; Kadota, Tomoko; Matsuno, Yoshiharu; Miyaso, Hidenobu; Komiyama, Masatoshi; Mori, Chisato

2008-06-01

At the Medical School of Chiba University, educational dissection tours have been conducted for intra- and extramural students in other programs, such as students of nursing. In the 2006 school year there were more than 1,500 students. As presented in a previous report, we tested an educational program in which our medical students teach other students parts of splanchnology, neurology, and myology to promote student understanding of human physiology through their own teaching. Since this system, termed the "teaching assistant system," was fairly laborious for many medical students, we attempted to improve it by decreasing the students' load and reducing the frequency of teaching from several times to once during the one-term dissection practice. We assessed the improved method with questionnaires for medical students who had studied at the school in 2006 and 2007 (n = 206) before and after teaching other students. The response rate for the questionnaires was 91.3% (n = 188). The results were as follows. (1) Most medical students (69.7%) realized that the task of teaching had stimulating effects on their own learning motivation. (2) According to most of their evaluations (80.4%), the duties of teaching involved in the previous assistant system were laborious. In contrast, the ratio of medical students who considered teaching to be laborious decreased by about half (55.3%) in the present improved system. (3) Most students (79.8%) were satisfied with the teaching assistant system. We concluded that the improved teaching assistant system was effective for the dissection practice.

Learning about systems-based practice in the informal curriculum: a case study in an academic pediatric continuity clinic.

PubMed

Balmer, Dorene; Ruzek, Sheryl; Ludwig, Stephen; Giardino, Angelo P

2007-01-01

Pediatric residents learn about systems-based practice (SBP) explicitly in the formal curriculum and implicitly in the informal curriculum as they engage in practice alongside physician faculty. Recent studies describe innovative ways to address SBP in the formal curriculum for SBP, but the informal curriculum has not been explored. We examined what, and how, third-year pediatric residents learn about SBP in the informal curriculum at one continuity clinic, and to consider how this learning aligns with the formal curriculum. A case study involving 10 third-year pediatric residents and 10 continuity preceptors was conducted at one continuity clinic, housed in a community-based, pediatric primary care center. Data were derived from 5 months (100 hours) of direct observation in the precepting room at the case clinic, semistructured interviews with residents (before and after observation) and with preceptors (after observation). Interview transcripts and notes from observation were inductively coded and analyzed for major themes. Two themes emerged in the informal curriculum. Residents perceived "our system," the academic health system in which they trained and practiced as separate and distinct from the "real system," the larger, societal context of health care. Residents also understood SBP as a commitment to helping individual patients and families navigate the complexities of "our system," dealing with issues that concerned them. Residents learn important lessons about SBP in the informal curriculum in continuity clinic. These lessons may reinforce some elements of the competency-based formal curriculum for SBP, but challenge others.

Comparison of university and private-practice orthodontic treatment outcomes with the American Board of Orthodontics objective grading system.

PubMed

Cook, Devon R; Harris, Edward F; Vaden, James L

2005-06-01

Treatment outcomes and duration of treatment for patients treated in university graduate orthodontic programs and private orthodontic practices were assessed and compared with the ABO objective grading system. The treatment records of 139 randomly selected adolescents who had received comprehensive orthodontic treatment were examined. Seventy-seven subjects had been treated in 3 postgraduate orthodontic clinics, and 62 had been treated in 3 private orthodontic practices. Pretreatment, all subjects had Class II Division 1 malocclusions and ANB angles equal to or greater than 4 degrees . All patients were treated with premolar extractions. Posttreatment dental casts were measured and scored with the ABO objective grading system. No significant differences were found between the groups in the alignment, buccolingual inclination, and overjet components. Patients treated in private practice had significantly lower scores for marginal ridge height and occlusal relationship. Patients treated in the university programs had significantly lower scores for occlusal contact and interproximal contact components. There was no significant difference in the overall score, thus no significant difference in the overall quality of orthodontic treatment outcome between patients treated in university programs and private practices. However, the university group had a significantly larger sample variance for the overall score. There was no significant difference in the duration of the treatment between patients treated in a university setting and in a private practice.

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...

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...

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…

Highly Turbulent Counterflow Flames: A Laboratory Scale Benchmark for Practical Combustion Systems

NASA Astrophysics Data System (ADS)

Gomez, Alessandro

2013-11-01

Since the pioneering work of Weinberg's group at Imperial College in the `60s, the counterflow system has been the workhorse of laminar flame studies. Recent developments have shown that it is also a promising benchmark for highly turbulent (Ret ~ 1000) nonpremixed and premixed flames of direct relevance to gasturbine combustion. Case studies will demonstrate the versatility of the system in mimicking real flame effects, such as heat loss and flame stratification in premixed flames, and the compactness of the combustion region. The system may offer significant advantages from a computational viewpoint, including: a) aerodynamic flame stabilization near the interface between the two opposed jets, with ensuing simplifications in the prescription of boundary conditions; b) a fiftyfold reduction of the domain of interest as compared to conventional nonpremixed jet flames at the same Reynolds number; and c) millisecond mean residence times, which is particularly useful for DNS/LES computational modeling, and for soot suppression in the combustion of practical fuels.

Neuropathic pain: an updated grading system for research and clinical practice

PubMed Central

Finnerup, Nanna B.; Haroutounian, Simon; Kamerman, Peter; Baron, Ralf; Bennett, David L.H.; Bouhassira, Didier; Cruccu, Giorgio; Freeman, Roy; Hansson, Per; Nurmikko, Turo; Raja, Srinivasa N.; Rice, Andrew S.C.; Serra, Jordi; Smith, Blair H.; Treede, Rolf-Detlef; Jensen, Troels S.

2016-01-01

Abstract The redefinition of neuropathic pain as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system,” which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the “definite” level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research. PMID:27115670

Neuropathic pain: an updated grading system for research and clinical practice.

PubMed

Finnerup, Nanna B; Haroutounian, Simon; Kamerman, Peter; Baron, Ralf; Bennett, David L H; Bouhassira, Didier; Cruccu, Giorgio; Freeman, Roy; Hansson, Per; Nurmikko, Turo; Raja, Srinivasa N; Rice, Andrew S C; Serra, Jordi; Smith, Blair H; Treede, Rolf-Detlef; Jensen, Troels S

2016-08-01

The redefinition of neuropathic pain as "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system," which was suggested by the International Association for the Study of Pain (IASP) Special Interest Group on Neuropathic Pain (NeuPSIG) in 2008, has been widely accepted. In contrast, the proposed grading system of possible, probable, and definite neuropathic pain from 2008 has been used to a lesser extent. Here, we report a citation analysis of the original NeuPSIG grading paper of 2008, followed by an analysis of its use by an expert panel and recommendations for an improved grading system. As of February, 2015, 608 eligible articles in Scopus cited the paper, 414 of which cited the neuropathic pain definition. Of 220 clinical studies citing the paper, 56 had used the grading system. The percentage using the grading system increased from 5% in 2009 to 30% in 2014. Obstacles to a wider use of the grading system were identified, including (1) questions about the relative significance of confirmatory tests, (2) the role of screening tools, and (3) uncertainties about what is considered a neuroanatomically plausible pain distribution. Here, we present a revised grading system with an adjusted order, better reflecting clinical practice, improvements in the specifications, and a word of caution that even the "definite" level of neuropathic pain does not always indicate causality. In addition, we add a table illustrating the area of pain and sensory abnormalities in common neuropathic pain conditions and propose areas for further research.

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

SUPPORTING TEACHERS IN IMPLEMENTING FORMATIVE ASSESSMENT PRACTICES IN EARTH SYSTEMS SCIENCE

NASA Astrophysics Data System (ADS)

Harris, C. J.; Penuel, W. R.; Haydel Debarger, A.; Blank, J. G.

2009-12-01

An important purpose of formative assessment is to elicit student thinking to use in instruction to help all students learn and inform next steps in teaching. However, formative assessment practices are difficult to implement and thus present a formidable challenge for many science teachers. A critical need in geoscience education is a framework for providing teachers with real-time assessment tools as well as professional development to learn how to use formative assessment to improve instruction. Here, we describe a comprehensive support system, developed for our NSF-funded Contingent Pedagogies project, for addressing the challenge of helping teachers to use formative assessment to enhance student learning in middle school Earth Systems science. Our support system is designed to improve student understanding about the geosphere by integrating classroom network technology, interactive formative assessments, and contingent curricular activities to guide teachers from formative assessment to instructional decision-making and improved student learning. To accomplish this, we are using a new classroom network technology, Group Scribbles, in the context of an innovative middle-grades Earth Science curriculum called Investigating Earth Systems (IES). Group Scribbles, developed at SRI International, is a collaborative software tool that allows individual students to compose “scribbles” (i.e., drawings and notes), on “post-it” notes in a private workspace (a notebook computer) in response to a public task. They can post these notes anonymously to a shared, public workspace (a teacher-controlled large screen monitor) that becomes the centerpiece of group and class discussion. To help teachers implement formative assessment practices, we have introduced a key resource, called a teaching routine, to help teachers take advantage of Group Scribbles for more interactive assessments. Routine refers to a sequence of repeatable interactions that, over time, become

Multi-Tiered System of Support: Best Differentiation Practices for English Language Learners in Tier 1

ERIC Educational Resources Information Center

Izaguirre, Cecilia

2017-01-01

Purpose: This qualitative case study explored the best practices of differentiation of Tier 1 instruction within a multi-tiered system of support for English Language Learners who were predominately Spanish speaking. Theoretical Framework: The zone of proximal development theory, cognitive theory, and the affective filter hypothesis guided this…

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...

Understanding how orthopaedic surgery practices generate value for healthcare systems.

PubMed

Olson, Steven A; Mather, Richard C

2013-06-01

Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems. We provide an overview of two basic types of value orthopaedic surgeons create for healthcare systems: financial or volume-driven benefits and nonfinancial quality or value-driven patient care benefits. We performed a search of PubMed from 1965 to 2012 using the term "service line." Of the 351 citations identified, 18 citations specifically involved the use of service lines to improve patient care in both nursing and medical journals. A service line is a structure used in healthcare organizations to enable management of a subset of activities or resources in a focused area of patient care delivery. There is not a consistent definition of what resources are managed within a service line from hospital to hospital. Physicians can positively impact patient care through engaging in service line management. There is increasing pressure for healthcare systems and hospitals to partner with orthopaedic surgeons. The peer-reviewed literature demonstrates there are limited resources for physicians to understand the value they create when attempting to negotiate with their hospital or healthcare organization. To effectively negotiate for resources to provide the best care for patients, orthopaedic surgeons need to claim and

Traceability of Biologics in The Netherlands: An Analysis of Information-Recording Systems in Clinical Practice and Spontaneous ADR Reports.

PubMed

Klein, Kevin; Scholl, Joep H G; Vermeer, Niels S; Broekmans, André W; Van Puijenbroek, Eugène P; De Bruin, Marie L; Stolk, Pieter

2016-02-01

Pharmacovigilance requirements for biologics mandate that EU Member States shall ensure that any biologic that is the subject of a suspected adverse drug reaction (ADR) is identifiable by brand name and batch number. Recent studies showed that brand name identification is well established, whereas batch numbers are (still) poorly reported. We evaluated information-recording systems and practices in the Dutch hospital setting to identify determinants for brand name and batch number recording as well as success factors and bottlenecks for traceability. We surveyed Dutch hospital pharmacists with an online questionnaire on systems and practices in hospitals for recording brand names and batch numbers. Additionally, we performed an analysis of the traceability of recombinant biologics in spontaneous ADR reports (received between 2009 and 2014) from the Netherlands Pharmacovigilance Centre Lareb. The survey showed that brand names are not routinely recorded in the clinical practice of Dutch hospitals, whereas batch numbers are poorly recorded. Seventy-six percent of the 1523 ADR reports for recombinant biologics had a traceable brand name whereas 5% of these reports contained a batch number. The results suggest a possible relationship between the availability of brand and batch number information in clinical practice and the inclusion of this information in ADR reports for biologics. The limited traceability of brand names and batch numbers in ADR reports may be primarily caused by the shortcomings in the recording of information in clinical practice. We recommend efforts to improve information-recording systems as a first step to improve the traceability of biologics in ADR reporting.

A new practice-driven approach to develop software in a cyber-physical system environment

NASA Astrophysics Data System (ADS)

Jiang, Yiping; Chen, C. L. Philip; Duan, Junwei

2016-02-01

Cyber-physical system (CPS) is an emerging area, which cannot work efficiently without proper software handling of the data and business logic. Software and middleware is the soul of the CPS. The software development of CPS is a critical issue because of its complicity in a large scale realistic system. Furthermore, object-oriented approach (OOA) is often used to develop CPS software, which needs some improvements according to the characteristics of CPS. To develop software in a CPS environment, a new systematic approach is proposed in this paper. It comes from practice, and has been evolved from software companies. It consists of (A) Requirement analysis in event-oriented way, (B) architecture design in data-oriented way, (C) detailed design and coding in object-oriented way and (D) testing in event-oriented way. It is a new approach based on OOA; the difference when compared with OOA is that the proposed approach has different emphases and measures in every stage. It is more accord with the characteristics of event-driven CPS. In CPS software development, one should focus on the events more than the functions or objects. A case study of a smart home system is designed to reveal the effectiveness of the approach. It shows that the approach is also easy to be operated in the practice owing to some simplifications. The running result illustrates the validity of this approach.

New entrants' practice patterns in Medicare home health care after the prospective payment system revision in 2008.

PubMed

Kim, Hyunjee; Jung, Jeah Kyoungrae

2015-09-01

Medicare home health care spending increased under the prospective payment system (PPS) that was introduced specifically to control the rising spending. To explain this unexpected spending rise, we focused on new home health agencies that entered the market under the PPS. The high profit margins under the PPS attracted many new agencies to the market partially due to home health care's unique feature of low entry costs. We examined whether new entrants were more likely to adopt the practice patterns leading to higher profit margins than incumbent agencies that had been operating in the market before the PPS. Using 2008 to 2010 Medicare Home Health Claims and Provider of Services File, we estimated regressions of agencies' practice patterns controlling for agency and patient characteristics. We found that new entrants were more likely than incumbents to adopt practice patterns leading to high profit margins. They were more likely to target the 14th and 20th therapy visit where marginal revenue is relatively greater than that of other number of visits. Under the payment system that compensates extra therapy visits but not for other types of visits, entrants were also more likely to provide therapy visits, but less likely to provide medical social service visits. Given the high entry rates of agencies under the PPS, distinct practice patterns among entrants explain the drastic home health spending increase under the PPS. Heterogeneity in agencies' practice patterns also suggests an opportunity to improve efficiency in the Medicare home health care market. Copyright © 2015 Elsevier Inc. All rights reserved.

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…

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.

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

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

Advancing the application of systems thinking in health: exploring dual practice and its management in Kampala, Uganda

PubMed Central

2014-01-01

Background Many full-time Ugandan government health providers take on additional jobs – a phenomenon called dual practice. We describe the complex patterns that characterize the evolution of dual practice in Uganda, and the local management practices that emerged in response, in five government facilities. An in-depth understanding of dual practice can contribute to policy discussions on improving public sector performance. Methods A multiple case study design with embedded units of analysis was supplemented by interviews with policy stakeholders and a review of historical and policy documents. Five facility case studies captured the perspective of doctors, nurses, and health managers through semi-structured in-depth interviews. A causal loop diagram illustrated interactions and feedback between old and new actors, as well as emerging roles and relationships. Results The causal loop diagram illustrated how feedback related to dual practice policy developed in Uganda. As opportunities for dual practice grew and the public health system declined over time, government providers increasingly coped through dual practice. Over time, government restrictions to dual practice triggered policy resistance and protest from government providers. Resulting feedback contributed to compromising the supply of government providers and, potentially, of service delivery outcomes. Informal government policies and restrictions replaced the formal restrictions identified in the early phases. In some instances, government health managers, particularly those in hospitals, developed their own practices to cope with dual practice and to maintain public sector performance. Management practices varied according to the health manager’s attitude towards dual practice and personal experience with dual practice. These practices were distinct in hospitals. Hospitals faced challenges managing internal dual practice opportunities, such as those created by externally-funded research projects based

Developing geospatial thinking and the science practices of investigation and evalutation with geographic information systems

NASA Astrophysics Data System (ADS)

Hamilton, Kelli

Geospatial thinking is a subset of spatial thinking, which has been identified by the National Geography Standards as an essential skill for students to gain through geography instruction (Heffron & Downs, 2013). One tool which has been shown to help students develop their geospatial thinking skills is Geographic Information Systems (GIS) (Kim & Bednraz, 2013; Lee & Bednarz, 2009; Patterson, 2007). Much of the research conducted with GIS has been in the context of social studies classrooms. This study examined the use of GIS with seventh grade students in a science classroom. Results of this study indicate that students who use GIS as part of their science instruction are able to practice geospatial thinking skills. In addition, this study examined how GIS could be used to enhance the instruction of the science practices of investigation and evaluation. The Next Generation Science Standards identify certain science practices which students should experience as part of science instruction (NGSS Lead States, 2013). Among those practices are investigation and evaluation. Students in this study used GIS to investigate and evaluate scientific data. Both the teacher and the students were able to identify ways that GIS enhanced both the investigation and evaluation of data.

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 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.

The Practical Concept of an Evaluator and Its Use in the Design of Training Systems.

ERIC Educational Resources Information Center

Gibbons, Andrew S.; Rogers, Dwayne H.

1991-01-01

The evaluator is an instructional system product that provides practice, testing capability, and feedback in a way not yet seen in computer-assisted instruction. Training methods using an evaluator contain scenario-based simulation exercises, followed by a critique of performance. A focus on competency-based education and performance makes the…

40 CFR Table 10 to Subpart Ffff of... - Work Practice Standards for Heat Exchange Systems

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 13 2013-07-01 2012-07-01 true Work Practice Standards for Heat Exchange Systems 10 Table 10 to Subpart FFFF of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National...

40 CFR Table 10 to Subpart Ffff of... - Work Practice Standards for Heat Exchange Systems

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 12 2011-07-01 2009-07-01 true Work Practice Standards for Heat Exchange Systems 10 Table 10 to Subpart FFFF of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission...

40 CFR Table 10 to Subpart Ffff of... - Work Practice Standards for Heat Exchange Systems

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 12 2010-07-01 2010-07-01 true Work Practice Standards for Heat Exchange Systems 10 Table 10 to Subpart FFFF of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES National Emission...

40 CFR Table 10 to Subpart Ffff of... - Work Practice Standards for Heat Exchange Systems

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 13 2014-07-01 2014-07-01 false Work Practice Standards for Heat Exchange Systems 10 Table 10 to Subpart FFFF of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National...

40 CFR Table 10 to Subpart Ffff of... - Work Practice Standards for Heat Exchange Systems

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 13 2012-07-01 2012-07-01 false Work Practice Standards for Heat Exchange Systems 10 Table 10 to Subpart FFFF of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National...

A Self-instructional Model to Teach Systems-based Practice and Practice-based Learning and Improvement

PubMed Central

Kimura, Joe; Ladden, MaryJoan D.; March, Elizabeth; Moore, Gordon T.

2008-01-01

Background When mandated as resident competencies in 1999, systems-based practice (SBP) and practice-based learning and improvement (PBLI) were new concepts to many. Objective To describe and evaluate a 4-week clinical elective (Achieving Competence Today—ACT) to teach residents SBP and PBLI. Design ACT consisted of a four-week active learning course and follow-up teaching experience, guided and supported by web-based materials. The curriculum included readings, scheduled activities, work products including an improvement project, and weekly meetings with a non-expert preceptor. The evaluation used a before–after cross-comparison of ACT residents and their peers. Participants Seventy-eight residents and 42 faculty in 18 US Internal Medicine residency programs participated between 2003 and 2005. Results and Main Measurements All residents and faculty preceptors responded to a knowledge test, survey of attitudes, and self-assessment of competency to do 15 tasks related to SBP/PBLI. All measures were normalized to a 100-point scale. Each program’s principal investigator (PI) identified aspects of ACT that were most and least effective in enhancing resident learning. ACT residents’ gains in knowledge (4.4 on a 100-point scale) and self-assessed competency (11.3) were greater than controls’ (−1.9, −8.0), but changes in attitudes were not significantly different. Faculty preceptors’ knowledge scores did not change, but their attitudes became more positive (15.8). PIs found a ready-to-use curriculum effective (rated 8.5 on a 10-point scale). Conclusions ACT increased residents’ knowledge and self-assessment of their own competency and raised faculty’s assessment of the importance of residents’ learning SBP/PBLI. Faculty content expertise is not required for residents to learn SBP/PBLI. PMID:18612719

Adaptive Practice: Next Generation Evidence-Based Practice in Digital Environments.

PubMed

Kennedy, Margaret Ann

2016-01-01

Evidence-based practice in nursing is considered foundational to safe, competent care. To date, rigid traditional perceptions of what constitutes 'evidence' have constrained the recognition and use of practice-based evidence and the exploitation of novel forms of evidence from data rich environments. Advancements such as the conceptualization of clinical intelligence, the prevalence of increasingly sophisticated digital health information systems, and the advancement of the Big Data phenomenon have converged to generate a new contemporary context. In today's dynamic data-rich environments, clinicians have new sources of valid evidence, and need a new paradigm supporting clinical practice that is adaptive to information generated by diverse electronic sources. This opinion paper presents adaptive practice as the next generation of evidence-based practice in contemporary evidence-rich environments and provides recommendations for the next phase of evolution.

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

PubMed

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

2015-04-21

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

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…

Physician Professional Satisfaction and Area of Clinical Practice: Evidence from an Integrated Health Care Delivery System.

PubMed

Caloyeras, John P; Kanter, Michael; Ives, Nicole; Kim, Chong Y; Kanzaria, Hemal K; Berry, Sandra H; Brook, Robert H

2016-01-01

For health care reform to succeed, health care systems need a professionally satisfied primary care workforce. Evidence suggests that primary care physicians are less satisfied than those in other medical specialties. To assess three domains of physician satisfaction by area of clinical practice among physicians practicing in an established integrated health system. Cross-sectional online survey of all Southern California Permanente Medical Group (SCPMG) partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers. Primary measure was satisfaction with one's day-to-day professional life as a physician. Secondary measures were satisfaction with quality of care and income. Of the 636 physicians responding to the survey (61.5% response rate), on average, 8 in 10 SCPMG physicians reported satisfaction with their day-to-day professional life as a physician. Primary care physicians were only minimally less likely to report being satisfied (difference of 8.2-9.5 percentage points; p < 0.05) than were other physicians. Nearly all physicians (98.2%) were satisfied with the quality of care they are able to provide. Roughly 8 in 10 physicians reported satisfaction with their income. No differences were found between primary care physicians and those in other clinical practice areas regarding satisfaction with quality of care or income. It is possible to create practice settings, such as SCPMG, in which most physicians, including those in primary care, experience high levels of professional satisfaction.

Physician Professional Satisfaction and Area of Clinical Practice: Evidence from an Integrated Health Care Delivery System

PubMed Central

Caloyeras, John P; Kanter, Michael; Ives, Nicole; Kim, Chong Y; Kanzaria, Hemal K; Berry, Sandra H; Brook, Robert H

2016-01-01

Context: For health care reform to succeed, health care systems need a professionally satisfied primary care workforce. Evidence suggests that primary care physicians are less satisfied than those in other medical specialties. Objective: To assess three domains of physician satisfaction by area of clinical practice among physicians practicing in an established integrated health system. Design: Cross-sectional online survey of all Southern California Permanente Medical Group (SCPMG) partner and associate physicians (N = 1034) who were primarily providing clinic-based care in 1 of 4 geographically and operationally distinct Kaiser Permanente Southern California Medical Centers. Main Outcome Measures: Primary measure was satisfaction with one’s day-to-day professional life as a physician. Secondary measures were satisfaction with quality of care and income. Results: Of the 636 physicians responding to the survey (61.5% response rate), on average, 8 in 10 SCPMG physicians reported satisfaction with their day-to-day professional life as a physician. Primary care physicians were only minimally less likely to report being satisfied (difference of 8.2–9.5 percentage points; p < 0.05) than were other physicians. Nearly all physicians (98.2%) were satisfied with the quality of care they are able to provide. Roughly 8 in 10 physicians reported satisfaction with their income. No differences were found between primary care physicians and those in other clinical practice areas regarding satisfaction with quality of care or income. Conclusion: It is possible to create practice settings, such as SCPMG, in which most physicians, including those in primary care, experience high levels of professional satisfaction. PMID:27057819

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...

Evaluating Professionalism, Practice-Based Learning and Improvement, and Systems-Based Practice: Utilization of a Compliance Form and Correlation with Conflict Styles

PubMed Central

Ogunyemi, Dotun; Eno, Michelle; Rad, Steve; Fong, Alex; Alexander, Carolyn; Azziz, Ricardo

2010-01-01

Objective The purpose of this article was to develop and determine the utility of a compliance form in evaluating and teaching the Accreditation Council for Graduate Medical Education competencies of professionalism, practice-based learning and improvement, and systems-based practice. Methods In 2006, we introduced a 17-item compliance form in an obstetrics and gynecology residency program. The form prospectively monitored residents on attendance at required activities (5 items), accountability of required obligations (9 items), and completion of assigned projects (3 items). Scores were compared to faculty evaluations of residents, resident status as a contributor or a concerning resident, and to the residents' conflict styles, using the Thomas-Kilmann Conflict MODE Instrument. Results Our analysis of 18 residents for academic year 2007–2008 showed a mean (standard error of mean) of 577 (65.3) for postgraduate year (PGY)-1, 692 (42.4) for PGY-2, 535 (23.3) for PGY-3, and 651.6 (37.4) for PGY-4. Non-Hispanic white residents had significantly higher scores on compliance, faculty evaluations on interpersonal and communication skills, and competence in systems-based practice. Contributing residents had significantly higher scores on compliance compared with concerning residents. Senior residents had significantly higher accountability scores compared with junior residents, and junior residents had increased project completion scores. Attendance scores increased and accountability scores decreased significantly between the first and second 6 months of the academic year. There were positive correlations between compliance scores with competing and collaborating conflict styles, and significant negative correlations between compliance with avoiding and accommodating conflict styles. Conclusions Maintaining a compliance form allows residents and residency programs to focus on issues that affect performance and facilitate assessment of the ACGME competencies

A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy.

PubMed

Liu, Dora; Ahmet, Alexandra; Ward, Leanne; Krishnamoorthy, Preetha; Mandelcorn, Efrem D; Leigh, Richard; Brown, Jacques P; Cohen, Albert; Kim, Harold

2013-08-15

Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing's syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy, particularly when used at high doses for prolonged periods. This comprehensive article reviews these adverse events and provides practical recommendations for their prevention and management based on both current literature and the clinical experience of the authors.

Flying Lessons for Clinicians: Developing System 2 Practice.

PubMed

Gregoire, Jerome N; Alfes, Celeste M; Reimer, Andrew P; Terhaar, Mary F

There is a long history of adopting lessons learned from aviation to improve health care practice. Two of the major practices that have successfully transferred include using a checklist and simulation. Training and simulation technology is currently underdeveloped for nurses and health care providers entering critical care transport. This article describes a pedagogical approach adopted from aviation to develop a new simulation platform and program of research to develop the science of critical care transport nursing education. Copyright © 2017 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

A practical indoor context-aware surveillance system with multi-Kinect sensors

NASA Astrophysics Data System (ADS)

Jia, Lili; You, Ying; Li, Tiezhu; Zhang, Shun

2014-11-01

In this paper we develop a novel practical application, which give scalable services to the end users when abnormal actives are happening. Architecture of the application has been presented consisting of network infrared cameras and a communication module. In this intelligent surveillance system we use Kinect sensors as the input cameras. Kinect is an infrared laser camera which its user can access the raw infrared sensor stream. We install several Kinect sensors in one room to track the human skeletons. Each sensor returns the body positions with 15 coordinates in its own coordinate system. We use calibration algorithms to calibrate all the body positions points into one unified coordinate system. With the body positions points, we can infer the surveillance context. Furthermore, the messages from the metadata index matrix will be sent to mobile phone through communication module. User will instantly be aware of an abnormal case happened in the room without having to check the website. In conclusion, theoretical analysis and experimental results in this paper show that the proposed system is reasonable and efficient. And the application method introduced in this paper is not only to discourage the criminals and assist police in the apprehension of suspects, but also can enabled the end-users monitor the indoor environments anywhere and anytime by their phones.

Systems solutions by lactic acid bacteria: from paradigms to practice

PubMed Central

2011-01-01

Lactic acid bacteria are among the powerhouses of the food industry, colonize the surfaces of plants and animals, and contribute to our health and well-being. The genomic characterization of LAB has rocketed and presently over 100 complete or nearly complete genomes are available, many of which serve as scientific paradigms. Moreover, functional and comparative metagenomic studies are taking off and provide a wealth of insight in the activity of lactic acid bacteria used in a variety of applications, ranging from starters in complex fermentations to their marketing as probiotics. In this new era of high throughput analysis, biology has become big science. Hence, there is a need to systematically store the generated information, apply this in an intelligent way, and provide modalities for constructing self-learning systems that can be used for future improvements. This review addresses these systems solutions with a state of the art overview of the present paradigms that relate to the use of lactic acid bacteria in industrial applications. Moreover, an outlook is presented of the future developments that include the transition into practice as well as the use of lactic acid bacteria in synthetic biology and other next generation applications. PMID:21995776

Systemic Hydration: Relating Science to Clinical Practice in Vocal Health

PubMed Central

Hartley, Naomi A.; Thibeault, Susan L.

2014-01-01

Objectives To examine the current state of the science regarding the role of systemic hydration in vocal function and health. Study Design Literature Review Methods Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics, medicine, sports and exercise science, physiology and biomechanics. Results The relationship between hydration and physical function is an area of common interest amongst multiple professions. Each discipline provides valuable insight into the connection between performance and water balance, as well as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and voice production, however the underlying mechanisms are not yet defined and a treatment effect for systemic hydration remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and in some cases offers an alternative explanation for observed phenomena. Conclusions A growing body of literature in the field of voice science is documenting a relationship between hydration and vocal function, however greater understanding is required to guide best practice in the maintenance of vocal health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines facilitates analysis of existing literature and provides guidance as to future research. PMID:24880674

Changing Health Professionals' Attitudes and Practice Behaviors Through Interprofessional Continuing Education in Oral-Systemic Health.

PubMed

Mowat, Stephanie; Hein, Casey; Walsh, Tanya; MacDonald, Laura; Grymonpre, Ruby; Sisler, Jeffrey

2017-12-01

Integration of oral-systemic science into clinical care holds promise for improving patient outcomes and presenting opportunities for individuals in various health care professions to learn with, from, and about each other. The aim of this study was to examine whether an interprofessional continuing education program dedicated to oral-systemic health improved participants' attitudes toward interprofessional education and collaboration between dental and non-dental health care professionals and whether it influenced the physicians' practice of screening for debilitating oral diseases. The study took place in 2014 and used a mixed-methods approach, consisting of Readiness for Interprofessional Learning Scale (RIPLS) surveys conducted before, immediately after, and six months after the intervention, as well as surveys of self-reported practice behaviors and semi-structured interviews. A total of 231 health care professionals participated in the lectures and roundtable discussions. Of those, 134 responded to the pre-program survey (58% response rate), 110 responded to the post-program survey (48% response rate), and 58 responded to the survey six months after the program (25% response rate). The participants' median total RIPLS score at baseline was 76.5, which increased significantly immediately following the program (81.0) but returned to baseline six months later (76.5). Participants' RIPLS domain scores also increased significantly by profession from before to after the event, with effects returning to baseline after six months. Significantly more physicians reported screening for caries and periodontal disease after the intervention. An overall theme of "learning with, from, and about each other" was drawn from the interviews with 15 participants. The physicians took away a message of "just look in the mouth," while the dental professionals reported feeling valued as members of the health care team. Although reported improvements in oral-systemic health practice

Practical Action Programs in Education: Highlights of the Third National Conference on General Systems Education.

ERIC Educational Resources Information Center

Southern Connecticut State Coll., New Haven. Center for Interdisciplinary Creativity.

In this collection of papers Harold G. Cassidy outlines the conceptual framework for the conference which is based on a systems approach to development of practical action programs in education. A basic model is presented as a basis for shifting from the post-crisis to the pre-crisis approach to curriculum development and educational…

A practical three-dimensional dosimetry system for radiation therapy

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

Guo Pengyi; Adamovics, John; Oldham, Mark

2006-10-15

There is a pressing need for a practical three-dimensional (3D) dosimetry system, convenient for clinical use, and with the accuracy and resolution to enable comprehensive verification of the complex dose distributions typical of modern radiation therapy. Here we introduce a dosimetry system that can achieve this challenge, consisting of a radiochromic dosimeter (PRESAGE trade mark sign ) and a commercial optical computed tomography (CT) scanning system (OCTOPUS trade mark sign ). PRESAGE trade mark sign is a transparent material with compelling properties for dosimetry, including insensitivity of the dose response to atmospheric exposure, a solid texture negating the need formore » an external container (reducing edge effects), and amenability to accurate optical CT scanning due to radiochromic optical contrast as opposed to light-scattering contrast. An evaluation of the performance and viability of the PRESAGE trade mark sign /OCTOPUS, combination for routine clinical 3D dosimetry is presented. The performance of the two components (scanner and dosimeter) was investigated separately prior to full system test. The optical CT scanner has a spatial resolution of {<=}1 mm, geometric accuracy within 1 mm, and high reconstruction linearity (with a R{sup 2} value of 0.9979 and a standard error of estimation of {approx}1%) relative to independent measurement. The overall performance of the PRESAGE trade mark sign /OCTOPUS system was evaluated with respect to a simple known 3D dose distribution, by comparison with GAFCHROMIC[reg] EBT film and the calculated dose from a commissioned planning system. The 'measured' dose distribution in a cylindrical PRESAGE trade mark sign dosimeter (16 cm diameter and 11 cm height) was determined by optical-CT, using a filtered backprojection reconstruction algorithm. A three-way Gamma map comparison (4% dose difference and 4 mm distance to agreement), between the PRESAGE trade mark sign , EBT and calculated dose distributions, showed

A practical model for pressure probe system response estimation (with review of existing models)

NASA Astrophysics Data System (ADS)

Hall, B. F.; Povey, T.

2018-04-01

The accurate estimation of the unsteady response (bandwidth) of pneumatic pressure probe systems (probe, line and transducer volume) is a common practical problem encountered in the design of aerodynamic experiments. Understanding the bandwidth of the probe system is necessary to capture unsteady flow features accurately. Where traversing probes are used, the desired traverse speed and spatial gradients in the flow dictate the minimum probe system bandwidth required to resolve the flow. Existing approaches for bandwidth estimation are either complex or inaccurate in implementation, so probes are often designed based on experience. Where probe system bandwidth is characterized, it is often done experimentally, requiring careful experimental set-up and analysis. There is a need for a relatively simple but accurate model for estimation of probe system bandwidth. A new model is presented for the accurate estimation of pressure probe bandwidth for simple probes commonly used in wind tunnel environments; experimental validation is provided. An additional, simple graphical method for air is included for convenience.

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.

The Cancer Prevention and Control Research Network: An Interactive Systems Approach to Advancing Cancer Control Implementation Research and Practice

PubMed Central

Fernández, María E.; Melvin, Cathy L.; Leeman, Jennifer; Ribisl, Kurt M.; Allen, Jennifer D.; Kegler, Michelle C.; Bastani, Roshan; Ory, Marcia G.; Risendal, Betsy C.; Hannon, Peggy A.; Kreuter, Matthew W.; Hebert, James R.

2018-01-01

Background Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions. Methods The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model. Results We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice. Conclusions The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control. Impact Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them. PMID:25155759

Physician Quality Reporting System (PQRS) for Interventional Pain Management Practices: Challenges and Opportunities.

PubMed

Manchikanti, Laxmaiah; Hammer, Marvel; Benyamin, Ramsin M; Hirsch, Joshua A

2016-01-01

Basing their rationale on multiple publications from Institute of Medicine (IOM), specifically Crossing the Quality Chasm, policy makers have focused on a broad range of issues, including assessment of the influence of medical practice organization structures on quality performance and development of quality measures. The 2006 Tax Relief and Health Care Act established the Physician Quality Reporting System (PQRS), to enable eligible professionals to report health care quality and health outcome information that cannot be obtained from standard Medicare claims. However, the Patient Protection and Affordable Care Act (ACA) of 2010 required the Centers for Medicare and Medicaid Services (CMS) to incorporate a combination of cost and quality into the payment systems for health care as a precursor to value-based payments. The final change to PQRS pending initiation after 2018, is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which has incorporated alternative payment models and merit-based payment systems. Recent publication of quality performance scores by CMS has been less than optimal. When voluntary participation began in July 2007, providers were paid a bonus for reporting quality measures from 2008 through 2014, ranging from 0.5% to 2% of the Medicare Part B allowed charges furnished during the reporting period. Starting in 2015, penalties started for nonparticipation. Eligible professionals and group practices that failed to satisfactorily report data on quality measures during 2014 are subject to a 2% reduction in Medicare fee-for-service amounts for services furnished by the eligible professional or group practice during 2016. The CMS proposed rule for 2016 physician payments contained a number of provisions with proposed updates to the PQRS and Physician Value-Based Payment Modifier among other changes. The proposed rule is the first release since MACRA repealed the sustainable growth rate formula. CMS proposed to continue many

Experience of Using Information Systems in Public Health Practice: Findings from a Qualitative Study

PubMed Central

Vest, Joshua R; Issel, L. Michele; Lee, Sean

2014-01-01

Objective Data collection and management by local health departments (LHDs) is a complex endeavor, complicated by system level and organizational factors. The purpose of this study was to describe the processes and use of information systems (IS) utilized for data collection, management, and sharing by LHD employees. Methods We interviewed a purposive sample of 12 staff working in the key public health practice areas of communicable disease control, immunizations, and vital records from three LHDs in different states. Our interview questions addressed job descriptions, daily activities, and the use and perceptions of both data and IS in support of their work. A content analytic approach was used to derive themes and categories common across programmatic areas. Results Local public health involves the use of mix of state-supplied and locally implemented IS supported by paper records. Additionally, each LHD in this study used at least one shadow system to maintain a duplicate set of information. Experiences with IS functionality and the extent to which it supported work varied by programmatic area, but inefficiencies, challenges in generating reports, limited data accessibility, and workarounds were commonly reported. Conclusions Current approaches to data management and sharing do not always support efficient public health practice or allow data to be used for organizational and community decision making. Many of the challenges to effective and efficient public health work were not solely technological. These findings suggest the need for interorganizational collaboration, increasing organizational capacity, workflow redesign, and end user training. PMID:24678380

Practices implemented by a Texas charter school system to overcome science teacher shortage

NASA Astrophysics Data System (ADS)

Yasar, Bilgehan M.

The purpose of this study was to examine practices used by a charter school system to hire and retain science teachers. The research design for this study was a qualitative case study. This single instrumental case study explored the issue within a bounded system. Purposeful sampling strategy was used to identify the participants who were interviewed individually. Findings of the case study supported that using online resources, advertising in the newspaper, attending job fairs, using alternative certification programs, attracting alumni, contacting the college of educations and hiring internationally helped the charter school system with hiring science teachers. Improving teacher salary scale, implementing teacher mentorship programs, reimbursing teachers for certification and master's programs, providing professional development and supporting teachers helped to retain science teachers. Therefore, this study contributes to determining strategies and techniques, selecting methods and programs, training administrators, and monitoring for successful hiring and retaining science teacher implementation.

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.

A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

PubMed Central

2013-01-01

Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing’s syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy, particularly when used at high doses for prolonged periods. This comprehensive article reviews these adverse events and provides practical recommendations for their prevention and management based on both current literature and the clinical experience of the authors. PMID:23947590

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…

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.

28 CFR 16.78 - Exemption of the Special Counsel for Immigration-Related, Unfair Employment Practices Systems.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Exemption of the Special Counsel for Immigration-Related, Unfair Employment Practices Systems. 16.78 Section 16.78 Judicial Administration... the Privacy Act § 16.78 Exemption of the Special Counsel for Immigration-Related, Unfair Employment...

Reclamation of landfills and dumps of municipal solid waste in a energy efficient waste management system: methodology and practice

NASA Astrophysics Data System (ADS)

Orlova, Tatyana; Melnichuk, Aleksandr; Klimenko, Kseniya; Vitvitskaya, Valentina; Popovych, Valentina; Dunaieva, Ielizaveta; Terleev, Vitaly; Nikonorov, Aleksandr; Togo, Issa; Volkova, Yulia; Mirschel, Wilfried; Garmanov, Vitaly

2017-10-01

The article considers the methodological and practical aspects of reclamation of landfills and dumps of municipal solid waste in a waste management system. The general tendencies of system development in the context of elements of the international concept of waste hierarchy are analyzed. Statistics of the formation and burial of domestic waste indicate a strategic non-alternative to the rejection of landfill technologies in favor of environmentally, energy efficient and economically expedient ways of utilization of municipal waste as a world trend. Practical approaches to the study of territories on which there are dumps and landfills are considered to justify the design solutions for reclamation.

A Practical Study of the 66kV Fault Current Limiter (FCL) System with Rectifier

NASA Astrophysics Data System (ADS)

Tokuda, Noriaki; Matsubara, Yoshio; Yuguchi, Kyosuke; Ohkuma, Takeshi; Hobara, Natsuro; Takahashi, Yoshihisa

A fault current limiter (FCL) is extensively expected to suppress fault current, particularly required for trunk power systems heavily connected high-voltage transmission lines, such as 500kV class power system which constitutes the nucleus of the electric power system. By installing such FCL in the power system, the system interconnection is possible without the need to raise the capacity of the circuit breakers, and facilities can be configured for efficiency, among other benefits. For these reasons, fault current limiters based on various principles of operation have been developed both in Japan and abroad. In this paper, we have proposed a new type of FCL system, consisting of solid-state diodes, DC coil and bypass AC coil, and described the specification of distribution power system and 66kV model at the island power system and the superconducting cable power system. Also we have made a practical study of 66kV class, which is the testing items and the future subjects of the rectifier type FCL system.

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...

Healthcare improvement as planned system change or complex responsive processes? a longitudinal case study in general practice

PubMed Central

2013-01-01

Background Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives – re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions The current discourse

Systems Advocacy in the Professional Practice of Early Childhood Teachers: From the Antithetical to the Ethical

ERIC Educational Resources Information Center

Fenech, Marianne; Lotz, Mianna

2018-01-01

Dominant constructions of professionalism in early childhood education can diminish early childhood teachers' and educators' undertaking of advocacy at the systems or political level. In this paper, we propose an ethically grounded construction of professionalism that provides space for professional practice to move beyond the classroom and into…

Policies on and Practices of Cultural Inclusivity in Learning Management Systems: Perspectives of Indigenous Holistic Pedagogies

ERIC Educational Resources Information Center

Dreamson, Neal; Thomas, Gary; Lee Hong, Anita; Kim, Soyoung

2017-01-01

Online learning has become a conventional term and practice in Australian higher education, yet cultural inclusivity for Indigenous (Indigenous for the purposes of this paper refers to Australian Aboriginal and Torres Strait Islander peoples) students is insufficiently reflected in learning management system (LMS) policies and design. This study…

Research-Based Practices for Reintegrating Students with Emotional and Behavioral Disorders from the Juvenile Justice System

ERIC Educational Resources Information Center

Mathur, Sarup R.; Griller Clark, Heather; LaCroix, Leslie; Short, James

2018-01-01

This article discusses the unique and influential role of school teachers in the rehabilitation and reintegration of students with emotional and behavioral disorders who have been involved with the juvenile justice (JJ) system. By adopting evidenced-based practices, highlighted within this article, teachers can prevent further escalation of…

Interactive effects among ecosystem services and management practices on crop production: pollination in coffee agroforestry systems.

PubMed

Boreux, Virginie; Kushalappa, Cheppudira G; Vaast, Philippe; Ghazoul, Jaboury

2013-05-21

Crop productivity is improved by ecosystem services, including pollination, but this should be set in the context of trade-offs among multiple management practices. We investigated the impact of pollination services on coffee production, considering variation in fertilization, irrigation, shade cover, and environmental variables such as rainfall (which stimulates coffee flowering across all plantations), soil pH, and nitrogen availability. After accounting for management interventions, bee abundance improved coffee production (number of berries harvested). Some management interventions, such as irrigation, used once to trigger asynchronous flowering, dramatically increased bee abundance at coffee trees. Others, such as the extent and type of tree cover, revealed interacting effects on pollination and, ultimately, crop production. The effects of management interventions, notably irrigation and addition of lime, had, however, far more substantial positive effects on coffee production than tree cover. These results suggest that pollination services matter, but managing the asynchrony of flowering was a more effective tool for securing good pollination than maintaining high shade tree densities as pollinator habitat. Complex interactions across farm and landscape scales, including both management practices and environmental conditions, shape pollination outcomes. Effective production systems therefore require the integrated consideration of management practices in the context of the surrounding habitat structure. This paper points toward a more strategic use of ecosystem services in agricultural systems, where ecosystem services are shaped by the coupling of management interventions and environmental variables.

Variability in Accreditation Council for Graduate Medical Education Resident Case Log System practices among orthopaedic surgery residents.

PubMed

Salazar, Dane; Schiff, Adam; Mitchell, Erika; Hopkinson, William

2014-02-05

The Accreditation Council for Graduate Medical Education (ACGME) Resident Case Log System is designed to be a reflection of residents' operative volume and an objective measure of their surgical experience. All operative procedures and manipulations in the operating room, Emergency Department, and outpatient clinic are to be logged into the Resident Case Log System. Discrepancies in the log volumes between residents and residency programs often prompt scrutiny. However, it remains unclear if such disparities truly represent differences in operative experiences or if they are reflections of inconsistent logging practices. The purpose of this study was to investigate individual recording practices among orthopaedic surgery residents prior to August 1, 2011. Orthopaedic surgery residents received a questionnaire on case log practices that was distributed through the Council of Orthopaedic Residency Directors list server. Respondents were asked to respond anonymously about recording practices in different clinical settings as well as types of cases routinely logged. Hypothetical scenarios of common orthopaedic procedures were presented to investigate the differences in the Current Procedural Terminology codes utilized. Two hundred and ninety-eight orthopaedic surgery residents completed the questionnaire; 37% were fifth-year residents, 22% were fourth-year residents, 18% were third-year residents, 15% were second-year residents, and 8% were first-year residents. Fifty-six percent of respondents reported routinely logging procedures performed in the Emergency Department or urgent care setting. Twenty-two percent of participants routinely logged procedures in the clinic or outpatient setting, 20% logged joint injections, and only 13% logged casts or splints applied in the office setting. There was substantial variability in the Current Procedural Terminology codes selected for the seven clinical scenarios. There has been a lack of standardization in case

Validity evidence for an OSCE to assess competency in systems-based practice and practice-based learning and improvement: a preliminary investigation.

PubMed

Varkey, Prathibha; Natt, Neena; Lesnick, Timothy; Downing, Steven; Yudkowsky, Rachel

2008-08-01

To determine the psychometric properties and validity of an OSCE to assess the competencies of Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP) in graduate medical education. An eight-station OSCE was piloted at the end of a three-week Quality Improvement elective for nine preventive medicine and endocrinology fellows at Mayo Clinic. The stations assessed performance in quality measurement, root cause analysis, evidence-based medicine, insurance systems, team collaboration, prescription errors, Nolan's model, and negotiation. Fellows' performance in each of the stations was assessed by three faculty experts using checklists and a five-point global competency scale. A modified Angoff procedure was used to set standards. Evidence for the OSCE's validity, feasibility, and acceptability was gathered. Evidence for content and response process validity was judged as excellent by institutional content experts. Interrater reliability of scores ranged from 0.85 to 1 for most stations. Interstation correlation coefficients ranged from -0.62 to 0.99, reflecting case specificity. Implementation cost was approximately $255 per fellow. All faculty members agreed that the OSCE was realistic and capable of providing accurate assessments. The OSCE provides an opportunity to systematically sample the different subdomains of Quality Improvement. Furthermore, the OSCE provides an opportunity for the demonstration of skills rather than the testing of knowledge alone, thus making it a potentially powerful assessment tool for SBP and PBLI. The study OSCE was well suited to assess SBP and PBLI. The evidence gathered through this study lays the foundation for future validation work.

A practical method to standardise and optimise the Philips DoseRight 2.0 CT automatic exposure control system.

PubMed

Wood, T J; Moore, C S; Stephens, A; Saunderson, J R; Beavis, A W

2015-09-01

Given the increasing use of computed tomography (CT) in the UK over the last 30 years, it is essential to ensure that all imaging protocols are optimised to keep radiation doses as low as reasonably practicable, consistent with the intended clinical task. However, the complexity of modern CT equipment can make this task difficult to achieve in practice. Recent results of local patient dose audits have shown discrepancies between two Philips CT scanners that use the DoseRight 2.0 automatic exposure control (AEC) system in the 'automatic' mode of operation. The use of this system can result in drifting dose and image quality performance over time as it is designed to evolve based on operator technique. The purpose of this study was to develop a practical technique for configuring examination protocols on four CT scanners that use the DoseRight 2.0 AEC system in the 'manual' mode of operation. This method used a uniform phantom to generate reference images which form the basis for how the AEC system calculates exposure factors for any given patient. The results of this study have demonstrated excellent agreement in the configuration of the CT scanners in terms of average patient dose and image quality when using this technique. This work highlights the importance of CT protocol harmonisation in a modern Radiology department to ensure both consistent image quality and radiation dose. Following this study, the average radiation dose for a range of CT examinations has been reduced without any negative impact on clinical image quality.

The impact of a private group practice of converting to an automated medical information system.

PubMed

Templeton, J; Bernes, M; Ostrowski, M

1983-08-01

As hardware and software developments make medical information systems increasingly available to physicians office practices and outpatients facilities, there is a need to focus on systems installation and conversion issues. In addition to the detailed step-by-step implementation plan, the overall impact of the new system should be anticipated. The purchasers should consider such issues as new information flow and user communication patterns between patient care and ancillary and support departments; restructuring of fundamental approaches to work allocation for either batch or real-time systems; and new emphasis on any departments vital to problem-spotting and solving. At California Primary Physicians (CPP), an awareness of these changes did not develop until well after the official "live" data had passed and the staff had been successfully using the system for several months. This paper explains how the above issues have emerged and the impact they have had on CPP, and provides a framework for anticipating such matters in any system installation.

Interventional radiology peer, a newly developed peer-review scoring system designed for interventional radiology practice.

PubMed

d'Othée, Bertrand Janne; Haskal, Ziv J

2013-10-01

Existing diagnostic radiology peer-review systems do not address the specificities of interventional radiology (IR) practice. The purpose of this study was to assess the feasibility of a specifically developed interventional peer review method, IR Peer. Retrospective review of a prospectively encoded pilot database aimed at demonstrating the feasibility of IR Peer in a multiphysician practice was performed. This scoring system used morning peer review of selected IR cases from the previous day in the form of a five-item questionnaire and an ordinal answer scale that grades reviewers' agreement with imaging findings, procedural/technical management, early outcomes, and follow-up plan. Patient lists from IR Peer and morbidity and mortality (M&M) conferences were compared to evaluate the amount of overlap and capability of IR Peer to help detect adverse events (AEs). A total of 417 consecutive reviews of IR attending physician cases by peers were performed in 163 consecutive patients over 18 months, and 94% of cases were reviewed by two or three IR attending physicians. Each question was answered 99%-100% of the time. Answers showed disagreement in 10% of cases (2% by a single reviewer, 8% by several), most related to procedural technique. Overall AE incidence was 1.8%. IR Peer contributed 10.7% of cases to the M&M list. IR Peer is feasible, relevant, and easy to implement in a multiphysician IR practice. When used along with other quality-assurance processes, it might help in the detection of AEs for M&M; the latter will require further confirmatory research. © SIR, 2013.

Neonatal physical therapy. Part II: Practice frameworks and evidence-based practice guidelines.

PubMed

Sweeney, Jane K; Heriza, Carolyn B; Blanchard, Yvette; Dusing, Stacey C

2010-01-01

(1) To outline frameworks for neonatal physical therapy based on 3 theoretical models, (2) to describe emerging literature supporting neonatal physical therapy practice, and (3) to identify evidence-based practice recommendations. Three models are presented as a framework for neonatal practice: (1) dynamic systems theory including synactive theory and the theory of neuronal group selection, (2) the International Classification of Functioning, Disability and Health, and (3) family-centered care. Literature is summarized to support neonatal physical therapists in the areas of examination, developmental care, intervention, and parent education. Practice recommendations are offered with levels of evidence identified. Neonatal physical therapy practice has a theoretical and evidence-based structure, and evidence is emerging for selected clinical procedures. Continued research to expand the science of neonatal physical therapy is critical to elevate the evidence and support practice recommendations.

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

PubMed

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

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,…

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...