[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.

Teacher performance goal practices and elementary students' behavioral engagement: a developmental perspective.

PubMed

Hughes, Jan N; Wu, Wei; West, Stephen G

2011-02-01

We investigated growth trajectories for classroom performance goal practices and for student behavioral engagement across grades 2 to 5 for 497 academically at-risk elementary students. This study is the first longitudinal investigation of performance goal practices in the early elementary years. On average, teacher use of performance goal practices increased and students' behavioral engagement declined across the four years. Using autoregressive latent trajectory (ALT) models, we examined the synchronous relations between teacher-reported performance goal practices and teacher-reported student behavioral engagement. As expected, as students move into classrooms with a new teacher with less emphasis on performance goal practices, they become more behaviorally engaged in school. Gender did not moderate these results. Implications for teacher professional development are discussed. Published by Elsevier Ltd.

An Intensive Onsite Technical Assistance Model to Promote Inclusive Educational Practices for Students with Disabilities in Middle School and High School

ERIC Educational Resources Information Center

Clark, Nitasha M.; Cushing, Lisa S.; Kennedy, Craig H.

2004-01-01

The authors examined the effects of an intensive onsite technical assistance (IOTA) model on the inclusive practices of special educators. Three special educators received technical assistance that included performance assessments, workshops on inclusive practices, and intensive onsite follow-up support. Inclusive practices were measured using…

Are Low-Performing Schools Adopting Practices Promoted by School Improvement Grants? NCEE Evaluation Brief. NCEE 2015-4001

ERIC Educational Resources Information Center

Herrmann, Mariesa; Dragoset, Lisa; James-Burdumy, Susanne

2014-01-01

The federal School Improvement Grants (SIG) program aims to improve student achievement by promoting the implementation of four school intervention models: transformation, turnaround, restart, and closure. Previous research provides evidence that low-performing schools adopt some practices promoted by the four models, but little is known about how…

Alignment of Human Resource Practices and Teacher Performance Competency

ERIC Educational Resources Information Center

Heneman III, Herbert G.; Milanowski, Anthony T.

2004-01-01

In this article, we argue that human resource (HR) management practices are important components of strategies for improving student achievement in an accountability environment. We present a framework illustrating the alignment of educational HR management practices to a teacher performance competency model, which in turn is aligned with student…

Risk-adjusted payment and performance assessment for primary care.

PubMed

Ash, Arlene S; Ellis, Randall P

2012-08-01

Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected primary care activity levels (PCAL) and 9 patient outcomes for performance assessment. We evaluated models using 457,000 people assigned to 436 primary care physician panels, and among 13,000 people in a distinct multipayer medical home implementation with commercially insured, Medicare, and Medicaid patients. Each outcome is separately predicted from age, sex, and diagnoses. We define the PCAL outcome as a subset of all costs that proxies the bundled payment needed for comprehensive primary care. Other expected outcomes are used to establish targets against which actual performance can be fairly judged. We evaluate model performance using R(2)'s at patient and practice levels, and within policy-relevant subgroups. The PCAL model explains 67% of variation in its outcome, performing well across diverse patient ages, payers, plan types, and provider specialties; it explains 72% of practice-level variation. In 9 performance measures, the outcome-specific models explain 17%-86% of variation at the practice level, often substantially outperforming a generic score like the one used for full capitation payments in Medicare: for example, with grouped R(2)'s of 47% versus 5% for predicting "prescriptions for antibiotics of concern." Existing data can support the risk-adjusted bundled payment calculations and performance assessments needed to encourage desired transformations in primary care.

COLLABORATE©, Part IV: Ramping Up Competency-Based Performance Management.

PubMed

Treiger, Teresa M; Fink-Samnick, Ellen

The purpose of this fourth part of the COLLABORATE© article series provides an expansion and application of previously presented concepts pertaining to the COLLABORATE paradigm of professional case management practice. The model is built upon a value-driven foundation that: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. As an industry, health care continues to evolve. Terrain shifts and new influences continually surface to challenge professional case management practice. The need for top-performing and nimble professionals who are knowledgeable and proficient in the workplace continues to challenge human resource departments. In addition to care setting knowledge, professional case managers must continually invest in their practice competence toolbox to grow skills and abilities that transcend policies and processes. These individuals demonstrate agility in framing (and reframing) their professional practice to facilitate the best possible outcomes for their clients. Therefore, the continued emphasis on practice competence conveyed through the performance management cycle is an essential ingredient to performance management focused on customer service excellence and organizational improvement. Professional case management transcends professional disciplines, educational levels, and practice settings. Business objectives continue to drive work process and priorities in many practice settings. However, competencies that align with regulatory and accreditation requirements should be the critical driver for consistent, high-quality case management practice. Although there is inherent value in what various disciplines bring to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities.

Cheques and challenges: business performance in New Zealand general practice.

PubMed

Greatbanks, Richard; Doolan-Noble, Fiona; McKenna, Alex

2017-09-01

INTRODUCTION New Zealand general practice mainly functions as small businesses, usually owned by a single or small group of doctors. Consequently, owners often have to balance the provision of patient care with varying funding priorities, changing patient needs and the pressures of running a sustainable business. Such balancing inevitably leads to tensions developing between these factors. AIM To explore and understand these tensions and responses to them, by examining the business performance measurements used by general practice. METHODS For this study, the unit of analysis and focus were individual practices, but qualitative semi-structured interviews with general practitioners (GPs) and practice managers were used to gather the data. RESULTS All participating practices had some form of governance or board review, where high-level aggregated business performance data were presented. More sophisticated business performance measures were evident in the larger, more developed practices and in practices functioning as community trusts. Examples of such measures included doctor utilisation and efficiency, appraisal of risk, patient satisfaction with services and responses to changes in patient demand. DISCUSSION As the number of general practices based on the traditional model decrease, a corresponding increase is likely in the establishment and development of 'super practices' based on a corporatized, multi-service, single-location model. Consequently, service delivery will become increasingly complex and will drive a need for increased sophistication in how general practice measures its business performance, thus ensuring a balance between high-quality, safe patient care and the maintenance of a sustainable business.

Current practices in pavement performance modeling project 08-03 (C07) : task 4 report final summary of findings.

DOT National Transportation Integrated Search

2010-02-26

In anticipation of developing pavement performance models as part of a proposed pavement management : system, the Pennsylvania Department of Transportation (PennDOT) initiated a study in 2009 to investigate : performance modeling activities and condi...

The relationship between quality management practices and organisational performance: A structural equation modelling approach

NASA Astrophysics Data System (ADS)

Jamaluddin, Z.; Razali, A. M.; Mustafa, Z.

2015-02-01

The purpose of this paper is to examine the relationship between the quality management practices (QMPs) and organisational performance for the manufacturing industry in Malaysia. In this study, a QMPs and organisational performance framework is developed according to a comprehensive literature review which cover aspects of hard and soft quality factors in manufacturing process environment. A total of 11 hypotheses have been put forward to test the relationship amongst the six constructs, which are management commitment, training, process management, quality tools, continuous improvement and organisational performance. The model is analysed using Structural Equation Modeling (SEM) with AMOS software version 18.0 using Maximum Likelihood (ML) estimation. A total of 480 questionnaires were distributed, and 210 questionnaires were valid for analysis. The results of the modeling analysis using ML estimation indicate that the fits statistics of QMPs and organisational performance model for manufacturing industry is admissible. From the results, it found that the management commitment have significant impact on the training and process management. Similarly, the training had significant effect to the quality tools, process management and continuous improvement. Furthermore, the quality tools have significant influence on the process management and continuous improvement. Likewise, the process management also has a significant impact to the continuous improvement. In addition the continuous improvement has significant influence the organisational performance. However, the results of the study also found that there is no significant relationship between management commitment and quality tools, and between the management commitment and continuous improvement. The results of the study can be used by managers to prioritize the implementation of QMPs. For instances, those practices that are found to have positive impact on organisational performance can be recommended to managers so that they can allocate resources to improve these practices to get better performance.

Associations between motor timing, music practice, and intelligence studied in a large sample of twins.

PubMed

Ullén, Fredrik; Mosing, Miriam A; Madison, Guy

2015-03-01

Music performance depends critically on precise processing of time. A common model behavior in studies of motor timing is isochronous serial interval production (ISIP), that is, hand/finger movements with a regular beat. ISIP accuracy is related to both music practice and intelligence. Here we present a study of these associations in a large twin cohort, demonstrating that the effects of music practice and intelligence on motor timing are additive, with no significant multiplicative (interaction) effect. Furthermore, the association between music practice and motor timing was analyzed with the use of a co-twin control design using intrapair differences. These analyses revealed that the phenotypic association disappeared when all genetic and common environmental factors were controlled. This suggests that the observed association may not reflect a causal effect of music practice on ISIP performance but rather reflect common influences (e.g., genetic effects) on both outcomes. The relevance of these findings for models of practice and expert performance is discussed. © 2014 New York Academy of Sciences.

Predicting medical students' intentions to take up rural practice after graduation.

PubMed

Jones, Michael; Humphreys, John; Prideaux, David

2009-10-01

Using a novel longitudinal tracking project, this study develops and evaluates the performance of a predictive model and index of rural medical practice intention based on the characteristics of incoming medical students. Medical school entry survey data were obtained from the Medical Schools Outcome Database (MSOD) project implemented in all Australian and New Zealand medical schools and coordinated through Medical Deans Australia and New Zealand, the representative body for the Deans of 18 Australian and two New Zealand medical schools and faculties. The medical school commencement survey collects data on students' education and family background, including rural upbringing, personal circumstances and scholarships, and on their practice intentions in terms of location and specialty. The MSOD will also allow tracking of medical graduates after graduation. Logistic regression modelling was used to develop a predictive model of rural practice intention. Split-sample validation was used to gain some insight into the stability of performance of the model. Response rates to the MSOD survey exceeded 90% on average. The model findings confirm and extend previous research examining the association of medical student characteristics with intention to take up rural medical practice. The statistically significant independent factors in the model included students' rural backgrounds, financial arrangements and intentions regarding specialist versus generalist practice upon graduation. Model performance was good, with an area under the receiver-operator characteristics curve of 0.86, and reproducible, with an area in a validation sample of 0.83. The model and related index provide important insights into individual factors associated with rural practice intention among students commencing medical studies. The model can also provide a means for optimising the use of scarce medical programme resources, thereby helping to improve the supply of rural medical practitioners. This study illustrates the power and potential of a robust, consistent, systematic longitudinal tracking project.

Explaining high and low performers in complex intervention trials: a new model based on diffusion of innovations theory.

PubMed

McMullen, Heather; Griffiths, Chris; Leber, Werner; Greenhalgh, Trisha

2015-05-31

Complex intervention trials may require health care organisations to implement new service models. In a recent cluster randomised controlled trial, some participating organisations achieved high recruitment, whereas others found it difficult to assimilate the intervention and were low recruiters. We sought to explain this variation and develop a model to inform organisational participation in future complex intervention trials. The trial included 40 general practices in a London borough with high HIV prevalence. The intervention was offering a rapid HIV test as part of the New Patient Health Check. The primary outcome was mean CD4 cell count at diagnosis. The process evaluation consisted of several hundred hours of ethnographic observation, 21 semi-structured interviews and analysis of routine documents (e.g., patient leaflets, clinical protocols) and trial documents (e.g., inclusion criteria, recruitment statistics). Qualitative data were analysed thematically using--and, where necessary, extending--Greenhalgh et al.'s model of diffusion of innovations. Narrative synthesis was used to prepare case studies of four practices representing maximum variety in clinicians' interest in HIV (assessed by level of serological testing prior to the trial) and performance in the trial (high vs. low recruiters). High-recruiting practices were, in general though not invariably, also innovative practices. They were characterised by strong leadership, good managerial relations, readiness for change, a culture of staff training and available staff time ('slack resources'). Their front-line staff believed that patients might benefit from the rapid HIV test ('relative advantage'), were emotionally comfortable administering it ('compatibility'), skilled in performing it ('task issues') and made creative adaptations to embed the test in local working practices ('reinvention'). Early experience of a positive HIV test ('observability') appeared to reinforce staff commitment to recruiting more participants. Low-performing practices typically had less good managerial relations, significant resource constraints, staff discomfort with the test and no positive results early in the trial. An adaptation of the diffusion of innovations model was an effective analytical tool for retrospectively explaining high and low-performing practices in a complex intervention research trial. Whether the model will work prospectively to predict performance (and hence shape the design of future trials) is unknown. ISRCTN Registry number: ISRCTN63473710. Date assigned: 22 April 2010.

An Illustrative Case Study of the Heuristic Practices of a High-Performing Research Department: Toward Building a Model Applicable in the Context of Large Urban Districts

ERIC Educational Resources Information Center

Munoz, Marco A.; Rodosky, Robert J.

2011-01-01

This case study provides an illustration of the heuristic practices of a high-performing research department, which in turn, will help build much needed models applicable in the context of large urban districts. This case study examines the accountability, planning, evaluation, testing, and research functions of a research department in a large…

Unifying practice schedules in the timescales of motor learning and performance.

PubMed

Verhoeven, F Martijn; Newell, Karl M

2018-06-01

In this article, we elaborate from a multiple time scales model of motor learning to examine the independent and integrated effects of massed and distributed practice schedules within- and between-sessions on the persistent (learning) and transient (warm-up, fatigue) processes of performance change. The timescales framework reveals the influence of practice distribution on four learning-related processes: the persistent processes of learning and forgetting, and the transient processes of warm-up decrement and fatigue. The superposition of the different processes of practice leads to a unified set of effects for massed and distributed practice within- and between-sessions in learning motor tasks. This analysis of the interaction between the duration of the interval of practice trials or sessions and parameters of the introduced time scale model captures the unified influence of the between trial and session scheduling of practice on learning and performance. It provides a starting point for new theoretically based hypotheses, and the scheduling of practice that minimizes the negative effects of warm-up decrement, fatigue and forgetting while exploiting the positive effects of learning and retention. Copyright © 2018 Elsevier B.V. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2018-02-01

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

Development of an Empirically Based Learning Performances Framework for Third-Grade Students' Model-Based Explanations about Plant Processes

ERIC Educational Resources Information Center

Zangori, Laura; Forbes, Cory T.

2016-01-01

To develop scientific literacy, elementary students should engage in knowledge building of core concepts through scientific practice (Duschl, Schweingruber, & Schouse, 2007). A core scientific practice is engagement in scientific modeling to build conceptual understanding about discipline-specific concepts. Yet scientific modeling remains…

Performance of new alternative providers of primary care services in England: an observational study

PubMed Central

Greaves, Felix; Laverty, Anthony A; Pape, Utz; Ratneswaren, Anenta; Majeed, Azeem

2015-01-01

Summary Objectives Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants – including private companies – have been allowed into the primary care market under ‘alternative provider of medical services’ contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. Design Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. Setting The English National Health Service. Participants All general practices open from 2008/2009 to 2012/2013. Main outcome measures Seventeen established quality indicators – covering clinical effectiveness, efficiency, access and patient experience. Results In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p < 0.01 for all). Switching to a new alternative provider contract did not result in improved performance. Conclusions The introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers. PMID:25908312

Performance of new alternative providers of primary care services in England: an observational study.

PubMed

Greaves, Felix; Laverty, Anthony A; Pape, Utz; Ratneswaren, Anenta; Majeed, Azeem; Millett, Christopher

2015-05-01

Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants--including private companies--have been allowed into the primary care market under 'alternative provider of medical services' contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice. Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type. The English National Health Service. All general practices open from 2008/2009 to 2012/2013. Seventeen established quality indicators--covering clinical effectiveness, efficiency, access and patient experience. In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p < 0.01 for all). Switching to a new alternative provider contract did not result in improved performance. The introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers. © The Royal Society of Medicine.

The public health nutrition intervention management bi-cycle: a model for training and practice improvement.

PubMed

Hughes, Roger; Margetts, Barrie

2012-11-01

The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

Using a shared governance structure to evaluate the implementation of a new model of care: the shared experience of a performance improvement committee.

PubMed

Myers, Mary; Parchen, Debra; Geraci, Marilla; Brenholtz, Roger; Knisely-Carrigan, Denise; Hastings, Clare

2013-10-01

Sustaining change in the behaviors and habits of experienced practicing nurses can be frustrating and daunting, even when changes are based on evidence. Partnering with an active shared governance structure to communicate change and elicit feedback is an established method to foster partnership, equity, accountability, and ownership. Few recent exemplars in the literature link shared governance, change management, and evidence-based practice to transitions in care models. This article describes an innovative staff-driven approach used by nurses in a shared governance performance improvement committee to use evidence-based practice in determining the best methods to evaluate the implementation of a new model of care.

Using a Shared Governance Structure to Evaluate the Implementation of a New Model of Care: The Shared Experience of a Performance Improvement Committee

PubMed Central

Myers, Mary; Parchen, Debra; Geraci, Marilla; Brenholtz, Roger; Knisely-Carrigan, Denise; Hastings, Clare

2013-01-01

Sustaining change in the behaviors and habits of experienced practicing nurses can be frustrating and daunting, even when changes are based on evidence. Partnering with an active shared governance structure to communicate change and elicit feedback is an established method to foster partnership, equity, accountability and ownership. Few recent exemplars in the literature link shared governance, change management and evidence-based practice to transitions in care models. This article describes an innovative staff-driven approach used by nurses in a shared governance performance improvement committee to use evidence based practice in determining the best methods to evaluate the implementation of a new model of care. PMID:24061583

A New Model of Tracheostomy Care: Closing the Research-Practice Gap

DTIC Science & Technology

2003-01-01

521 A New Model of Tracheostomy Care: Closing the Research –Practice Gap Joel St. Clair Abstract Performance improvements have brought about...and it continues to close the research - practice gap . The WRAMC Department of Nursing is presently developing similar evidence-based procedures for... Research -Practice Gap 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK

Using Performance Analysis for Training in an Organization Implementing ISO-9000 Manufacturing Practices: A Case Study.

ERIC Educational Resources Information Center

Kunneman, Dale E.; Sleezer, Catherine M.

2000-01-01

This case study examines the application of the Performance Analysis for Training (PAT) Model in an organization that was implementing ISO-9000 (International Standards Organization) processes for manufacturing practices. Discusses the interaction of organization characteristics, decision maker characteristics, and analyst characteristics to…

An honest day's work: pay for performance in a pediatric radiology department.

PubMed

Bisset, George S

2017-06-01

Compensation models in radiology take a variety of forms, but regardless of practice type, successful models must reward productivity, be simple, and epitomize fairness. The ideal model should also be flexible enough to transition, based upon the changing strategic goals of a department. The plan should be constructed around rewarding the behaviors that the organization values. In this minisymposium article the author presents the value of different types of compensation plans and discusses advantages and disadvantages. Finally, the author presents a pay-for-performance model that has had long-term success at a private-turned-academic practice in pediatric radiology.

Thermal comfort: research and practice.

PubMed

van Hoof, Joost; Mazej, Mitja; Hensen, Jan L M

2010-01-01

Thermal comfort--the state of mind, which expresses satisfaction with the thermal environment--is an important aspect of the building design process as modern man spends most of the day indoors. This paper reviews the developments in indoor thermal comfort research and practice since the second half of the 1990s, and groups these developments around two main themes; (i) thermal comfort models and standards, and (ii) advances in computerization. Within the first theme, the PMV-model (Predicted Mean Vote), created by Fanger in the late 1960s is discussed in the light of the emergence of models of adaptive thermal comfort. The adaptive models are based on adaptive opportunities of occupants and are related to options of personal control of the indoor climate and psychology and performance. Both models have been considered in the latest round of thermal comfort standard revisions. The second theme focuses on the ever increasing role played by computerization in thermal comfort research and practice, including sophisticated multi-segmental modeling and building performance simulation, transient thermal conditions and interactions, thermal manikins.

An Integrated Performance-Based Budgeting Model for Thai Higher Education

ERIC Educational Resources Information Center

Charoenkul, Nantarat; Siribanpitak, Pruet

2012-01-01

This research mainly aims to develop an administrative model of performance-based budgeting for autonomous state universities. The sample population in this study covers 4 representatives of autonomous state universities from 4 regions of Thailand, where the performance-based budgeting system has been fully practiced. The research informants…

Performance Improvement: Applying a Human Performance Model to Organizational Processes in a Military Training Environment

ERIC Educational Resources Information Center

Aaberg, Wayne; Thompson, Carla J.; West, Haywood V.; Swiergosz, Matthew J.

2009-01-01

This article provides a description and the results of a study that utilized the human performance (HP) model and methods to explore and analyze a training organization. The systemic and systematic practices of the HP model are applicable to military training organizations as well as civilian organizations. Implications of the study for future…

Quality of care for patients with diabetes mellitus type 2 in 'model practices' in Slovenia - first results.

PubMed

Petek, Davorina; Mlakar, Mitja

2016-09-01

A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices. A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared. The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort. The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.

Why Study Time Does Not Predict Grade Point Average across College Students: Implications of Deliberate Practice for Academic Performance

ERIC Educational Resources Information Center

Plant, E. Ashby; Ericsson, K. Anders; Hill, Len; Asberg, Kia

2005-01-01

The current work draws upon the theoretical framework of deliberate practice in order to clarify why the amount of study by college students is a poor predictor of academic performance. A model was proposed where performance in college, both cumulatively and for a current semester, was jointly determined by previous knowledge and skills as well as…

Best practices for assessing competence and performance of the behavioral health workforce.

PubMed

Bashook, Philip G

2005-01-01

The need for mechanisms to assess the competence and performance of the behavioral health workforce has received increasing attention. This article reviews strategies used in general medicine and other disciplines for assessing trainees and practitioners. The possibilities and limitations of various approaches are reviewed, and the implications for behavioral health are addressed. A conceptual model of competence is presented, and practical applications of this model are reviewed. Finally, guidelines are proposed for building competency assessment protocols for behavioral health.

Impact of organisational characteristics on turnover intention among care workers in nursing homes in Korea: a structural equation model.

PubMed

Ha, Jong Goon; Man Kim, Ji; Hwang, Won Ju; Lee, Sang Gyu

2014-09-01

The aim of the present study was to analyse the impact of organisational characteristics on the turnover intention of care workers working at nursing homes in Korea. Study participants included 504 care workers working at 14 nursing homes in Korea. The variables measured were: high-performance work practices, consisting of five subfactors (official training, employment stability, autonomy, employee participation and group-based payment); organisational commitment, consisting of three subfactors (affective, normative and continuance commitment); organisational support; and turnover intention. The inter-relationship between high-performance work practices, organisational support, organisational commitment and turnover intention and the fit of the hypothetical model were analysed using structural equation modelling. According to our analysis, high-performance work practices not only had a direct effect on turnover intention, but also an indirect effect by mediating organisational support and commitment. The factor having the largest direct influence on turnover intention was organisational commitment. The results of the present study suggest that to improve health conditions for frail elderly patients at nursing homes, as well as the efficiency of nursing homes through the continuance of nursing service and enhancement of quality of service, long-term care facilities should reduce the turnover intention of care workers by increasing their organisational commitment by actively implementing high-performance work practices.

[Students' physical activity: an analysis according to Pender's health promotion model].

PubMed

Guedes, Nirla Gomes; Moreira, Rafaella Pessoa; Cavalcante, Tahissa Frota; de Araujo, Thelma Leite; Ximenes, Lorena Barbosa

2009-12-01

The objective of this study was to describe the everyday physical activity habits of students and analyze the practice of physical activity and its determinants, based on the first component of Pender's health promotion model. This cross-sectional study was performed from 2004 to 2005 with 79 students in a public school in Fortaleza, Ceará, Brazil. Data collection was performed by interviews and physical examinations. The data were analyzed according to the referred theoretical model. Most students (n=60) were physically active. Proportionally, adolescents were the most active (80.4%). Those with a sedentary lifestyle had higher rates for overweight and obesity (21.1%). Many students practiced outdoor physical activities, which did not require any physical structure and good financial conditions. The results show that it is possible to associate the first component of Pender's health promotion model with the everyday lives of students in terms of the physical activity practice.

Adaptation and learning: characteristic time scales of performance dynamics.

PubMed

Newell, Karl M; Mayer-Kress, Gottfried; Hong, S Lee; Liu, Yeou-Teh

2009-12-01

A multiple time scales landscape model is presented that reveals structures of performance dynamics that were not resolved in the traditional power law analysis of motor learning. It shows the co-existence of separate processes during and between practice sessions that evolve in two independent dimensions characterized by time scales that differ by about an order of magnitude. Performance along the slow persistent dimension of learning improves often as much and sometimes more during rest (memory consolidation and/or insight generation processes) than during a practice session itself. In contrast, the process characterized by the fast, transient dimension of adaptation reverses direction between practice sessions, thereby significantly degrading performance at the beginning of the next practice session (warm-up decrement). The theoretical model fits qualitatively and quantitatively the data from Snoddy's [Snoddy, G. S. (1926). Learning and stability. Journal of Applied Psychology, 10, 1-36] classic learning study of mirror tracing and other averaged and individual data sets, and provides a new account of the processes of change in adaptation and learning. 2009 Elsevier B.V. All rights reserved.

Instructional practices and science performance of 10 top-performing regions in PISA 2015

NASA Astrophysics Data System (ADS)

Lau, Kwok-chi; Lam, Terence Yuk-ping

2017-10-01

This study analysed 10 top-performing regions in PISA 2015 on their science performances and instructional practices. The regions include Singapore, Japan, Estonia, Taipei, Finland, Macao, Canada, Hong Kong, China and Korea. The science performances of the 10 regions and their teaching practices are described and compared. The construct of enquiry-based instruction as developed in PISA 2015 is revised into two new constructs using factor analysis. Then, the relationships of the teaching practices with science performance are analysed using hierarchical linear modelling. Adaptive instruction, teacher-directed instruction and interactive application are found positively associated with performance in all regions, while investigation and perceived feedback are all negative. The regions except Japan and Korea tend to have a high frequency of teacher-directed instruction facilitated by more or less authoritative class discussion in class. A fair amount of practical work is done, but not many of them are investigations. The cultural influences on teaching practices are discussed on how an amalgam of didactic and constructivist pedagogy is created by the Western progressive educational philosophy meeting the Confucian culture. The reasons for investigation's negative association with performance are also explored.

Ensuring quality and safety.

PubMed

Reid, Jerry

2010-01-01

The certification model addresses quality and safety by directly targeting the qualifications of individuals. The practice accreditation model takes a more global approach to quality and safety and addresses the qualifications of individuals and standards for additional components of the quality chain. Although both certification and practice accreditation fundamentally are voluntary, the programs may become mandatory when enforcement mechanisms are linked to the programs via state or federal legislation or via private reimbursement policies, effectively resulting in mandatory standards. The CARE bill takes a certification approach to quality and safety by focusing on the qualifications of the individual. MIPPA takes an accreditation approach by focusing on the practice. MQSA is somewhat of a hybrid in that it takes an accreditation approach, but spells out standards for the individual that the accreditor must follow. If the practice accreditation standards require that all technologists employed in the practice be certified in the modalities performed, then the practice accreditation model and the certification model become functionally equivalent in terms of personnel qualifications. To the extent that practice accreditation models are less prescriptive regarding personnel standards, the certification model results in more stringent standards.

Children's perceptions of the classroom environment and social and academic performance: a longitudinal analysis of the contribution of the Responsive Classroom approach.

PubMed

Brock, Laura L; Nishida, Tracy K; Chiong, Cynthia; Grimm, Kevin J; Rimm-Kaufman, Sara E

2008-04-01

This study examines the contribution of the Responsive Classroom (RC) Approach, a set of teaching practices that integrate social and academic learning, to children's perceptions of their classroom, and children's academic and social performance over time. Three questions emerge: (a) What is the concurrent and cumulative relation between children's perceptions of the classroom and social and academic outcomes over time? (b) What is the contribution of teacher's use of RC practices to children's perceptions and social and academic outcomes? (c) Do children's perceptions of the classroom mediate the relation between RC teacher practices and child outcomes? Cross-lagged autoregressive structural equation models were used to analyze teacher and child-report questionnaire data, along with standardized test scores collected over 3 years from a sample of 520 children in grades 3-5. Results indicate a significant positive relation between RC teacher practices and child perceptions and outcomes over time. Further, children's perceptions partially mediated the relation between RC teacher practices and social competence. However, the models did not demonstrate that child perceptions mediated the relation between RC practices and achievement outcomes. Results are explained in terms of the contribution of teacher practices to children's perceptions and student performance.

DoD Product Line Practice Workshop Report

DTIC Science & Technology

1998-05-01

capability. The essential enterprise management practices include ensuring sound business goals providing an appropriate funding model performing...business. This way requires vision and explicit support at the organizational level. There must be an explicit funding model to support the development...the same group seems to work best in smaller organizations. A funding model for core asset development also needs to be developed because the core

Uncovering and Explaining Variance in the Features and Outcomes of Contingent Work.

ERIC Educational Resources Information Center

Lautsch, Brenda A.

2002-01-01

Internal labor market theory and data from two case studies were used to construct four models of contingent work (integration, seasonal, separation, two tier) with different performance objectives, technology, work practices, and worker outcomes. Each model involved practices related to job descriptions, wage, rules, and career ladders that…

PV_LIB Toolbox

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

2012-09-11

While an organized source of reference information on PV performance modeling is certainly valuable, there is nothing to match the availability of actual examples of modeling algorithms being used in practice. To meet this need, Sandia has developed a PV performance modeling toolbox (PV_LIB) for Matlab. It contains a set of well-documented, open source functions and example scripts showing the functions being used in practical examples. This toolbox is meant to help make the multi-step process of modeling a PV system more transparent and provide the means for model users to validate and understand the models they use and ormore » develop. It is fully integrated into Matlab's help and documentation utilities. The PV_LIB Toolbox provides more than 30 functions that are sorted into four categories« less

Practical Formal Verification of Diagnosability of Large Models via Symbolic Model Checking

NASA Technical Reports Server (NTRS)

Cavada, Roberto; Pecheur, Charles

2003-01-01

This document reports on the activities carried out during a four-week visit of Roberto Cavada at the NASA Ames Research Center. The main goal was to test the practical applicability of the framework proposed, where a diagnosability problem is reduced to a Symbolic Model Checking problem. Section 2 contains a brief explanation of major techniques currently used in Symbolic Model Checking, and how these techniques can be tuned in order to obtain good performances when using Model Checking tools. Diagnosability is performed on large and structured models of real plants. Section 3 describes how these plants are modeled, and how models can be simplified to improve the performance of Symbolic Model Checkers. Section 4 reports scalability results. Three test cases are briefly presented, and several parameters and techniques have been applied on those test cases in order to produce comparison tables. Furthermore, comparison between several Model Checkers is reported. Section 5 summarizes the application of diagnosability verification to a real application. Several properties have been tested, and results have been highlighted. Finally, section 6 draws some conclusions, and outlines future lines of research.

Physical Activity Predicts Performance in an Unpracticed Bimanual Coordination Task.

PubMed

Boisgontier, Matthieu P; Serbruyns, Leen; Swinnen, Stephan P

2017-01-01

Practice of a given physical activity is known to improve the motor skills related to this activity. However, whether unrelated skills are also improved is still unclear. To test the impact of physical activity on an unpracticed motor task, 26 young adults completed the international physical activity questionnaire and performed a bimanual coordination task they had never practiced before. Results showed that higher total physical activity predicted higher performance in the bimanual task, controlling for multiple factors such as age, physical inactivity, music practice, and computer games practice. Linear mixed models allowed this effect of physical activity to be generalized to a large population of bimanual coordination conditions. This finding runs counter to the notion that generalized motor abilities do not exist and supports the existence of a "learning to learn" skill that could be improved through physical activity and that impacts performance in tasks that are not necessarily related to the practiced activity.

How to Construct More Accurate Student Models: Comparing and Optimizing Knowledge Tracing and Performance Factor Analysis

ERIC Educational Resources Information Center

Gong, Yue; Beck, Joseph E.; Heffernan, Neil T.

2011-01-01

Student modeling is a fundamental concept applicable to a variety of intelligent tutoring systems (ITS). However, there is not a lot of practical guidance on how to construct and train such models. This paper compares two approaches for student modeling, Knowledge Tracing (KT) and Performance Factors Analysis (PFA), by evaluating their predictive…

Model performance evaluation (validation and calibration) in model-based studies of therapeutic interventions for cardiovascular diseases : a review and suggested reporting framework.

PubMed

Haji Ali Afzali, Hossein; Gray, Jodi; Karnon, Jonathan

2013-04-01

Decision analytic models play an increasingly important role in the economic evaluation of health technologies. Given uncertainties around the assumptions used to develop such models, several guidelines have been published to identify and assess 'best practice' in the model development process, including general modelling approach (e.g., time horizon), model structure, input data and model performance evaluation. This paper focuses on model performance evaluation. In the absence of a sufficient level of detail around model performance evaluation, concerns regarding the accuracy of model outputs, and hence the credibility of such models, are frequently raised. Following presentation of its components, a review of the application and reporting of model performance evaluation is presented. Taking cardiovascular disease as an illustrative example, the review investigates the use of face validity, internal validity, external validity, and cross model validity. As a part of the performance evaluation process, model calibration is also discussed and its use in applied studies investigated. The review found that the application and reporting of model performance evaluation across 81 studies of treatment for cardiovascular disease was variable. Cross-model validation was reported in 55 % of the reviewed studies, though the level of detail provided varied considerably. We found that very few studies documented other types of validity, and only 6 % of the reviewed articles reported a calibration process. Considering the above findings, we propose a comprehensive model performance evaluation framework (checklist), informed by a review of best-practice guidelines. This framework provides a basis for more accurate and consistent documentation of model performance evaluation. This will improve the peer review process and the comparability of modelling studies. Recognising the fundamental role of decision analytic models in informing public funding decisions, the proposed framework should usefully inform guidelines for preparing submissions to reimbursement bodies.

Evaluation of a Jugular Venipuncture Alpaca Model to Teach the Technique of Blood Sampling in Adult Alpacas.

PubMed

Rousseau, Marjolaine; Beauchamp, Guy; Nichols, Sylvain

The effectiveness of teaching aids in veterinary medical education is not often assessed rigorously. The objective in the present study was to evaluate the effectiveness of a commercially available jugular venipuncture alpaca model as a complementary tool to teach veterinary students how to perform venipuncture in adult alpacas. We hypothesized that practicing on the model would allow veterinary students to draw blood in alpacas more rapidly with fewer attempts than students without previous practice on the model. Thirty-six third-year veterinary students were enrolled and randomly allocated to the model (group M; n=18) or the control group (group C; n=18). The venipuncture technique was taught to all students on day 0. Students in group M practiced on the model on day 2. On day 5, an evaluator blinded to group allocation evaluated the students' venipuncture skills during a practical examination using live alpacas. Success was defined as the aspiration of a 6-ml sample of blood. Measured outcomes included number of attempts required to achieve success (success score), total procedural time, and overall qualitative score. Success scores, total procedural time, and overall scores did not differ between groups. Use of restless alpacas reduced performance. The jugular venipuncture alpaca model failed to improve jugular venipuncture skills in this student population. Lack of movement represents a significant weakness of this training model.

An Approach for Calculating Land Valuation by Using Inspire Data Models

NASA Astrophysics Data System (ADS)

Aydinoglu, A. C.; Bovkir, R.

2017-11-01

Land valuation is a highly important concept for societies and governments have always emphasis on the process especially for taxation, expropriation, market capitalization and economic activity purposes. To success an interoperable and standardised land valuation, INSPIRE data models can be very practical and effective. If data used in land valuation process produced in compliance with INSPIRE specifications, a reliable and effective land valuation process can be performed. In this study, possibility of the performing land valuation process with using the INSPIRE data models was analysed and with the help of Geographic Information Systems (GIS) a case study in Pendik was implemented. For this purpose, firstly data analysis and gathering was performed. After, different data structures were transformed according to the INSPIRE data model requirements. For each data set necessary ETL (Extract-Transform-Load) tools were produced and all data transformed according to the target data requirements. With the availability and practicability of spatial analysis tools of GIS software, land valuation calculations were performed for study area.

The robust model predictive control based on mixed H2/H∞ approach with separated performance formulations and its ISpS analysis

NASA Astrophysics Data System (ADS)

Li, Dewei; Li, Jiwei; Xi, Yugeng; Gao, Furong

2017-12-01

In practical applications, systems are always influenced by parameter uncertainties and external disturbance. Both the H2 performance and the H∞ performance are important for the real applications. For a constrained system, the previous designs of mixed H2/H∞ robust model predictive control (RMPC) optimise one performance with the other performance requirement as a constraint. But the two performances cannot be optimised at the same time. In this paper, an improved design of mixed H2/H∞ RMPC for polytopic uncertain systems with external disturbances is proposed to optimise them simultaneously. In the proposed design, the original uncertain system is decomposed into two subsystems by the additive character of linear systems. Two different Lyapunov functions are used to separately formulate the two performance indices for the two subsystems. Then, the proposed RMPC is designed to optimise both the two performances by the weighting method with the satisfaction of the H∞ performance requirement. Meanwhile, to make the design more practical, a simplified design is also developed. The recursive feasible conditions of the proposed RMPC are discussed and the closed-loop input state practical stable is proven. The numerical examples reflect the enlarged feasible region and the improved performance of the proposed design.

Modeling effectiveness of management practices for flood mitigation using GIS spatial analysis functions in Upper Cilliwung watershed

NASA Astrophysics Data System (ADS)

Darma Tarigan, Suria

2016-01-01

Flooding is caused by excessive rainfall flowing downstream as cumulative surface runoff. Flooding event is a result of complex interaction of natural system components such as rainfall events, land use, soil, topography and channel characteristics. Modeling flooding event as a result of interaction of those components is a central theme in watershed management. The model is usually used to test performance of various management practices in flood mitigation. There are various types of management practices for flood mitigation including vegetative and structural management practices. Existing hydrological model such as SWAT and HEC-HMS models have limitation to accommodate discrete management practices such as infiltration well, small farm reservoir, silt pits in its analysis due to the lumped structure of these models. Aim of this research is to use raster spatial analysis functions of Geo-Information System (RGIS-HM) to model flooding event in Ciliwung watershed and to simulate impact of discrete management practices on surface runoff reduction. The model was validated using flooding data event of Ciliwung watershed on 29 January 2004. The hourly hydrograph data and rainfall data were available during period of model validation. The model validation provided good result with Nash-Suthcliff efficiency of 0.8. We also compared the RGIS-HM with Netlogo Hydrological Model (NL-HM). The RGIS-HM has similar capability with NL-HM in simulating discrete management practices in watershed scale.

Quality of care for patients with diabetes mellitus type 2 in ‘model practices’ in Slovenia – first results

PubMed Central

Mlakar, Mitja

2016-01-01

Abstract Background A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices. Methods A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared. Results The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort. Conclusion The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation. PMID:27703537

Evaluation of an instructional model to teach clinically relevant medicinal chemistry in a campus and a distance pathway.

PubMed

Alsharif, Naser Z; Galt, Kimberly A

2008-04-15

To evaluate an instructional model for teaching clinically relevant medicinal chemistry. An instructional model that uses Bloom's cognitive and Krathwohl's affective taxonomy, published and tested concepts in teaching medicinal chemistry, and active learning strategies, was introduced in the medicinal chemistry courses for second-professional year (P2) doctor of pharmacy (PharmD) students (campus and distance) in the 2005-2006 academic year. Student learning and the overall effectiveness of the instructional model were assessed. Student performance after introducing the instructional model was compared to that in prior years. Student performance on course examinations improved compared to previous years. Students expressed overall enthusiasm about the course and better understood the value of medicinal chemistry to clinical practice. The explicit integration of the cognitive and affective learning objectives improved student performance, student ability to apply medicinal chemistry to clinical practice, and student attitude towards the discipline. Testing this instructional model provided validation to this theoretical framework. The model is effective for both our campus and distance-students. This instructional model may also have broad-based applications to other science courses.

E-learning optimization: the relative and combined effects of mental practice and modeling on enhanced podcast-based learning-a randomized controlled trial.

PubMed

Alam, Fahad; Boet, Sylvain; Piquette, Dominique; Lai, Anita; Perkes, Christopher P; LeBlanc, Vicki R

2016-10-01

Enhanced podcasts increase learning, but evidence is lacking on how they should be designed to optimize their effectiveness. This study assessed the impact two learning instructional design methods (mental practice and modeling), either on their own or in combination, for teaching complex cognitive medical content when incorporated into enhanced podcasts. Sixty-three medical students were randomised to one of four versions of an airway management enhanced podcast: (1) control: narrated presentation; (2) modeling: narration with video demonstration of skills; (3) mental practice: narrated presentation with guided mental practice; (4) combined: modeling and mental practice. One week later, students managed a manikin-based simulated airway crisis. Knowledge acquisition was assessed by baseline and retention multiple-choice quizzes. Two blinded raters assessed all videos obtained from simulated crises to measure the students' skills using a key-elements scale, critical error checklist, and the Ottawa global rating scale (GRS). Baseline knowledge was not different between all four groups (p = 0.65). One week later, knowledge retention was significantly higher for (1) both the mental practice and modeling group than the control group (p = 0.01; p = 0.01, respectively) and (2) the combined mental practice and modeling group compared to all other groups (all ps = 0.01). Regarding skills acquisition, the control group significantly under-performed in comparison to all other groups on the key-events scale (all ps ≤ 0.05), the critical error checklist (all ps ≤ 0.05), and the Ottawa GRS (all ps ≤ 0.05). The combination of mental practice and modeling led to greater improvement on the key events checklist (p = 0.01) compared to either strategy alone. However, the combination of the two strategies did not result in any further learning gains on the two other measures of clinical performance (all ps > 0.05). The effectiveness of enhanced podcasts for knowledge retention and clinical skill acquisition is increased with either mental practice or modeling. The combination of mental practice and modeling had synergistic effects on knowledge retention, but conveyed less clear advantages in its application through clinical skills.

Parsimonious estimation of the Wechsler Memory Scale, Fourth Edition demographically adjusted index scores: immediate and delayed memory.

PubMed

Miller, Justin B; Axelrod, Bradley N; Schutte, Christian

2012-01-01

The recent release of the Wechsler Memory Scale Fourth Edition contains many improvements from a theoretical and administration perspective, including demographic corrections using the Advanced Clinical Solutions. Although the administration time has been reduced from previous versions, a shortened version may be desirable in certain situations given practical time limitations in clinical practice. The current study evaluated two- and three-subtest estimations of demographically corrected Immediate and Delayed Memory index scores using both simple arithmetic prorating and regression models. All estimated values were significantly associated with observed index scores. Use of Lin's Concordance Correlation Coefficient as a measure of agreement showed a high degree of precision and virtually zero bias in the models, although the regression models showed a stronger association than prorated models. Regression-based models proved to be more accurate than prorated estimates with less dispersion around observed values, particularly when using three subtest regression models. Overall, the present research shows strong support for estimating demographically corrected index scores on the WMS-IV in clinical practice with an adequate performance using arithmetically prorated models and a stronger performance using regression models to predict index scores.

Applying health information technology and team-based care to residency education.

PubMed

Brown, Kristy K; Master-Hunter, Tara A; Cooke, James M; Wimsatt, Leslie A; Green, Lee A

2011-01-01

Training physicians capable of practicing within the Patient-centered Medical Home (PCMH) is an emerging area of scholarly inquiry within residency education. This study describes an effort to integrate PCMH principles into teaching practices within a university-based residency setting and evaluates the effect on clinical performance. Using participant feedback and clinical data extracted from an electronic clinical quality management system, we retrospectively examined performance outcomes at two family medicine residency clinics over a 7-year period. Instructional approaches were identified and clinical performance patterns analyzed. Alumni ratings of the practice-based curriculum increased following institution of the PCMH model. Clinical performance outcomes indicated improvements in the delivery of clinical care to patients. Implementation of instructional methodologies posed some challenges to residency faculty, particularly in development of consistent scheduling of individualized feedback sessions. Residents required the greatest support and guidance in managing point-of-care clinical reminders during patient encounters. Teaching practices that take into consideration the integration of team-based care and use of electronic health technologies can successfully be used to deliver residency education in the context of the PCMH model. Ongoing assessment provides important information to residency directors and faculty in support of improving the quality of clinical instruction.

Evaluation and Development of Pavement Scores, Performance Models and Needs Estimates for the TXDOT Pavement Management Information System : Final Report

DOT National Transportation Integrated Search

2012-10-01

This project conducted a thorough review of the existing Pavement Management Information System (PMIS) database, : performance models, needs estimates, utility curves, and scores calculations, as well as a review of District practices : concerning th...

A Conceptual Framework for Evaluating Higher Education Institutions

ERIC Educational Resources Information Center

Chinta, Ravi; Kebritchi, Mansureh; Ellias, Janelle

2016-01-01

Purpose: Performance evaluation is a topic that has been researched and practiced extensively in business organizations but has received scant attention in higher education institutions. A review of literature revealed that context, input, process, product (CIPP) model is an appropriate performance evaluation model for higher education…

Leveraging People-Related Maturity Issues for Achieving Higher Maturity and Capability Levels

NASA Astrophysics Data System (ADS)

Buglione, Luigi

During the past 20 years Maturity Models (MM) become a buzzword in the ICT world. Since the initial Crosby's idea in 1979, plenty of models have been created in the Software & Systems Engineering domains, addressing various perspectives. By analyzing the content of the Process Reference Models (PRM) in many of them, it can be noticed that people-related issues have little weight in the appraisals of the capabilities of organizations while in practice they are considered as significant contributors in traditional process and organizational performance appraisals, as stressed instead in well-known Performance Management models such as MBQA, EFQM and BSC. This paper proposes some ways for leveraging people-related maturity issues merging HR practices from several types of maturity models into the organizational Business Process Model (BPM) in order to achieve higher organizational maturity and capability levels.

Perspectives to performance of environment and health assessments and models--from outputs to outcomes?

PubMed

Pohjola, Mikko V; Pohjola, Pasi; Tainio, Marko; Tuomisto, Jouni T

2013-06-26

The calls for knowledge-based policy and policy-relevant research invoke a need to evaluate and manage environment and health assessments and models according to their societal outcomes. This review explores how well the existing approaches to assessment and model performance serve this need. The perspectives to assessment and model performance in the scientific literature can be called: (1) quality assurance/control, (2) uncertainty analysis, (3) technical assessment of models, (4) effectiveness and (5) other perspectives, according to what is primarily seen to constitute the goodness of assessments and models. The categorization is not strict and methods, tools and frameworks in different perspectives may overlap. However, altogether it seems that most approaches to assessment and model performance are relatively narrow in their scope. The focus in most approaches is on the outputs and making of assessments and models. Practical application of the outputs and the consequential outcomes are often left unaddressed. It appears that more comprehensive approaches that combine the essential characteristics of different perspectives are needed. This necessitates a better account of the mechanisms of collective knowledge creation and the relations between knowledge and practical action. Some new approaches to assessment, modeling and their evaluation and management span the chain from knowledge creation to societal outcomes, but the complexity of evaluating societal outcomes remains a challenge.

An Introduction to the Partial Credit Model for Developing Nursing Assessments.

ERIC Educational Resources Information Center

Fox, Christine

1999-01-01

Demonstrates how the partial credit model, a variation of the Rasch Measurement Model, can be used to develop performance-based assessments for nursing education. Applies the model using the Practical Knowledge Inventory for Nurses. (SK)

Management systems, patient quality improvement, resource availability, and substance abuse treatment quality.

PubMed

Fields, Dail; Roman, Paul M; Blum, Terry C

2012-06-01

To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007-2008. Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. © Health Research and Educational Trust.

Management Systems, Patient Quality Improvement, Resource Availability, and Substance Abuse Treatment Quality

PubMed Central

Fields, Dail; Roman, Paul M; Blum, Terry C

2012-01-01

Objective To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data Sources/Study Setting Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). Study Design The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Data Collection Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007–2008. Principal Findings Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Conclusions Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. PMID:22098342

Cerebellar activation during motor sequence learning is associated with subsequent transfer to new sequences.

PubMed

Shimizu, Renee E; Wu, Allan D; Knowlton, Barbara J

2016-12-01

Effective learning results not only in improved performance on a practiced task, but also in the ability to transfer the acquired knowledge to novel, similar tasks. Using a modified serial reaction time (RT) task, the authors examined the ability to transfer to novel sequences after practicing sequences in a repetitive order versus a nonrepeating interleaved order. Interleaved practice resulted in better performance on new sequences than repetitive practice. In a second study, participants practiced interleaved sequences in a functional MRI (fMRI) scanner and received a transfer test of novel sequences. Transfer ability was positively correlated with cerebellar blood oxygen level dependent activity during practice, indicating that greater cerebellar engagement during training resulted in better subsequent transfer performance. Interleaved practice may thus result in a more generalized representation that is robust to interference, and the degree of activation in the cerebellum may be a reflection of the instantiation and engagement of internal models. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

PRACTICE TEACHING--MODELS AND MODULES.

ERIC Educational Resources Information Center

MACKEY, WILLIAM F.

THE PURPOSE OF THIS DOCUMENT IS TO DISCUSS THE PROBLEMS INVOLVED IN THE OBSERVATION, PRACTICE, AND CRITICISM PHASES OF PRACTICE TEACHING IN THE LANGUAGE TEACHER TRAINING PROGRAM, AND TO GIVE AN ACCOUNT OF THE PROPER USE OF VIDEOTAPE IN THE MORE EFFICIENT AND LESS TIME-CONSUMING PERFORMANCE OF THESE ACTIVITIES. AFTER PINPOINTING THE PROBLEM OF…

Evidence-based transition to practice: developing a model for North Carolina.

PubMed

Johnson, Mary P; Roth, Joyce W; Jenkins, Pamela R

2011-01-01

To enhance patient safety and increase retention of new nurses, structures and processes should be developed to ensure that newly licensed nurses are afforded the opportunity to gain confidence and competence as they enter the workforce. This commentary provides an overview of the work performed to date in North Carolina to build an evidence-based transition-to-practice model.

The Influence of Test-Based Accountability Policies on Teacher Stress and Instructional Practices: A Moderated Mediation Model

ERIC Educational Resources Information Center

von der Embse, Nathaniel P.; Schoemann, Alexander M.; Kilgus, Stephen P.; Wicoff, Maribeth; Bowler, Mark

2017-01-01

The present study examined the use of student test performance for merit pay and teacher evaluation as predictive of both educator stress and counterproductive teaching practices, and the moderating role of perceived test value. Structural equation modelling of data from a sample of 7281 educators in a South-eastern state in the United States…

Comparison of CFD simulations with experimental data for a tanker model advancing in waves

NASA Astrophysics Data System (ADS)

Orihara, Hideo

2011-03-01

In this paper, CFD simulation results for a tanker model are compared with experimental data over a range of wave conditions to verify a capability to predict the sea-keeping performance of practical hull forms. CFD simulations are conducted using WISDAM-X code which is capable of unsteady RANS calculations in arbitrary wave conditions. Comparisons are made of unsteady surface pressures, added resistance and ship motions in regular waves for cases of fully-loaded and ballast conditions of a large tanker model. It is shown that the simulation results agree fairly well with the experimental data, and that WISDAM-X code can predict sea-keeping performance of practical hull forms.

The Parallel Episodic Processing (PEP) model 2.0: A single computational model of stimulus-response binding, contingency learning, power curves, and mixing costs.

PubMed

Schmidt, James R; De Houwer, Jan; Rothermund, Klaus

2016-12-01

The current paper presents an extension of the Parallel Episodic Processing model. The model is developed for simulating behaviour in performance (i.e., speeded response time) tasks and learns to anticipate both how and when to respond based on retrieval of memories of previous trials. With one fixed parameter set, the model is shown to successfully simulate a wide range of different findings. These include: practice curves in the Stroop paradigm, contingency learning effects, learning acquisition curves, stimulus-response binding effects, mixing costs, and various findings from the attentional control domain. The results demonstrate several important points. First, the same retrieval mechanism parsimoniously explains stimulus-response binding, contingency learning, and practice effects. Second, as performance improves with practice, any effects will shrink with it. Third, a model of simple learning processes is sufficient to explain phenomena that are typically (but perhaps incorrectly) interpreted in terms of higher-order control processes. More generally, we argue that computational models with a fixed parameter set and wider breadth should be preferred over those that are restricted to a narrow set of phenomena. Copyright © 2016 Elsevier Inc. All rights reserved.

Different paths to high-quality care: three archetypes of top-performing practice sites.

PubMed

Feifer, Chris; Nemeth, Lynne; Nietert, Paul J; Wessell, Andrea M; Jenkins, Ruth G; Roylance, Loraine; Ornstein, Steven M

2007-01-01

Primary care practices use different approaches in their quest for high-quality care. Previous work in the Practice Partner Research Network (PPRNet) found that improved outcomes are associated with strategies to prioritize performance, involve staff, redesign elements of the delivery system, make patients active partners in guideline adherence, and use tools embedded in the electronic medical record. The aim of this study was to examine variations in the adoption of improvements among sites achieving the best outcomes. This study used an observational case study design. A practice-level measure of adherence to clinical guidelines was used to identify the highest performing practices in a network of internal and family medicine practices participating in a national demonstration project. We analyzed qualitative and quantitative information derived from project documents, field notes, and evaluation questionnaires to develop and compare case studies. Nine cases are described. All use many of the same improvement strategies. Differences in the way improvements are organized define 3 distinct archetypes: the Technophiles, the Motivated Team, and the Care Enterprise. There is no single approach that explains the superior performance of high-performing practices, though each has adopted variations of PPRNet's improvement model. Practices will vary in their path to high-quality care. The archetypes could prove to be a useful guide to other practices selecting an overall quality improvement approach.

The simplest acquisition protocol is sometimes the best protocol: performing and learning a 1:2 bimanual coordination task.

PubMed

Panzer, Stefan; Kennedy, Deanna; Wang, Chaoyi; Shea, Charles H

2018-02-01

An experiment was conducted to determine if the performance and learning of a multi-frequency (1:2) coordination pattern between the limbs are enhanced when a model is provided prior to each acquisition trial. Research has indicated very effective performance of a wide variety of bimanual coordination tasks when Lissajous plots with goal templates are provided, but this research has also found that participants become dependent on this information and perform quite poorly when it is withdrawn. The present experiment was designed to test three forms of modeling (Lissajous with template, Lissajous without template, and limb model), but in each situations, the model was presented prior to practice and not available during the performance of the task. This was done to decrease dependency on the model and increase the development of an internal reference of correctness that could be applied on test trials. A control condition was also collected, where a metronome was used to guide the movement. Following less than 7 min of practice, participants in the three modeling conditions performed the first test block very effectively; however, performance of the control condition was quite poor. Note that Test 1 was performed under the same conditions as used during acquisition. Test 2 was conducted with no augmented information provided prior to or during the performance of the task. Only participants in the limb model condition were able to maintain performance on Test 2. The findings suggest that a very simple intuitive display can provide the necessary information to form an effective internal representation of the coordination pattern which can be used guide performance when the augmented display is withdrawn.

Technology transfer from biomedical research to clinical practice: measuring innovation performance.

PubMed

Balas, E Andrew; Elkin, Peter L

2013-12-01

Studies documented 17 years of transfer time from clinical trials to practice of care. Launched in 2002, the National Institutes of Health (NIH) translational research initiative needs to develop metrics for impact assessment. A recent White House report highlighted that research and development productivity is declining as a result of increased research spending while the new drugs output is flat. The goal of this study was to develop an expanded model of research-based innovation and performance thresholds of transfer from research to practice. Models for transfer of research to practice have been collected and reviewed. Subsequently, innovation pathways have been specified based on common characteristics. An integrated, intellectual property transfer model is described. The central but often disregarded role of research innovation disclosure is highlighted. Measures of research transfer and milestones of progress have been identified based on the Association of University Technology Managers 2012 performance reports. Numeric milestones of technology transfer are recommended at threshold (top 50%), target (top 25%), and stretch goal (top 10%) performance levels. Transfer measures and corresponding target levels include research spending to disclosure (<$1.88 million), disclosure to patents (>0.81), patents to start-up (>0.1), patents to licenses (>2.25), and average per license income (>$48,000). Several limitations of measurement are described. Academic institutions should take strategic steps to bring innovation to the center of scholarly discussions. Research on research, particularly on pathways to disclosures, is needed to improve R&D productivity. Researchers should be informed about the technology transfer performance of their institution and regulations should better support innovators.

Forecasting biodiversity in breeding birds using best practices

PubMed Central

Taylor, Shawn D.; White, Ethan P.

2018-01-01

Biodiversity forecasts are important for conservation, management, and evaluating how well current models characterize natural systems. While the number of forecasts for biodiversity is increasing, there is little information available on how well these forecasts work. Most biodiversity forecasts are not evaluated to determine how well they predict future diversity, fail to account for uncertainty, and do not use time-series data that captures the actual dynamics being studied. We addressed these limitations by using best practices to explore our ability to forecast the species richness of breeding birds in North America. We used hindcasting to evaluate six different modeling approaches for predicting richness. Hindcasts for each method were evaluated annually for a decade at 1,237 sites distributed throughout the continental United States. All models explained more than 50% of the variance in richness, but none of them consistently outperformed a baseline model that predicted constant richness at each site. The best practices implemented in this study directly influenced the forecasts and evaluations. Stacked species distribution models and “naive” forecasts produced poor estimates of uncertainty and accounting for this resulted in these models dropping in the relative performance compared to other models. Accounting for observer effects improved model performance overall, but also changed the rank ordering of models because it did not improve the accuracy of the “naive” model. Considering the forecast horizon revealed that the prediction accuracy decreased across all models as the time horizon of the forecast increased. To facilitate the rapid improvement of biodiversity forecasts, we emphasize the value of specific best practices in making forecasts and evaluating forecasting methods. PMID:29441230

The economic benefit for family/general medicine practices employing physician assistants.

PubMed

Grzybicki, Dana M; Sullivan, Paul J; Oppy, J Miller; Bethke, Anne-Marie; Raab, Stephen S

2002-07-01

To measure the economic benefit of a family/general medicine physician assistant (PA) practice. Qualitative description of a model PA practice in a family/general medicine practice office setting, and comparison of the financial productivity of a PA practice with that of a non-PA (physician-only) practice. The study site was a family/general medicine practice office in southwestern Pennsylvania. The description of PA practice was obtained through direct observation and semistructured interviews during site visits in 1998. Comparison of site practice characteristics with published national statistics was performed to confirm the site's usefulness as a model practice. Data used for PA productivity analyses were obtained from site visits, interviews, office billing records, office appointment logs, and national organizations. The PA in the model practice had a same-task substitution ratio of 0.86 compared with the supervising physician. The PA was economically beneficial for the practice, with a compensation-to-production ratio of 0.36. Compared with a practice employing a full-time physician, the annual financial differential of a practice employing a full-time PA was $52,592. Sensitivity analyses illustrated the economic benefit of a PA practice in a variety of theoretical family/general medicine practice office settings. Family/general medicine PAs are of significant economic benefit to practices that employ them.

A comprehensive model for diagnosing the causes of individual medical performance problems: skills, knowledge, internal, past and external factors (SKIPE).

PubMed

Norfolk, Tim; Siriwardena, A Niroshan

2013-01-01

This discussion paper describes a new and comprehensive model for diagnosing the causes of individual medical performance problems: SKIPE (skills, knowledge, internal, past and external factors). This builds on a previous paper describing a unifying theory of clinical practice, the RDM-p model, which captures the primary skill sets required for effective medical performance (relationship, diagnostics and management), and the professionalism that needs to underpin them. The SKIPE model is currently being used, in conjunction with the RDM-p model, for the in-depth assessment and management of doctors whose performance is a cause for concern.

Doctors' trustworthiness, practice orientation, performance and patient satisfaction.

PubMed

Van Den Assem, Barend; Dulewicz, Victor

2015-01-01

The purpose of this paper is to provide a greater understanding of the general practitioner (GP)-patient relationship for academics and practitioners. A new model for dyadic professional relationships specifically designed for research into the doctor-patient relationship was developed and tested. Various conceptual models of trust and related constructs in the literature were considered and assessed for their relevance as were various related scales. The model was designed and tested using purposefully designed scales measuring doctors' trustworthiness, practice orientation performance and patient satisfaction. A quantitative survey used closed-ended questions and 372 patients responded from seven GP practices. The sample closely reflected the profile of the patients who responded to the DoH/NHS GP Patient Survey for England, 2010. Hierarchical regression and partial least squares both accounted for 74 per cent of the variance in "overall patient satisfaction", the dependent variable. Trust accounted for 39 per cent of the variance explained, with the other independent variables accounting for the other 35 per cent. ANOVA showed good model fit. The findings on the factors which affect patient satisfaction and the doctor-patient relationship have direct implications for GPs and other health professionals. They are of particular relevance at a time of health reform and change. The paper provides: a new model of the doctor-patient relationship and specifically designed scales to test it; a greater understanding of the effects of doctors' trustworthiness, practice orientation and performance on patient satisfaction; and a new framework for examining the breadth and meaning of the doctor-patient relationship and the management of care from the patient's viewpoint.

Asphalt surface treatment practice in southeastern United States : [tech summary].

DOT National Transportation Integrated Search

2014-09-01

Pavement preservation is an approach in enhancing pavement performance using a set of practices that extends the life : of the pavement and improves safety and ride quality. According to the World Banks Pavement Deterioration Model, the : cost of ...

Comparison of Colonoscopy Quality Measures Across Various Practice Settings and the Impact of Performance Scorecards.

PubMed

Inra, Jennifer A; Nayor, Jennifer; Rosenblatt, Margery; Mutinga, Muthoka; Reddy, Sarathchandra I; Syngal, Sapna; Kastrinos, Fay

2017-04-01

Quality performance measures for screening colonoscopy vary among endoscopists. The impact of practice setting is unknown. We aimed to (1) compare screening colonoscopy performance measures among three different US practice settings; (2) evaluate factors associated with adenoma detection; and (3) assess a scorecard intervention on performance metrics. This multi-center prospective study compared patient, endoscopist, and colonoscopy characteristics performed at a tertiary care hospital (TCH), community-based hospital (CBH), and private practice group (PPG). Withdrawal times (WT), cecal intubation, and adenoma detection rates (ADR) were compared by site at baseline and 12 weeks following scorecard distribution. Generalized linear mixed models identified factors associated with adenoma detection. Twenty-eight endoscopists performed colonoscopies on 1987 asymptomatic, average-risk individuals ≥50 years. Endoscopist and patient characteristics were similar across sites. The PPG screened more men (TCH: 42.8%, CBH: 45.0%, PPG: 54.2%; p < 0.0001). Preparation quality varied with good/excellent results in 70.6, 88.3, and 92% of TCH, CBH, and PPG cases, respectively (p < 0.0001). Male ADRs, cecal intubation, and WT exceeded recommended benchmarks despite variable results at each site; female ADRs were <15% at the PPG which screened the fewest females. Performance remained unchanged following scorecard distribution. Adenoma detection was associated with increasing patient age, male gender, WT, adequate preparation, but not practice setting. Each practice performed high-quality screening colonoscopy. Scorecards did not improve performance metrics. Preparation quality varies among practice settings and can be modified to improve adenoma detection.

Modeling hurricane evacuation traffic : development of a time-dependent hurricane evacuation demand model.

DOT National Transportation Integrated Search

2008-04-01

The objective of this research is to develop alternative time-dependent travel demand models of hurricane evacuation travel and to compare the performance of these models with each other and with the state-of-the-practice models in current use. Speci...

Human resources management and firm performance: The differential role of managerial affective and continuance commitment.

PubMed

Gong, Yaping; Law, Kenneth S; Chang, Song; Xin, Katherine R

2009-01-01

In this study, the authors developed a dual-concern (i.e., maintenance and performance) model of human resources (HR) management. The authors identified commonly examined HR practices that apply to the middle manager level and classified them into the maintenance- and performance-oriented HR subsystems. The authors found support for the 2-factor model on the basis of responses from 2,148 managers from 463 firms operating in China. Regression results indicate that the performance-oriented HR subsystems had a positive relationship with firm performance and that the relationship was mediated by middle managers' affective commitment to the firm. The maintenance-oriented HR subsystems had a positive relationship with middle managers' continuance commitment but not with their affective commitment and firm performance. This study contributes to the understanding of how HR practices relate to firm performance and offers an improved test of the argument that valuable and firm-specific HR provide a source of competitive advantage. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Using the Intervention Mapping Protocol to develop an online video intervention for parents to prevent childhood obesity: Movie Models.

PubMed

De Lepeleere, Sara; Verloigne, Maïté; Brown, Helen Elizabeth; Cardon, Greet; De Bourdeaudhuij, Ilse

2016-08-08

The increasing prevalence of childhood overweight/obesity caused by an unhealthy diet, insufficient physical activity (PA) and high levels of sedentary behaviour (SB) is a prominent public health concern. Parenting practices may contribute to healthy behaviour change in children, but well-researched examples are limited. The aim of this study is to describe the systematic development of an intervention for parents to prevent childhood overweight/obesity through the improvement of parenting practices. The six steps of the Intervention Mapping Protocol (IMP), a theory- and evidence-based tool to develop health-related interventions, were used as a framework to develop the 'Movie Models' programme. In Step 1, a needs assessment was performed to better understand the health problem of overweight/obesity in children and its association with diet, PA and SB. In Step 2, the programme goal (increasing the adoption of effective parenting practices) was sub-divided into performance objectives. Change objectives, which specify explicit actions required to accomplish the performance objectives, were also identified. Step 3 included the selection of theoretical methods (e.g. 'modelling' and 'images'), which were then translated into the practical strategy of online parenting videos. Step 4 comprised the development of a final intervention framework, and Step 5 included the planning of programme adoption and implementation. The final phase, Step 6, included the development of an effect- and process-evaluation plan. The IMP was used to structure the development of 'Movie Models', an intervention targeting specific parenting practices related to children's healthy diet, PA, SB, and parental self-efficacy. A clear framework for process analyses is offered, which aims to increase the potential effectiveness of an intervention and can be useful for those developing health promotion programmes. © The Author(s) 2016.

General practice performance in referral for suspected cancer: influence of number of cases and case-mix on publicly reported data.

PubMed

Murchie, P; Chowdhury, A; Smith, S; Campbell, N C; Lee, A J; Linden, D; Burton, C D

2015-05-26

Publicly available data show variation in GPs' use of urgent suspected cancer (USC) referral pathways. We investigated whether this could be due to small numbers of cancer cases and random case-mix, rather than due to true variation in performance. We analysed individual GP practice USC referral detection rates (proportion of the practice's cancer cases that are detected via USC) and conversion rates (proportion of the practice's USC referrals that prove to be cancer) in routinely collected data from GP practices in all of England (over 4 years) and northeast Scotland (over 7 years). We explored the effect of pooling data. We then modelled the effects of adding random case-mix to practice variation. Correlations between practice detection rate and conversion rate became less positive when data were aggregated over several years. Adding random case-mix to between-practice variation indicated that the median proportion of poorly performing practices correctly identified after 25 cancer cases were examined was 20% (IQR 17 to 24) and after 100 cases was 44% (IQR 40 to 47). Much apparent variation in GPs' use of suspected cancer referral pathways can be attributed to random case-mix. The methods currently used to assess the quality of GP-suspected cancer referral performance, and to compare individual practices, are misleading. These should no longer be used, and more appropriate and robust methods should be developed.

The Relationship of AP® Teacher Practices and Student AP Exam Performance. Research Report No. 2007-5. ETS RR-05-10

ERIC Educational Resources Information Center

Paek, Pamela L.; Braun, Henry; Trapani, Catherine; Ponte, Eva; Powers, Don

2008-01-01

This report analyzes the relationship of Advanced Placement Program® (AP®) teacher practices and student performance on AP Biology and AP U.S. History Exams. Using a national survey of AP teachers, the study developed four models for each subject with public school teachers only and both public and nonpublic school teachers, using two standards of…

Evaluation of an Instructional Model to Teach Clinically Relevant Medicinal Chemistry in a Campus and a Distance Pathway

PubMed Central

Galt, Kimberly A.

2008-01-01

Objectives To evaluate an instructional model for teaching clinically relevant medicinal chemistry. Methods An instructional model that uses Bloom's cognitive and Krathwohl's affective taxonomy, published and tested concepts in teaching medicinal chemistry, and active learning strategies, was introduced in the medicinal chemistry courses for second-professional year (P2) doctor of pharmacy (PharmD) students (campus and distance) in the 2005-2006 academic year. Student learning and the overall effectiveness of the instructional model were assessed. Student performance after introducing the instructional model was compared to that in prior years. Results Student performance on course examinations improved compared to previous years. Students expressed overall enthusiasm about the course and better understood the value of medicinal chemistry to clinical practice. Conclusion The explicit integration of the cognitive and affective learning objectives improved student performance, student ability to apply medicinal chemistry to clinical practice, and student attitude towards the discipline. Testing this instructional model provided validation to this theoretical framework. The model is effective for both our campus and distance-students. This instructional model may also have broad-based applications to other science courses. PMID:18483599

Inadequate performance measures affecting practices, organizations and outcomes of Ontario's family health teams.

PubMed

Ashcroft, Rachelle

2014-01-01

Emphasis on quantity as the main performance measure may be posing challenges for Family Health Team (FHT) practices and organizational structures. This study asked: What healthcare practices and organizational structures are encouraged by the FHT model? An exploratory qualitative design guided by discourse analysis was used. This paper presents findings from in-depth semi-structured interviews conducted with seven policy informants and 29 FHT leaders. Participants report that performance measures value quantity and are not inclusive of the broad scope of attributes that comprise primary healthcare. Performance measures do not appear to be accurately capturing the demand for healthcare services, or the actual amount of services being provided by FHTs. RESULTS suggest that unintended consequences of performance measures may be posing challenges to access and health outcomes. It is recommended that performance measures be developed and used to measure, support and encourage FHTs to achieve the goals of PHC. Copyright © 2014 Longwoods Publishing.

A multilevel analysis of trimethoprim and ciprofloxacin prescribing and resistance of uropathogenic Escherichia coli in general practice.

PubMed

Vellinga, Akke; Murphy, Andrew W; Hanahoe, Belinda; Bennett, Kathleen; Cormican, Martin

2010-07-01

A retrospective analysis of databases was performed to describe trimethoprim and ciprofloxacin prescribing and resistance in Escherichia coli within general practices in the West of Ireland from 2004 to 2008. Antimicrobial susceptibility testing was performed by disc diffusion methods according to the CLSI methods and criteria on significant E. coli isolates (colony count >10(5) cfu/mL) from urine samples submitted from general practice. Data were collected over a 4.5 year period and aggregated at practice level. Data on antimicrobial prescribing of practices were obtained from the national Irish prescribing database, which accounts for approximately 70% of all medicines prescribed in primary care. A multilevel model (MLwiN) was fitted with trimethoprim/ciprofloxacin resistance rates as outcome and practice prescribing as predictor. Practice and individual routinely collected variables were controlled for in the model. Seventy-two general practices sent between 13 and 720 (median 155) samples that turned out to be E. coli positive. Prescribing at practice level was significantly correlated with the probability of antimicrobial-resistant E. coli with an odds ratio of 1.02 [95% confidence interval (CI) 1.01-1.04] for every additional prescription of trimethoprim per 1000 patients per month in the practice and 1.08 (1.04-1.11) for ciprofloxacin. Age was a significant risk factor in both models. Higher variation between practices was found for ciprofloxacin as well as a yearly increase in resistance. Comparing a 'mean' practice with 1 prescription per month with one with 10 prescriptions per month showed an increase in predicted probability of a resistant E. coli for the 'mean' patient from 23.9% to 27.5% for trimethoprim and from 3.0% to 5.5% for ciprofloxacin. A higher level of antimicrobial prescribing in a practice is associated with a higher probability of a resistant E. coli for the patient. The variation in antimicrobial resistance levels between practices was relatively higher for ciprofloxacin than for trimethoprim.

Modeling the Delivery Physiology of Distributed Learning Systems.

ERIC Educational Resources Information Center

Paquette, Gilbert; Rosca, Ioan

2003-01-01

Discusses instructional delivery models and their physiology in distributed learning systems. Highlights include building delivery models; types of delivery models, including distributed classroom, self-training on the Web, online training, communities of practice, and performance support systems; and actors (users) involved, including experts,…

A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home

PubMed Central

Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.

2013-01-01

PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393

Partnering through Training and Practice to Achieve Performance Improvement

ERIC Educational Resources Information Center

Lyons, Paul R.

2010-01-01

This article presents a partnership effort among managers, trainers, and employees to spring to life performance improvement using the performance templates (P-T) approach. P-T represents a process model as well as a method of training leading to performance improvement. Not only does it add to our repertoire of training and performance management…

Models of clinical reasoning with a focus on general practice: A critical review.

PubMed

Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat

2017-10-01

Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.

Prediction of wastewater treatment plants performance based on artificial fish school neural network

NASA Astrophysics Data System (ADS)

Zhang, Ruicheng; Li, Chong

2011-10-01

A reliable model for wastewater treatment plant is essential in providing a tool for predicting its performance and to form a basis for controlling the operation of the process. This would minimize the operation costs and assess the stability of environmental balance. For the multi-variable, uncertainty, non-linear characteristics of the wastewater treatment system, an artificial fish school neural network prediction model is established standing on actual operation data in the wastewater treatment system. The model overcomes several disadvantages of the conventional BP neural network. The results of model calculation show that the predicted value can better match measured value, played an effect on simulating and predicting and be able to optimize the operation status. The establishment of the predicting model provides a simple and practical way for the operation and management in wastewater treatment plant, and has good research and engineering practical value.

Practical Consequences of Item Response Theory Model Misfit in the Context of Test Equating with Mixed-Format Test Data

PubMed Central

Zhao, Yue; Hambleton, Ronald K.

2017-01-01

In item response theory (IRT) models, assessing model-data fit is an essential step in IRT calibration. While no general agreement has ever been reached on the best methods or approaches to use for detecting misfit, perhaps the more important comment based upon the research findings is that rarely does the research evaluate IRT misfit by focusing on the practical consequences of misfit. The study investigated the practical consequences of IRT model misfit in examining the equating performance and the classification of examinees into performance categories in a simulation study that mimics a typical large-scale statewide assessment program with mixed-format test data. The simulation study was implemented by varying three factors, including choice of IRT model, amount of growth/change of examinees’ abilities between two adjacent administration years, and choice of IRT scaling methods. Findings indicated that the extent of significant consequences of model misfit varied over the choice of model and IRT scaling methods. In comparison with mean/sigma (MS) and Stocking and Lord characteristic curve (SL) methods, separate calibration with linking and fixed common item parameter (FCIP) procedure was more sensitive to model misfit and more robust against various amounts of ability shifts between two adjacent administrations regardless of model fit. SL was generally the least sensitive to model misfit in recovering equating conversion and MS was the least robust against ability shifts in recovering the equating conversion when a substantial degree of misfit was present. The key messages from the study are that practical ways are available to study model fit, and, model fit or misfit can have consequences that should be considered when choosing an IRT model. Not only does the study address the consequences of IRT model misfit, but also it is our hope to help researchers and practitioners find practical ways to study model fit and to investigate the validity of particular IRT models for achieving a specified purpose, to assure that the successful use of the IRT models are realized, and to improve the applications of IRT models with educational and psychological test data. PMID:28421011

Organizational Leadership and Adaptive Reserve in Blood Pressure Control: The Heart Health NOW Study.

PubMed

Henderson, Kamal H; DeWalt, Darren A; Halladay, Jacquie; Weiner, Bryan J; Kim, Jung I; Fine, Jason; Cykert, Samuel

2018-04-01

Our purpose was to assess whether a practice's adaptive reserve and high leadership capability in quality improvement are associated with population blood pressure control. We divided practices into quartiles of blood pressure control performance and considered the top quartile as the benchmark for comparison. Using abstracted clinical data from electronic health records, we performed a cross-sectional study to assess the association of top quartile hypertension control and (1) the baseline practice adaptive reserve (PAR) scores and (2) baseline practice leadership scores, using modified Poisson regression models adjusting for practice-level characteristics. Among 181 practices, 46 were in the top quartile, which averaged 68% or better blood pressure control. Practices with higher PAR scores compared with lower PAR scores were not more likely to reside in the top quartile of performance (prevalence ratio [PR] = 1.92 for highest quartile; 95% CI, 0.9-4.1). Similarly, high quality improvement leadership capability compared with lower capability did not predict better blood pressure control performance (PR = 0.94; 95% CI, 0.57-1.56). Practices with higher proportions of commercially insured patients were more likely than practices with lower proportions of commercially insured patients to have top quartile performance (37% vs 26%, P =.002), whereas lower proportions of the uninsured (8% vs 14%, P =.055) were associated with better performance. Our findings show that adaptive reserve and leadership capability in quality improvement implementation are not statistically associated with achieving top quartile practice-level hypertension control at baseline in the Heart Health NOW project. Our findings, however, may be limited by a lack of patient-related factors and small sample size to preclude strong conclusions. © 2018 Annals of Family Medicine, Inc.

Rethinking Remediation: A Model to Support the Detailed Diagnosis of Clinicians' Performance Problems and the Development of Effective Remediation Plans.

PubMed

Prescott-Clements, Linda; Voller, Vicky; Bell, Mark; Nestors, Natasha; van der Vleuten, Cees P M

2017-01-01

The successful remediation of clinicians demonstrating poor performance in the workplace is essential to ensure the provision of safe patient care. Clinicians may develop performance problems for numerous reasons, including health, personal factors, the workplace environment, or outdated knowledge/skills. Performance problems are often complex involving multifactorial issues, encompassing knowledge, skills, and professional behaviors. It is important that (where possible and appropriate) clinicians are supported through effective remediation to return them to safe clinical practice. A review of the literature demonstrated that research into remediation is in its infancy, with little known about the effectiveness of remediation programs currently. Current strategies for the development of remediation programs are mostly "intuitive"; a few draw upon established theories to inform their approach. Similarly, although it has been established that identification of the nature/scope of performance problems through assessment is an essential first step within remediation, the need for a more widespread "diagnosis" of why the problems exist is emerging. These reasons for poor performance, particularly in the context of experienced practicing clinicians, are likely to have an impact on the potential success of remediation and should be considered within the "diagnosis." A new model for diagnosing the performance problems of the clinicians has been developed, using behavioral change theories to explore known barriers to successful remediation, such as insight, motivation, attitude, self-efficacy, and the working environment, in addition to addressing known deficits regarding knowledge and skills. This novel approach is described in this article. An initial feasibility study has demonstrated the acceptability and practical implementation of our model.

Toward a high-performance management system in health care, part 4: Using high-performance work practices to prevent central line-associated blood stream infections-a comparative case study.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer; Robbins, Julie; Garman, Andrew N

2016-01-01

Central line-associated bloodstream infections (CLABSIs) are among the most harmful health care-associated infections and a major patient safety concern. Nationally, CLABSI rates have been reduced through the implementation of evidence-based interventions; thus far, however, hospitals still differ substantially in their success implementing these practices. Prior research on high-performance work practices (HPWPs) suggests that these practices may explain some of the differences health systems experience in the success of their quality improvement efforts; however, these relationships have not yet been systematically investigated. In this study, we sought to explore the potential role HPWPs may play in explaining differences in the success of CLABSI reduction efforts involving otherwise similar organizations and approaches. To form our sample, we identified eight hospitals participating in the federally funded "On the CUSP: Stop BSI" initiative. This sample included four hospital "pairs" matched on organizational characteristics (e.g., state, size, teaching status) but having reported contrasting CLABSI reduction outcomes. We collected data through site visits as well as 194 key informant interviews, which were framed using an evidence-informed model of health care HPWPs. We found evidence that, at higher performing sites, HPWPs facilitated the adoption and consistent application of practices known to prevent CLABSIs; these HPWPs were virtually absent at lower performing sites. We present examples of management practices and illustrative quotes categorized into four HPWP subsystems: (a) staff engagement, (b) staff acquisition/development, (c) frontline empowerment, and (d) leadership alignment/development. We present the HPWP model as an organizing framework that can be applied to facilitate quality and patient safety efforts in health care. Managers and senior leaders can use these four HPWP subsystems to select, prioritize, and communicate about management practices critical to the success of their CLABSI prevention efforts.

Numerical simulation of damage evolution for ductile materials and mechanical properties study

NASA Astrophysics Data System (ADS)

El Amri, A.; Hanafi, I.; Haddou, M. E. Y.; Khamlichi, A.

2015-12-01

This paper presents results of a numerical modelling of ductile fracture and failure of elements made of 5182H111 aluminium alloys subjected to dynamic traction. The analysis was performed using Johnson-Cook model based on ABAQUS software. The modelling difficulty related to prediction of ductile fracture mainly arises because there is a tremendous span of length scales from the structural problem to the micro-mechanics problem governing the material separation process. This study has been used the experimental results to calibrate a simple crack propagation criteria for shell elements of which one has often been used in practical analyses. The performance of the proposed model is in general good and it is believed that the presented results and experimental-numerical calibration procedure can be of use in practical finite-element simulations.

The Mediating Effect of Kaizen between Total Quality Management (TQM) and Business Performance

NASA Astrophysics Data System (ADS)

Shan, Ang Wei; Fauzi Ahmad, Mohd; Hisyamudin Muhd Nor, Nik

2016-11-01

Every customer preference is different but yet important. The global market is shifting rapidly, organizations are needed to continuously identify new opportunity to obtain competitive advantages. Literature suggested that manufacturing companies are needed to differentiate themselves through emphasize on quality and continuous improvement in product and services as a crucial part to secure and success in the future. The Total Quality Management (TQM) practices has developed a strong bearing on growth and competitiveness in market. Therefore, a proper continuous improvement (Kaizen) practice is needed to eliminate waste and value added in production to remain competitiveness and retained the potential customer. However, based on the previous study it had indicated an inconsistent result between TQM and BP. Besides that, researcher also less emphasized on mediator in previous work. Therefore, the purpose of this paper is to recommend the relationship between TQM and business performance with a mediator's effect of Kaizen. This proposed model attempt to create knowledge to both academician and company players to acquire a better understanding among the TQM and Kaizen practices. Consequently, the Structural Equation Modelling (SEM) techniques is applying to identify and evaluate the relationship among TQM, Kaizen, and business performance in developing a new TQM model.

Development of an online, publicly accessible naive Bayesian decision support tool for mammographic mass lesions based on the American College of Radiology (ACR) BI-RADS lexicon.

PubMed

Benndorf, Matthias; Kotter, Elmar; Langer, Mathias; Herda, Christoph; Wu, Yirong; Burnside, Elizabeth S

2015-06-01

To develop and validate a decision support tool for mammographic mass lesions based on a standardized descriptor terminology (BI-RADS lexicon) to reduce variability of practice. We used separate training data (1,276 lesions, 138 malignant) and validation data (1,177 lesions, 175 malignant). We created naïve Bayes (NB) classifiers from the training data with tenfold cross-validation. Our "inclusive model" comprised BI-RADS categories, BI-RADS descriptors, and age as predictive variables; our "descriptor model" comprised BI-RADS descriptors and age. The resulting NB classifiers were applied to the validation data. We evaluated and compared classifier performance with ROC-analysis. In the training data, the inclusive model yields an AUC of 0.959; the descriptor model yields an AUC of 0.910 (P < 0.001). The inclusive model is superior to the clinical performance (BI-RADS categories alone, P < 0.001); the descriptor model performs similarly. When applied to the validation data, the inclusive model yields an AUC of 0.935; the descriptor model yields an AUC of 0.876 (P < 0.001). Again, the inclusive model is superior to the clinical performance (P < 0.001); the descriptor model performs similarly. We consider our classifier a step towards a more uniform interpretation of combinations of BI-RADS descriptors. We provide our classifier at www.ebm-radiology.com/nbmm/index.html . • We provide a decision support tool for mammographic masses at www.ebm-radiology.com/nbmm/index.html . • Our tool may reduce variability of practice in BI-RADS category assignment. • A formal analysis of BI-RADS descriptors may enhance radiologists' diagnostic performance.

Volunteer Development. Practice Application Brief.

ERIC Educational Resources Information Center

Kerka, Sandra

Certain practices in volunteer development have proved successful to help organizations make the best use of their volunteers. Development should be a comprehensive, continuous process through which individuals can extend, update, and adapt their knowledge, skills, and abilities to enhance their performance and potential. A model for volunteer…

Perspectives to Performance of Environment and Health Assessments and Models—From Outputs to Outcomes?

PubMed Central

Pohjola, Mikko V.; Pohjola, Pasi; Tainio, Marko; Tuomisto, Jouni T.

2013-01-01

The calls for knowledge-based policy and policy-relevant research invoke a need to evaluate and manage environment and health assessments and models according to their societal outcomes. This review explores how well the existing approaches to assessment and model performance serve this need. The perspectives to assessment and model performance in the scientific literature can be called: (1) quality assurance/control, (2) uncertainty analysis, (3) technical assessment of models, (4) effectiveness and (5) other perspectives, according to what is primarily seen to constitute the goodness of assessments and models. The categorization is not strict and methods, tools and frameworks in different perspectives may overlap. However, altogether it seems that most approaches to assessment and model performance are relatively narrow in their scope. The focus in most approaches is on the outputs and making of assessments and models. Practical application of the outputs and the consequential outcomes are often left unaddressed. It appears that more comprehensive approaches that combine the essential characteristics of different perspectives are needed. This necessitates a better account of the mechanisms of collective knowledge creation and the relations between knowledge and practical action. Some new approaches to assessment, modeling and their evaluation and management span the chain from knowledge creation to societal outcomes, but the complexity of evaluating societal outcomes remains a challenge. PMID:23803642

Diminishing-cues retrieval practice: A memory-enhancing technique that works when regular testing doesn't.

PubMed

Fiechter, Joshua L; Benjamin, Aaron S

2017-08-28

Retrieval practice has been shown to be a highly effective tool for enhancing memory, a fact that has led to major changes to educational practice and technology. However, when initial learning is poor, initial retrieval practice is unlikely to be successful and long-term benefits of retrieval practice are compromised or nonexistent. Here, we investigate the benefit of a scaffolded retrieval technique called diminishing-cues retrieval practice (Finley, Benjamin, Hays, Bjork, & Kornell, Journal of Memory and Language, 64, 289-298, 2011). Under learning conditions that favored a strong testing effect, diminishing cues and standard retrieval practice both enhanced memory performance relative to restudy. Critically, under learning conditions where standard retrieval practice was not helpful, diminishing cues enhanced memory performance substantially. These experiments demonstrate that diminishing-cues retrieval practice can widen the range of conditions under which testing can benefit memory, and so can serve as a model for the broader application of testing-based techniques for enhancing learning.

Good Manufacturing Practices (GMP) manufacturing of advanced therapy medicinal products: a novel tailored model for optimizing performance and estimating costs.

PubMed

Abou-El-Enein, Mohamed; Römhild, Andy; Kaiser, Daniel; Beier, Carola; Bauer, Gerhard; Volk, Hans-Dieter; Reinke, Petra

2013-03-01

Advanced therapy medicinal products (ATMP) have gained considerable attention in academia due to their therapeutic potential. Good Manufacturing Practice (GMP) principles ensure the quality and sterility of manufacturing these products. We developed a model for estimating the manufacturing costs of cell therapy products and optimizing the performance of academic GMP-facilities. The "Clean-Room Technology Assessment Technique" (CTAT) was tested prospectively in the GMP facility of BCRT, Berlin, Germany, then retrospectively in the GMP facility of the University of California-Davis, California, USA. CTAT is a two-level model: level one identifies operational (core) processes and measures their fixed costs; level two identifies production (supporting) processes and measures their variable costs. The model comprises several tools to measure and optimize performance of these processes. Manufacturing costs were itemized using adjusted micro-costing system. CTAT identified GMP activities with strong correlation to the manufacturing process of cell-based products. Building best practice standards allowed for performance improvement and elimination of human errors. The model also demonstrated the unidirectional dependencies that may exist among the core GMP activities. When compared to traditional business models, the CTAT assessment resulted in a more accurate allocation of annual expenses. The estimated expenses were used to set a fee structure for both GMP facilities. A mathematical equation was also developed to provide the final product cost. CTAT can be a useful tool in estimating accurate costs for the ATMPs manufactured in an optimized GMP process. These estimates are useful when analyzing the cost-effectiveness of these novel interventions. Copyright © 2013 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2011-10-01

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

A conceptual model of physician work intensity: guidance for evaluating policies and practices to improve health care delivery.

PubMed

Horner, Ronnie D; Matthews, Gerald; Yi, Michael S

2012-08-01

Physician work intensity, although a major factor in determining the payment for medical services, may potentially affect patient health outcomes including quality of care and patient safety, and has implications for the redesign of medical practice to improve health care delivery. However, to date, there has been minimal research regarding the relationship between physician work intensity and either patient outcomes or the organization and management of medical practices. A theoretical model on physician work intensity will provide useful guidance to such inquiries. To describe an initial conceptual model to facilitate further investigations of physician work intensity. A conceptual model of physician work intensity is described using as its theoretical base human performance science relating to work intensity. For each of the theoretical components, we present relevant empirical evidence derived from a review of the current literature. The proposed model specifies that the level of work intensity experienced by a physician is a consequence of the physician performing the set of tasks (ie, demands) relating to a medical service. It is conceptualized that each medical service has an inherent level of intensity that is experienced by a physician as a function of factors relating to the physician, patient, and medical practice environment. The proposed conceptual model provides guidance to researchers as to the factors to consider in studies of how physician work intensity impacts patient health outcomes and how work intensity may be affected by proposed policies and approaches to health care delivery.

Evaluating, interpreting, and communicating performance of hydrologic/water quality models considering intended use: A review and recommendations

USDA-ARS?s Scientific Manuscript database

Previous publications have outlined recommended practices for hydrologic and water quality (H/WQ) modeling, but none have formulated comprehensive guidelines for the final stage of modeling applications, namely evaluation, interpretation, and communication of model results and the consideration of t...

Specialty Payment Model Opportunities and Assessment: Oncology Simulation Report.

PubMed

White, Chapin; Chan, Chris; Huckfeldt, Peter J; Kofner, Aaron; Mulcahy, Andrew W; Pollak, Julia; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

2015-07-15

This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis-$960 total per six-month episode-represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices' Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced.

Driving and sustaining culture change in Olympic sport performance teams: a first exploration and grounded theory.

PubMed

Cruickshank, Andrew; Collins, Dave; Minten, Sue

2014-02-01

Stimulated by growing interest in the organizational and performance leadership components of Olympic success, sport psychology researchers have identified performance director-led culture change as a process of particular theoretical and applied significance. To build on initial work in this area and develop practically meaningful understanding, a pragmatic research philosophy and grounded theory methodology were engaged to uncover culture change best practice from the perspective of newly appointed performance directors. Delivered in complex and contested settings, results revealed that the optimal change process consisted of an initial evaluation, planning, and impact phase adjoined to the immediate and enduring management of a multidirectional perception- and power-based social system. As the first inquiry of its kind, these findings provide a foundation for the continued theoretical development of culture change in Olympic sport performance teams and a first model on which applied practice can be based.

Sharing Research Models: Using Software Engineering Practices for Facilitation

PubMed Central

Bryant, Stephanie P.; Solano, Eric; Cantor, Susanna; Cooley, Philip C.; Wagener, Diane K.

2011-01-01

Increasingly, researchers are turning to computational models to understand the interplay of important variables on systems’ behaviors. Although researchers may develop models that meet the needs of their investigation, application limitations—such as nonintuitive user interface features and data input specifications—may limit the sharing of these tools with other research groups. By removing these barriers, other research groups that perform related work can leverage these work products to expedite their own investigations. The use of software engineering practices can enable managed application production and shared research artifacts among multiple research groups by promoting consistent models, reducing redundant effort, encouraging rigorous peer review, and facilitating research collaborations that are supported by a common toolset. This report discusses three established software engineering practices— the iterative software development process, object-oriented methodology, and Unified Modeling Language—and the applicability of these practices to computational model development. Our efforts to modify the MIDAS TranStat application to make it more user-friendly are presented as an example of how computational models that are based on research and developed using software engineering practices can benefit a broader audience of researchers. PMID:21687780

Optimizing construction quality management of pavements using mechanistic performance analysis.

DOT National Transportation Integrated Search

2004-08-01

This report presents a statistical-based algorithm that was developed to reconcile the results from several pavement performance models used in the state of practice with systematic process control techniques. These algorithms identify project-specif...

Ventana{trade mark, serif} power train features and performance

NASA Astrophysics Data System (ADS)

Mohedano, R.; Benitez, P.; Zamora, P.; Miñano, J. C.; Mendes, J.; Cvetkovic, A.; Vilaplana, J.; Hernandez, M.; Chaves, J.; Biot, G.

2013-09-01

Most CPV systems are based on Fresnel lenses. Among these, LPI-patented Fresnel-Köhler (FK) concentrator outstands owing to performance and practical reasons. The Ventana{trade mark, serif} power train is the first off-the-shelf commercial product based on the FK and comprises both the primary (POE) lenses (a 36-units 1×1 m2 acrylic panel) and glass (or silica glass) secondary optics (SOE). This high concentration optical train (Cg=1,024×, ˜250mm optical depth) fits with 5×5 mm2 (at least) solar cells. The optical train is the fruit of a 1-year development that has included design, modeling, prototyping and characterization, and through the process we had the opportunity to find out how well the actual performance correlates with models, but also learned practical aspects of a CPV system of this kind, some of which have very positive impact on system performance and reliability.

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.

Authentic Instruction and Technology Literacy

ERIC Educational Resources Information Center

Cydis, Susan

2015-01-01

Technology integration is an important aspect of student competence in the 21st century. The use of technology in teaching and learning is a valuable practice for supporting student learning and engagement. Modelling the pedagogical practices that integrate authentic, performance-based opportunities for technology integration was the focus of a…

Cardiac Screening Prior to Stimulant Treatment of ADHD: A Survey of US-Based Pediatricians

PubMed Central

Rodday, Angie Mae; Saunders, Tully S.; Cohen, Joshua T.; Wong, John B.; Parsons, Susan K.

2012-01-01

OBJECTIVES: To determine pediatricians’ attitudes, barriers, and practices regarding cardiac screening before initiating treatment with stimulants for attention-deficit/hyperactivity disorder. METHODS: A survey of 1600 randomly selected, practicing US pediatricians with American Academy of Pediatrics membership was conducted. Multivariate models were created for 3 screening practices: (1) performing an in-depth cardiac history and physical (H & P) examination, (2) discussing potential stimulant-related cardiac risks, and (3) ordering an electrocardiogram (ECG). RESULTS: Of 817 respondents (51%), 525 (64%) met eligibility criteria. Regarding attitudes, pediatricians agreed that both the risk for sudden cardiac death (SCD) (24%) and legal liability (30%) were sufficiently high to warrant cardiac assessment; 75% agreed that physicians were responsible for informing families about SCD risk. When identifying cardiac disorders, few (18%) recognized performing an in-depth cardiac H & P as a barrier; in contrast, 71% recognized interpreting a pediatric ECG as a barrier. When asked about cardiac screening practices before initiating stimulant treatment for a recent patient, 93% completed a routine H & P, 48% completed an in-depth cardiac H & P, and 15% ordered an ECG. Almost half (46%) reported discussing stimulant-related cardiac risks. Multivariate modeling indicated that ≥1 of these screening practices were associated with physicians’ attitudes about SCD risk, legal liability, their responsibility to inform about risk, their ability to perform an in-depth cardiac H & P, and family concerns about risk. CONCLUSIONS: Variable pediatrician attitudes and cardiac screening practices reflect the limited evidence base and conflicting guidelines regarding cardiac screening. Barriers to identifying cardiac disorders influence practice. PMID:22250023

The 10 Building Blocks of High-Performing Primary Care

PubMed Central

Bodenheimer, Thomas; Ghorob, Amireh; Willard-Grace, Rachel; Grumbach, Kevin

2014-01-01

Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led to a formulation of the essential elements of primary care, which we call the 10 building blocks of high-performing primary care. The building blocks include 4 foundational elements—engaged leadership, data-driven improvement, empanelment, and team-based care—that assist the implementation of the other 6 building blocks—patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future. The building blocks, which represent a synthesis of the innovative thinking that is transforming primary care in the United States, are both a description of existing high-performing practices and a model for improvement. PMID:24615313

The 10 building blocks of high-performing primary care.

PubMed

Bodenheimer, Thomas; Ghorob, Amireh; Willard-Grace, Rachel; Grumbach, Kevin

2014-01-01

Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led to a formulation of the essential elements of primary care, which we call the 10 building blocks of high-performing primary care. The building blocks include 4 foundational elements-engaged leadership, data-driven improvement, empanelment, and team-based care-that assist the implementation of the other 6 building blocks-patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future. The building blocks, which represent a synthesis of the innovative thinking that is transforming primary care in the United States, are both a description of existing high-performing practices and a model for improvement.

Practical implications for genetic modeling in the genomics era

USDA-ARS?s Scientific Manuscript database

Genetic models convert data into estimated breeding values and other information useful to breeders. The goal is to provide accurate and timely predictions of the future performance for each animal (or embryo). Modeling involves defining traits, editing raw data, removing environmental effects, incl...

A flexible framework for process-based hydraulic and water quality modeling of stormwater green infrastructure performance

EPA Science Inventory

Background Models that allow for design considerations of green infrastructure (GI) practices to control stormwater runoff and associated contaminants have received considerable attention in recent years. While popular, generally, the GI models are relatively simplistic. However,...

Observation learning versus physical practice leads to different consolidation outcomes in a movement timing task.

PubMed

Trempe, Maxime; Sabourin, Maxime; Rohbanfard, Hassan; Proteau, Luc

2011-03-01

Motor learning is a process that extends beyond training sessions. Specifically, physical practice triggers a series of physiological changes in the CNS that are regrouped under the term "consolidation" (Stickgold and Walker 2007). These changes can result in between-session improvement or performance stabilization (Walker 2005). In a series of three experiments, we tested whether consolidation also occurs following observation. In Experiment 1, participants observed an expert model perform a sequence of arm movements. Although we found evidence of observation learning, no significant difference was revealed between participants asked to reproduce the observed sequence either 5 min or 24 h later (no between-session improvement). In Experiment 2, two groups of participants observed an expert model perform two distinct movement sequences (A and B) either 10 min or 8 h apart; participants then physically performed both sequences after a 24-h break. Participants in the 8-h group performed Sequence B less accurately compared to participants in the 5-min group, suggesting that the memory representation of the first sequence had been stabilized and that it interfered with the learning of the second sequence. Finally, in Experiment 3, the initial observation phase was replaced by a physical practice phase. In contrast with the results of Experiment 2, participants in the 8-h group performed Sequence B significantly more accurately compared to participants in the 5-min group. Together, our results suggest that the memory representation of a skill learned through observation undergoes consolidation. However, consolidation of an observed motor skill leads to distinct behavioural outcomes in comparison with physical practice.

Model Policies in Support of High Performance School Buildings for All Children

ERIC Educational Resources Information Center

21st Century School Fund, 2006

2006-01-01

Model Policies in Support of High Performance School Buildings for All Children is to begin to create a coherent and comprehensive set of state policies that will provide the governmental infrastructure for effective and creative practice in facility management. There are examples of good policy in many states, but no state has a coherent set of…

Modeling the Psychometric Properties of Complex Performance Assessment Tasks Using Confirmatory Factor Analysis: A Multistage Model for Calibrating Tasks

ERIC Educational Resources Information Center

Kahraman, Nilufer; De Champlain, Andre; Raymond, Mark

2012-01-01

Item-level information, such as difficulty and discrimination are invaluable to the test assembly, equating, and scoring practices. Estimating these parameters within the context of large-scale performance assessments is often hindered by the use of unbalanced designs for assigning examinees to tasks and raters because such designs result in very…

The role of production and teamwork practices in construction safety: a cognitive model and an empirical case study.

PubMed

Mitropoulos, Panagiotis Takis; Cupido, Gerardo

2009-01-01

In construction, the challenge for researchers and practitioners is to develop work systems (production processes and teams) that can achieve high productivity and high safety at the same time. However, construction accident causation models ignore the role of work practices and teamwork. This study investigates the mechanisms by which production and teamwork practices affect the likelihood of accidents. The paper synthesizes a new model for construction safety based on the cognitive perspective (Fuller's Task-Demand-Capability Interface model, 2005) and then presents an exploratory case study. The case study investigates and compares the work practices of two residential framing crews: a 'High Reliability Crew' (HRC)--that is, a crew with exceptional productivity and safety over several years, and an average performing crew from the same company. The model explains how the production and teamwork practices generate the work situations that workers face (the task demands) and affect the workers ability to cope (capabilities). The case study indicates that the work practices of the HRC directly influence the task demands and match them with the applied capabilities. These practices were guided by the 'principle' of avoiding errors and rework and included work planning and preparation, work distribution, managing the production pressures, and quality and behavior monitoring. The Task Demand-Capability model links construction research to a cognitive model of accident causation and provides a new way to conceptualize safety as an emergent property of the production practices and teamwork processes. The empirical evidence indicates that the crews' work practices and team processes strongly affect the task demands, the applied capabilities, and the match between demands and capabilities. The proposed model and the exploratory case study will guide further discovery of work practices and teamwork processes that can increase both productivity and safety in construction operations. Such understanding will enable training of construction foremen and crews in these practices to systematically develop high reliability crews.

Static and transient performance prediction for CFB boilers using a Bayesian-Gaussian Neural Network

NASA Astrophysics Data System (ADS)

Ye, Haiwen; Ni, Weidou

1997-06-01

A Bayesian-Gaussian Neural Network (BGNN) is put forward in this paper to predict the static and transient performance of Circulating Fluidized Bed (CFB) boilers. The advantages of this network over Back-Propagation Neural Networks (BPNNs), easier determination of topology, simpler and time saving in training process as well as self-organizing ability, make this network more practical in on-line performance prediction for complicated processes. Simulation shows that this network is comparable to the BPNNs in predicting the performance of CFB boilers. Good and practical on-line performance predictions are essential for operation guide and model predictive control of CFB boilers, which are under research by the authors.

For Performance through Learning, Knowledge Management Is Critical Practice

ERIC Educational Resources Information Center

Gorelick, Carol; Tantawy-Monsou, Brigitte

2005-01-01

Purpose: This paper proposes that knowledge management is a system that integrates people, process and technology for sustainable results by increasing performance through learning. Definitions of knowledge, knowledge management and performance serve as a foundation. Design/methodology/approach: The model for the knowledge era proposed in this…

Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

ERIC Educational Resources Information Center

Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

2010-01-01

Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

Deliberate Practice as a Theoretical Framework for Interprofessional Experiential Education.

PubMed

Wang, Joyce M; Zorek, Joseph A

2016-01-01

The theory of deliberate practice has been applied to many skill-based performance activities. The primary aim of this project was to integrate synergistic principles from deliberate practice and consensus-derived competencies for interprofessional education into a framework upon which educational models to advance interprofessional experiential education (IEE) might be built. CINAHL, ERIC, and MEDLINE databases were searched using the keywords "deliberate practice" and "interprofessional education," both individually and in combination. Relevant articles were selected from the catalog based on support for the premise of the project. Defining characteristics of deliberate practice were distilled with particular emphasis on their application to the Interprofessional Education Collaborative's (IPEC) core competencies. Recommendations for IEE development were identified through the synthesis of deliberate practice principles and IPEC competencies. There is a high degree of synergy between deliberate practice principles and IPEC competencies. Our synthesis of the literature yielded a cyclical four-step process to advance IEE: (1) implement an IEE plan guided by the student's strengths/weaknesses and in consideration of the collaborative practice skills they wish to develop, (2) engage in IPE experiences that will challenge targeted skills according to the IEE plan, (3) embed frequent opportunities for student reflection and preceptor/team feedback within IEE plan, and (4) revise the IEE plan and the IPE experience based on insights gained during step 3. The cyclical four-step process synthesized through this literature review may be used to guide the development of new IEE models. The purposeful development of IEE models grounded in a theory that has already been operationalized in other skill-based performance areas is an important step to address expanding accreditation standards throughout the health professions mandating interprofessional education for pre-licensure health professional students.

An evaluation of gender equity in different models of primary care practices in Ontario

PubMed Central

2010-01-01

Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued. PMID:20331861

Practice Management: The Game Changer

PubMed Central

Pessis, Paul

2016-01-01

The reimbursement landscape is undergoing significant changes. Practice management, which encompasses reimbursement, is becoming increasingly more important in securing business success. Each practitioner within a facility is responsible for fortifying the practice through thoughtful business protocols. Knowing legislation that impacts health care along with understanding the foundational components of reimbursement is key for keeping a practice financially healthy. Change is good, but making the changes is what counts! Legislation such as the Medicare Access and Chip Reauthorization Act defines the new payment models. Correcting current business practices might seem difficult on the surface, but implementing change is rewarding and an obligation of the practitioners within a facility to their patients. Financial stability for a practice occurs when sound business practices are routine. Today's audiologist must not only be proficient at performing his or her scope of practice, but must also accept that performing best business practices is part of the job. In the end, the patients seeking the services of the audiologist benefit most when a practice has the financial stability to be best in its class. PMID:28028326

Sediment delivery modeling in practice: Comparing the effects of watershed characteristics and data resolution across hydroclimatic regions.

PubMed

Hamel, Perrine; Falinski, Kim; Sharp, Richard; Auerbach, Daniel A; Sánchez-Canales, María; Dennedy-Frank, P James

2017-02-15

Geospatial models are commonly used to quantify sediment contributions at the watershed scale. However, the sensitivity of these models to variation in hydrological and geomorphological features, in particular to land use and topography data, remains uncertain. Here, we assessed the performance of one such model, the InVEST sediment delivery model, for six sites comprising a total of 28 watersheds varying in area (6-13,500km 2 ), climate (tropical, subtropical, mediterranean), topography, and land use/land cover. For each site, we compared uncalibrated and calibrated model predictions with observations and alternative models. We then performed correlation analyses between model outputs and watershed characteristics, followed by sensitivity analyses on the digital elevation model (DEM) resolution. Model performance varied across sites (overall r 2 =0.47), but estimates of the magnitude of specific sediment export were as or more accurate than global models. We found significant correlations between metrics of sediment delivery and watershed characteristics, including erosivity, suggesting that empirical relationships may ultimately be developed for ungauged watersheds. Model sensitivity to DEM resolution varied across and within sites, but did not correlate with other observed watershed variables. These results were corroborated by sensitivity analyses performed on synthetic watersheds ranging in mean slope and DEM resolution. Our study provides modelers using InVEST or similar geospatial sediment models with practical insights into model behavior and structural uncertainty: first, comparison of model predictions across regions is possible when environmental conditions differ significantly; second, local knowledge on the sediment budget is needed for calibration; and third, model outputs often show significant sensitivity to DEM resolution. Copyright © 2016 Elsevier B.V. All rights reserved.

A model to teach concomitant patient communication during psychomotor skill development.

PubMed

Nicholls, Delwyn; Sweet, Linda; Muller, Amanda; Hyett, Jon

2018-01-01

Many health professionals use psychomotor or task-based skills in clinical practice that require concomitant communication with a conscious patient. Verbally engaging with the patient requires highly developed verbal communication skills, enabling the delivery of patient-centred care. Historically, priority has been given to learning the psychomotor skills essential to clinical practice. However, there has been a shift towards also ensuring competent communication with the patient during skill performance. While there is literature outlining the steps to teach and learn verbal communication skills, little is known about the most appropriate instructional approach to teach how to verbally engage with the patient when also learning to perform a task. A literature review was performed and it identified that there was no model or proven approach which could be used to integrate the learning of both psychomotor and communication skills. This paper reviews the steps to teach a communication skill and provides a suggested model to guide the acquisition and development of the concomitant -communication skills required with a patient at the time a psychomotor skill is performed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Internal audit in a microbiology laboratory.

PubMed Central

Mifsud, A J; Shafi, M S

1995-01-01

AIM--To set up a programme of internal laboratory audit in a medical microbiology laboratory. METHODS--A model of laboratory based process audit is described. Laboratory activities were examined in turn by specimen type. Standards were set using laboratory standard operating procedures; practice was observed using a purpose designed questionnaire and the data were analysed by computer; performance was assessed at laboratory audit meetings; and the audit circle was closed by re-auditing topics after an interval. RESULTS--Improvements in performance scores (objective measures) and in staff morale (subjective impression) were observed. CONCLUSIONS--This model of process audit could be applied, with amendments to take local practice into account, in any microbiology laboratory. PMID:7665701

Impact of Apex Model parameterization strategy on estimated benefit of conservation practices

USDA-ARS?s Scientific Manuscript database

Three parameterized Agriculture Policy Environmental eXtender (APEX) models for corn-soybean rotation on clay pan soils were developed with the objectives, 1. Evaluate model performance of three parameterization strategies on a validation watershed; and 2. Compare predictions of water quality benefi...

High-performance work systems in health care management, part 1: development of an evidence-informed model.

PubMed

Garman, Andrew N; McAlearney, Ann Scheck; Harrison, Michael I; Song, Paula H; McHugh, Megan

2011-01-01

: Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.

Evaluation of economic efficiencies in clinical retina practice: activity-based cost analysis and modeling to determine impacts of changes in patient management

PubMed Central

Murray, Timothy G; Tornambe, Paul; Dugel, Pravin; Tong, Kuo Bianchini

2011-01-01

Background The purpose of this study is to report the use of activity-based cost analysis to identify areas of practice efficiencies and inefficiencies within a large academic retinal center and a small single-specialty group. This analysis establishes a framework for evaluating rapidly shifting clinical practices (anti-vascular endothelial growth factor therapy, microincisional vitrectomy surgery) and incorporating changing reimbursements for care delivery (intravitreal injections, optical coherence tomography [OCT]) to determine the impact on practice profitability. Pro forma modeling targeted the impact of declining reimbursement for OCT imaging and intravitreal injection using a strategy that incorporates activity-based cost analysis into a direct evaluation schema for clinical operations management. Methods Activity-based costing analyses were performed at two different types of retinal practices in the US, ie, a small single-specialty group practice and an academic hospital-based practice (Bascom Palmer Eye Institute). Retrospective claims data were utilized to identify all procedures performed and billed, submitted charges, allowed charges, and net collections from each of these two practices for the calendar years 2005–2006 and 2007–2008. A pro forma analysis utilizing current reimbursement profiles was performed to determine the impact of altered reimbursement on practice profitability. All analyses were performed by a third party consulting firm. Results The small single-specialty group practice outperformed the academic hospital-based practice on almost all markers of efficiency. In the academic hospital-based practice, only four service lines were profitable, ie, nonlaser surgery, laser surgery, non-OCT diagnostics, and injections. Profit margin varied from 62% for nonlaser surgery to 1% for intravitreal injections. Largest negative profit contributions were associated with office visits and OCT imaging. Conclusion Activity-based cost analysis is a powerful tool to evaluate retinal practice efficiencies. These two distinct practices were able to provide significant increases in clinical care (office visits, ophthalmic imaging, and patient procedures) through maintaining efficiencies of care. Pro forma analysis of 2011 data noted that OCT payments to facilities and physicians continue to decrease dramatically and that this payment decrease further reduced the profitability for the two largest aspects of these retinal practices, ie, intravitreal injections and OCT retinal imaging. Ultimately, all retinal practices are at risk for significant shifts in financial health related to rapidly evolving changes in patterns of care and reimbursement associated with providing outstanding clinical care. PMID:21792278

The Application of Modeling and Simulation in Capacity Management within the ITIL Framework

NASA Technical Reports Server (NTRS)

Rahmani, Sonya; vonderHoff, Otto

2010-01-01

Tightly integrating modeling and simulation techniques into Information Technology Infrastructure Library (ITIL) practices can be one of the driving factors behind a successful and cost-effective capacity management effort for any Information Technology (IT) system. ITIL is a best practices framework for managing IT infrastructure, development and operations. Translating ITIL theory into operational reality can be a challenge. This paper aims to highlight how to best integrate modeling and simulation into an ITIL implementation. For cases where the project team initially has difficulty gaining consensus on investing in modeling and simulation resources, a clear definition for M&S implementation into the ITIL framework, specifically its role in supporting Capacity Management, is critical to gaining the support required to garner these resources. This implementation should also help to clearly define M&S support to the overall system mission. This paper will describe the development of an integrated modeling approach and how best to tie M&S to definitive goals for evaluating system capacity and performance requirements. Specifically the paper will discuss best practices for implementing modeling and simulation into ITIL. These practices hinge on implementing integrated M&S methods that 1) encompass at least two or more predictive modeling techniques, 2) complement each one's respective strengths and weaknesses to support the validation of predicted results, and 3) are tied to the system's performance and workload monitoring efforts. How to structure two forms of modeling: statistical and simUlation in the development of "As Is" and "To Be" efforts will be used to exemplify the integrated M&S methods. The paper will show how these methods can better support the project's overall capacity management efforts.

Modeling the effects of LID practices on streams health at watershed scale

NASA Astrophysics Data System (ADS)

Shannak, S.; Jaber, F. H.

2013-12-01

Increasing impervious covers due to urbanization will lead to an increase in runoff volumes, and eventually increase flooding. Stream channels adjust by widening and eroding stream bank which would impact downstream property negatively (Chin and Gregory, 2001). Also, urban runoff drains in sediment bank areas in what's known as riparian zones and constricts stream channels (Walsh, 2009). Both physical and chemical factors associated with urbanization such as high peak flows and low water quality further stress aquatic life and contribute to overall biological condition of urban streams (Maxted et al., 1995). While LID practices have been mentioned and studied in literature for stormwater management, they have not been studied in respect to reducing potential impact on stream health. To evaluate the performance and the effectiveness of LID practices at a watershed scale, sustainable detention pond, bioretention, and permeable pavement will be modeled at watershed scale. These measures affect the storm peak flows and base flow patterns over long periods, and there is a need to characterize their effect on stream bank and bed erosion, and aquatic life. These measures will create a linkage between urban watershed development and stream conditions specifically biological health. The first phase of this study is to design and construct LID practices at the Texas A&M AgriLife Research and Extension Center-Dallas, TX to collect field data about the performance of these practices on a smaller scale. The second phase consists of simulating the performance of LID practices on a watershed scale. This simulation presents a long term model (23 years) using SWAT to evaluate the potential impacts of these practices on; potential stream bank and bed erosion, and potential impact on aquatic life in the Blunn Watershed located in Austin, TX. Sub-daily time step model simulations will be developed to simulate the effectiveness of the three LID practices with respect to reducing potential erosion from stream beds and banks by studying annual average excess shear and reducing potential impact on aquatic life by studying rapid changes and variation in flow regimes in urban streams. This study will contribute to develop a methodology that evaluates the impact of hydrological changes that occur due to urban development, on aquatic life, stream bank and bed erosion. This is an ongoing research project and results will be shared and discussed at the conference.

Participation and occupation in occupational therapy models of practice: A discussion of possibilities and challenges.

PubMed

Larsson-Lund, Maria; Nyman, Anneli

2017-11-01

Occupation has been the focus in occupational therapy practice to greater or lesser degrees from a historical viewpoint. This evokes a need to discuss whether concepts that are added to our field will enhance or blur our focus on occupation. To explore how the concept of participation in the International Classification of Functioning, Disability and Health (ICF) is related to the concept of occupation by reviewing and comparing its use in three models of practice within occupational therapy. The aim was also to generate discussion on possibilities and challenges concerning the relationship of participation and occupation. The models reviewed were The Model of Human Occupation (MOHO), the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Occupational Therapy Intervention Process Model (OTIPM). The concept of participation was related to occupation in different ways in these models. Based on the review some challenges and considerations for occupational therapy were generated. Relating the concept of participation from the ICF to the concept of occupation in models of practice can be challenging. At the same time, relating the concepts can be a resource to develop occupational therapy and the understanding of occupational issues in society.

Patient-Centered Specialty Practice: Defining the Role of Specialists in Value-Based Health Care.

PubMed

Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani

2017-04-01

Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.

Reforming the Portuguese mental health system: an incentive-based approach.

PubMed

Perelman, Julian; Chaves, Pedro; de Almeida, José Miguel Caldas; Matias, Maria Ana

2018-01-01

To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices. We performed a comprehensive review of healthcare providers' payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way. We designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness. The implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.

The Impact of Urban US Policing Practices on Black Men Who Have Sex with Men's HIV Vulnerability: Ethnographic Findings and a Conceptual Model for Future Research.

PubMed

Parker, Caroline M; Parker, Richard G; Philbin, Morgan M; Hirsch, Jennifer S

2018-04-01

This paper advances research on racism and health by presenting a conceptual model that delineates pathways linking policing practices to HIV vulnerability among Black men who have sex with men in the urban USA. Pathways include perceived discrimination based on race, sexuality and gender performance, mental health, and condom-carrying behaviors. The model, intended to stimulate future empirical work, is based on a review of the literature and on ethnographic data collected in 2014 in New York City. This paper contributes to a growing body of work that examines policing practices as drivers of racial health disparities extending far beyond violence-related deaths.

How Well Does LCA Model Land Use Impacts on Biodiversity?--A Comparison with Approaches from Ecology and Conservation.

PubMed

Curran, Michael; de Souza, Danielle Maia; Antón, Assumpció; Teixeira, Ricardo F M; Michelsen, Ottar; Vidal-Legaz, Beatriz; Sala, Serenella; Milà i Canals, Llorenç

2016-03-15

The modeling of land use impacts on biodiversity is considered a priority in life cycle assessment (LCA). Many diverging approaches have been proposed in an expanding literature on the topic. The UNEP/SETAC Life Cycle Initiative is engaged in building consensus on a shared modeling framework to highlight best-practice and guide model application by practitioners. In this paper, we evaluated the performance of 31 models from both the LCA and the ecology/conservation literature (20 from LCA, 11 from non-LCA fields) according to a set of criteria reflecting (i) model completeness, (ii) biodiversity representation, (iii) impact pathway coverage, (iv) scientific quality, and (v) stakeholder acceptance. We show that LCA models tend to perform worse than those from ecology and conservation (although not significantly), implying room for improvement. We identify seven best-practice recommendations that can be implemented immediately to improve LCA models based on existing approaches in the literature. We further propose building a "consensus model" through weighted averaging of existing information, to complement future development. While our research focuses on conceptual model design, further quantitative comparison of promising models in shared case studies is an essential prerequisite for future informed model choice.

Models of clinical reasoning with a focus on general practice: A critical review

PubMed Central

YAZDANI, SHAHRAM; HOSSEINZADEH, MOHAMMAD; HOSSEINI, FAKHROLSADAT

2017-01-01

Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed. PMID:28979912

A theory of planned behaviour-based analysis of TIMSS 2011 to determine factors influencing inquiry teaching practices in high-performing countries

NASA Astrophysics Data System (ADS)

Pongsophon, Pongprapan; Herman, Benjamin C.

2017-07-01

Given the abundance of literature describing the strong relationship between inquiry-based teaching and student achievement, more should be known about the factors impacting science teachers' classroom inquiry implementation. This study utilises the theory of planned behaviour to propose and validate a causal model of inquiry-based teaching through analysing data relating to high-performing countries retrieved from the 2011 Trends in International Mathematics and Science Study assessments. Data analysis was completed through structural equation modelling using a polychoric correlation matrix for data input and diagonally weighted least squares estimation. Adequate fit of the full model to the empirical data was realised. The model demonstrates that the extent the teachers participated in academic collaborations was positively related to their occupational satisfaction, confidence in teaching inquiry, and classroom inquiry practices. Furthermore, the teachers' confidence with implementing inquiry was positively related to their classroom inquiry implementation and occupational satisfaction. However, perceived student-generated constraints demonstrated a negative relationship with the teachers' confidence with implementing inquiry and occupational satisfaction. Implications from this study include supporting teachers through promoting collaborative opportunities that facilitate inquiry-based practices and occupational satisfaction.

A systematic review of evidence for education and training interventions in microsurgery.

PubMed

Ghanem, Ali M; Hachach-Haram, Nadine; Leung, Clement Chi Ming; Myers, Simon Richard

2013-07-01

Over the past decade, driven by advances in educational theory and pressures for efficiency in the clinical environment, there has been a shift in surgical education and training towards enhanced simulation training. Microsurgery is a technical skill with a steep competency learning curve on which the clinical outcome greatly depends. This paper investigates the evidence for educational and training interventions of traditional microsurgical skills courses in order to establish the best evidence practice in education and training and curriculum design. A systematic review of MEDLINE, EMBASE, and PubMed databases was performed to identify randomized control trials looking at educational and training interventions that objectively improved microsurgical skill acquisition, and these were critically appraised using the BestBETs group methodology. The databases search yielded 1,148, 1,460, and 2,277 citations respectively. These were then further limited to randomized controlled trials from which abstract reviews reduced the number to 5 relevant randomised controlled clinical trials. The best evidence supported a laboratory based low fidelity model microsurgical skills curriculum. There was strong evidence that technical skills acquired on low fidelity models transfers to improved performance on higher fidelity human cadaver models and that self directed practice leads to improved technical performance. Although there is significant paucity in the literature to support current microsurgical education and training practices, simulated training on low fidelity models in microsurgery is an effective intervention that leads to acquisition of transferable skills and improved technical performance. Further research to identify educational interventions associated with accelerated skill acquisition is required.

A pollution fate and transport model application in a semi-arid region: Is some number better than no number?

PubMed

Özcan, Zeynep; Başkan, Oğuz; Düzgün, H Şebnem; Kentel, Elçin; Alp, Emre

2017-10-01

Fate and transport models are powerful tools that aid authorities in making unbiased decisions for developing sustainable management strategies. Application of pollution fate and transport models in semi-arid regions has been challenging because of unique hydrological characteristics and limited data availability. Significant temporal and spatial variability in rainfall events, complex interactions between soil, vegetation and topography, and limited water quality and hydrological data due to insufficient monitoring network make it a difficult task to develop reliable models in semi-arid regions. The performances of these models govern the final use of the outcomes such as policy implementation, screening, economical analysis, etc. In this study, a deterministic distributed fate and transport model, SWAT, is applied in Lake Mogan Watershed, a semi-arid region dominated by dry agricultural practices, to estimate nutrient loads and to develop the water budget of the watershed. To minimize the discrepancy due to limited availability of historical water quality data extensive efforts were placed in collecting site-specific data for model inputs such as soil properties, agricultural practice information and land use. Moreover, calibration parameter ranges suggested in the literature are utilized during calibration in order to obtain more realistic representation of Lake Mogan Watershed in the model. Model performance is evaluated using comparisons of the measured data with 95%CI for the simulated data and comparison of unit pollution load estimations with those provided in the literature for similar catchments, in addition to commonly used evaluation criteria such as Nash-Sutcliffe simulation efficiency, coefficient of determination and percent bias. These evaluations demonstrated that even though the model prediction power is not high according to the commonly used model performance criteria, the calibrated model may provide useful information in the comparison of the effects of different management practices on diffuse pollution and water quality in Lake Mogan Watershed. Copyright © 2017 Elsevier B.V. All rights reserved.

Where are the food animal veterinarian shortage areas anyway?

PubMed

Wang, Tong; Hennessy, David A; O'Connor, Annette M

2012-05-01

In 2010 the United States implemented the Veterinary Medicine Loan Repayment Program (VMLRP) to address perceived regional shortages in certain veterinary occupations, including food animal practice. With county as the unit of analysis, this paper describes a pair of models to evaluate factors associated with being designated a private practice shortage area in 2010. One model is used to explain food animal veterinarian location choices so as to provide an objective evaluation of comparative shortage. The other model seeks to explain the counties chosen as shortage areas. Model results are then used to evaluate the program. On the whole the program appears to perform quite well. For several states, however, VMLRP shortage designations are inconsistent with the food animal veterinarian location model. Comparative shortage is generally more severe in states that have no VMLRP designated private practice shortage counties than in states that do. Copyright © 2012 Elsevier B.V. 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 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

Practical implications for genetic modeling in the genomics era for the dairy industry

USDA-ARS?s Scientific Manuscript database

Genetic models convert data into estimated breeding values and other information useful to breeders. The goal is to provide accurate and timely predictions of the future performance for each animal (or embryo). Modeling involves defining traits, editing raw data, removing environmental effects, incl...

Workflow for Integrating Mesoscale Heterogeneities in Materials Structure with Process Simulation of Titanium Alloys (Postprint)

DTIC Science & Technology

2014-10-01

offer a practical solution to calculating the grain -scale hetero- geneity present in the deformation field. Consequently, crystal plasticity models...process/performance simulation codes (e.g., crystal plasticity finite element method). 15. SUBJECT TERMS ICME; microstructure informatics; higher...iii) protocols for direct and efficient linking of materials models/databases into process/performance simulation codes (e.g., crystal plasticity

Towards Core Modelling Practices in Integrated Water Resource Management: An Interdisciplinary View of the Modelling Process

NASA Astrophysics Data System (ADS)

Jakeman, A. J.; Elsawah, S.; Pierce, S. A.; Ames, D. P.

2016-12-01

The National Socio-Environmental Synthesis Center (SESYNC) Core Modelling Practices Pursuit is developing resources to describe core practices for developing and using models to support integrated water resource management. These practices implement specific steps in the modelling process with an interdisciplinary perspective; however, the particular practice that is most appropriate depends on contextual aspects specific to the project. The first task of the pursuit is to identify the various steps for which implementation practices are to be described. This paper reports on those results. The paper draws on knowledge from the modelling process literature for environmental modelling (Jakeman et al., 2006), engaging stakeholders (Voinov and Bousquet, 2010) and general modelling (Banks, 1999), as well as the experience of the consortium members. We organise the steps around the four modelling phases. The planning phase identifies what is to be achieved, how and with what resources. The model is built and tested during the construction phase, and then used in the application phase. Finally, models that become part of the ongoing policy process require a maintenance phase. For each step, the paper focusses on what is to be considered or achieved, rather than how it is performed. This reflects the separation of the steps from the practices that implement them in different contexts. We support description of steps with a wide range of examples. Examples are designed to be generic and do not reflect any one project or context, but instead are drawn from common situations or from extremely different ones so as to highlight some of the issues that may arise at each step. References Banks, J. (1999). Introduction to simulation. In Proceedings of the 1999 Winter Simulation Conference. Jakeman, A. J., R. A. Letcher, and J. P. Norton (2006). Ten iterative steps in development and evaluation of environmental models. Environmental Modelling and Software 21, 602-614. Voinov, A. and F. Bousquet (2010). Modelling with stakeholders. Environmental Modelling & Software 25 (11), 1268-1281.

Teaching elliptical excision skills to novice medical students: a randomized controlled study comparing low- and high-fidelity bench models.

PubMed

Denadai, Rafael; Oshiiwa, Marie; Saad-Hossne, Rogério

2014-03-01

The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals. To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students. Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills' training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs' skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances. The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills' training) was considered large (>0.80) in all measurements. The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.

Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial.

PubMed

Meropol, Sharon B; Schiltz, Nicholas K; Sattar, Abdus; Stange, Kurt C; Nevar, Ann H; Davey, Christina; Ferretti, Gerald A; Howell, Diana E; Strosaker, Robyn; Vavrek, Pamela; Bader, Samantha; Ruhe, Mary C; Cuttler, Leona

2014-06-01

Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care. Copyright © 2014 by the American Academy of Pediatrics.

Group Performance in Information Systems Project Groups: An Empirical Study

ERIC Educational Resources Information Center

Bahli, Bouchaib; Buyukkurt, Meral Demirbag

2005-01-01

The importance of teamwork in Information Systems Development (ISD) practice and education has been acknowledged but not studied extensively to date. This paper tests a model of how groups participating in ISD projects perform and examines the relationships between some antecedents of this performance based on group research theory well…

Study of the Performance and Characteristics of U.S. Academic Research Institution Technology Commercialization (ARITC)

ERIC Educational Resources Information Center

Kim, Jisun

2012-01-01

This dissertation aims to provide a better understanding of the technology licensing practices of academic research institutions. The study identifies time durations in licensing and incorporates these into a model to evaluate licensing performance. Performance is measured by the efficiency of an institution's technology licensing process and…

Leadership development practices and hospital financial outcomes.

PubMed

Crowe, Daniel; Garman, Andrew N; Li, Chien-Ching; Helton, Jeff; Anderson, Matthew M; Butler, Peter

2017-08-01

Affordable Care Act legislation is requiring leaders in US health systems to adapt to new and very different approaches to improving operating performance. Research from other industries suggests leadership development can be a helpful component of organizational change strategies; however, there is currently very little healthcare-specific research available to guide design and deployment. The goal of this exploratory study is to examine potential relationships between specific leadership development practices and health system financial outcomes. Results from the National Center for Healthcare Leadership survey of leadership development practices were correlated with hospital and health system financial performance data from the 2013 Medicare Cost Reports. A general linear regression model, controlling for payer mix, case-mix index, and bed size, was used to assess possible relationships between leadership practices and three financial performance metrics: operating margin, days cash on hand, and debt to capitalization. Statistically significant associations were found between hospital-level operating margins and 5 of the 11 leadership practices as well as the composite score. Relationships at the health system level, however, were not statistically significant. Results provide preliminary evidence of an association between hospital financial performance and investments made in developing their leaders.

A Reflective Learning Framework to Evaluate CME Effects on Practice Reflection

ERIC Educational Resources Information Center

Leung, Kit H.; Pluye, Pierre; Grad, Roland; Weston, Cynthia

2010-01-01

Introduction: The importance of reflective practice is recognized by the adoption of a reflective learning model in continuing medical education (CME), but little is known about how to evaluate reflective learning in CME. Reflective learning seldom is defined in terms of specific cognitive processes or observable performances. Competency-based…

Augmentative and Alternative Communication and Language: Evidence-Based Practice and Language Activity Monitoring

ERIC Educational Resources Information Center

Hill, Katya

2004-01-01

The goal of augmentative and alternative communication (AAC) is the most effective communication possible. Speech-language pathologists are obligated to collect data, measure communication, and apply the principles of evidence-based practice (EBP). This article presents a model for EBP that represents how collecting and evaluating performance data…

Performing Disability in Music Teacher Education: Moving beyond Inclusion through Expanded Professionalism

ERIC Educational Resources Information Center

Laes, Tuulikki; Westerlund, Heidi

2018-01-01

Disability is a neglected field of diversity within music education scholarship and practices. The study reported in this article sought alternatives for the hierarchical practice-model and ableist discourses that have thus far pervaded music teacher education, through a reconceptualization of expertise. The focus is on a Finnish university…

Strategy Execution in Cognitive Skill Learning: An Item-Level Test of Candidate Models

ERIC Educational Resources Information Center

Rickard, Timothy C.

2004-01-01

This article investigates the transition to memory-based performance that commonly occurs with practice on tasks that initially require use of a multistep algorithm. In an alphabet arithmetic task, item response times exhibited pronounced step-function decreases after moderate practice that were uniquely predicted by T. C. Rickard's (1997)…

Putting Teachers First: Leading Change through Design--Initiating and Sustaining Effective Teaching of Mathematics

ERIC Educational Resources Information Center

Proffitt-White, Rob

2017-01-01

The Teachers First initiative is a grass-roots cluster-model approach for bringing together primary and secondary teachers and school principals: to analyse student performance data; design and practice activities and assessment tools; and promote teaching practices that address students' learning difficulties in mathematics. The balance of both…

Teaching Practical Science Online Using GIS: A Cautionary Tale of Coping Strategies

ERIC Educational Resources Information Center

Argles, Tom

2017-01-01

Strong demand for GIS and burgeoning cohorts have encouraged the delivery of GIS teaching via online distance education models. This contribution reviews a brief foray (2012-2014) into this field by the Open University, deploying open source GIS software to enable students to perform practical science investigations online. The "Remote…

Organizational Alignment Supporting Distance Education in Post-Secondary Institutions.

ERIC Educational Resources Information Center

Prestera, Gustavo E.; Moller, Leslie A.

2001-01-01

Applies an established model of organizational alignment to distance education in postsecondary institutions and recommends performance-oriented approaches to support growth by analyzing goals, structure, and management practices across the organization. Presents performance improvement strategies such as benchmarking and documenting workflows,…

Patient satisfaction with ambulatory care in Germany: effects of patient- and medical practice-related factors.

PubMed

Auras, Silke; Ostermann, Thomas; de Cruppé, Werner; Bitzer, Eva-Maria; Diel, Franziska; Geraedts, Max

2016-12-01

The study aimed to illustrate the effect of the patients' sex, age, self-rated health and medical practice specialization on patient satisfaction. Secondary analysis of patient survey data using multilevel analysis (generalized linear mixed model, medical practice as random effect) using a sequential modelling strategy. We examined the effects of the patients' sex, age, self-rated health and medical practice specialization on four patient satisfaction dimensions: medical practice organization, information, interaction, professional competence. The study was performed in 92 German medical practices providing ambulatory care in general medicine, internal medicine or gynaecology. In total, 9888 adult patients participated in a patient survey using the validated 'questionnaire on satisfaction with ambulatory care-quality from the patient perspective [ZAP]'. We calculated four models for each satisfaction dimension, revealing regression coefficients with 95% confidence intervals (CIs) for all independent variables, and using Wald Chi-Square statistic for each modelling step (model validity) and LR-Tests to compare the models of each step with the previous model. The patients' sex and age had a weak effect (maximum regression coefficient 1.09, CI 0.39; 1.80), and the patients' self-rated health had the strongest positive effect (maximum regression coefficient 7.66, CI 6.69; 8.63) on satisfaction ratings. The effect of medical practice specialization was heterogeneous. All factors studied, specifically the patients' self-rated health, affected patient satisfaction. Adjustment should always be considered because it improves the comparability of patient satisfaction in medical practices with atypically varying patient populations and increases the acceptance of comparisons. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Formal implementation of a performance evaluation model for the face recognition system.

PubMed

Shin, Yong-Nyuo; Kim, Jason; Lee, Yong-Jun; Shin, Woochang; Choi, Jin-Young

2008-01-01

Due to usability features, practical applications, and its lack of intrusiveness, face recognition technology, based on information, derived from individuals' facial features, has been attracting considerable attention recently. Reported recognition rates of commercialized face recognition systems cannot be admitted as official recognition rates, as they are based on assumptions that are beneficial to the specific system and face database. Therefore, performance evaluation methods and tools are necessary to objectively measure the accuracy and performance of any face recognition system. In this paper, we propose and formalize a performance evaluation model for the biometric recognition system, implementing an evaluation tool for face recognition systems based on the proposed model. Furthermore, we performed evaluations objectively by providing guidelines for the design and implementation of a performance evaluation system, formalizing the performance test process.

Practice-Tailored Facilitation to Improve Pediatric Preventive Care Delivery: A Randomized Trial

PubMed Central

Schiltz, Nicholas K.; Sattar, Abdus; Stange, Kurt C.; Nevar, Ann H.; Davey, Christina; Ferretti, Gerald A.; Howell, Diana E.; Strosaker, Robyn; Vavrek, Pamela; Bader, Samantha; Ruhe, Mary C.; Cuttler, Leona

2014-01-01

OBJECTIVE: Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services. METHODS: In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods. RESULTS: Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices’ control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need. CONCLUSIONS: Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care. PMID:24799539

Family medicine practice performance and knowledge management.

PubMed

Orzano, A John; McInerney, Claire R; Tallia, Alfred F; Scharf, Davida; Crabtree, Benjamin F

2008-01-01

Knowledge management (KM) is the process by which people in organizations find, share, and develop knowledge for action. KM affects performance by influencing work relationships to enhance learning and decision making. To identify how family medicine practices exhibit KM. A model and a template of KM concepts were derived from a comprehensive organizational literature review. Two higher and two lower performing family medicine practices were purposefully selected from existing comparative case studies based on prevention delivery rates and innovation. Interviews, fieldnotes of operations, and clinical encounters were coded independently using the template. Face-to-face discussions resolved coding differences. All practices had processes and tools for finding, sharing, and developing knowledge; however, KM overall was limited despite implementation of expensive technologies like an electronic medical record. Where present, KM processes and tools were used by individuals but not integrated throughout the organization. Loss of information was prominent, and finding knowledge was underdeveloped. The use of technical tools and developing knowledge by reconfiguration and measurement were particularly limited. Socially related tools, such as face-to-face-communication for sharing and developing knowledge, were more developed. As in other organizations, tool use was tailored for specific outcomes and leveraged by other organizational capacities. Differences in KM occur within family practices and between family practices and other organizations and may have implications for improving practice performance. Understanding interaction patterns of work relationships and KM may explain why costly technical or externally imposed "one size fits all" practice organizational interventions have had mixed results and limited sustainability.

A Methodological Framework for Instructional Design Model Development: Critical Dimensions and Synthesized Procedures

ERIC Educational Resources Information Center

Lee, Jihyun; Jang, Seonyoung

2014-01-01

Instructional design (ID) models have been developed to promote understandings of ID reality and guide ID performance. As the number and diversity of ID practices grows, implicit doubts regarding the reliability, validity, and usefulness of ID models suggest the need for methodological guidance that would help to generate ID models that are…

Determining passive cooling limits in CPV using an analytical thermal model

NASA Astrophysics Data System (ADS)

Gualdi, Federico; Arenas, Osvaldo; Vossier, Alexis; Dollet, Alain; Aimez, Vincent; Arès, Richard

2013-09-01

We propose an original thermal analytical model aiming to predict the practical limits of passive cooling systems for high concentration photovoltaic modules. The analytical model is described and validated by comparison with a commercial 3D finite element model. The limiting performances of flat plate cooling systems in natural convection are then derived and discussed.

Vision for a treasured resource. Part 2. Nurse manager learning needs.

PubMed

Horvath, K J; Aroian, J F; Secatore, J A; Alpert, H; Costa, M J; Powers, E; Stengrevics, S S

1997-04-01

Part 1 in this two-part series focused on the meaning of significant incidents in nurse managers' practice related to role implementation. Explanation of the authors' application of the Manager as Developer Model (MADM) as a useful model for organizing and understanding some of the data was also discussed. Part 2 describes significant incidents in nurse managers' practice related to their ongoing learning needs. The authors address issues of performance counseling and intervention versus coaching and make recommendations for management development programs.

Development of a comprehensive model for stakeholder management in mental healthcare.

PubMed

Bierbooms, Joyce; Van Oers, Hans; Rijkers, Jeroen; Bongers, Inge

2016-06-20

Purpose - Stakeholder management is not yet incorporated into the standard practice of most healthcare providers. The purpose of this paper is to assess the applicability of a comprehensive model for stakeholder management in mental healthcare organization for more evidence-based (stakeholder) management. Design/methodology/approach - The assessment was performed in two research parts: the steps described in the model were executed in a single case study at a mental healthcare organization in the Netherlands; and a process and effect evaluation was done to find the supporting and impeding factors with regard to the applicability of the model. Interviews were held with managers and directors to evaluate the effectiveness of the model with a view to stakeholder management. Findings - The stakeholder analysis resulted in the identification of eight stakeholder groups. Different expectations were identified for each of these groups. The analysis on performance gaps revealed that stakeholders generally find the collaboration with a mental healthcare provider "sufficient." Finally a prioritization showed that five stakeholder groups were seen as "definite" stakeholders by the organization. Practical implications - The assessment of the model showed that it generated useful knowledge for more evidence-based (stakeholder) management. Adaptation of the model is needed to increase its feasibility in practice. Originality/value - Provided that the model is properly adapted for the specific field, the analysis can provide more knowledge on stakeholders and can help integrate stakeholder management as a comprehensive process in policy planning.

Measuring Operational Resilience Using the CERT(Registered) Resilience Management Model

DTIC Science & Technology

2010-09-01

such as ISO 27002 [ ISO 2005]) and then measure the implementation and performance of practices contained in the standard. This checklist-based ap...Security techniques – Code of practice for information security management. ISO /IEC 27002 :2005, June 2005. Also known as ISO /IEC 17799:2005. [ ISO 2007...Table 23: ISO 15939 Process Activities and Tasks 54 Table 24: CERT-RMM Measurement and Analysis Process Area Goals and Practices 55 CMU/SEI

Studying the effect of clinical uncertainty on physicians' decision-making using ILIAD.

PubMed

Anderson, J D; Jay, S J; Weng, H C; Anderson, M M

1995-01-01

The influence of uncertainty on physicians' practice behavior is not well understood. In this research, ILIAD, a diagnostic expert system, has been used to study physicians' responses to uncertainty and how their responses affected clinical performance. The simulation mode of ILIAD was used to standardize the presentation and scoring of two cases to 46 residents in emergency medicine, internal medicine, family practice and transitional medicine at Methodist Hospital of Indiana. A questionnaire was used to collect additional data on how physicians respond to clinical uncertainty. A structural equation model was developed, estimated, and tested. The results indicate that stress that physicians experience in dealing with clinical uncertainty has a negative effect on their clinical performance. Moreover, the way that physicians respond to uncertainty has positive and negative effects on their performance. Open discussions with patients about clinical decisions and the use of practice guidelines improves performance. However, when the physician's clinical decisions are influenced by patient demands or their peers, their performance scores decline.

Modeling the Longitudinal Direct and Indirect Effects of Attitudes, Self-Efficacy, and Behavioral Intentions on Practice Behavior Outcomes of Suicide Intervention Training.

PubMed

Osteen, Philip; Frey, Jodi M; Woods, MaKenna N; Ko, Jungyai; Shipe, Stacey

2017-08-01

The purpose of this study was to use a longitudinal path analysis to test attitudes toward suicide prevention, self-efficacy, and behavioral intentions as mediators/moderators of clinical skill development over time following suicide intervention training. Results support a direct effect of attitudes on practice behaviors and self-efficacy, but no moderating effect. Self-efficacy performed as a mediator of practice behaviors over time. Behavioral intention had a direct effect on practice behaviors and mediated the relationship between attitudes and practice behaviors. Implications for research and practice are discussed. © 2016 The American Association of Suicidology.

Quantitative Evaluation of Performance in Interventional Neuroradiology: An Integrated Curriculum Featuring Theoretical and Practical Challenges.

PubMed

Ernst, Marielle; Kriston, Levente; Romero, Javier M; Frölich, Andreas M; Jansen, Olav; Fiehler, Jens; Buhk, Jan-Hendrik

2016-01-01

We sought to develop a standardized curriculum capable of assessing key competencies in Interventional Neuroradiology by the use of models and simulators in an objective, quantitative, and efficient way. In this evaluation we analyzed the associations between the practical experience, theoretical knowledge, and the skills lab performance of interventionalists. We evaluated the endovascular skills of 26 participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology with a set of three tasks (aneurysm coiling and thrombectomy in a virtual simulator and placement of an intra-aneurysmal flow disruptor in a flow model). Practical experience was assessed by a survey. Participants completed a written and oral examination to evaluate theoretical knowledge. Bivariate and multivariate analyses were performed. In multivariate analysis knowledge of materials and techniques in Interventional Neuroradiology was moderately associated with skills in aneurysm coiling and thrombectomy. Experience in mechanical thrombectomy was moderately associated with thrombectomy skills, while age was negatively associated with thrombectomy skills. We found no significant association between age, sex, or work experience and skills in aneurysm coiling. Our study gives an example of how an integrated curriculum for reasonable and cost-effective assessment of key competences of an interventional neuroradiologist could look. In addition to traditional assessment of theoretical knowledge practical skills are measured by the use of endovascular simulators yielding objective, quantitative, and constructive data for the evaluation of the current performance status of participants as well as the evolution of their technical competency over time.

A simple parametric model observer for quality assurance in computer tomography

NASA Astrophysics Data System (ADS)

Anton, M.; Khanin, A.; Kretz, T.; Reginatto, M.; Elster, C.

2018-04-01

Model observers are mathematical classifiers that are used for the quality assessment of imaging systems such as computer tomography. The quality of the imaging system is quantified by means of the performance of a selected model observer. For binary classification tasks, the performance of the model observer is defined by the area under its ROC curve (AUC). Typically, the AUC is estimated by applying the model observer to a large set of training and test data. However, the recording of these large data sets is not always practical for routine quality assurance. In this paper we propose as an alternative a parametric model observer that is based on a simple phantom, and we provide a Bayesian estimation of its AUC. It is shown that a limited number of repeatedly recorded images (10–15) is already sufficient to obtain results suitable for the quality assessment of an imaging system. A MATLAB® function is provided for the calculation of the results. The performance of the proposed model observer is compared to that of the established channelized Hotelling observer and the nonprewhitening matched filter for simulated images as well as for images obtained from a low-contrast phantom on an x-ray tomography scanner. The results suggest that the proposed parametric model observer, along with its Bayesian treatment, can provide an efficient, practical alternative for the quality assessment of CT imaging systems.

A flexible tool for hydraulic and water quality performance analysis of green infrastructure

NASA Astrophysics Data System (ADS)

Massoudieh, A.; Alikhani, J.

2017-12-01

Models that allow for design considerations of green infrastructure (GI) practices to control stormwater runoff and associated contaminants have received considerable attention in recent years. To be used to evaluate the effect design configurations on the long-term performance of GIs, models should be able to consider processes within GIs with good fidelity. In this presentation, a sophisticated, yet flexible tool for hydraulic and water quality assessment of GIs will be introduced. The tool can be used by design engineers and researchers to capture and explore the effect of design factors and properties of the media employed in the performance of GI systems at a relatively small scale. We deemed it essential to have a flexible GI modeling tool that is capable of simulating GI system components and specific biogeochemical processes affecting contaminants such as evapotranspiration, plant uptake, reactions, and particle-associated transport accurately while maintaining a high degree of flexibility to account for the myriad of GI alternatives. The mathematical framework for a stand-alone GI performance assessment tool has been developed and will be demonstrated. The process-based model framework developed here can be used to model a diverse range of GI practices such as stormwater ponds, green roofs, retention ponds, bioretention systems, infiltration trench, permeable pavement and other custom-designed combinatory systems. An example of the application of the system to evaluate the performance of a rain-garden system will be demonstrated.

A person based formula for allocating commissioning funds to general practices in England: development of a statistical model.

PubMed

Dixon, Jennifer; Smith, Peter; Gravelle, Hugh; Martin, Steve; Bardsley, Martin; Rice, Nigel; Georghiou, Theo; Dusheiko, Mark; Billings, John; Lorenzo, Michael De; Sanderson, Colin

2011-11-22

To develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practice Multivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices. All general practices in England as of 1 April 2007. All NHS inpatient admissions and outpatient attendances for individuals registered with a general practice on that date. All individuals registered with a general practice in England at 1 April 2007. Power of the statistical models to predict the costs of the individual patient or each practice's registered population for 2007-8 tested with a range of metrics (R(2) reported here). Comparisons of predicted costs in 2007-8 with actual costs incurred in the same year were calculated by individual and by practice. Models including person level information (age, sex, and ICD-10 codes diagnostic recorded) and a range of area level information (such as socioeconomic deprivation and supply of health facilities) were most predictive of costs. After accounting for person level variables, area level variables added little explanatory power. The best models for resource allocation could predict upwards of 77% of the variation in costs at practice level, and about 12% at the person level. With these models, the predicted costs of about a third of practices would exceed or undershoot the actual costs by 10% or more. Smaller practices were more likely to be in these groups. A model was developed that performed well by international standards, and could be used for allocations to practices for commissioning. The best formulas, however, could predict only about 12% of the variation in next year's costs of most inpatient and outpatient NHS care for each individual. Person-based diagnostic data significantly added to the predictive power of the models.

Scalable File Systems for High Performance Computing Final Report

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

Brandt, S A

2007-10-03

Simulations of mode I interlaminar fracture toughness tests of a carbon-reinforced composite material (BMS 8-212) were conducted with LSDYNA. The fracture toughness tests were performed by U.C. Berkeley. The simulations were performed to investigate the validity and practicality of employing decohesive elements to represent interlaminar bond failures that are prevalent in carbon-fiber composite structure penetration events. The simulations employed a decohesive element formulation that was verified on a simple two element model before being employed to perform the full model simulations. Care was required during the simulations to ensure that the explicit time integration of LSDYNA duplicate the near steady-statemore » testing conditions. In general, this study validated the use of employing decohesive elements to represent the interlaminar bond failures seen in carbon-fiber composite structures, but the practicality of employing the elements to represent the bond failures seen in carbon-fiber composite structures during penetration events was not established.« less

Managing hospital doctors and their practice: what can we learn about human resource management from non-healthcare organisations?

PubMed

Trebble, Timothy M; Heyworth, Nicola; Clarke, Nicholas; Powell, Timothy; Hockey, Peter M

2014-11-21

Improved management of clinicians' time and practice is advocated to address increasing demands on healthcare provision in the UK National Health Service (NHS). Human resource management (HRM) is associated with improvements in organisational performance and outcomes within and outside of healthcare, but with limited use in managing individual clinicians. This may reflect the absence of effective and transferrable models. The current systems of managing the performance of individual clinicians in a secondary healthcare organisation were reviewed through the study of practice in 10 successful partnership organisations, including knowledge worker predominant, within commercial, public and voluntary sector operating environments. Reciprocal visits to the secondary healthcare environment were undertaken. Six themes in performance related HRM were identified across the external organisations representing best practice and considered transferrable to managing clinicians in secondary care organisations. These included: performance measurement through defined outcomes at the team level with decision making through local data interpretation; performance improvement through empowered formal leadership with organisational support; individual performance review (IPR); and reward, recognition and talent management. The role of the executive was considered essential to support and implement effective HRM, with management of staff performance, behaviour and development integrated into organisational strategy, including through the use of universally applied values and effective communication. These approaches reflected many of the key aspects of high performance work systems and strategic HRM. There is the potential to develop systems of HRM of individual clinicians in secondary healthcare to improve practice. This should include both performance measurement and performance improvement but also engagement at an organisational level. This suggests that effective HRM and performance management of individual clinicians may be possible but requires an alternative approach for the NHS.

Simulations of carbon fiber composite delamination tests

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

Kay, G

2007-10-25

Simulations of mode I interlaminar fracture toughness tests of a carbon-reinforced composite material (BMS 8-212) were conducted with LSDYNA. The fracture toughness tests were performed by U.C. Berkeley. The simulations were performed to investigate the validity and practicality of employing decohesive elements to represent interlaminar bond failures that are prevalent in carbon-fiber composite structure penetration events. The simulations employed a decohesive element formulation that was verified on a simple two element model before being employed to perform the full model simulations. Care was required during the simulations to ensure that the explicit time integration of LSDYNA duplicate the near steady-statemore » testing conditions. In general, this study validated the use of employing decohesive elements to represent the interlaminar bond failures seen in carbon-fiber composite structures, but the practicality of employing the elements to represent the bond failures seen in carbon-fiber composite structures during penetration events was not established.« less

Mining the Dynamics of Student Utility and Strategy Use during Vocabulary Learning

ERIC Educational Resources Information Center

Pavlik, Philip I., Jr.

2013-01-01

This paper describes the development of a dynamical systems model of motivation and metacognition during learning, which explains some of the practically and theoretically important relationships among three student engagement constructs and performance metrics during learning. In order to better calibrate and understand the model, the model was…

Simulating forage crop production in a northern climate with the Integrated Farm System Model

USDA-ARS?s Scientific Manuscript database

Whole-farm simulation models are useful tools for evaluating the effect of management practices and climate variability on the agro-environmental and economic performance of farms. A few process-based farm-scale models have been developed, but none have been evaluated in a northern region with a sho...

Characterizing (rating) the performance of large photovoltaic arrays for all operating conditions

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

King, D.L.; Eckert, P.E.

1996-06-01

A new method has been developed for characterizing the electrical performance of photovoltaic arrays. The method provides both a ``rating`` at standard reporting conditions and a rigorous yet straightforward model for predicting array performance at all operating conditions. For the first time, the performance model handles the influences of irradiance, module temperature, solar spectrum, solar angle-of-incidence, and temperature coefficients, in a practical way. Validity of the procedure was confirmed during field testing of a 25-kW array recently installed by Arizona Public Service Co. on Carol Spring Mountain (which powers microwave, ceullular phone, and TV communictions equipment). This paper describes themore » characterization procedure, measured array performance, and the predictive model.« less

Preliminary testing of turbulence and radionuclide transport modeling in deep ocean environment

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

Onishi, Y.; Dummuller, D.C.; Trent, D.S.

Pacific Northwest Laboratory (PNL) performed a study for the US Environmental Protection Agency's Office of Radiation Programs to (1) identify candidate models for regional modeling of low-level waste ocean disposal sites in the mid-Atlantic ocean; (2) evaluate mathematical representation of the model's eddy viscosity/dispersion coefficients; and (3) evaluate the adequacy of the k-{epsilon} turbulence model and the feasibility of one of the candidate models, TEMPEST{copyright}/FLESCOT{copyright}, to deep-ocean applications on a preliminary basis. PNL identified the TEMPEST{copyright}/FLESCOT{copyright}, FLOWER, Blumberg's, and RMA 10 models as appropriate candidates for the regional radionuclide modeling. Among these models, TEMPEST/FLESCOT is currently the only model thatmore » solves distributions of flow, turbulence (with the k-{epsilon} model), salinity, water temperature, sediment, dissolved contaminants, and sediment-sorbed contaminants. Solving the Navier-Stokes equations using higher order correlations is not practical for regional modeling because of the prohibitive computational requirements; therefore, the turbulence modeling is a more practical approach. PNL applied the three-dimensional code, TEMPEST{copyright}/FLESCOT{copyright} with the k-{epsilon} model, to a very simple, hypothetical, two-dimensional, deep-ocean case, producing at least qualitatively appropriate results. However, more detailed testing should be performed for the further testing of the code. 46 refs., 39 figs., 6 tabs.« less

Practical Techniques for Modeling Gas Turbine Engine Performance

NASA Technical Reports Server (NTRS)

Chapman, Jeffryes W.; Lavelle, Thomas M.; Litt, Jonathan S.

2016-01-01

The cost and risk associated with the design and operation of gas turbine engine systems has led to an increasing dependence on mathematical models. In this paper, the fundamentals of engine simulation will be reviewed, an example performance analysis will be performed, and relationships useful for engine control system development will be highlighted. The focus will be on thermodynamic modeling utilizing techniques common in industry, such as: the Brayton cycle, component performance maps, map scaling, and design point criteria generation. In general, these topics will be viewed from the standpoint of an example turbojet engine model; however, demonstrated concepts may be adapted to other gas turbine systems, such as gas generators, marine engines, or high bypass aircraft engines. The purpose of this paper is to provide an example of gas turbine model generation and system performance analysis for educational uses, such as curriculum creation or student reference.

Pharmacists' perceptions of pay for performance versus fee-for-service remuneration for the management of hypertension through pharmacist prescribing.

PubMed

Rosenthal, Meagen M; Desai, Nimisha; Houle, Sherilyn K D

2017-10-01

As pharmacists expand their roles as patient care providers, remuneration must be offered for patient care activities apart from dispensing. Most jurisdictions paying for such services utilize the fee-for-service (FFS) model, while little is known about the role of pay for performance (P4P) within the pharmacy profession. This study aimed to elicit the experience of pharmacists practicing under both models within the Alberta Clinical Trial in Optimizing Hypertension (RxACTION) study in Alberta, Canada. Pharmacist participants in RxACTION caring for at least one patient under FFS and under P4P were interviewed about their experiences until data saturation was reached. Interviews were conducted in June-July 2015, with responses audio recorded, transcribed and coded to identify key themes. Eight pharmacists were interviewed, with three key themes identified: a perceived comfort with the existing FFS model particularly due to its ease related to business planning, the transformative effect of the study on their practices and a preference for future models to consider a blend of both service count- and performance-driven metrics. The degree of influence pharmacists feel they can have on outcomes achieved by patients, the perceptions of patients and other healthcare professionals on outcome-based payment, and concerns with the impact of variable remuneration on the pharmacy business model are concerns raised with P4P in pharmacy practice. This study reveals a hesitation to radically transform payment for pharmacists' patient care services towards a P4P model. Efforts to implement P4P should therefore be gradual and accompanied with a robust evaluation plan. © 2017 Royal Pharmaceutical Society.

From production to performance: solving the positioning dilemma in dental practice.

PubMed

Armstrong, James; Pitt, Leyland; Berthon, Pierre

2006-09-01

Thriving dental practices are excellent at providing a warm personal experience or are efficient, fast and cost-effective. Those that that attempt to do both end up being mediocre at just about everything. Introducing ideas from dramaturgy and service simultaneity in the services marketing literature, the authors provide a model for the conceptualization and redesign of the dental practice. Successful dental practices will be those that concentrate on low customization of activities in the back office or high customization of activities in the front office.

A test of the California competency-based differentiated role model.

PubMed

Keating, Sarah B; Rutledge, Dana N; Sargent, Arlene; Walker, Polly

2003-01-01

To address the incongruence between the expectations of nursing service and education in California, the Education Industry Interface Task Force of the California Strategic Planning Committee for Nursing developed descriptions to assist employers and educators in clearly differentiating practice and educational competencies. The completion of the Competency-Based Role Differentiation Model resulted in the need to test the model for its utility in the service setting, in education, and for career planning for nurses. Three alpha demonstration sites were selected based on representative geographical regions of California. The sites were composed of tri-partnerships consisting of a medical center, an associate degree in nursing program, and a baccalaureate nursing program. Observers rated senior students and new graduates in medical-surgical units on their behaviors in teacher and leadership care provider and care coordinator roles. The alpha demonstration study results were as expected. That is, senior students practice predominantly at a novice level in teacher and management/leadership care provider functions and new graduates practice predominately at the competent level. New graduates are more likely to take on novice and competent care coordinator roles. The CBRDM may be useful for practice and education settings to evaluate student and nurse performance, to define role expectations, and to identify the preparation necessary for the roles. It is useful for all of nursing as it continues to define its levels of practice and their relationship to on-the-job performance, curriculum development, and carrier planning.

Practical controller design for ultra-precision positioning of stages with a pneumatic artificial muscle actuator

NASA Astrophysics Data System (ADS)

Tang, T. F.; Chong, S. H.

2017-06-01

This paper presents a practical controller design method for ultra-precision positioning of pneumatic artificial muscle actuator stages. Pneumatic artificial muscle (PAM) actuators are safe to use and have numerous advantages which have brought these actuators to wide applications. However, PAM exhibits strong non-linear characteristics, and these limitations lead to low controllability and limit its application. In practice, the non-linear characteristics of PAM mechanism are difficult to be precisely modeled, and time consuming to model them accurately. The purpose of the present study is to clarify a practical controller design method that emphasizes a simple design procedure that does not acquire plants parameters modeling, and yet is able to demonstrate ultra-precision positioning performance for a PAM driven stage. The practical control approach adopts continuous motion nominal characteristic trajectory following (CM NCTF) control as the feedback controller. The constructed PAM driven stage is in low damping characteristic and causes severe residual vibration that deteriorates motion accuracy of the system. Therefore, the idea to increase the damping characteristic by having an acceleration feedback compensation to the plant has been proposed. The effectiveness of the proposed controller was verified experimentally and compared with a classical PI controller in point-to-point motion. The experiment results proved that the CM NCTF controller demonstrates better positioning performance in smaller motion error than the PI controller. Overall, the CM NCTF controller has successfully to reduce motion error to 3µm, which is 88.7% smaller than the PI controller.

On the practice of ignoring center-patient interactions in evaluating hospital performance.

PubMed

Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els

2016-01-30

We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

Financial incentives for quality in breast cancer care.

PubMed

Tisnado, Diana M; Rose-Ash, Danielle E; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L

2008-07-01

To examine the use of financial incentives related to performance on quality measures reported by oncologists and surgeons associated with a population-based cohort of patients with breast cancer in Los Angeles County, California, and to explore the physician and practice characteristics associated with the use of these incentives among breast cancer care providers. Cross-sectional observational study. Physician self-reported financial arrangements from a survey of 348 medical oncologists, radiation oncologists, and surgeons caring for patients with breast cancer in Los Angeles County (response rate, 76%). Physicians were asked whether they were subject to financial incentives for quality (ie, patient satisfaction surveys and adherence to practice guidelines). We examined the prevalence and correlates of incentives and performed multivariate logistic regression analyses to assess predictors of incentives, controlling for other covariates. Twenty percent of respondents reported incentives based on patient satisfaction, and 15% reported incentives based on guideline adherence. The use of incentives for quality in this cohort of oncologists and surgeons was modest and was primarily associated with staff- or group-model health maintenance organization (HMO) settings. In other settings, important predictors were partial physician ownership interest, large practice size, and capitation. Most cancer care providers in Los Angeles County outside of staff- or group-model HMOs are not subject to explicit financial incentives based on quality-of-care measures. Those who are, seem more likely to be associated with large practice settings. New approaches are needed to direct financial incentives for quality toward specialists outside of staff- or group-model HMOs if pay-for-performance programs are to succeed in influencing care.

Performance-Based Funding of Higher Education: A Detailed Look at Best Practices in 6 States

ERIC Educational Resources Information Center

Miao, Kysie

2012-01-01

Performance-based funding is a system based on allocating a portion of a state's higher education budget according to specific performance measures such as course completion, credit attainment, and degree completion, instead of allocating funding based entirely on enrollment. It is a model that provides a fuller picture of how successfully…

Worst error performance of continuous Kalman filters. [for deep space navigation and maneuvers

NASA Technical Reports Server (NTRS)

Nishimura, T.

1975-01-01

The worst error performance of estimation filters is investigated for continuous systems in this paper. The pathological performance study, without assuming any dynamical model such as Markov processes for perturbations, except for its bounded amplitude, will give practical and dependable criteria in establishing the navigation and maneuver strategy in deep space missions.

Statistical mechanics of broadcast channels using low-density parity-check codes.

PubMed

Nakamura, Kazutaka; Kabashima, Yoshiyuki; Morelos-Zaragoza, Robert; Saad, David

2003-03-01

We investigate the use of Gallager's low-density parity-check (LDPC) codes in a degraded broadcast channel, one of the fundamental models in network information theory. Combining linear codes is a standard technique in practical network communication schemes and is known to provide better performance than simple time sharing methods when algebraic codes are used. The statistical physics based analysis shows that the practical performance of the suggested method, achieved by employing the belief propagation algorithm, is superior to that of LDPC based time sharing codes while the best performance, when received transmissions are optimally decoded, is bounded by the time sharing limit.

Role of the registered nurse in primary health care: meeting health care needs in the 21st century.

PubMed

Smolowitz, Janice; Speakman, Elizabeth; Wojnar, Danuta; Whelan, Ellen-Marie; Ulrich, Suzan; Hayes, Carolyn; Wood, Laura

2015-01-01

There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered. Copyright © 2015 Elsevier Inc. All rights reserved.

Learning a Procedure from Multimedia Instructions: The Effects of Film and Practice.

ERIC Educational Resources Information Center

Baggett, Patricia

In a study that was conducted to measure performance as a function of multimedia instructions, 360 college students in a University of Colorado introductory psychology course were taught to build a model helicopter from an assembly kit. Their instructions consisted of either viewing a narrated film (one or two viewings), or hands-on practice using…

Cumulative and Randomized Evaluation: Ascertaining Performance in Pharmacy Coursework in a Manner Congruent with Pharmacy Practice

ERIC Educational Resources Information Center

Bender, Kenneth J.; Purohit, Anal

1977-01-01

A testing mechanism that provides a closer approximation than traditional testing of the frequency and random manner with which disease state and therapeutic problems present in practice was developed with the initiation of self-directed study courses in pharmacy therapeutics. The rationales, construction, and application of this model for…

High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands

PubMed Central

van den Hombergh, Pieter; Künzi, Beat; Elwyn, Glyn; van Doremalen, Jan; Akkermans, Reinier; Grol, Richard; Wensing, Michel

2009-01-01

Background The impact of high physician workload and job stress on quality and outcomes of healthcare delivery is not clear. Our study explored whether high workload and job stress were associated with lower performance in general practices in the Netherlands. Methods Secondary analysis of data from 239 general practices, collected in practice visits between 2003 to 2006 in the Netherlands using a comprehensive set of measures of practice management. Data were collected by a practice visitor, a trained non-physician observer using patients questionnaires, doctors and staff. For this study we selected five measures of practice performance as outcomes and six measures of GP workload and job stress as predictors. A total of 79 indicators were used out of the 303 available indicators. Random coefficient regression models were applied to examine associations. Results and discussion Workload and job stress are associated with practice performance. Workload: Working more hours as a GP was associated with more positive patient experiences of accessibility and availability (b = 0.16). After list size adjustment, practices with more GP-time per patient scored higher on GP care (b = 0.45). When GPs provided more than 20 hours per week per 1000 patients, patients scored over 80% on the Europep questionnaire for quality of GP care. Job stress: High GP job stress was associated with lower accessibility and availability (b = 0.21) and insufficient practice management (b = 0.25). Higher GP commitment and more satisfaction with the job was associated with more prevention and disease management (b = 0.35). Conclusion Providing more time in the practice, and more time per patient and experiencing less job stress are all associated with perceptions by patients of better care and better practice performance. Workload and job stress should be assessed by using list size adjusted data in order to realise better quality of care. Organisational development using this kind of data feedback could benefit both patients and GP. PMID:19604386

A systematic review of advance practice providers in acute care: options for a new model in a burn intensive care unit.

PubMed

Edkins, Renee E; Cairns, Bruce A; Hultman, C Scott

2014-03-01

Accreditation Council for Graduate Medical Education mandated work-hour restrictions have negatively impacted many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions. As surgery residents become less available to meet service needs, new models integrating advanced practice providers (APPs) into the burn team must emerge. We performed a systematic review of APPs in critical care questioning, how best to use all providers to solve these workforce challenges? We performed a systematic review of PubMed, CINAHL, Ovid, and Google Scholar, from 2002 to 2012, using the key words: nurse practitioner, physician assistant, critical care, and burn care. After applying inclusion/exclusion criteria, 18 relevant articles were selected for review. In addition, throughput and financial models were developed to examine provider staffing patterns. Advanced practice providers in critical care settings function in various models, both with and without residents, reporting to either an intensivist or an attending physician. When APPs participated, patient outcomes were similar or improved compared across provider models. Several studies reported considerable cost-savings due to decrease length of stay, decreased ventilator days, and fewer urinary tract infections when nurse practitioners were included in the provider mix. Restrictions in resident work-hours and changing health care environments require that new provider models be created for acute burn care. This article reviews current utilization of APPs in critical care units and proposes a new provider model for burn centers.

Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

PubMed

Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

2015-03-01

Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

Specialty Payment Model Opportunities and Assessment

PubMed Central

White, Chapin; Chan, Chris; Huckfeldt, Peter J.; Kofner, Aaron; Mulcahy, Andrew W.; Pollak, Julia; Popescu, Ioana; Timbie, Justin W.; Hussey, Peter S.

2015-01-01

Abstract This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis—$960 total per six-month episode—represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices’ Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced. PMID:28083365

Solid, Cystic, and Tubular: Novice Ultrasound Skills Training Using a Versatile, Affordable Practice Model.

PubMed

Sevak, Shruti; Lurvey, Benjamin; Woodfin, Ashley A; Hothem, Zachary; Callahan, Rose E; Robbins, James; Ziegler, Kathryn

2018-04-09

In spite of the recognized benefits of ultrasound, many physicians have little experience with using ultrasound to perform procedures. Many medical schools and residency programs lack a formal ultrasound training curriculum. We describe an affordable ultrasound training curriculum and versatile, inexpensive practice model. Participants underwent a didactic session to teach the theory required to perform ultrasound-guided procedures. Motor skills were taught using a practice model incorporating analogs of common anatomic and pathologic structures into an opacified gelatin substrate. The Marcia and Eugene Applebaum Simulation Learning Institute, Beaumont Hospital, Royal Oak, MI; a private nonprofit tertiary care hospital associated with the OUWB School of Medicine, Rochester, MI. The model was tested in a cohort of 50 medical students and general surgery residents. The gelatin model can be constructed for $1.03 per learner. The solid, cystic, and vascular structural analogs were readily identifiable on ultrasound and easily differentiated based on their echotextures. Eighty-four percent of participants successfully aspirated the cystic structure, 88% successfully biopsied a portion of the solid structure, and 76% successfully cannulated the tubular structure. Overall, 82% of participants achieved a passing score for the exercise based on a validated Objective Structured Assessment of Technical Skill instrument. There were no significant differences between the medical students and residents. This model can be used to teach basic ultrasound skills such as aspiration, biopsy, and vessel cannulation, providing a foundation for the use of ultrasound in a broad range of clinical procedures, as well as providing practice opportunities for medical students and residents to gain increased ultrasound competency and confidence. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Teaching Communication Skills in Science: Tracing Teacher Change

ERIC Educational Resources Information Center

Spektor-Levy, Ornit; Eylon, Bat-Sheva; Scherz, Zahava

2008-01-01

This paper describes a general model for skills instruction and its implementation through the program "Scientific Communication" for acquiring learning skills. The model is characterized by modularity, explicit instruction, spiral integration into contents, practice in various contexts, and implementation in performance tasks. It requires…

EINO the Answer

ERIC Educational Resources Information Center

Hollister, James; Richie, Sam; Weeks, Arthur

2010-01-01

This study investigated the various methods involved in creating an intelligent tutor for the University of Central Florida Web Applets (UCF Web Applets), an online environment where student can perform and/or practice experiments. After conducting research into various methods, two major models emerged. These models include: 1) solving the…

An Integrated MCDM Model for Conveyor Equipment Evaluation and Selection in an FMC Based on a Fuzzy AHP and Fuzzy ARAS in the Presence of Vagueness.

PubMed

Nguyen, Huu-Tho; Dawal, Siti Zawiah Md; Nukman, Yusoff; Rifai, Achmad P; Aoyama, Hideki

2016-01-01

The conveyor system plays a vital role in improving the performance of flexible manufacturing cells (FMCs). The conveyor selection problem involves the evaluation of a set of potential alternatives based on qualitative and quantitative criteria. This paper presents an integrated multi-criteria decision making (MCDM) model of a fuzzy AHP (analytic hierarchy process) and fuzzy ARAS (additive ratio assessment) for conveyor evaluation and selection. In this model, linguistic terms represented as triangular fuzzy numbers are used to quantify experts' uncertain assessments of alternatives with respect to the criteria. The fuzzy set is then integrated into the AHP to determine the weights of the criteria. Finally, a fuzzy ARAS is used to calculate the weights of the alternatives. To demonstrate the effectiveness of the proposed model, a case study is performed of a practical example, and the results obtained demonstrate practical potential for the implementation of FMCs.

An Integrated MCDM Model for Conveyor Equipment Evaluation and Selection in an FMC Based on a Fuzzy AHP and Fuzzy ARAS in the Presence of Vagueness

PubMed Central

Nguyen, Huu-Tho; Md Dawal, Siti Zawiah; Nukman, Yusoff; P. Rifai, Achmad; Aoyama, Hideki

2016-01-01

The conveyor system plays a vital role in improving the performance of flexible manufacturing cells (FMCs). The conveyor selection problem involves the evaluation of a set of potential alternatives based on qualitative and quantitative criteria. This paper presents an integrated multi-criteria decision making (MCDM) model of a fuzzy AHP (analytic hierarchy process) and fuzzy ARAS (additive ratio assessment) for conveyor evaluation and selection. In this model, linguistic terms represented as triangular fuzzy numbers are used to quantify experts’ uncertain assessments of alternatives with respect to the criteria. The fuzzy set is then integrated into the AHP to determine the weights of the criteria. Finally, a fuzzy ARAS is used to calculate the weights of the alternatives. To demonstrate the effectiveness of the proposed model, a case study is performed of a practical example, and the results obtained demonstrate practical potential for the implementation of FMCs. PMID:27070543

Components of Fatigue: Mind and Body.

PubMed

Carriker, Colin R

2017-11-01

Carriker, CR. Components of fatigue: mind and body. J Strength Cond Res 31(11): 3170-3176, 2017-Maximal intensity exercise requires significant energy demand. Subsequently, prolonged high-intensity effort eventually initiates volitional cessation of the event; often preceeded by a sensation of fatigue. Those examining the basis of fatigue tend to advocate either a peripheral or central model to explain such volitional failure. Practitioners and athletes who understand the tenants of fatigue can tailor their exercise regimens to target areas of potential physical or mental limitation. This review examines the rationale surrounding 2 separate models which postulate the origination of fatigue. Although the peripheral model suggests that fatigue occurs at the muscles, others have suggested a teloanticipatory cognitive component which plays a dominant role. Those familiar with both models may better integrate practice-based evidence into evidence-based practice. The highly individual nature of human performance further highlights the compulsion to comprehend the spectrum of fatigue, such that the identification of insufficiencies should mandate the development of a training purview for peak human performance.

Achievement goals, self-handicapping, and performance: a 2 x 2 achievement goal perspective.

PubMed

Ntoumanis, Nikos; Thøgersen-Ntoumani, Cecilie; Smith, Alison L

2009-11-01

Elliot and colleagues (2006) examined the effects of experimentally induced achievement goals, proposed by the trichotomous model, on self-handicapping and performance in physical education. Our study replicated and extended the work of Elliot et al. by experimentally promoting all four goals proposed by the 2 x 2 model (Elliot & McGregor, 2001), measuring the participants' own situational achievement goals, using a relatively novel task, and testing the participants in a group setting. We used a randomized experimental design with four conditions that aimed to induce one of the four goals advanced by the 2 x 2 model. The participants (n = 138) were undergraduates who engaged in a dart-throwing task. The results pertaining to self-handicapping partly replicated Elliot and colleagues' findings by showing that experimentally promoted performance-avoidance goals resulted in less practice. In contrast, the promotion of mastery-avoidance goals did not result in less practice compared with either of the approach goals. Dart-throwing performance did not differ among the four goal conditions. Personal achievement goals did not moderate the effects of experimentally induced goals on self-handicapping and performance. The extent to which mastery-avoidance goals are maladaptive is discussed, as well as the interplay between personal and experimentally induced goals.

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

PubMed

Peikes, Deborah; Dale, Stacy; Ghosh, Arkadipta; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Day, Timothy J; Duda, Nancy; Singh, Pragya; Anglin, Grace; Sessums, Laura L; Brown, Randall S

2018-06-01

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

Teaching Elliptical Excision Skills to Novice Medical Students: A Randomized Controlled Study Comparing Low- and High-Fidelity Bench Models

PubMed Central

Denadai, Rafael; Oshiiwa, Marie; Saad-Hossne, Rogério

2014-01-01

Background: The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals. Aims: To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students. Materials and Methods: Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills’ training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs’ skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances. Results: The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills’ training) was considered large (>0.80) in all measurements. Conclusion: The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials. PMID:24700937

Use of restorative procedures by allied dental health professionals in Minnesota.

PubMed

Post, Jennifer J; Stoltenberg, Jill L

2014-10-01

In 2003, the Minnesota legislature revised the Dental Practice Act to include restorative procedures in the scope of practice for registered dental assistants (RDAs) and registered dental hygienists (RDHs). The authors examined these practitioners' characteristics and made comparisons on the basis of their use of restorative function (RF) training and their practices' locations. They also examined practice type, models of implementation and perceived outcomes. The authors mailed a survey to all RF-certified RDAs and RDHs in Minnesota (N = 387). They used descriptive statistics to summarize the data and t tests and Fisher exact tests (P <.0001) to make comparisons between groups. The authors received 243 surveys (63 percent). Less than one-half (38 percent) of the RF-certified practitioners performed RFs. Of these, 29 percent were RDHs and 71 percent were RDAs. These practitioners performed RFs most often by working with a dentist or when time allowed. They perceived increased access to dental care and an increase in the number of patients treated to be outcomes of performing RFs. The results of this survey indicated use of restorative procedures varied greatly by practitioner type. The perceptions of those who performed RFs indicated they had a positive effect on dental practice. The addition of RF-certified personnel to the dental team has the potential to increase the number of patients seen in practice and the job satisfaction of team members.

Doctor discontent. A comparison of physician satisfaction in different delivery system settings, 1986 and 1997.

PubMed

Murray, A; Montgomery, J E; Chang, H; Rogers, W H; Inui, T; Safran, D G

2001-07-01

To examine the differences in physician satisfaction associated with open- versus closed-model practice settings and to evaluate changes in physician satisfaction between 1986 and 1997. Open-model practices refer to those in which physicians accept patients from multiple health plans and insurers (i.e., do not have an exclusive arrangement with any single health plan). Closed-model practices refer to those wherein physicians have an exclusive relationship with a single health plan (i.e., staff- or group-model HMO). Two cross-sectional surveys of physicians; one conducted in 1986 (Medical Outcomes Study) and one conducted in 1997 (Study of Primary Care Performance in Massachusetts). Primary care practices in Massachusetts. General internists and family practitioners in Massachusetts. Seven measures of physician satisfaction, including satisfaction with quality of care, the potential to achieve professional goals, time spent with individual patients, total earnings from practice, degree of personal autonomy, leisure time, and incentives for high quality. Physicians in open- versus closed-model practices differed significantly in several aspects of their professional satisfaction. In 1997, open-model physicians were less satisfied than closed-model physicians with their total earnings, leisure time, and incentives for high quality. Open-model physicians reported significantly more difficulty with authorization procedures and reported more denials for care. Overall, physicians in 1997 were less satisfied in every aspect of their professional life than 1986 physicians. Differences were significant in three areas: time spent with individual patients, autonomy, and leisure time (P < or =.05). Among open-model physicians, satisfaction with autonomy and time with individual patients were significantly lower in 1997 than 1986 (P < or =.01). Among closed-model physicians, satisfaction with total earnings and with potential to achieve professional goals were significantly lower in 1997 than in 1986 (P < or =.01). This study finds that the state of physician satisfaction in Massachusetts is extremely low, with the majority of physicians dissatisfied with the amount of time they have with individual patients, their leisure time, and their incentives for high quality. Satisfaction with most areas of practice declined significantly between 1986 and 1997. Open-model physicians were less satisfied than closed-model physicians in most aspects of practices.

Doctor Discontent

PubMed Central

Murray, Alison; Montgomery, Jana E; Chang, Hong; Rogers, William H; Inui, Thomas; Safran, Dana Gelb

2001-01-01

OBJECTIVE To examine the differences in physician satisfaction associated with open- versus closed-model practice settings and to evaluate changes in physician satisfaction between 1986 and 1997. Open-model practices refer to those in which physicians accept patients from multiple health plans and insurers (i.e., do not have an exclusive arrangement with any single health plan). Closed-model practices refer to those wherein physicians have an exclusive relationship with a single health plan (i.e., staff- or group-model HMO). DESIGN Two cross-sectional surveys of physicians; one conducted in 1986 (Medical Outcomes Study) and one conducted in 1997 (Study of Primary Care Performance in Massachusetts). SETTING Primary care practices in Massachusetts. PARTICIPANTS General internists and family practitioners in Massachusetts. MEASUREMENTS Seven measures of physician satisfaction, including satisfaction with quality of care, the potential to achieve professional goals, time spent with individual patients, total earnings from practice, degree of personal autonomy, leisure time, and incentives for high quality. RESULTS Physicians in open- versus closed-model practices differed significantly in several aspects of their professional satisfaction. In 1997, open-model physicians were less satisfied than closed-model physicians with their total earnings, leisure time, and incentives for high quality. Open-model physicians reported significantly more difficulty with authorization procedures and reported more denials for care. Overall, physicians in 1997 were less satisfied in every aspect of their professional life than 1986 physicians. Differences were significant in three areas: time spent with individual patients, autonomy, and leisure time (P ≤ .05). Among open-model physicians, satisfaction with autonomy and time with individual patients were significantly lower in 1997 than 1986 (P ≤ .01). Among closed-model physicians, satisfaction with total earnings and with potential to achieve professional goals were significantly lower in 1997 than in 1986 (P ≤ .01). CONCLUSIONS This study finds that the state of physician satisfaction in Massachusetts is extremely low, with the majority of physicians dissatisfied with the amount of time they have with individual patients, their leisure time, and their incentives for high quality. Satisfaction with most areas of practice declined significantly between 1986 and 1997. Open-model physicians were less satisfied than closed-model physicians in most aspects of practices.

Neuromotor Noise Is Malleable by Amplifying Perceived Errors

PubMed Central

Zhang, Zhaoran; Abe, Masaki O.; Sternad, Dagmar

2016-01-01

Variability in motor performance results from the interplay of error correction and neuromotor noise. This study examined whether visual amplification of error, previously shown to improve performance, affects not only error correction, but also neuromotor noise, typically regarded as inaccessible to intervention. Seven groups of healthy individuals, with six participants in each group, practiced a virtual throwing task for three days until reaching a performance plateau. Over three more days of practice, six of the groups received different magnitudes of visual error amplification; three of these groups also had noise added. An additional control group was not subjected to any manipulations for all six practice days. The results showed that the control group did not improve further after the first three practice days, but the error amplification groups continued to decrease their error under the manipulations. Analysis of the temporal structure of participants’ corrective actions based on stochastic learning models revealed that these performance gains were attained by reducing neuromotor noise and, to a considerably lesser degree, by increasing the size of corrective actions. Based on these results, error amplification presents a promising intervention to improve motor function by decreasing neuromotor noise after performance has reached an asymptote. These results are relevant for patients with neurological disorders and the elderly. More fundamentally, these results suggest that neuromotor noise may be accessible to practice interventions. PMID:27490197

Models of performance of evolutionary program induction algorithms based on indicators of problem difficulty.

PubMed

Graff, Mario; Poli, Riccardo; Flores, Juan J

2013-01-01

Modeling the behavior of algorithms is the realm of evolutionary algorithm theory. From a practitioner's point of view, theory must provide some guidelines regarding which algorithm/parameters to use in order to solve a particular problem. Unfortunately, most theoretical models of evolutionary algorithms are difficult to apply to realistic situations. However, in recent work (Graff and Poli, 2008, 2010), where we developed a method to practically estimate the performance of evolutionary program-induction algorithms (EPAs), we started addressing this issue. The method was quite general; however, it suffered from some limitations: it required the identification of a set of reference problems, it required hand picking a distance measure in each particular domain, and the resulting models were opaque, typically being linear combinations of 100 features or more. In this paper, we propose a significant improvement of this technique that overcomes the three limitations of our previous method. We achieve this through the use of a novel set of features for assessing problem difficulty for EPAs which are very general, essentially based on the notion of finite difference. To show the capabilities or our technique and to compare it with our previous performance models, we create models for the same two important classes of problems-symbolic regression on rational functions and Boolean function induction-used in our previous work. We model a variety of EPAs. The comparison showed that for the majority of the algorithms and problem classes, the new method produced much simpler and more accurate models than before. To further illustrate the practicality of the technique and its generality (beyond EPAs), we have also used it to predict the performance of both autoregressive models and EPAs on the problem of wind speed forecasting, obtaining simpler and more accurate models that outperform in all cases our previous performance models.

Setting performance standards for medical practice: a theoretical framework.

PubMed

Southgate, L; Hays, R B; Norcini, J; Mulholland, H; Ayers, B; Woolliscroft, J; Cusimano, M; McAvoy, P; Ainsworth, M; Haist, S; Campbell, M

2001-05-01

The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily reflect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that reflect the more complex world in which experienced medical practitioners work. The paper reflects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. Standards that reflect the complexity of medical practice may best be developed through an "expert systems" analysis of clinical conditions for which desired health care outcomes reflect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.

You can’t teach speed: sprinters falsify the deliberate practice model of expertise

PubMed Central

Deaner, Robert O.

2014-01-01

Many scientists agree that expertise requires both innate talent and proper training. Nevertheless, the highly influential deliberate practice model (DPM) of expertise holds that talent does not exist or makes a negligible contribution to performance. It predicts that initial performance will be unrelated to achieving expertise and that 10 years of deliberate practice is necessary. We tested these predictions in the domain of sprinting. In Studies 1 and 2 we reviewed biographies of 15 Olympic champions and the 20 fastest American men in U.S. history. In all documented cases, sprinters were exceptional prior to initiating training, and most reached world class status rapidly (Study 1 median = 3 years; Study 2 = 7.5). In Study 3 we surveyed U.S. national collegiate championships qualifiers in sprinters (n = 20) and throwers (n = 44). Sprinters recalled being faster as youths than did throwers, whereas throwers recalled greater strength and throwing ability. Sprinters’ best performances in their first season of high school, generally the onset of formal training, were consistently faster than 95–99% of their peers. Collectively, these results falsify the DPM for sprinting. Because speed is foundational for many sports, they challenge the DPM generally. PMID:25024914

Data Envelopment Analysis (DEA) Model in Operation Management

NASA Astrophysics Data System (ADS)

Malik, Meilisa; Efendi, Syahril; Zarlis, Muhammad

2018-01-01

Quality management is an effective system in operation management to develops, maintains, and improves quality from groups of companies that allow marketing, production, and service at the most economycal level as well as ensuring customer satisfication. Many companies are practicing quality management to improve their bussiness performance. One of performance measurement is through measurement of efficiency. One of the tools can be used to assess efficiency of companies performance is Data Envelopment Analysis (DEA). The aim of this paper is using Data Envelopment Analysis (DEA) model to assess efficiency of quality management. In this paper will be explained CCR, BCC, and SBM models to assess efficiency of quality management.

Effects of different practice conditions on acquisition, retention, and transfer of soccer skills by 9-year-old schoolchildren.

PubMed

Vera, Juan Granda; Alvarez, José Carlos Barbero; Medina, Mariano Montilla

2008-04-01

This study was designed to examine effects of three practice models, blocked, variable, and combined, on the acquisition, retention, and transfer of new motor skills. 67 subjects (M age = 9.5 yr., SD = .3) from the fourth year of primary school (31 boys and 26 girls) were assigned at random to three different practice groups (Blocked = 22, Variable = 23, Combined = 22) to study acquisition of two skills, dribbling a soccer ball and kicking a soccer ball at a stationary target using the dominant foot. All participants received a pretest and posttest, a transfer test, and a retention test 2 wk. later. Analysis showed significant improvement after practice of kicking skills by the three groups but not in the dribbling skills, for which only the combined practice group showed any notable improvement. At the end of acquisition, the combined practice group had significantly better performance on the dribbling task than the other two groups. However, the only differences noted in performance of kicking the ball with the dominant foot were by combined practice and blocked groups.

Distributed Leadership and Organizational Change: Implementation of a Teaching Performance Measure

ERIC Educational Resources Information Center

Sloan, Tine

2013-01-01

This article explores leadership practice and change as evidenced in multiple data sources gathered during a self-study implementation of a teaching performance assessment. It offers promising models of distributed leadership and organizational change that can inform future program implementers and the field in general. Our experiences suggest…

Performance-Based Funding: State Policy Influences on Small Rural Community Colleges

ERIC Educational Resources Information Center

Thornton, Zoë Mercedes; Friedel, Janice Nahra

2016-01-01

Performance-based funding (PBF) models intend to increase efficiency and productivity of the institution, thereby influencing organizational change. This change may be structural, programmatic, or procedural, and it may affect institutional practice and/or policy. The purpose of this qualitative case study was to understand the organizational…

Toward an Ecological Perspective of Resident Teaching Clinic

ERIC Educational Resources Information Center

Smith, C. Scott; Francovich, Chris; Morris, Magdalena; Hill, William; Langlois-Winkle, Francine; Rupper, Randall; Roth, Craig; Wheeler, Stephanie; Vo, Anthony

2010-01-01

Teaching clinic managers struggle to convert performance data into meaningful behavioral change in their trainees, and quality improvement measures in medicine have had modest results. This may be due to several factors including clinical performance being based more on team function than individual action, models of best practice that are…

Post-processing techniques to enhance reliability of assignment algorithm based performance measures : [technical summary].

DOT National Transportation Integrated Search

2011-01-01

Travel demand modeling plays a key role in the transportation system planning and evaluation process. The four-step sequential travel demand model is the most widely used technique in practice. Traffic assignment is the key step in the conventional f...

Modelling Management Practices in Viticulture while Considering Resource Limitations: The Dhivine Model

PubMed Central

Martin-Clouaire, Roger; Rellier, Jean-Pierre; Paré, Nakié; Voltz, Marc; Biarnès, Anne

2016-01-01

Many farming-system studies have investigated the design and evaluation of crop-management practices with respect to economic performance and reduction in environmental impacts. In contrast, little research has been devoted to analysing these practices in terms of matching the recurrent context-dependent demand for resources (labour in particular) with those available on the farm. This paper presents Dhivine, a simulation model of operational management of grape production at the vineyard scale. Particular attention focuses on representing a flexible plan, which organises activities temporally, the resources available to the vineyard manager and the process of scheduling and executing the activities. The model relies on a generic production-system ontology used in several agricultural production domains. The types of investigations that the model supports are briefly illustrated. The enhanced realism of the production-management situations simulated makes it possible to examine and understand properties of resource-constrained work-organisation strategies and possibilities for improving them. PMID:26990089

Philosophy and the practice of Bayesian statistics

PubMed Central

Gelman, Andrew; Shalizi, Cosma Rohilla

2015-01-01

A substantial school in the philosophy of science identifies Bayesian inference with inductive inference and even rationality as such, and seems to be strengthened by the rise and practical success of Bayesian statistics. We argue that the most successful forms of Bayesian statistics do not actually support that particular philosophy but rather accord much better with sophisticated forms of hypothetico-deductivism. We examine the actual role played by prior distributions in Bayesian models, and the crucial aspects of model checking and model revision, which fall outside the scope of Bayesian confirmation theory. We draw on the literature on the consistency of Bayesian updating and also on our experience of applied work in social science. Clarity about these matters should benefit not just philosophy of science, but also statistical practice. At best, the inductivist view has encouraged researchers to fit and compare models without checking them; at worst, theorists have actively discouraged practitioners from performing model checking because it does not fit into their framework. PMID:22364575

Philosophy and the practice of Bayesian statistics.

PubMed

Gelman, Andrew; Shalizi, Cosma Rohilla

2013-02-01

A substantial school in the philosophy of science identifies Bayesian inference with inductive inference and even rationality as such, and seems to be strengthened by the rise and practical success of Bayesian statistics. We argue that the most successful forms of Bayesian statistics do not actually support that particular philosophy but rather accord much better with sophisticated forms of hypothetico-deductivism. We examine the actual role played by prior distributions in Bayesian models, and the crucial aspects of model checking and model revision, which fall outside the scope of Bayesian confirmation theory. We draw on the literature on the consistency of Bayesian updating and also on our experience of applied work in social science. Clarity about these matters should benefit not just philosophy of science, but also statistical practice. At best, the inductivist view has encouraged researchers to fit and compare models without checking them; at worst, theorists have actively discouraged practitioners from performing model checking because it does not fit into their framework. © 2012 The British Psychological Society.

Strategies for improving the quality of verbal patient and family education: a review of the literature and creation of the EDUCATE model

PubMed Central

Marcus, Cara

2014-01-01

Objective: Patient and family education includes print, audio-visual methods, demonstration, and verbal instruction. Our objective was to study verbal instruction as a component of patient and family education and make recommendations for best practices for healthcare providers who use this method. Methods: We conducted a literature review of articles from 1990 to 2014 about verbal education and collaborated on departmental presentations to determine best practices. A survey was sent to all nursing staff to determine perceptions of verbal education and barriers to learning. Results: Through our work, we were able to identify verbal education models, best practices, and needs. We then constructed the EDUCATE model of verbal education, which built upon our findings. Conclusion: Verbal education of patients and family members requires a multidisciplinary approach that takes into account learning styles, literacy, and culture to apply clear communication and methods for the assessment of learning. Providers need the skills, time, and training to effectively perform patient and family verbal education every time they care for patients. Further research needs to be performed on how to test, document, and quantify patients' comprehension and retention of verbal instructions. PMID:25750796

On the development of a new methodology in sub-surface parameterisation on the calibration of groundwater models

NASA Astrophysics Data System (ADS)

Klaas, D. K. S. Y.; Imteaz, M. A.; Sudiayem, I.; Klaas, E. M. E.; Klaas, E. C. M.

2017-10-01

In groundwater modelling, robust parameterisation of sub-surface parameters is crucial towards obtaining an agreeable model performance. Pilot point is an alternative in parameterisation step to correctly configure the distribution of parameters into a model. However, the methodology given by the current studies are considered less practical to be applied on real catchment conditions. In this study, a practical approach of using geometric features of pilot point and distribution of hydraulic gradient over the catchment area is proposed to efficiently configure pilot point distribution in the calibration step of a groundwater model. A development of new pilot point distribution, Head Zonation-based (HZB) technique, which is based on the hydraulic gradient distribution of groundwater flow, is presented. Seven models of seven zone ratios (1, 5, 10, 15, 20, 25 and 30) using HZB technique were constructed on an eogenetic karst catchment in Rote Island, Indonesia and their performances were assessed. This study also concludes some insights into the trade-off between restricting and maximising the number of pilot points and offers a new methodology for selecting pilot point properties and distribution method in the development of a physically-based groundwater model.

Agent-based modeling as a tool for program design and evaluation.

PubMed

Lawlor, Jennifer A; McGirr, Sara

2017-12-01

Recently, systems thinking and systems science approaches have gained popularity in the field of evaluation; however, there has been relatively little exploration of how evaluators could use quantitative tools to assist in the implementation of systems approaches therein. The purpose of this paper is to explore potential uses of one such quantitative tool, agent-based modeling, in evaluation practice. To this end, we define agent-based modeling and offer potential uses for it in typical evaluation activities, including: engaging stakeholders, selecting an intervention, modeling program theory, setting performance targets, and interpreting evaluation results. We provide demonstrative examples from published agent-based modeling efforts both inside and outside the field of evaluation for each of the evaluative activities discussed. We further describe potential pitfalls of this tool and offer cautions for evaluators who may chose to implement it in their practice. Finally, the article concludes with a discussion of the future of agent-based modeling in evaluation practice and a call for more formal exploration of this tool as well as other approaches to simulation modeling in the field. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Effects of Peer Tutoring on the Reading Comprehension Performance of Secondary Students with Disabilities: A Systematic Review

ERIC Educational Resources Information Center

Alzahrani, Turkey; Leko, Melinda

2018-01-01

The purposes of this review were to examine the effects of peer tutoring models on the reading comprehension performance of secondary students with disabilities and to provide evidence of the extent to which peer tutoring can be considered an evidence-based practice (EBP) for improving reading comprehension performance among secondary students…

Evaluating the Performance Improvement Preferences of Disability Service Managers: An Exploratory Study Using Gilbert's Behavior Engineering Model

ERIC Educational Resources Information Center

Wooderson, John R.; Cuskelly, Monica; Meyer, Kim A.

2017-01-01

Background: Front-line managers play an important role in managing the performance of staff working in services for people with intellectual disability, but little is known about the practices they prefer to use to improve staff performance and whether these align with what research has shown to be effective. Method: This study comprised two…

Structural capabilities in small and medium-sized patient-centered medical homes.

PubMed

Alidina, Shehnaz; Schneider, Eric C; Singer, Sara J; Rosenthal, Meredith B

2014-07-01

1) Evaluate structural capabilities associated with the patient-centered medical home (PCMH) model in PCMH pilots in Colorado, Ohio, and Rhode Island; 2) evaluate changes in capabilities over 2 years in the Rhode Island pilot; and 3) evaluate facilitators and barriers to the adoption of capabilities. We assessed structural capabilities in the 30 pilot practices using a cross-sectional study design and examined changes over 2 years in 5 Rhode Island practices using a pre/post design. We used National Committee for Quality Assurance's Physician Practice Connections-Patient-Centered Medical Home (PPC/PCMH) accreditation survey data to measure capabilities. We stratified by high and low performance based on total score and by practice size. We analyzed change from baseline to 24 months for the Rhode Island practices. We analyzed qualitative data from interviews with practice leaders to identify facilitators and barriers to building capabilities. On average, practices scored 73 points (out of 100 points) for structural capabilities. High and low performers differed most on electronic prescribing, patient self-management, and care-management standards. Rhode Island practices averaged 42 points at baseline, and reached 90 points by the end of year 2. Some of the key facilitators that emerged were payment incentives, "transformation coaches," learning collaboratives, and data availability supporting performance management and quality improvement. Barriers to improvement included the extent of transformation required, technology shortcomings, slow cultural change, change fatigue, and lack of broader payment reform. For these early adopters, prevalence of structural capabilities was high, and performance was substantially improved for practices with initially lower capabilities. We conclude that building capabilities requires payment reform, attention to implementation, and cultural change.

ASRM standard embryo transfer protocol template: a committee opinion.

PubMed

Penzias, Alan; Bendikson, Kristin; Butts, Samantha; Coutifaris, Christos; Falcone, Tommaso; Fossum, Gregory; Gitlin, Susan; Gracia, Clarisa; Hansen, Karl; Mersereau, Jennifer; Odem, Randall; Rebar, Robert; Reindollar, Richard; Rosen, Mitchell; Sandlow, Jay; Vernon, Michael

2017-04-01

Standardization improves performance and safety. A template for standardizing the embryo transfer procedure is presented here with 12 basic steps supported by published scientific literature and a survey of common practice of SART programs; it can be used by ART practices to model their own standard protocol. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Simulating the Use of Alternative Fuels in a Turbofan Engine

NASA Technical Reports Server (NTRS)

Litt, Jonathan S.; Chin, Jeffrey Chevoor; Liu, Yuan

2013-01-01

The interest in alternative fuels for aviation has created a need to evaluate their effect on engine performance. The use of dynamic turbofan engine simulations enables the comparative modeling of the performance of these fuels on a realistic test bed in terms of dynamic response and control compared to traditional fuels. The analysis of overall engine performance and response characteristics can lead to a determination of the practicality of using specific alternative fuels in commercial aircraft. This paper describes a procedure to model the use of alternative fuels in a large commercial turbofan engine, and quantifies their effects on engine and vehicle performance. In addition, the modeling effort notionally demonstrates that engine performance may be maintained by modifying engine control system software parameters to account for the alternative fuel.

Adaptation of clinical prediction models for application in local settings.

PubMed

Kappen, Teus H; Vergouwe, Yvonne; van Klei, Wilton A; van Wolfswinkel, Leo; Kalkman, Cor J; Moons, Karel G M

2012-01-01

When planning to use a validated prediction model in new patients, adequate performance is not guaranteed. For example, changes in clinical practice over time or a different case mix than the original validation population may result in inaccurate risk predictions. To demonstrate how clinical information can direct updating a prediction model and development of a strategy for handling missing predictor values in clinical practice. A previously derived and validated prediction model for postoperative nausea and vomiting was updated using a data set of 1847 patients. The update consisted of 1) changing the definition of an existing predictor, 2) reestimating the regression coefficient of a predictor, and 3) adding a new predictor to the model. The updated model was then validated in a new series of 3822 patients. Furthermore, several imputation models were considered to handle real-time missing values, so that possible missing predictor values could be anticipated during actual model use. Differences in clinical practice between our local population and the original derivation population guided the update strategy of the prediction model. The predictive accuracy of the updated model was better (c statistic, 0.68; calibration slope, 1.0) than the original model (c statistic, 0.62; calibration slope, 0.57). Inclusion of logistical variables in the imputation models, besides observed patient characteristics, contributed to a strategy to deal with missing predictor values at the time of risk calculation. Extensive knowledge of local, clinical processes provides crucial information to guide the process of adapting a prediction model to new clinical practices.

A Generic Multibody Parachute Simulation Model

NASA Technical Reports Server (NTRS)

Neuhaus, Jason Richard; Kenney, Patrick Sean

2006-01-01

Flight simulation of dynamic atmospheric vehicles with parachute systems is a complex task that is not easily modeled in many simulation frameworks. In the past, the performance of vehicles with parachutes was analyzed by simulations dedicated to parachute operations and were generally not used for any other portion of the vehicle flight trajectory. This approach required multiple simulation resources to completely analyze the performance of the vehicle. Recently, improved software engineering practices and increased computational power have allowed a single simulation to model the entire flight profile of a vehicle employing a parachute.

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices.

PubMed

Dahrouge, Simone; Hogg, William E; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K; Kristjansson, Elizabeth; Fletcher, John

2012-02-07

Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = -6.3, 95% confidence interval [CI] -11.9 to -0.6) and practices in the established capitation model (β = -9.1, 95% CI -14.9 to -3.3) but not for those with salaried remuneration (β = -0.8, 95% CI -6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely consistent across the preventive manoeuvres. No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology.

Establishing Good Practices for Exposure–Response Analysis of Clinical Endpoints in Drug Development

PubMed Central

Overgaard, RV; Ingwersen, SH; Tornøe, CW

2015-01-01

This tutorial aims at promoting good practices for exposure–response (E-R) analyses of clinical endpoints in drug development. The focus is on practical aspects of E-R analyses to assist modeling scientists with a process of performing such analyses in a consistent manner across individuals and projects and tailored to typical clinical drug development decisions. This includes general considerations for planning, conducting, and visualizing E-R analyses, and how these are linked to key questions. PMID:26535157

Predicting Forearm Physical Exposures During Computer Work Using Self-Reports, Software-Recorded Computer Usage Patterns, and Anthropometric and Workstation Measurements.

PubMed

Huysmans, Maaike A; Eijckelhof, Belinda H W; Garza, Jennifer L Bruno; Coenen, Pieter; Blatter, Birgitte M; Johnson, Peter W; van Dieën, Jaap H; van der Beek, Allard J; Dennerlein, Jack T

2017-12-15

Alternative techniques to assess physical exposures, such as prediction models, could facilitate more efficient epidemiological assessments in future large cohort studies examining physical exposures in relation to work-related musculoskeletal symptoms. The aim of this study was to evaluate two types of models that predict arm-wrist-hand physical exposures (i.e. muscle activity, wrist postures and kinematics, and keyboard and mouse forces) during computer use, which only differed with respect to the candidate predicting variables; (i) a full set of predicting variables, including self-reported factors, software-recorded computer usage patterns, and worksite measurements of anthropometrics and workstation set-up (full models); and (ii) a practical set of predicting variables, only including the self-reported factors and software-recorded computer usage patterns, that are relatively easy to assess (practical models). Prediction models were build using data from a field study among 117 office workers who were symptom-free at the time of measurement. Arm-wrist-hand physical exposures were measured for approximately two hours while workers performed their own computer work. Each worker's anthropometry and workstation set-up were measured by an experimenter, computer usage patterns were recorded using software and self-reported factors (including individual factors, job characteristics, computer work behaviours, psychosocial factors, workstation set-up characteristics, and leisure-time activities) were collected by an online questionnaire. We determined the predictive quality of the models in terms of R2 and root mean squared (RMS) values and exposure classification agreement to low-, medium-, and high-exposure categories (in the practical model only). The full models had R2 values that ranged from 0.16 to 0.80, whereas for the practical models values ranged from 0.05 to 0.43. Interquartile ranges were not that different for the two models, indicating that only for some physical exposures the full models performed better. Relative RMS errors ranged between 5% and 19% for the full models, and between 10% and 19% for the practical model. When the predicted physical exposures were classified into low, medium, and high, classification agreement ranged from 26% to 71%. The full prediction models, based on self-reported factors, software-recorded computer usage patterns, and additional measurements of anthropometrics and workstation set-up, show a better predictive quality as compared to the practical models based on self-reported factors and recorded computer usage patterns only. However, predictive quality varied largely across different arm-wrist-hand exposure parameters. Future exploration of the relation between predicted physical exposure and symptoms is therefore only recommended for physical exposures that can be reasonably well predicted. © The Author 2017. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

Exploring Third-Grade Student Model-Based Explanations about Plant Relationships within an Ecosystem

NASA Astrophysics Data System (ADS)

Zangori, Laura; Forbes, Cory T.

2015-12-01

Elementary students should have opportunities to develop scientific models to reason and build understanding about how and why plants depend on relationships within an ecosystem for growth and survival. However, scientific modeling practices are rarely included within elementary science learning environments and disciplinary content is often treated as discrete pieces separate from scientific practice. Elementary students have few, if any, opportunities to reason about how individual organisms, such as plants, hold critical relationships with their surrounding environment. The purpose of this design-based research study is to build a learning performance to identify and explore the third-grade students' baseline understanding of and their reasoning about plant-ecosystem relationships when engaged in the practices of modeling. The developed learning performance integrated scientific content and core scientific activity to identify and measure how students build knowledge about the role of plants in ecosystems through the practices of modeling. Our findings indicate that the third-grade students' ideas about plant growth include abiotic and biotic relationships. Further, they used their models to reason about how and why these relationships were necessary to maintain plant stasis. However, while the majority of the third-grade students were able to identify and reason about plant-abiotic relationships, a much smaller group reasoned about plant-abiotic-animal relationships. Implications from the study suggest that modeling serves as a tool to support elementary students in reasoning about system relationships, but they require greater curricular and instructional support in conceptualizing how and why ecosystem relationships are necessary for plant growth and development. This paper is based on data from a doctoral dissertation. An earlier version of this paper was presented at the 2015 international conference for the National Association for Research in Science Teaching (NARST) Zangori, L., & Forbes, C. T. (2015). Exploring 3rd-grade student model-based explanations about plant process interactions within the hydrosphere Portions of this paper are based on that work.

Quantitative Evaluation of Performance in Interventional Neuroradiology: An Integrated Curriculum Featuring Theoretical and Practical Challenges

PubMed Central

Ernst, Marielle; Kriston, Levente; Romero, Javier M.; Frölich, Andreas M.; Jansen, Olav; Fiehler, Jens; Buhk, Jan-Hendrik

2016-01-01

Purpose We sought to develop a standardized curriculum capable of assessing key competencies in Interventional Neuroradiology by the use of models and simulators in an objective, quantitative, and efficient way. In this evaluation we analyzed the associations between the practical experience, theoretical knowledge, and the skills lab performance of interventionalists. Materials and Methods We evaluated the endovascular skills of 26 participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology with a set of three tasks (aneurysm coiling and thrombectomy in a virtual simulator and placement of an intra-aneurysmal flow disruptor in a flow model). Practical experience was assessed by a survey. Participants completed a written and oral examination to evaluate theoretical knowledge. Bivariate and multivariate analyses were performed. Results In multivariate analysis knowledge of materials and techniques in Interventional Neuroradiology was moderately associated with skills in aneurysm coiling and thrombectomy. Experience in mechanical thrombectomy was moderately associated with thrombectomy skills, while age was negatively associated with thrombectomy skills. We found no significant association between age, sex, or work experience and skills in aneurysm coiling. Conclusion Our study gives an example of how an integrated curriculum for reasonable and cost-effective assessment of key competences of an interventional neuroradiologist could look. In addition to traditional assessment of theoretical knowledge practical skills are measured by the use of endovascular simulators yielding objective, quantitative, and constructive data for the evaluation of the current performance status of participants as well as the evolution of their technical competency over time. PMID:26848840

A reliability-based maintenance technicians' workloads optimisation model with stochastic consideration

NASA Astrophysics Data System (ADS)

Ighravwe, D. E.; Oke, S. A.; Adebiyi, K. A.

2016-06-01

The growing interest in technicians' workloads research is probably associated with the recent surge in competition. This was prompted by unprecedented technological development that triggers changes in customer tastes and preferences for industrial goods. In a quest for business improvement, this worldwide intense competition in industries has stimulated theories and practical frameworks that seek to optimise performance in workplaces. In line with this drive, the present paper proposes an optimisation model which considers technicians' reliability that complements factory information obtained. The information used emerged from technicians' productivity and earned-values using the concept of multi-objective modelling approach. Since technicians are expected to carry out routine and stochastic maintenance work, we consider these workloads as constraints. The influence of training, fatigue and experiential knowledge of technicians on workload management was considered. These workloads were combined with maintenance policy in optimising reliability, productivity and earned-values using the goal programming approach. Practical datasets were utilised in studying the applicability of the proposed model in practice. It was observed that our model was able to generate information that practicing maintenance engineers can apply in making more informed decisions on technicians' management.

Automatically updating predictive modeling workflows support decision-making in drug design.

PubMed

Muegge, Ingo; Bentzien, Jörg; Mukherjee, Prasenjit; Hughes, Robert O

2016-09-01

Using predictive models for early decision-making in drug discovery has become standard practice. We suggest that model building needs to be automated with minimum input and low technical maintenance requirements. Models perform best when tailored to answering specific compound optimization related questions. If qualitative answers are required, 2-bin classification models are preferred. Integrating predictive modeling results with structural information stimulates better decision making. For in silico models supporting rapid structure-activity relationship cycles the performance deteriorates within weeks. Frequent automated updates of predictive models ensure best predictions. Consensus between multiple modeling approaches increases the prediction confidence. Combining qualified and nonqualified data optimally uses all available information. Dose predictions provide a holistic alternative to multiple individual property predictions for reaching complex decisions.

[Real patients in virtual reality: the link between phantom heads and clinical dentistry].

PubMed

Serrano, C M; Wesselink, P R; Vervoorn, J M

2018-05-01

Preclinical training in phantom heads has until now been considered the 'gold standard' for restorative dental education, but the transition from preclinic to the treatment of real patients has remained a challenge. With the introduction of the latest generation of virtual reality simulators, students and dental practitioners can make digital impressions of their patients in virtual reality models and practice procedures in virtual reality before clinically performing them. In this way, clinical decisions can be investigated and practiced prior to actual treatment, enhancing the safety of the treatment and the self-confidence to perform it. With the 3M™ True Definition Scanner and the Moog Simodont Dental Trainer, 3 masters students and a general dental practitioner practiced their procedures in virtual reality prior to performing them on real patients. They were very satisfied with this preparation and the result of the treatment.

Enhancing performance of P300-Speller under mental workload by incorporating dual-task data during classifier training.

PubMed

Chen, Yuqian; Ke, Yufeng; Meng, Guifang; Jiang, Jin; Qi, Hongzhi; Jiao, Xuejun; Xu, Minpeng; Zhou, Peng; He, Feng; Ming, Dong

2017-12-01

As one of the most important brain-computer interface (BCI) paradigms, P300-Speller was shown to be significantly impaired once applied in practical situations due to effects of mental workload. This study aims to provide a new method of building training models to enhance performance of P300-Speller under mental workload. Three experiment conditions based on row-column P300-Speller paradigm were performed including speller-only, 3-back-speller and mental-arithmetic-speller. Data under dual-task conditions were introduced to speller-only data respectively to build new training models. Then performance of classifiers with different models was compared under the same testing condition. The results showed that when tasks of imported training data and testing data were the same, character recognition accuracies and round accuracies of P300-Speller with mixed-data training models significantly improved (FDR, p < 0.005). When they were different, performance significantly improved when tested on mental-arithmetic-speller (FDR, p < 0.05) while the improvement was modest when tested on n-back-speller (FDR, p < 0.1). The analysis of ERPs revealed that ERP difference between training data and testing data was significantly diminished when the dual-task data was introduced to training data (FDR, p < 0.05). The new method of training classifier on mixed data proved to be effective in enhancing performance of P300-Speller under mental workload, confirmed the feasibility to build a universal training model and overcome the effects of mental workload in its practical applications. Copyright © 2017 Elsevier B.V. All rights reserved.

Predicting habits of vegetable parenting practices to facilitate the design of change programmes.

PubMed

Baranowski, Tom; Chen, Tzu-An; O'Connor, Teresia M; Hughes, Sheryl O; Diep, Cassandra S; Beltran, Alicia; Brand, Leah; Nicklas, Theresa; Baranowski, Janice

2016-08-01

Habit has been defined as the automatic performance of a usual behaviour. The present paper reports the relationships of variables from a Model of Goal Directed Behavior to four scales in regard to parents' habits when feeding their children: habit of (i) actively involving child in selection of vegetables; (ii) maintaining a positive vegetable environment; (iii) positive communications about vegetables; and (iv) controlling vegetable practices. We tested the hypothesis that the primary predictor of each habit variable would be the measure of the corresponding parenting practice. Internet survey data from a mostly female sample. Primary analyses employed regression modelling with backward deletion, controlling for demographics and parenting practices behaviour. Houston, Texas, USA. Parents of 307 pre-school (3-5-year-old) children. Three of the four models accounted for about 50 % of the variance in the parenting practices habit scales. Each habit scale was primarily predicted by the corresponding parenting practices scale (suggesting validity). The habit of active child involvement in vegetable selection was also most strongly predicted by two barriers and rudimentary self-efficacy; the habit of maintaining a positive vegetable environment by one barrier; the habit of maintaining positive communications about vegetables by an emotional scale; and the habit of controlling vegetable practices by a perceived behavioural control scale. The predictiveness of the psychosocial variables beyond parenting practices behaviour was modest. Discontinuing the habit of ineffective controlling parenting practices may require increasing the parent's perceived control of parenting practices, perhaps through simulated parent-child interactions.

The Influence of the Superintendent of Schools on Student Academic Performance

ERIC Educational Resources Information Center

Hanks, Jeffrey Mark

2010-01-01

The purpose of this study was to model, through structural equation modeling techniques, the relationships among superintendent practices of collaborative goal-setting, establishment of nonnegotiable goals for achievement and instruction, board alignment with and support of district goals, monitoring goals for achievement and instruction, use of…

A new framework for modeling decentralized low impact developments using Soil and Water Assessment Tool

USDA-ARS?s Scientific Manuscript database

Assessing the performance of Low Impact Development (LID) practices at a catchment scale is important in managing urban watersheds. Few modeling tools exist that are capable of explicitly representing the hydrological mechanisms of LIDs while considering the diverse land uses of urban watersheds. ...

SWAT ungauged: Hydrological budget and crop yield predictions in the Upper Mississippi River Basin

USDA-ARS?s Scientific Manuscript database

Physically based, distributed hydrologic models are increasingly used in assessments of water resources, best management practices, and climate and land use changes. Model performance evaluation in ungauged basins is an important research topic. In this study, we propose a framework for developing S...

Metrics for Evaluation of Student Models

ERIC Educational Resources Information Center

Pelanek, Radek

2015-01-01

Researchers use many different metrics for evaluation of performance of student models. The aim of this paper is to provide an overview of commonly used metrics, to discuss properties, advantages, and disadvantages of different metrics, to summarize current practice in educational data mining, and to provide guidance for evaluation of student…

Analysis instruments for the performance of Advanced Practice Nursing.

PubMed

Sevilla-Guerra, Sonia; Zabalegui, Adelaida

2017-11-29

Advanced Practice Nursing has been a reality in the international context for several decades and recently new nursing profiles have been developed in Spain as well that follow this model. The consolidation of these advanced practice roles has also led to of the creation of tools that attempt to define and evaluate their functions. This study aims to identify and explore the existing instruments that enable the domains of Advanced Practice Nursing to be defined. A review of existing international questionnaires and instruments was undertaken, including an analysis of the design process, the domains/dimensions defined, the main results and an exploration of clinimetric properties. Seven studies were analysed but not all proved to be valid, stable or reliable tools. One included tool was able to differentiate between the functions of the general nurse and the advanced practice nurse by the level of activities undertaken within the five domains described. These tools are necessary to evaluate the scope of advanced practice in new nursing roles that correspond to other international models of competencies and practice domains. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

PubMed Central

West, Robert; Rushforth, Bruno; Stokes, Tim; Glidewell, Liz; Carder, Paul; Faulkner, Simon; Foy, Robbie

2017-01-01

Background There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected ‘big data’ in the evaluation of healthcare. We developed a set of evidence-based ‘high impact’ quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and ‘risky’ prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions Despite various policy and improvement initiatives, there are enduring inappropriate variations in the delivery of evidence-based care. Much of this variation is not explained by routinely collected patient or practice variables, and is likely to be attributable to differences in clinical and organisational behaviour. PMID:28704407

Predictors affecting breast self-examination practice among undergraduate female students in Klang Valley, Malaysia.

PubMed

Akhtari-Zavare, Mehrnoosh; Lattif, Latiffah A; Juni, Muhamad Hanafiah; Md Said, Salmiah; Ismail, Irmi Zarina

2015-12-01

Breast cancer is the most common cancer among women worldwide, including Malaysia. In developing countries, predictors affecting breast self-examination (BSE) practice are different. This cross-sectional study was conducted to determine the prevalence of BSE practice and the predictors affecting BSE practice among undergraduate female students in Klang Valley, Malaysia. A cross-sectional study was conducted among 820 female undergraduate students to assess the BSE performance and related determinants of BSE practice in Klang Valley, Malaysia. Data were collected via a self-administered structured questionnaire that was developed for this study. The mean age of the respondents was 21.7 ± 1.2 years old. Most of them were single (96.8%), Malay (91.9%) and 19.6% of the participants performed BSE regularly. Multivariate logistic regression modeling revealed that BSE performance was more likely among women who have checked their breast with a doctor (odds ratio = 2.04, P = 0.00), and women who have personal history of breast disease (odds ratio = 4.43, P = 0.03). The findings showed a low BSE practice rate among young Malaysian women. Hence, the community's breast health awareness is needed to improve breast cancer prevention among young Malaysian women. © 2015 Japan Society of Obstetrics and Gynecology.

Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence.

PubMed

Phillips, Christine B; Pearce, Christopher M; Hall, Sally; Travaglia, Joanne; de Lusignan, Simon; Love, Tom; Kljakovic, Marjan

2010-11-15

To review the literature on different models of clinical governance and to explore their relevance to Australian primary health care, and their potential contributions on quality and safety. 25 electronic databases, scanning reference lists of articles and consultation with experts in the field. We searched publications in English after 1999, but a search of the German language literature for a specific model type was also undertaken. The grey literature was explored through a hand search of the medical trade press and websites of relevant national and international clearing houses and professional or industry bodies. 11 software packages commonly used in Australian general practice were reviewed for any potential contribution to clinical governance. 19 high-quality studies that assessed outcomes were included. All abstracts were screened by one researcher, and 10% were screened by a second researcher to crosscheck screening quality. Studies were reviewed and coded by four reviewers, with all studies being rated using standard critical appraisal tools such as the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Two researchers reviewed the Australian general practice software. Interviews were conducted with 16 informants representing service, regional primary health care, national and international perspectives. Most evidence supports governance models which use targeted, peer-led feedback on the clinician's own practice. Strategies most used in clinical governance models were audit, performance against indicators, and peer-led reflection on evidence or performance. The evidence base for clinical governance is fragmented, and focuses mainly on process rather than outcomes. Few publications address models that enhance safety, efficiency, sustainability and the economics of primary health care. Locally relevant clinical indicators, the use of computerised medical record systems, regional primary health care organisations that have the capacity to support the uptake of clinical governance at the practice level, and learning from the Aboriginal community-controlled sector will help integrate clinical governance into primary care.

United States Air Force Summer Faculty Research Program (1983). Technical Report. Volume 2

DTIC Science & Technology

1983-12-01

filters are given below: (1) Inverse filter - Based on the model given in Eq. (2) and the criterion of minimizing the norm (i.e., power ) of the...and compared based on their performances In machine classification under a variety of blur and noise conditions. These filters are analyzed to...criteria based on various assumptions of the Image models* In practice filter performance varies with the type of image, the blur and the noise conditions

A simple daily soil-water balance model for estimating the spatial and temporal distribution of groundwater recharge in temperate humid areas

USGS Publications Warehouse

Dripps, W.R.; Bradbury, K.R.

2007-01-01

Quantifying the spatial and temporal distribution of natural groundwater recharge is usually a prerequisite for effective groundwater modeling and management. As flow models become increasingly utilized for management decisions, there is an increased need for simple, practical methods to delineate recharge zones and quantify recharge rates. Existing models for estimating recharge distributions are data intensive, require extensive parameterization, and take a significant investment of time in order to establish. The Wisconsin Geological and Natural History Survey (WGNHS) has developed a simple daily soil-water balance (SWB) model that uses readily available soil, land cover, topographic, and climatic data in conjunction with a geographic information system (GIS) to estimate the temporal and spatial distribution of groundwater recharge at the watershed scale for temperate humid areas. To demonstrate the methodology and the applicability and performance of the model, two case studies are presented: one for the forested Trout Lake watershed of north central Wisconsin, USA and the other for the urban-agricultural Pheasant Branch Creek watershed of south central Wisconsin, USA. Overall, the SWB model performs well and presents modelers and planners with a practical tool for providing recharge estimates for modeling and water resource planning purposes in humid areas. ?? Springer-Verlag 2007.

Evaluation of sticky traps for adult Aedes mosquitoes in Malaysia: a potential monitoring and surveillance tool for the efficacy of control strategies.

PubMed

Roslan, Muhammad Aidil; Ngui, Romano; Vythilingam, Indra; Sulaiman, Wan Yusoff Wan

2017-12-01

The present study compared the performance of sticky traps in order to identify the most effective and practical trap for capturing Aedes aegypti and Aedes albopictus mosquitoes. Three phases were conducted in the study, with Phase 1 evaluating the five prototypes (Models A, B, C, D, and E) of sticky trap release-and-recapture using two groups of mosquito release numbers (five and 50) that were released in each replicate. Similarly, Phase 2 compared the performance between Model E and the classical ovitrap that had been modified (sticky ovitrap), using five and 50 mosquito release numbers. Further assessment of both traps was carried out in Phase 3, in which both traps were installed in nine sampling grids. Results from Phase 1 showed that Model E was the trap that recaptured higher numbers of mosquitoes when compared to Models A, B, C, and D. Further assessment between Model E and the modified sticky ovitrap (known as Model F) found that Model F outperformed Model E in both Phases 2 and 3. Thus, Model F was selected as the most effective and practical sticky trap, which could serve as an alternative tool for monitoring and controlling dengue vectors in Malaysia. © 2017 The Society for Vector Ecology.

The business end of health information technology. Can a fully integrated electronic health record increase provider productivity in a large community practice?

PubMed

De Leon, Samantha; Connelly-Flores, Alison; Mostashari, Farzad; Shih, Sarah C

2010-01-01

Electronic health records (EHRs) are expected to transform and improve the way medicine is practiced. However, providers perceive many barriers toward implementing new health information technology. Specifically, they are most concerned about the potentially negative impact on their practice finances and productivity. This study compares the productivity of 75 providers at a large urban primary care practice from January 2005 to February 2009, before and after implementing an EHR system, using longitudinal mixed model analyses. While decreases in productivity were observed at the time the EHR system was implemented, most providers quickly recovered, showing increases in productivity per month shortly after EHR implementation. Overall, providers had significant productivity increases of 1.7% per month per provider from pre- to post-EHR adoption. The majority of the productivity gains occurred after the practice instituted a pay-for-performance program, enabled by the data capture of the EHRs. Coupled with pay-for-performance, EHRs can spur rapid gains in provider productivity.

Nurses' performance on indigenous and African-Brazilian health care practices.

PubMed

Lima, Maria do Rosário de Araújo; Nunes, Maria Luísa de Almeida; Klüppel, Berta Lúcia Pinheiro; Medeiros, Soraya Maria de; Sá, Lenilde Duarte de

2016-01-01

to analyze the performance of nurses from the Estratégia Saúde da Família (Family Health Strategy) on health care practices rooted in African and Indigenous cultures. Thematic Oral History was used and interviews were conducted with seven participants, who worked with Primary Health Care in Northeastern Brazil. The analysis was based on Leininger's Theory of Cultural Care and the intercultural concept of human rights, among others. nurses are unaware of the religious and historical context of the ethnic groups cared for and do not appreciate their self-care practices in areas with a predominance of African and indigenous cultures. These practices coexist with the hegemonic biomedical model. the debate on cultural competence in the context of professional qualification and exercise is required, aiming to promote the nursing work in the perspective of diversity and comprehensiveness of health care.

Bilinearity, Rules, and Prefrontal Cortex

PubMed Central

Dayan, Peter

2007-01-01

Humans can be instructed verbally to perform computationally complex cognitive tasks; their performance then improves relatively slowly over the course of practice. Many skills underlie these abilities; in this paper, we focus on the particular question of a uniform architecture for the instantiation of habitual performance and the storage, recall, and execution of simple rules. Our account builds on models of gated working memory, and involves a bilinear architecture for representing conditional input-output maps and for matching rules to the state of the input and working memory. We demonstrate the performance of our model on two paradigmatic tasks used to investigate prefrontal and basal ganglia function. PMID:18946523

Comparison of Student Performance, Student Perception, and Teacher Satisfaction with Traditional versus Flipped Classroom Models

ERIC Educational Resources Information Center

Unal, Zafer; Unal, Aslihan

2017-01-01

As new technologies become available, they are often embraced in educational innovation to enhance traditional instruction. The flipped teaching model is one of the most recent and popular technology-infused teaching models in which learning new concepts takes place at home while practice is conducted in the classroom. The purpose of this study…

Performance analysis of mini-propellers based on FlightGear

NASA Astrophysics Data System (ADS)

Vogeltanz, Tomáš

2016-06-01

This paper presents a performance analysis of three mini-propellers based on the FlightGear flight simulator. Although a basic propeller analysis has to be performed before the use of FlightGear, for a complex and more practical performance analysis, it is advantageous to use a propeller model in cooperation with a particular aircraft model. This approach may determine whether the propeller has sufficient quality in respect of aircraft requirements. In the first section, the software used for the analysis is illustrated. Then, the parameters of the analyzed mini-propellers and the tested UAV are described. Finally, the main section shows and discusses the results of the performance analysis of the mini-propellers.

Payment models to support population health management.

PubMed

Huerta, Timothy R; Hefner, Jennifer L; McAlearney, Ann Scheck

2014-01-01

To survey the policy-driven financial controls currently being used to drive physician change in the care of populations. This paper offers a review of current health care payment models and discusses the impact of each on the potential success of PHM initiatives. We present the benefits of a multi-part model, combining visit-based fee-for-service reimbursement with a monthly "care coordination payment" and a performance-based payment system. A multi-part model removes volume-based incentives and promotes efficiency. However, it is predicated on a pay-for-performance framework that requires standardized measurement. Application of this model is limited due to the current lack of standardized measurement of quality goals that are linked to payment incentives. Financial models dictated by health system payers are inextricably linked to the organization and management of health care. There is a need for better measurements and realistic targets as part of a comprehensive system of measurement assessment that focuses on practice redesign, with the goal of standardizing measurement of the structure and process of redesign. Payment reform is a necessary component of an accurate measure of the associations between practice transformation and outcomes important to both patients and society.

How the gender of a victim character in a virtual scenario created to learn CPR protocol affects student nurses' performance.

PubMed

Boada, Imma; Rodriguez-Benitez, Antonio; Thió-Henestrosa, Santiago; Olivet, Josep; Soler, Josep

2018-08-01

Virtual simulations recreate scenarios where student nurses can practice procedures in a safe and supervised manner and with no risk to the patient. Virtual scenarios include digital characters that reproduce human actions. Generally, these characters are modeled as males and restricted roles are assigned to females. Our objective is to evaluate how the character gender of a victim in a scenario created to practice the cardiopulmonary resuscitation protocol (CPR) affects performance of student nurses. Three virtual scenarios with cardiac arrest victims modeled as males or females were assigned to 41 students of the Nursing Faculty to practice the CPR protocol. We evaluated student performance with respect to the time to remove clothes, the time to perform the CPR maneuver, and the hands position for CPR. Chi-square, Fisher exact, and Mann-Whitney U were used to test primary outcome measures in the experimental design of victim character sex (male vs. female) and student sex (men vs. women). The analysis performed did not find statistically differences in time to remove clothes or in time to start CPR. With respect to hands placement we also did not find significant difference in any of the cases. Nurse student actions are not influenced by the character gender of the victim. Excellent results with respect to hands placement to start CPR are obtained. Virtual scenarios can be a suitable strategy to reduce gender differences in gender sensitive situations such as CPR performance. Copyright © 2018 Elsevier B.V. All rights reserved.

Multisite Evaluation of APEX for Water Quality: I. Best Professional Judgment Parameterization.

PubMed

Baffaut, Claire; Nelson, Nathan O; Lory, John A; Senaviratne, G M M M Anomaa; Bhandari, Ammar B; Udawatta, Ranjith P; Sweeney, Daniel W; Helmers, Matt J; Van Liew, Mike W; Mallarino, Antonio P; Wortmann, Charles S

2017-11-01

The Agricultural Policy Environmental eXtender (APEX) model is capable of estimating edge-of-field water, nutrient, and sediment transport and is used to assess the environmental impacts of management practices. The current practice is to fully calibrate the model for each site simulation, a task that requires resources and data not always available. The objective of this study was to compare model performance for flow, sediment, and phosphorus transport under two parameterization schemes: a best professional judgment (BPJ) parameterization based on readily available data and a fully calibrated parameterization based on site-specific soil, weather, event flow, and water quality data. The analysis was conducted using 12 datasets at four locations representing poorly drained soils and row-crop production under different tillage systems. Model performance was based on the Nash-Sutcliffe efficiency (NSE), the coefficient of determination () and the regression slope between simulated and measured annualized loads across all site years. Although the BPJ model performance for flow was acceptable (NSE = 0.7) at the annual time step, calibration improved it (NSE = 0.9). Acceptable simulation of sediment and total phosphorus transport (NSE = 0.5 and 0.9, respectively) was obtained only after full calibration at each site. Given the unacceptable performance of the BPJ approach, uncalibrated use of APEX for planning or management purposes may be misleading. Model calibration with water quality data prior to using APEX for simulating sediment and total phosphorus loss is essential. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

A Selected Review of the Underpinnings of Ethics for Human Performance Technology Professionals--Part One: Key Ethical Theories and Research.

ERIC Educational Resources Information Center

Dean, Peter J.

1993-01-01

Provides a review of the key ethical theories and relevant empirical research relating to the practice of human performance technology. Topics addressed include ethics, morals, business ethics, ethics officers, empiricism versus normative ethical theory, consequentialism, utilitarianism, nonconsequentialism, Kohlberg model of cognitive moral…

Driving Performance Improvements by Integrating Competencies with Human Resource Practices

ERIC Educational Resources Information Center

Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

2010-01-01

This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

Performance-Based Accountability in Qatar: A State in Progress

ERIC Educational Resources Information Center

Jaafar, Sonia Ben

2011-01-01

It has become a normative practice to include Performance-Based Accountability (PBA) policies in educational reforms to foster school changes that enhance student learning and success. There is considerable variation in PBA models that have an important impact on how they operate in schools. It is, therefore, important to characterize PBA models…

Improving Problem-Solving Performance of Students with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Yakubova, Gulnoza; Taber-Doughty, Teresa

2017-01-01

The effectiveness of a multicomponent intervention to improve the problem-solving performance of students with autism spectrum disorders (ASD) during vocational tasks was examined. A multiple-probe across-students design was used to illustrate the effectiveness of point-of-view video modeling paired with practice sessions and a self-operated cue…

Identifying Aspects of Parental Involvement that Affect the Academic Achievement of High School Students

ERIC Educational Resources Information Center

Roulette-McIntyre, Ovella; Bagaka's, Joshua G.; Drake, Daniel D.

2005-01-01

This study identified parental practices that relate positively to high school students' academic performance. Parents of 643 high school students participated in the study. Data analysis, using a multiple linear regression model, shows parent-school connection, student gender, and race are significant predictors of student academic performance.…

Injury Profile SIMulator, a Qualitative Aggregative Modelling Framework to Predict Injury Profile as a Function of Cropping Practices, and Abiotic and Biotic Environment. II. Proof of Concept: Design of IPSIM-Wheat-Eyespot

PubMed Central

Robin, Marie-Hélène; Colbach, Nathalie; Lucas, Philippe; Montfort, Françoise; Cholez, Célia; Debaeke, Philippe; Aubertot, Jean-Noël

2013-01-01

IPSIM (Injury Profile SIMulator) is a generic modelling framework presented in a companion paper. It aims at predicting a crop injury profile as a function of cropping practices and abiotic and biotic environment. IPSIM's modelling approach consists of designing a model with an aggregative hierarchical tree of attributes. In order to provide a proof of concept, a model, named IPSIM-Wheat-Eyespot, has been developed with the software DEXi according to the conceptual framework of IPSIM to represent final incidence of eyespot on wheat. This paper briefly presents the pathosystem, the method used to develop IPSIM-Wheat-Eyespot using IPSIM's modelling framework, simulation examples, an evaluation of the predictive quality of the model with a large dataset (526 observed site-years) and a discussion on the benefits and limitations of the approach. IPSIM-Wheat-Eyespot proved to successfully represent the annual variability of the disease, as well as the effects of cropping practices (Efficiency = 0.51, Root Mean Square Error of Prediction = 24%; bias = 5.0%). IPSIM-Wheat-Eyespot does not aim to precisely predict the incidence of eyespot on wheat. It rather aims to rank cropping systems with regard to the risk of eyespot on wheat in a given production situation through ex ante evaluations. IPSIM-Wheat-Eyespot can also help perform diagnoses of commercial fields. Its structure is simple and permits to combine available knowledge in the scientific literature (data, models) and expertise. IPSIM-Wheat-Eyespot is now available to help design cropping systems with a low risk of eyespot on wheat in a wide range of production situations, and can help perform diagnoses of commercial fields. In addition, it provides a proof of concept with regard to the modelling approach of IPSIM. IPSIM-Wheat-Eyespot will be a sub-model of IPSIM-Wheat, a model that will predict injury profile on wheat as a function of cropping practices and the production situation. PMID:24146783

Injury profile SIMulator, a Qualitative aggregative modelling framework to predict injury profile as a function of cropping practices, and abiotic and biotic environment. II. Proof of concept: design of IPSIM-wheat-eyespot.

PubMed

Robin, Marie-Hélène; Colbach, Nathalie; Lucas, Philippe; Montfort, Françoise; Cholez, Célia; Debaeke, Philippe; Aubertot, Jean-Noël

2013-01-01

IPSIM (Injury Profile SIMulator) is a generic modelling framework presented in a companion paper. It aims at predicting a crop injury profile as a function of cropping practices and abiotic and biotic environment. IPSIM's modelling approach consists of designing a model with an aggregative hierarchical tree of attributes. In order to provide a proof of concept, a model, named IPSIM-Wheat-Eyespot, has been developed with the software DEXi according to the conceptual framework of IPSIM to represent final incidence of eyespot on wheat. This paper briefly presents the pathosystem, the method used to develop IPSIM-Wheat-Eyespot using IPSIM's modelling framework, simulation examples, an evaluation of the predictive quality of the model with a large dataset (526 observed site-years) and a discussion on the benefits and limitations of the approach. IPSIM-Wheat-Eyespot proved to successfully represent the annual variability of the disease, as well as the effects of cropping practices (Efficiency = 0.51, Root Mean Square Error of Prediction = 24%; bias = 5.0%). IPSIM-Wheat-Eyespot does not aim to precisely predict the incidence of eyespot on wheat. It rather aims to rank cropping systems with regard to the risk of eyespot on wheat in a given production situation through ex ante evaluations. IPSIM-Wheat-Eyespot can also help perform diagnoses of commercial fields. Its structure is simple and permits to combine available knowledge in the scientific literature (data, models) and expertise. IPSIM-Wheat-Eyespot is now available to help design cropping systems with a low risk of eyespot on wheat in a wide range of production situations, and can help perform diagnoses of commercial fields. In addition, it provides a proof of concept with regard to the modelling approach of IPSIM. IPSIM-Wheat-Eyespot will be a sub-model of IPSIM-Wheat, a model that will predict injury profile on wheat as a function of cropping practices and the production situation.

PI Passivity-Based Control for Maximum Power Extraction of a Wind Energy System with Guaranteed Stability Properties

NASA Astrophysics Data System (ADS)

Cisneros, Rafael; Gao, Rui; Ortega, Romeo; Husain, Iqbal

2016-10-01

The present paper proposes a maximum power extraction control for a wind system consisting of a turbine, a permanent magnet synchronous generator, a rectifier, a load and one constant voltage source, which is used to form the DC bus. We propose a linear PI controller, based on passivity, whose stability is guaranteed under practically reasonable assumptions. PI structures are widely accepted in practice as they are easier to tune and simpler than other existing model-based methods. Real switching based simulations have been performed to assess the performance of the proposed controller.

All-in-one model for designing optimal water distribution pipe networks

NASA Astrophysics Data System (ADS)

Aklog, Dagnachew; Hosoi, Yoshihiko

2017-05-01

This paper discusses the development of an easy-to-use, all-in-one model for designing optimal water distribution networks. The model combines different optimization techniques into a single package in which a user can easily choose what optimizer to use and compare the results of different optimizers to gain confidence in the performances of the models. At present, three optimization techniques are included in the model: linear programming (LP), genetic algorithm (GA) and a heuristic one-by-one reduction method (OBORM) that was previously developed by the authors. The optimizers were tested on a number of benchmark problems and performed very well in terms of finding optimal or near-optimal solutions with a reasonable computation effort. The results indicate that the model effectively addresses the issues of complexity and limited performance trust associated with previous models and can thus be used for practical purposes.

A model for teaching and learning spinal thrust manipulation and its effect on participant confidence in technique performance.

PubMed

Wise, Christopher H; Schenk, Ronald J; Lattanzi, Jill Black

2016-07-01

Despite emerging evidence to support the use of high velocity thrust manipulation in the management of lumbar spinal conditions, utilization of thrust manipulation among clinicians remains relatively low. One reason for the underutilization of these procedures may be related to disparity in training in the performance of these techniques at the professional and post professional levels. To assess the effect of using a new model of active learning on participant confidence in the performance of spinal thrust manipulation and the implications for its use in the professional and post-professional training of physical therapists. A cohort of 15 DPT students in their final semester of entry-level professional training participated in an active training session emphasizing a sequential partial task practice (SPTP) strategy in which participants engaged in partial task practice over several repetitions with different partners. Participants' level of confidence in the performance of these techniques was determined through comparison of pre- and post-training session surveys and a post-session open-ended interview. The increase in scores across all items of the individual pre- and post-session surveys suggests that this model was effective in changing overall participant perception regarding the effectiveness and safety of these techniques and in increasing student confidence in their performance. Interviews revealed that participants greatly preferred the SPTP strategy, which enhanced their confidence in technique performance. Results indicate that this new model of psychomotor training may be effective at improving confidence in the performance of spinal thrust manipulation and, subsequently, may be useful for encouraging the future use of these techniques in the care of individuals with impairments of the spine. Inasmuch, this method of instruction may be useful for training of physical therapists at both the professional and post-professional levels.

Teachers' Implicit Attitudes, Explicit Beliefs, and the Mediating Role of Respect and Cultural Responsibility on Mastery and Performance-Focused Instructional Practices

ERIC Educational Resources Information Center

Kumar, Revathy; Karabenick, Stuart A.; Burgoon, Jacob N.

2015-01-01

The theory of planned behavior and the dual process attitude-to-behavior MODE model framed an examination of how White teachers' (N = 241) implicit and explicit attitudes toward White versus non-White students were related to their classroom instructional practices in 2 school districts with a high percentage of Arab American and Chaldean American…

Review and evaluation of performance measures for survival prediction models in external validation settings.

PubMed

Rahman, M Shafiqur; Ambler, Gareth; Choodari-Oskooei, Babak; Omar, Rumana Z

2017-04-18

When developing a prediction model for survival data it is essential to validate its performance in external validation settings using appropriate performance measures. Although a number of such measures have been proposed, there is only limited guidance regarding their use in the context of model validation. This paper reviewed and evaluated a wide range of performance measures to provide some guidelines for their use in practice. An extensive simulation study based on two clinical datasets was conducted to investigate the performance of the measures in external validation settings. Measures were selected from categories that assess the overall performance, discrimination and calibration of a survival prediction model. Some of these have been modified to allow their use with validation data, and a case study is provided to describe how these measures can be estimated in practice. The measures were evaluated with respect to their robustness to censoring and ease of interpretation. All measures are implemented, or are straightforward to implement, in statistical software. Most of the performance measures were reasonably robust to moderate levels of censoring. One exception was Harrell's concordance measure which tended to increase as censoring increased. We recommend that Uno's concordance measure is used to quantify concordance when there are moderate levels of censoring. Alternatively, Gönen and Heller's measure could be considered, especially if censoring is very high, but we suggest that the prediction model is re-calibrated first. We also recommend that Royston's D is routinely reported to assess discrimination since it has an appealing interpretation. The calibration slope is useful for both internal and external validation settings and recommended to report routinely. Our recommendation would be to use any of the predictive accuracy measures and provide the corresponding predictive accuracy curves. In addition, we recommend to investigate the characteristics of the validation data such as the level of censoring and the distribution of the prognostic index derived in the validation setting before choosing the performance measures.

A person based formula for allocating commissioning funds to general practices in England: development of a statistical model

PubMed Central

Smith, Peter; Gravelle, Hugh; Martin, Steve; Bardsley, Martin; Rice, Nigel; Georghiou, Theo; Dusheiko, Mark; Billings, John; Lorenzo, Michael De; Sanderson, Colin

2011-01-01

Objectives To develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practice Design Multivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices. Setting All general practices in England as of 1 April 2007. All NHS inpatient admissions and outpatient attendances for individuals registered with a general practice on that date. Subjects All individuals registered with a general practice in England at 1 April 2007. Main outcome measures Power of the statistical models to predict the costs of the individual patient or each practice’s registered population for 2007-8 tested with a range of metrics (R2 reported here). Comparisons of predicted costs in 2007-8 with actual costs incurred in the same year were calculated by individual and by practice. Results Models including person level information (age, sex, and ICD-10 codes diagnostic recorded) and a range of area level information (such as socioeconomic deprivation and supply of health facilities) were most predictive of costs. After accounting for person level variables, area level variables added little explanatory power. The best models for resource allocation could predict upwards of 77% of the variation in costs at practice level, and about 12% at the person level. With these models, the predicted costs of about a third of practices would exceed or undershoot the actual costs by 10% or more. Smaller practices were more likely to be in these groups. Conclusions A model was developed that performed well by international standards, and could be used for allocations to practices for commissioning. The best formulas, however, could predict only about 12% of the variation in next year’s costs of most inpatient and outpatient NHS care for each individual. Person-based diagnostic data significantly added to the predictive power of the models. PMID:22110252

Design Sketches For Optical Crossbar Switches Intended For Large-Scale Parallel Processing Applications

NASA Astrophysics Data System (ADS)

Hartmann, Alfred; Redfield, Steve

1989-04-01

This paper discusses design of large-scale (1000x 1000) optical crossbar switching networks for use in parallel processing supercom-puters. Alternative design sketches for an optical crossbar switching network are presented using free-space optical transmission with either a beam spreading/masking model or a beam steering model for internodal communications. The performances of alternative multiple access channel communications protocol-unslotted and slotted ALOHA and carrier sense multiple access (CSMA)-are compared with the performance of the classic arbitrated bus crossbar of conventional electronic parallel computing. These comparisons indicate an almost inverse relationship between ease of implementation and speed of operation. Practical issues of optical system design are addressed, and an optically addressed, composite spatial light modulator design is presented for fabrication to arbitrarily large scale. The wide range of switch architecture, communications protocol, optical systems design, device fabrication, and system performance problems presented by these design sketches poses a serious challenge to practical exploitation of highly parallel optical interconnects in advanced computer designs.

Twin Neurons for Efficient Real-World Data Distribution in Networks of Neural Cliques: Applications in Power Management in Electronic Circuits.

PubMed

Boguslawski, Bartosz; Gripon, Vincent; Seguin, Fabrice; Heitzmann, Frédéric

2016-02-01

Associative memories are data structures that allow retrieval of previously stored messages given part of their content. They, thus, behave similarly to the human brain's memory that is capable, for instance, of retrieving the end of a song, given its beginning. Among different families of associative memories, sparse ones are known to provide the best efficiency (ratio of the number of bits stored to that of the bits used). Recently, a new family of sparse associative memories achieving almost optimal efficiency has been proposed. Their structure, relying on binary connections and neurons, induces a direct mapping between input messages and stored patterns. Nevertheless, it is well known that nonuniformity of the stored messages can lead to a dramatic decrease in performance. In this paper, we show the impact of nonuniformity on the performance of this recent model, and we exploit the structure of the model to improve its performance in practical applications, where data are not necessarily uniform. In order to approach the performance of networks with uniformly distributed messages presented in theoretical studies, twin neurons are introduced. To assess the adapted model, twin neurons are used with the real-world data to optimize power consumption of electronic circuits in practical test cases.

A Collaborative Team Teaching Model for a MSW Capstone Course.

PubMed

Moore, Rebecca M; Darby, Kathleen H; Blake, Michelle E

2016-01-01

This exploratory study was embedded in a formative process for the purposes of improving content delivery to an evidence-based practice class, and improving students' performance on a comprehensive exam. A learning and teaching model was utilized by faculty from a three-university collaborative graduate social work program to examine the extent to which course texts and assignments explicitly supported the process, application, and evaluation of evidence-based practices. The model was grounded in a collaborative culture, allowing each faculty to share their collective skills and knowledge across a range of practice settings as they revised the course curriculum. As a result, faculty found they had created a unique community that allowed a wider context for learning and professional development that translated into the classroom. Students enrolled in the revised course across all three universities showed improvement on the comprehensive exam. When faculty themselves invest in collaborative learning and teaching, students benefit.

45 CFR 2522.500 - What is the purpose of this subpart?

Code of Federal Regulations, 2010 CFR

2010-10-01

... your approved measures will influence whether you continue to receive funding. (c) Performance measures..., and help identify best practices and models that merit replication, as well as programmatic weaknesses...

Clinical performance improvement series. Classic CQI integrated with comprehensive disease management as a model for performance improvement.

PubMed

Joshi, M S; Bernard, D B

1999-08-01

In recent years, health and disease management has emerged as an effective means of delivering, integrating, and improving care through a population-based approach. Since 1997 the University of Pennsylvania Health System (UPHS) has utilized the key principles and components of continuous quality improvement (CQI) and disease management to form a model for health care improvement that focuses on designing best practices, using best practices to influence clinical decision making, changing processes and systems to deploy and deliver best practices, and measuring outcomes to improve the process. Experience with 28 programs and more than 14,000 patients indicates significant improvement in outcomes, including high physician satisfaction, increased patient satisfaction, reduced costs, and improved clinical process and outcome measures across multiple diseases. DIABETES DISEASE MANAGEMENT: In three months a UPHS multidisciplinary diabetes disease management team developed a best practice approach for the treatment of all patients with diabetes in the UPHS. After the program was pilot tested in three primary care physician sites, it was then introduced progressively to additional practice sites throughout the health system. The establishment of the role of the diabetes nurse care managers (certified diabetes educators) was central to successful program deployment. Office-based coordinators ensure incorporation of the best practice protocols into routine flow processes. A disease management intranet disseminates programs electronically. Outcomes of the UPHS health and disease management programs so far demonstrate success across multiple dimensions of performance-service, clinical quality, access, and value. The task of health care leadership today is to remove barriers and enable effective implementation of key strategies, such as health and disease management. Substantial effort and resources must be dedicated to gain physician buy-in and achieve compliance. The challenge is to provide leadership support, to reward and recognize best practice performers, and to emphasize the use of data for feedback and improvement. As these processes are implemented successfully, and evidence of improved outcomes is documented, it is likely that this approach will be more widely embraced and that organizationwide performance improvement will increase significantly. Health care has traditionally invested extraordinary resources in developing best practice approaches, including guidelines, education programs, or other tangible products and services. Comparatively little time, effort, and resources have been targeted to implementation and use, the stage at which most efforts fail. CQI's emphasis on data, rapid diffusion of innovative programs, and rapid cycle improvements enhance the implementation and effectiveness of disease management.

Using Gagne's theory to teach procedural skills.

PubMed

Buscombe, Charlotte

2013-10-01

Many key medical procedures are performed every day in clinical practice to yield important diagnostic information and to help determine the disease response to intensive treatments. Training clinicians to perform procedures competently and confidently thus carries considerable weight, helping to assure patient safety, the obtainment of adequate samples and minimising patient discomfort. This article considers how Robert Gagne's instructional design model may be effectively used to design lesson plans and teach procedural skills in small group settings. Gagne's model is based upon the information-processing model of mental events that occur when adults are presented with various stimuli. It highlights nine specific instructional events, which correlate with crucial conditions of learning, and are arranged to maximally enhance the learning process, improve session flow and, ultimately, ensure lesson objectives are comprehensively addressed. This article uses the nine points described by Gagne to outline a comprehensive lesson guide for teaching psychomotor skills, using a bone-marrow aspirate procedure as an example. Each of Gagne's instructional events is considered with specific activities for each, and with the variety of activities delineated to meet diverse learning styles. Gagne's instructional events can produce an effective and comprehensive lesson plan for teaching procedural skills, preparing learners with various preferred learning styles to perform psychomotor skills competently in clinical practice. This lesson plan can be of use for both teachers and students across clinical specialties, encouragingly outlining how Gagne's systematic and widely referenced theory can be creatively and practically used. © 2013 John Wiley & Sons Ltd.

The flipped classroom: now or never?

PubMed

Hawks, Sharon J

2014-08-01

Pedagogical changes and new models of delivering educational content should be considered in the effort to address the recommendations of the 2007 Institute of Medicine report and Benner's recommendations on the radical transformation of nursing. Transition to the nurse anesthesia practice doctorate addresses the importance of these recommendations, but educational models and specific strategies on how to implement changes in educational models and systems are still emerging. The flipped classroom (FC) is generating a considerable amount of buzz in academic circles. The FC is a pedagogical model that employs asynchronous video lectures, reading assignments, practice problems, and other digital, technology-based resources outside the classroom, and interactive, group-based, problem-solving activities in the classroom. This FC represents a unique combination of constructivist ideology and behaviorist principles, which can be used to address the gap between didactic education and clinical practice performance. This article reviews recent evidence supporting use of the FC in health profession education and suggests ways to implement the FC in nurse anesthesia educational programs.

Increasing operating room productivity by duration categories and a newsvendor model.

PubMed

Lehtonen, Juha-Matti; Torkki, Paulus; Peltokorpi, Antti; Moilanen, Teemu

2013-01-01

Previous studies approach surgery scheduling mainly from the mathematical modeling perspective which is often hard to apply in a practical environment. The aim of this study is to develop a practical scheduling system that considers the advantages of both surgery categorization and newsvendor model to surgery scheduling. The research was carried out in a Finnish orthopaedic specialist centre that performs only joint replacement surgery. Four surgery categorization scenarios were defined and their productivity analyzed by simulation and newsvendor model. Detailed analyses of surgery durations and the use of more accurate case categories and their combinations in scheduling improved OR productivity 11.3 percent when compared to the base case. Planning to have one OR team to work longer led to remarkable decrease in scheduling inefficiency. In surgical services, productivity and cost-efficiency can be improved by utilizing historical data in case scheduling and by increasing flexibility in personnel management. The study increases the understanding of practical scheduling methods used to improve efficiency in surgical services.

The Impact of Pictorial Display on Operator Learning and Performance. M.S. Thesis

NASA Technical Reports Server (NTRS)

Miller, R. A.; Messing, L. J.; Jagacinski, R. J.

1984-01-01

The effects of pictorially displayed information on human learning and performance of a simple control task were investigated. The controlled system was a harmonic oscillator and the system response was displayed to subjects as either an animated pendulum or a horizontally moving dot. Results indicated that the pendulum display did not effect performance scores but did significantly effect the learning processes of individual operators. The subjects with the pendulum display demonstrated more vertical internal models early in the experiment and the manner in which their internal models were tuned with practice showed increased variability between subjects.

Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models.

PubMed

Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; Araújo, Thiago Cavalcante Vila Nova de; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S

2015-01-01

Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

Cardiovascular Surgery Residency Program: Training Coronary Anastomosis Using the Arroyo Simulator and UNIFESP Models

PubMed Central

Maluf, Miguel Angel; Gomes, Walter José; Bras, Ademir Massarico; de Araújo, Thiago Cavalcante Vila Nova; Mota, André Lupp; Cardoso, Caio Cesar; Coutinho, Rafael Viana dos S.

2015-01-01

OBJECTIVE Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models. METHODS First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum. RESULTS The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training. CONCLUSION 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art. PMID:26735604

Good, better, best? A comprehensive comparison of healthcare providers' performance: An application to physiotherapy practices in primary care.

PubMed

Steenhuis, Sander; Groeneweg, Niels; Koolman, Xander; Portrait, France

2017-12-01

Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care. We merged these datasets at the patient-level and compared the performances of these practices using case-mix corrected linear regression models. Several significant differences in performance were detected between practices. These results can be used by both physiotherapists, to improve treatment given, and insurers to support their purchasing decisions. The study demonstrates that it is feasible to compare the performance of providers using PROMs and PREMs. However, it would take an extra effort to increase usefulness and it remains unclear under which conditions this effort is cost-effective. Healthcare providers need to be aware of the added value of registering outcomes to improve their quality. Insurers need to facilitate this by designing value-based contracts with the right incentives. Only then can payment methods contribute to value-based healthcare and increase value for patients. Copyright © 2017 Elsevier B.V. All rights reserved.

4D Model on Assessing Psychomotor Aspect in Continental Food Processing Practice

NASA Astrophysics Data System (ADS)

Nurafiati, P.; Ana, A.; Ratnasusanti, H.; Maulana, I.

2018-02-01

This research aims to develop and find out the response of observers for the assessment instrument of student’s psychomotor aspect on continental food processing practice. This research belongs to development research with 4P model that confined till the definition, design, and development stages. The data that gained during the research is analyzed descriptively. Research’s product is assessment instrument rubric form that consists of performance’s aspect which should be assessed and performance’s quality which stated in gradation score with 0-4 level and performance description that completed with picture illustration in every single score. Product was validate and responded based on material, construction, language, objectively, systematic, and practicability aspects. The result show that assessment instrument of student’s psychomotor aspect on continental food processing practice which developed gain very good response with percentage of 84,47%.

Predicting the practice effects on the blood oxygenation level-dependent (BOLD) function of fMRI in a symbolic manipulation task

NASA Astrophysics Data System (ADS)

Qin, Yulin; Sohn, Myeong-Ho; Anderson, John R.; Stenger, V. Andrew; Fissell, Kate; Goode, Adam; Carter, Cameron S.

2003-04-01

Based on adaptive control of thought-rational (ACT-R), a cognitive architecture for cognitive modeling, researchers have developed an information-processing model to predict the blood oxygenation level-dependent (BOLD) response of functional MRI in symbol manipulation tasks. As an extension of this research, the current event-related functional MRI study investigates the effect of relatively extensive practice on the activation patterns of related brain regions. The task involved performing transformations on equations in an artificial algebra system. This paper shows that the base-level activation learning in the ACT-R theory can predict the change of the BOLD response in practice in a left prefrontal region reflecting retrieval of information. In contrast, practice has relatively little effect on the form of BOLD response in the parietal region reflecting imagined transformations to the equation or the motor region reflecting manual programming.

Performance Evaluation Within CASE_ATTI of MHT and JVC Association Algorithms for COMDAT TD

DTIC Science & Technology

2007-05-01

les résultats du travail effectué dans le cadre de l’analyse de sensibilité des algorithmes uti- lisés dans COMDAT, comparativement à ceux...is also very important in tracking system. Neverthe- less, tracking performance with even the best designed filter may become very degraded in the...for completeness. 2.2 IMM Some practical model of target motion is assumed for the design of the Kalman filter. This target kinematics model is

Measuring Learning Progressions Using Bayesian Modeling in Complex Assessments

ERIC Educational Resources Information Center

Rutstein, Daisy Wise

2012-01-01

This research examines issues regarding model estimation and robustness in the use of Bayesian Inference Networks (BINs) for measuring Learning Progressions (LPs). It provides background information on LPs and how they might be used in practice. Two simulation studies are performed, along with real data examples. The first study examines the case…

Using Multilevel Modeling in Counseling Research

ERIC Educational Resources Information Center

Lynch, Martin F.

2012-01-01

This conceptual and practical overview of multilevel modeling (MLM) for researchers in counseling and development provides guidelines on setting up SPSS to perform MLM and an example of how to present the findings. It also provides a discussion on how counseling and developmental researchers can use MLM to address their own research questions.…

The MDE Diploma: First International Postgraduate Specialization in Model-Driven Engineering

ERIC Educational Resources Information Center

Cabot, Jordi; Tisi, Massimo

2011-01-01

Model-Driven Engineering (MDE) is changing the way we build, operate, and maintain our software-intensive systems. Several projects using MDE practices are reporting significant improvements in quality and performance but, to be able to handle these projects, software engineers need a set of technical and interpersonal skills that are currently…

Teaching for Art Criticism: Incorporating Feldman's Critical Analysis Learning Model in Students' Studio Practice

ERIC Educational Resources Information Center

Subramaniam, Maithreyi; Hanafi, Jaffri; Putih, Abu Talib

2016-01-01

This study adopted 30 first year graphic design students' artwork, with critical analysis using Feldman's model of art criticism. Data were analyzed quantitatively; descriptive statistical techniques were employed. The scores were viewed in the form of mean score and frequencies to determine students' performances in their critical ability.…

Enabling Ethical Code Embeddedness in Construction Organizations: A Review of Process Assessment Approach.

PubMed

Oladinrin, Olugbenga Timo; Ho, Christabel Man-Fong

2016-08-01

Several researchers have identified codes of ethics (CoEs) as tools that stimulate positive ethical behavior by shaping the organisational decision-making process, but few have considered the information needed for code implementation. Beyond being a legal and moral responsibility, ethical behavior needs to become an organisational priority, which requires an alignment process that integrates employee behavior with the organisation's ethical standards. This paper discusses processes for the responsible implementation of CoEs based on an extensive review of the literature. The internationally recognized European Foundation for Quality Management Excellence Model (EFQM model) is proposed as a suitable framework for assessing an organisation's ethical performance, including CoE embeddedness. The findings presented herein have both practical and research implications. They will encourage construction practitioners to shift their attention from ethical policies to possible enablers of CoE implementation and serve as a foundation for further research on ethical performance evaluation using the EFQM model. This is the first paper to discuss the model's use in the context of ethics in construction practice.

Observing practice leadership in intellectual and developmental disability services.

PubMed

Beadle-Brown, J; Bigby, C; Bould, E

2015-12-01

Improving staff performance is an issue in services for people with intellectual disability. Practice leadership, where the front line leader of a staff team focuses on service user outcomes in everything they do and provides coaching, modeling, supervision and organisation to the team, has been identified as important in improving staff performance. To date this finding is based only on self-report measures. This paper describes and tests an observational measure of practice leadership based on an interview with the front-line manager, a review of paperwork and observations in 58 disability services in Australia. The measure showed good internal consistency and acceptable inter-rater reliability. Practice leadership was associated with staff practice and outcomes for service users. The observed measure of practice leadership appears to be a useful tool for assessing whether leadership within a service promotes enabling and empowering support by staff. It was found to discriminate higher and lower performing services in terms of active support. The measure had good reliability and validity although some further testing is required to give a complete picture of the possible uses and reliability of the measure. The measure is potentially useful in contexts of both research and service development. The confirmation of previous findings from self-report measures that practice leadership is related to the quality of staff practice and outcomes for service users has implications for policy and practice in terms of the training of managers and structures for organisational management. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Evaluation of annual, global seismicity forecasts, including ensemble models

NASA Astrophysics Data System (ADS)

Taroni, Matteo; Zechar, Jeremy; Marzocchi, Warner

2013-04-01

In 2009, the Collaboratory for the Study of the Earthquake Predictability (CSEP) initiated a prototype global earthquake forecast experiment. Three models participated in this experiment for 2009, 2010 and 2011—each model forecast the number of earthquakes above magnitude 6 in 1x1 degree cells that span the globe. Here we use likelihood-based metrics to evaluate the consistency of the forecasts with the observed seismicity. We compare model performance with statistical tests and a new method based on the peer-to-peer gambling score. The results of the comparisons are used to build ensemble models that are a weighted combination of the individual models. Notably, in these experiments the ensemble model always performs significantly better than the single best-performing model. Our results indicate the following: i) time-varying forecasts, if not updated after each major shock, may not provide significant advantages with respect to time-invariant models in 1-year forecast experiments; ii) the spatial distribution seems to be the most important feature to characterize the different forecasting performances of the models; iii) the interpretation of consistency tests may be misleading because some good models may be rejected while trivial models may pass consistency tests; iv) a proper ensemble modeling seems to be a valuable procedure to get the best performing model for practical purposes.

Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices.

PubMed

Verhees, Bart; van Kuijk, Kees; Simonse, Lianne

2017-12-21

Point-of-care testing (POCT)-laboratory tests performed with new mobile devices and online technologies outside of the central laboratory-is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP's network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre.

Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices

PubMed Central

Verhees, Bart; van Kuijk, Kees

2017-01-01

Point-of-care testing (POCT)—laboratory tests performed with new mobile devices and online technologies outside of the central laboratory—is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP’s network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre. PMID:29267224

Applying Weick's model of organizing to health care and health promotion: highlighting the central role of health communication.

PubMed

Kreps, Gary L

2009-03-01

Communication is a crucial process in the effective delivery of health care services and the promotion of public health. However, there are often tremendous complexities in using communication effectively to provide the best health care, direct the adoption of health promoting behaviors, and implement evidence-based public health policies and practices. This article describes Weick's model of organizing as a powerful theory of social organizing that can help increase understanding of the communication demands of health care and health promotion. The article identifies relevant applications from the model for health communication research and practice. Weick's model of organizing is a relevant and heuristic theoretical perspective for guiding health communication research and practice. There are many potential applications of this model illustrating the complexities of effective communication in health care and health promotion. Weick's model of organizing can be used as a template for guiding both research and practice in health care and health promotion. The model illustrates the important roles that communication performs in enabling health care consumers and providers to make sense of the complexities of modern health care and health promotion, select the best strategies for responding effectively to complex health care and health promotion situations, and retain relevant information (develop organizational intelligence) for guiding future responses to complex health care and health promotion challenges.

Use of simulation tools to illustrate the effect of data management practices for low and negative plate counts on the estimated parameters of microbial reduction models.

PubMed

Garcés-Vega, Francisco; Marks, Bradley P

2014-08-01

In the last 20 years, the use of microbial reduction models has expanded significantly, including inactivation (linear and nonlinear), survival, and transfer models. However, a major constraint for model development is the impossibility to directly quantify the number of viable microorganisms below the limit of detection (LOD) for a given study. Different approaches have been used to manage this challenge, including ignoring negative plate counts, using statistical estimations, or applying data transformations. Our objective was to illustrate and quantify the effect of negative plate count data management approaches on parameter estimation for microbial reduction models. Because it is impossible to obtain accurate plate counts below the LOD, we performed simulated experiments to generate synthetic data for both log-linear and Weibull-type microbial reductions. We then applied five different, previously reported data management practices and fit log-linear and Weibull models to the resulting data. The results indicated a significant effect (α = 0.05) of the data management practices on the estimated model parameters and performance indicators. For example, when the negative plate counts were replaced by the LOD for log-linear data sets, the slope of the subsequent log-linear model was, on average, 22% smaller than for the original data, the resulting model underpredicted lethality by up to 2.0 log, and the Weibull model was erroneously selected as the most likely correct model for those data. The results demonstrate that it is important to explicitly report LODs and related data management protocols, which can significantly affect model results, interpretation, and utility. Ultimately, we recommend using only the positive plate counts to estimate model parameters for microbial reduction curves and avoiding any data value substitutions or transformations when managing negative plate counts to yield the most accurate model parameters.

A comparison of imputation techniques for handling missing predictor values in a risk model with a binary outcome.

PubMed

Ambler, Gareth; Omar, Rumana Z; Royston, Patrick

2007-06-01

Risk models that aim to predict the future course and outcome of disease processes are increasingly used in health research, and it is important that they are accurate and reliable. Most of these risk models are fitted using routinely collected data in hospitals or general practices. Clinical outcomes such as short-term mortality will be near-complete, but many of the predictors may have missing values. A common approach to dealing with this is to perform a complete-case analysis. However, this may lead to overfitted models and biased estimates if entire patient subgroups are excluded. The aim of this paper is to investigate a number of methods for imputing missing data to evaluate their effect on risk model estimation and the reliability of the predictions. Multiple imputation methods, including hotdecking and multiple imputation by chained equations (MICE), were investigated along with several single imputation methods. A large national cardiac surgery database was used to create simulated yet realistic datasets. The results suggest that complete case analysis may produce unreliable risk predictions and should be avoided. Conditional mean imputation performed well in our scenario, but may not be appropriate if using variable selection methods. MICE was amongst the best performing multiple imputation methods with regards to the quality of the predictions. Additionally, it produced the least biased estimates, with good coverage, and hence is recommended for use in practice.

Aboriginal community controlled health services: leading the way in primary care.

PubMed

Panaretto, Kathryn S; Wenitong, Mark; Button, Selwyn; Ring, Ian T

2014-06-16

The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model; coverage of the Aboriginal population higher than 60% outside major metropolitan centres; consistently improving performance in key performance on best-practice care indicators; and superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best-practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.

A model structure for an EBM program in a multihospital system.

PubMed

Schumacher, Dale N; Stock, Joseph R; Richards, Joan K

2003-01-01

Evidence-based medicine (EBM) offers a great opportunity to translate advances in medical science into advances in clinical practice. We describe the structure of a comprehensive EBM program in a multihospital community teaching system. This EBM model is distinct and separate from the peer review process and has achieved substantial physician involvement. The program emanates from the Board of Directors Quality of Care Committee and has strong administrative support. The approach relies extensively on physician involvement and expert physician panels to enhance existing EBM practice guidelines, with an explicit strategy of performance reports and feedback.

Understanding pretest and posttest reactions to cognitive ability and personality tests.

PubMed

Chan, D; Schmitt, N; Sacco, J M; DeShon, R P

1998-06-01

To understand the nature of test reactions and their relationship to test performance, the relationships among belief in tests, pretest reactions, test performance, and posttest reactions were modeled for cognitive ability and personality tests. Results from structural equation models that were fitted to responses from 197 undergraduate examinees supported the hypothesized relationships. On the cognitive ability test, pretest reactions affected test performance and mediated the relationship between belief in tests and test performance. Test performance affected posttest reactions even after taking into account the effect of pretest reactions. On the personality test, belief in tests affected pretest and posttest reactions, but the three variables were unrelated to test performance (Conscientiousness scores). Conceptual, methodological, and practical implications of the findings are discussed in the context of research on test reactions and test performance.

Comparing the costs of three prostate cancer follow-up strategies: a cost minimisation analysis.

PubMed

Pearce, Alison M; Ryan, Fay; Drummond, Frances J; Thomas, Audrey Alforque; Timmons, Aileen; Sharp, Linda

2016-02-01

Prostate cancer follow-up is traditionally provided by clinicians in a hospital setting. Growing numbers of prostate cancer survivors mean that this model of care may not be economically sustainable, and a number of alternative approaches have been suggested. The aim of this study was to develop an economic model to compare the costs of three alternative strategies for prostate cancer follow-up in Ireland-the European Association of Urology (EAU) guidelines, the National Institute of Health Care Excellence (NICE) guidelines and current practice. A cost minimisation analysis was performed using a Markov model with three arms (EAU guidelines, NICE guidelines and current practice) comparing follow-up for men with prostate cancer treated with curative intent. The model took a health care payer's perspective over a 10-year time horizon. Current practice was the least cost efficient arm of the model, the NICE guidelines were most cost efficient (74 % of current practice costs) and the EAU guidelines intermediate (92 % of current practice costs). For the 2562 new cases of prostate cancer diagnosed in 2009, the Irish health care system could have saved €760,000 over a 10-year period if the NICE guidelines were adopted. This is the first study investigating costs of prostate cancer follow-up in the Irish setting. While economic models are designed as a simplification of complex real-world situations, these results suggest potential for significant savings within the Irish health care system associated with implementation of alternative models of prostate cancer follow-up care.

Hydrocarbon Fuel Thermal Performance Modeling based on Systematic Measurement and Comprehensive Chromatographic Analysis

DTIC Science & Technology

2016-07-27

is a common requirement for aircraft, rockets , and hypersonic vehicles. The Aerospace Fuels Quality Test and Model Development (AFQTMoDev) project...was initiated to mature fuel quality assurance practices for rocket grade kerosene, thereby ensuring operational readiness of conventional and...and reliability, is a common requirement for aircraft, rockets , and hypersonic vehicles. The Aerospace Fuels Quality Test and Model Development

The Mediating Effect of Innovation between Total Quality Management (TQM) and Business Performance

NASA Astrophysics Data System (ADS)

Shan, Ang Wei; Fauzi Ahmad, Mohd; Hisyamudin Muhd Nor, Nik

2016-11-01

Both TQM and Innovation are the competitive key factors that intensely embedded into organizational products, service and process. In order to achieve higher business performance, organizations are needed to adopt both quality and innovation. Therefore, the main objective of this paper is to identify the relationship between TQM and business performance with a mediator's effect of Innovation. After detailed review the extensive literature, a new TQM model is presented. The proposed model integrates the TQM practices and different type of innovation attempt to develop a theoretical knowledge to help academician and manufacturer to understand the relationship that design quality in product and service and engaging innovation in the activities. To this end, the SEM-PLS (Structural Equation Modelling - Partial Least Squares Structural) is used to identify and evaluate the relationship among TQM, Innovation and business performance in establishing a new TQM model.

Organizational and Market Influences on Physician Performance on Patient Experience Measures

PubMed Central

Rodriguez, Hector P; von Glahn, Ted; Rogers, William H; Safran, Dana Gelb

2009-01-01

Objective To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. Data Sources This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. Study Design We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Principal Findings Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication (p=.007) and care coordination (p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care (p=.04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care (p=.04) and care coordination (p<.001) measures. Conclusions Physicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high concentrations of vulnerable populations may be disadvantaged by constraints that affect performance. Future studies should clarify the extent to which performance deficits associated with area-level deprivation are modifiable. PMID:19674429

Organizational and market influences on physician performance on patient experience measures.

PubMed

Rodriguez, Hector P; von Glahn, Ted; Rogers, William H; Safran, Dana Gelb

2009-06-01

To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p=.007) and care coordination ( p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p=.04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p=.04) and care coordination ( p<.001) measures. Physicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high concentrations of vulnerable populations may be disadvantaged by constraints that affect performance. Future studies should clarify the extent to which performance deficits associated with area-level deprivation are modifiable.

Probabilistic neural networks modeling of the 48-h LC50 acute toxicity endpoint to Daphnia magna.

PubMed

Niculescu, S P; Lewis, M A; Tigner, J

2008-01-01

Two modeling experiments based on the maximum likelihood estimation paradigm and targeting prediction of the Daphnia magna 48-h LC50 acute toxicity endpoint for both organic and inorganic compounds are reported. The resulting models computational algorithms are implemented as basic probabilistic neural networks with Gaussian kernel (statistical corrections included). The first experiment uses strictly D. magna information for 971 structures as training/learning data and the resulting model targets practical applications. The second experiment uses the same training/learning information plus additional data on another 29 compounds whose endpoint information is originating from D. pulex and Ceriodaphnia dubia. It only targets investigation of the effect of mixing strictly D. magna 48-h LC50 modeling information with small amounts of similar information estimated from related species, and this is done as part of the validation process. A complementary 81 compounds dataset (involving only strictly D. magna information) is used to perform external testing. On this external test set, the Gaussian character of the distribution of the residuals is confirmed for both models. This allows the use of traditional statistical methodology to implement computation of confidence intervals for the unknown measured values based on the models predictions. Examples are provided for the model targeting practical applications. For the same model, a comparison with other existing models targeting the same endpoint is performed.

Not of one mind: mental models of clinical practice guidelines in the Veterans Health Administration.

PubMed

Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A; Moore, Frank I

2005-06-01

The purpose of this paper is to present differences in mental models of clinical practice guidelines (CPGs) among 15 Veterans Health Administration (VHA) facilities throughout the United States. Two hundred and forty-four employees from 15 different VHA facilities across four service networks around the country were invited to participate. Participants were selected from different levels throughout each service setting from primary care personnel to facility leadership. This qualitative study used purposive sampling, a semistructured interview process for data collection, and grounded theory techniques for analysis. A semistructured interview was used to collect information on participants' mental models of CPGs, as well as implementation strategies and barriers in their facility. Analysis of these interviews using grounded theory techniques indicated that there was wide variability in employees' mental models of CPGs. Findings also indicated that high-performing facilities exhibited both (a) a clear, focused shared mental model of guidelines and (b) a tendency to use performance feedback as a learning opportunity, thus suggesting that a shared mental model is a necessary but not sufficient step toward successful guideline implementation. We conclude that a clear shared mental model of guidelines, in combination with a learning orientation toward feedback are important components for successful guideline implementation and improved quality of care.

Managing the life cycle of electronic clinical documents.

PubMed

Payne, Thomas H; Graham, Gail

2006-01-01

To develop a model of the life cycle of clinical documents from inception to use in a person's medical record, including workflow requirements from clinical practice, local policy, and regulation. We propose a model for the life cycle of clinical documents as a framework for research on documentation within electronic medical record (EMR) systems. Our proposed model includes three axes: the stages of the document, the roles of those involved with the document, and the actions those involved may take on the document at each stage. The model includes the rules to describe who (in what role) can perform what actions on the document, and at what stages they can perform them. Rules are derived from needs of clinicians, and requirements of hospital bylaws and regulators. Our model encompasses current practices for paper medical records and workflow in some EMR systems. Commercial EMR systems include methods for implementing document workflow rules. Workflow rules that are part of this model mirror functionality in the Department of Veterans Affairs (VA) EMR system where the Authorization/ Subscription Utility permits document life cycle rules to be written in English-like fashion. Creating a model of the life cycle of clinical documents serves as a framework for discussion of document workflow, how rules governing workflow can be implemented in EMR systems, and future research of electronic documentation.

A flexible framework for process-based hydraulic and water ...

EPA Pesticide Factsheets

Background Models that allow for design considerations of green infrastructure (GI) practices to control stormwater runoff and associated contaminants have received considerable attention in recent years. While popular, generally, the GI models are relatively simplistic. However, GI model predictions are being relied upon by many municipalities and State/Local agencies to make decisions about grey vs. green infrastructure improvement planning. Adding complexity to GI modeling frameworks may preclude their use in simpler urban planning situations. Therefore, the goal here was to develop a sophisticated, yet flexible tool that could be used by design engineers and researchers to capture and explore the effect of design factors and properties of the media used in the performance of GI systems at a relatively small scale. We deemed it essential to have a flexible GI modeling tool that is capable of simulating GI system components and specific biophysical processes affecting contaminants such as reactions, and particle-associated transport accurately while maintaining a high degree of flexibly to account for the myriad of GI alternatives. The mathematical framework for a stand-alone GI performance assessment tool has been developed and will be demonstrated.Framework Features The process-based model framework developed here can be used to model a diverse range of GI practices such as green roof, retention pond, bioretention, infiltration trench, permeable pavement and

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices

PubMed Central

Dahrouge, Simone; Hogg, William E.; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K.; Kristjansson, Elizabeth; Fletcher, John

2012-01-01

Background: Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. Methods: In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. Results: A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = −6.3, 95% confidence interval [CI] −11.9 to −0.6) and practices in the established capitation model (β = −9.1, 95% CI −14.9 to −3.3) but not for those with salaried remuneration (β = −0.8, 95% CI −6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely consistent across the preventive manoeuvres. Interpretation: No funding model was clearly associated with superior preventive care. Factors related to physician characteristics and practice structure were stronger predictors of performance. Practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. Our findings raise questions about reform initiatives aimed at increasing patient numbers, but they support the adoption of information technology. PMID:22143227

How to get the most out of your orthopaedic fellowship: thinking about practice-based learning.

PubMed

Templeman, David

2012-09-01

Practice-based learning and improvement is an important skill set to develop during an orthopaedic trauma fellowship and is 1 of the 6 core competencies stated by the ACGME. The review of clinic cases is best done using a few simple models to develop a structured approach for studying cases. Three common sense and easy-to-use strategies to improve clinical practice are as follows: performing each case three times, studying the 4 quadrants of patient outcomes, and the application of the Pareto 80/20 rule. These principles help to develop a structured approach for analyzing and thinking about practice-based experiences.

Sports teams as superorganisms: implications of sociobiological models of behaviour for research and practice in team sports performance analysis.

PubMed

Duarte, Ricardo; Araújo, Duarte; Correia, Vanda; Davids, Keith

2012-08-01

Significant criticisms have emerged on the way that collective behaviours in team sports have been traditionally evaluated. A major recommendation has been for future research and practice to focus on the interpersonal relationships developed between team players during performance. Most research has typically investigated team game performance in subunits (attack or defence), rather than considering the interactions of performers within the whole team. In this paper, we offer the view that team performance analysis could benefit from the adoption of biological models used to explain how repeated interactions between grouping individuals scale to emergent social collective behaviours. We highlight the advantages of conceptualizing sports teams as functional integrated 'super-organisms' and discuss innovative measurement tools, which might be used to capture the superorganismic properties of sports teams. These tools are suitable for revealing the idiosyncratic collective behaviours underlying the cooperative and competitive tendencies of different sports teams, particularly their coordination of labour and the most frequent channels of communication and patterns of interaction between team players. The principles and tools presented here can serve as the basis for novel approaches and applications of performance analysis devoted to understanding sports teams as cohesive, functioning, high-order organisms exhibiting their own peculiar behavioural patterns.

Evaluation of 3D Additively Manufactured Canine Brain Models for Teaching Veterinary Neuroanatomy.

PubMed

Schoenfeld-Tacher, Regina M; Horn, Timothy J; Scheviak, Tyler A; Royal, Kenneth D; Hudson, Lola C

Physical specimens are essential to the teaching of veterinary anatomy. While fresh and fixed cadavers have long been the medium of choice, plastinated specimens have gained widespread acceptance as adjuncts to dissection materials. Even though the plastination process increases the durability of specimens, these are still derived from animal tissues and require periodic replacement if used by students on a regular basis. This study investigated the use of three-dimensional additively manufactured (3D AM) models (colloquially referred to as 3D-printed models) of the canine brain as a replacement for plastinated or formalin-fixed brains. The models investigated were built based on a micro-MRI of a single canine brain and have numerous practical advantages, such as durability, lower cost over time, and reduction of animal use. The effectiveness of the models was assessed by comparing performance among students who were instructed using either plastinated brains or 3D AM models. This study used propensity score matching to generate similar pairs of students. Pairings were based on gender and initial anatomy performance across two consecutive classes of first-year veterinary students. Students' performance on a practical neuroanatomy exam was compared, and no significant differences were found in scores based on the type of material (3D AM models or plastinated specimens) used for instruction. Students in both groups were equally able to identify neuroanatomical structures on cadaveric material, as well as respond to questions involving application of neuroanatomy knowledge. Therefore, we postulate that 3D AM canine brain models are an acceptable alternative to plastinated specimens in teaching veterinary neuroanatomy.

Evaluating an online pharmaceutical education system for pharmacy interns in critical care settings.

PubMed

Yeh, Yu-Ting; Chen, Hsiang-Yin; Cheng, Kuei-Ju; Hou, Ssu-An; Yen, Yu-Hsuan; Liu, Chien-Tsai

2014-02-01

Incorporating electronic learning (eLearning) system into professional experimental programs such as pharmacy internships is a challenge. However, none of the current systems can fully support the unique needs of clinical pharmacy internship. In this study we enhanced a commercial eLearning system for clinical pharmacy internship (The Clinical Pharmacy Internship eLearning System, CPIES). The KAP questionnaire was used to evaluate the performance of group A with the traditional teaching model and group B with the CPIES teaching model. The CPIES teaching model showed significant improvement in interns' knowledge and practice (p = 0.002 and 0.031, respectively). The traditional teaching model only demonstrated significant improvement in practice (p = 0.011). Moreover, professionalism, such as attitudes on cooperating with other health professionals, is developed by learning from a good mentor. The on-line teaching and traditional teaching methods should undoubtedly be blended in a complete teaching model in order to improve learners' professional knowledge, facilitate correct attitude, and influence good practice. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Agricultural Recharge Practices for Managing Nitrate in Regional Groundwater: Time-Resolution Assessment of Numerical Modeling Approach

NASA Astrophysics Data System (ADS)

Bastani, M.; Harter, T.

2017-12-01

Intentional recharge practices in irrigated landscapes are promising options to control and remediate groundwater quality degradation with respect to nitrate. To better understand the effect of these practices, a fully 3D transient heterogeneous transport model simulation is developed using MODFLOW and MT3D. The model is developed for a long-term study of nitrate improvements in an alluvial groundwater basin in Eastern San Joaquin Valley, CA. Different scenarios of agricultural recharge strategies including crop type change and winter flood flows are investigated. Transient simulations with high spatio-temporal resolutions are performed. We then consider upscaling strategies that would allow us to simplify the modeling process such that it can be applied at a very large basin-scale (1000s of square kilometers) for scenario analysis. We specifically consider upscaling of time-variant boundary conditions (both internal and external) that have significant influence on calculation cost of the model. We compare monthly transient stresses to upscaled annual and further upscaled average steady-state stresses on nitrate transport in groundwater under recharge scenarios.

Road safety risk evaluation and target setting using data envelopment analysis and its extensions.

PubMed

Shen, Yongjun; Hermans, Elke; Brijs, Tom; Wets, Geert; Vanhoof, Koen

2012-09-01

Currently, comparison between countries in terms of their road safety performance is widely conducted in order to better understand one's own safety situation and to learn from those best-performing countries by indicating practical targets and formulating action programmes. In this respect, crash data such as the number of road fatalities and casualties are mostly investigated. However, the absolute numbers are not directly comparable between countries. Therefore, the concept of risk, which is defined as the ratio of road safety outcomes and some measure of exposure (e.g., the population size, the number of registered vehicles, or distance travelled), is often used in the context of benchmarking. Nevertheless, these risk indicators are not consistent in most cases. In other words, countries may have different evaluation results or ranking positions using different exposure information. In this study, data envelopment analysis (DEA) as a performance measurement technique is investigated to provide an overall perspective on a country's road safety situation, and further assess whether the road safety outcomes registered in a country correspond to the numbers that can be expected based on the level of exposure. In doing so, three model extensions are considered, which are the DEA based road safety model (DEA-RS), the cross-efficiency method, and the categorical DEA model. Using the measures of exposure to risk as the model's input and the number of road fatalities as output, an overall road safety efficiency score is computed for the 27 European Union (EU) countries based on the DEA-RS model, and the ranking of countries in accordance with their cross-efficiency scores is evaluated. Furthermore, after applying clustering analysis to group countries with inherent similarity in their practices, the categorical DEA-RS model is adopted to identify best-performing and underperforming countries in each cluster, as well as the reference sets or benchmarks for those underperforming ones. More importantly, the extent to which each reference set could be learned from is specified, and practical yet challenging targets are given for each underperforming country, which enables policymakers to recognize the gap with those best-performing countries and further develop their own road safety policy. Copyright © 2012 Elsevier Ltd. All rights reserved.

A model-based economic evaluation of improved primary care management of patients with type 2 diabetes in Australia.

PubMed

Haji Ali Afzali, Hossein; Gray, Jodi; Beilby, Justin; Holton, Christine; Karnon, Jonathan

2013-12-01

There are few studies investigating the economic value of the Australian practice nurse workforce on the management of chronic conditions. This is particularly important in Australia, where the government needs evidence to inform decisions on whether to maintain or redirect current financial incentives that encourage practices to recruit practice nurses. The objective of this study was to estimate the lifetime costs and quality-adjusted life-years (QALYs) associated with two models of practice nurse involvement in clinical-based activities (high and low level) in the management of type 2 diabetes within the primary care setting. A previously validated state transition model (the United Kingdom Prospective Diabetes Study Outcomes Model) was adapted, which uses baseline prognostic factors (e.g. gender, haemoglobin A1c [HbA1c]) to predict the risk of occurrence of diabetes-related complications (e.g. stroke). The model was populated by data from Australian and UK observational studies. Costs and utility values associated with complications were summed over patients' lifetimes to estimate costs and QALY gains from the perspective of the health care system. All costs were expressed in 2011 Australian dollars (AU$). The base-case analysis assumed a 40-year time horizon with an annual discount rate of 5 %. Relative to low-level involvement of practice nurses in the provision of clinical-based activities, the high-level model was associated with lower mean lifetime costs of management of complications (-AU$8,738; 95 % confidence interval [CI] -AU$12,522 to -AU$4,954), and a greater average gain in QALYs (0.3; 95 % CI 0.2-0.4). A range of sensitivity analyses were performed, in which the high-level model was dominant in all cases. Our results suggest that the high-level model is a dominant management strategy over the low-level model in all modelled scenarios. These findings indicate the need for effective primary care-based incentives to encourage general practices not only to employ practice nurses, but to better integrate them into the provision of clinical services.

The Effect of Elementary Mathematics Coaching on Student Achievement in Fourth, Fifth, and Sixth Grade

ERIC Educational Resources Information Center

Trimuel Stewart, Merita

2013-01-01

Due to recent waivers and current expectations of teacher performance, schools have been tasked to close their student achievement gaps in mathematics by 2014. Yet students still have not performed well in mathematics, which may be a direct link to teachers' instructional practices. Identifying a coaching model to improve student achievement…

The Prediction of Performance in Navy Signalman Class "A" School. TAEG Report No. 90.

ERIC Educational Resources Information Center

Mew, Dorothy V.

A study designed to develop a selection model for the prediction of Signalman performance in sending and receiving Morse code and to evaluate training strategies was conducted with 180 Navy and Coast Guard enlisted men. Trainees were taught to send Morse code using innovative training materials (mnemonics and guided practice). High and average…

Study on Practical Application of Turboprop Engine Condition Monitoring and Fault Diagnostic System Using Fuzzy-Neuro Algorithms

NASA Astrophysics Data System (ADS)

Kong, Changduk; Lim, Semyeong; Kim, Keunwoo

2013-03-01

The Neural Networks is mostly used to engine fault diagnostic system due to its good learning performance, but it has a drawback due to low accuracy and long learning time to build learning data base. This work builds inversely a base performance model of a turboprop engine to be used for a high altitude operation UAV using measuring performance data, and proposes a fault diagnostic system using the base performance model and artificial intelligent methods such as Fuzzy and Neural Networks. Each real engine performance model, which is named as the base performance model that can simulate a new engine performance, is inversely made using its performance test data. Therefore the condition monitoring of each engine can be more precisely carried out through comparison with measuring performance data. The proposed diagnostic system identifies firstly the faulted components using Fuzzy Logic, and then quantifies faults of the identified components using Neural Networks leaned by fault learning data base obtained from the developed base performance model. In leaning the measuring performance data of the faulted components, the FFBP (Feed Forward Back Propagation) is used. In order to user's friendly purpose, the proposed diagnostic program is coded by the GUI type using MATLAB.

Implementing high-performance work practices in healthcare organizations: qualitative and conceptual evidence.

PubMed

McAlearney, Ann Scheck; Robbins, Julie; Garman, Andrew N; Song, Paula H

2013-01-01

Studies across industries suggest that the systematic use of high-performance work practices (HPWPs) may be an effective but underused strategy to improve quality of care in healthcare organizations. Optimal use of HPWPs depends on how they are implemented, yet we know little about their implementation in healthcare. We conducted 67 key informant interviews in five healthcare organizations, each considered to have exemplary work practices in place and to deliver high-quality care, as part of an extensive study of HPWP use in healthcare. We analyzed interview transcripts inductively and deductively to examine why and how organizations implement HPWPs. We used an evidence-based model of complex innovation adoption to guide our exploration of factors that facilitate HPWP implementation. We found considerable variability in interviewees' reasons for implementing HPWPs, including macro-organizational (strategic level) and micro-organizational (individual level) reasons. This variability highlighted the complex context for HPWP implementation in many organizations. We also found that our application of an innovation implementation model helped clarify and categorize facilitators of HPWP implementation, thus providing insight on how these factors can contribute to implementation effectiveness. Focusing efforts on clarifying definitions, building commitment, and ensuring consistency in the application of work practices may be particularly important elements of successful implementation.

Long-term practice effects on a new skilled motor learning: an electrophysiological study.

PubMed

Fattapposta, F; Amabile, G; Cordischi, M V; Di Venanzio, D; Foti, A; Pierelli, F; D'Alessio, C; Pigozzi, F; Parisi, A; Morrocutti, C

1996-12-01

Cortical functions concerned with the execution of skilled movements can be studied through complex interactive tasks. Skilled performance task (SPT) offers the greatest deal of information about the electrophysiological components reflecting pre-programming, execution of the movement and control of the results. Overall, these components are indicated as "movement-related brain macropotentials' (MRBMs). Among them, Bereitschaftspotential (BP) reflects cerebral processes related to the preparation of movement and skilled performance positivity (SPP) reflects control processes on the result of performance. There is some evidence supporting a training effect on MRBMs, but less clear is whether long-term practice of a skilled activity could modify learning strategies of a new skilled task. We recorded MRBMs in subjects trained for a long time to perform a highly skillful athletic activity, i.e. gun shooting, and in a group of control subjects without any former experience in skilled motor activities. Our findings demonstrated the existence of a relationship between pre-programming and performance control, as suggested by decrease of BP amplitude and increase of SPP amplitude in presence of high levels of performance. Long-term practice seems to develop better control models on performance, that reduce the need of a high mental effort in pre-programming a skilled action.

Robust modeling and performance analysis of high-power diode side-pumped solid-state laser systems.

PubMed

Kashef, Tamer; Ghoniemy, Samy; Mokhtar, Ayman

2015-12-20

In this paper, we present an enhanced high-power extrinsic diode side-pumped solid-state laser (DPSSL) model to accurately predict the dynamic operations and pump distribution under different practical conditions. We introduce a new implementation technique for the proposed model that provides a compelling incentive for the performance assessment and enhancement of high-power diode side-pumped Nd:YAG lasers using cooperative agents and by relying on the MATLAB, GLAD, and Zemax ray tracing software packages. A large-signal laser model that includes thermal effects and a modified laser gain formulation and incorporates the geometrical pump distribution for three radially arranged arrays of laser diodes is presented. The design of a customized prototype diode side-pumped high-power laser head fabricated for the purpose of testing is discussed. A detailed comparative experimental and simulation study of the dynamic operation and the beam characteristics that are used to verify the accuracy of the proposed model for analyzing the performance of high-power DPSSLs under different conditions are discussed. The simulated and measured results of power, pump distribution, beam shape, and slope efficiency are shown under different conditions and for a specific case, where the targeted output power is 140 W, while the input pumping power is 400 W. The 95% output coupler reflectivity showed good agreement with the slope efficiency, which is approximately 35%; this assures the robustness of the proposed model to accurately predict the design parameters of practical, high-power DPSSLs.

Reduced Gravity Studies of Soret Transport Effects in Liquid Fuel Combustion

NASA Technical Reports Server (NTRS)

Shaw, Benjamin D.

2004-01-01

Soret transport, which is mass transport driven by thermal gradients, can be important in practical flames as well as laboratory flames by influencing transport of low molecular weight species (e.g., monatomic and diatomic hydrogen). In addition, gas-phase Soret transport of high molecular weight fuel species that are present in practical liquid fuels (e.g., octane or methanol) can be significant in practical flames (Rosner et al., 2000; Dakhlia et al., 2002) and in high pressure droplet evaporation (Curtis and Farrell, 1992), and it has also been shown that Soret transport effects can be important in determining oxygen diffusion rates in certain classes of microgravity droplet combustion experiments (Aharon and Shaw, 1998). It is thus useful to obtain information on flames under conditions where Soret effects can be clearly observed. This research is concerned with investigating effects of Soret transport on combustion of liquid fuels, in particular liquid fuel droplets. Reduced-gravity is employed to provide an ideal (spherically-symmetrical) experimental model with which to investigate effects of Soret transport on combustion. The research will involve performing reduced-gravity experiments on combustion of liquid fuel droplets in environments where Soret effects significantly influence transport of fuel and oxygen to flame zones. Experiments will also be performed where Soret effects are not expected to be important. Droplets initially in the 0.5 to 1 mm size range will be burned. Data will be obtained on influences of Soret transport on combustion characteristics (e.g., droplet burning rates, droplet lifetimes, gas-phase extinction, and transient flame behaviors) under simplified geometrical conditions that are most amenable to theoretical modeling (i.e., spherical symmetry). The experiments will be compared with existing theoretical models as well as new models that will be developed. Normal gravity experiments will also be performed.

Target-classification approach applied to active UXO sites

NASA Astrophysics Data System (ADS)

Shubitidze, F.; Fernández, J. P.; Shamatava, Irma; Barrowes, B. E.; O'Neill, K.

2013-06-01

This study is designed to illustrate the discrimination performance at two UXO active sites (Oklahoma's Fort Sill and the Massachusetts Military Reservation) of a set of advanced electromagnetic induction (EMI) inversion/discrimination models which include the orthonormalized volume magnetic source (ONVMS), joint diagonalization (JD), and differential evolution (DE) approaches and whose power and flexibility greatly exceed those of the simple dipole model. The Fort Sill site is highly contaminated by a mix of the following types of munitions: 37-mm target practice tracers, 60-mm illumination mortars, 75-mm and 4.5'' projectiles, 3.5'', 2.36'', and LAAW rockets, antitank mine fuzes with and without hex nuts, practice MK2 and M67 grenades, 2.5'' ballistic windshields, M2A1-mines with/without bases, M19-14 time fuzes, and 40-mm practice grenades with/without cartridges. The site at the MMR site contains targets of yet different sizes. In this work we apply our models to EMI data collected using the MetalMapper (MM) and 2 × 2 TEMTADS sensors. The data for each anomaly are inverted to extract estimates of the extrinsic and intrinsic parameters associated with each buried target. (The latter include the total volume magnetic source or NVMS, which relates to size, shape, and material properties; the former includes location, depth, and orientation). The estimated intrinsic parameters are then used for classification performed via library matching and the use of statistical classification algorithms; this process yielded prioritized dig-lists that were submitted to the Institute for Defense Analyses (IDA) for independent scoring. The models' classification performance is illustrated and assessed based on these independent evaluations.

Nurse managers' role in older nurses' intention to stay.

PubMed

Armstrong-Stassen, Marjorie; Freeman, Michelle; Cameron, Sheila; Rajacic, Dale

2015-01-01

The purpose of this paper is to propose and test a model of the underlying mechanisms linking perceived availability of human resource (HR) practices relevant to older nurses and older nurses' intentions to stay with their hospitals. Quantitative data were collected from randomly selected older registered nurses (N=660) engaged in direct patient care in hospitals in Canada. Structural equation modelling was used to test the hypothesized model. The relationship between perceptions of HR practices (performance evaluation, recognition/respect) and intentions to stay was mediated by the perceived fairness with which nurse managers managed these HR practices and nurse manager satisfaction. When nurse managers were perceived to administer the HR practices fairly (high perceived procedural justice), older nurses were more satisfied with their nurse manager and, in turn, more likely to intend to stay. The cross-sectional research design does not allow determination of causality. It is important that nurse managers receive training to increase their awareness of the needs of older nurses and that nurse managers be educated on how to manage HR practices relevant to older nurses in a fair manner. Equally important is that hospital administrators and HR managers recognize the importance of providing such HR practices and supporting nurse managers in managing these practices. The findings increase the understanding of how HR practices tailored to older nurses are related to the intentions of these nurses to remain with their hospital, and especially the crucial role that first-line nurse managers play in this process.

Modelling the effect of perceived interdependence among mental healthcare professionals on their work role performance.

PubMed

Markon, Marie-Pierre; Chiocchio, François; Fleury, Marie-Josée

2017-07-01

The purpose of mental healthcare system reform was to enhance service efficiency by strengthening primary mental healthcare and increasing service integration in communities. Reinforcing interprofessional teamwork also intended to address the extensive and multidimensional needs of patients with mental disorders by bringing together a broader array of expertise. In this context, mental healthcare professionals (MHCPs) from various health and social care professions are more interdependent in many aspects of their work (tasks, resources, and goals). We wanted to examine the effect of perceived interdependence among MHCPs on their work role performance in the context of mental healthcare. For this purpose, we developed and tested a model coherent with the Input-Mediator-Outcome-Input (IMOI) framework of team effectiveness. Data from questionnaires administered to 315 MHCPs from four local health service networks in Quebec, Canada were analysed through structural equation modelling and mediation analysis. The structural equation model provided a good fit for the data and explained 51% of the variance of work role performance. Perceived collaboration, confidence in the advantages of interprofessional collaboration, involvement in the decision process, knowledge sharing, and satisfaction with the nature of the work partially mediated the effect of perceived interdependence among team members on work role performance. Therefore, perceived interdependence among team members had a positive impact on the work role performance of MHCPs mostly through its effect on favourable team functioning features. This implies, in practice, that increased interdependence of MHCPs would be more likely to truly enhance work role performance if team-based interventions to promote collaborative work and interprofessional teaching and training programs to support work within interprofessional teams were jointly implemented. Participation in the decision process and knowledge sharing should also be fostered, for instance, by adopting knowledge management best practices.

Prospects for rebuilding primary care using the patient-centered medical home.

PubMed

Landon, Bruce E; Gill, James M; Antonelli, Richard C; Rich, Eugene C

2010-05-01

Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U.S. health care system. Many commentators have adopted the model of the patient-centered medical home as policy shorthand to address the reinvention of primary care in the United States. We analyze potential barriers to implementing the medical home model for policy makers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice and methods to facilitate transformation of existing practices to functioning medical homes.

Core Competencies for Doctoral Education in Public Health

PubMed Central

Calhoun, Judith G.; Weist, Elizabeth M.; Raczynski, James M.

2012-01-01

The Association of Schools of Public Health (ASPH) released the Doctor of Public Health (DrPH) Core Competency Model in 2009. Between 2007 and 2009, a national expert panel with members of the academic and practice communities guided by the ASPH Education Committee developed its 7 performance domains, including 54 competencies. We provide an overview and analysis of the challenges and issues associated with the variability in DrPH degree offerings, reflect on the model development process and related outcomes, and discuss the significance of the model, future applications, and challenges for integration across educational settings. With the model, ASPH aims to stimulate national discussion on the competencies needed by DrPH graduates with the new challenges of 21st-century public health practice and to better define the DrPH degree. PMID:22095342

Measures of Potential Flexibility and Practical Flexibility in Equation Solving.

PubMed

Xu, Le; Liu, Ru-De; Star, Jon R; Wang, Jia; Liu, Ying; Zhen, Rui

2017-01-01

Researchers interested in mathematical proficiency have recently begun to explore the development of strategic flexibility, where flexibility is defined as knowledge of multiple strategies for solving a problem and the ability to implement an innovative strategy for a given problem solving circumstance. However, anecdotal findings from this literature indicate that students do not consistently use an innovative strategy for solving a given problem, even when these same students demonstrate knowledge of innovative strategies. This distinction, sometimes framed in the psychological literature as competence vs. performance-has not been previously studied for flexibility. In order to explore the competence/performance distinction in flexibility, this study developed and validated measures for potential flexibility (e.g., competence, or knowledge of multiple strategies) and practical flexibility (e.g., performance, use of innovative strategies) for solving equations. The measures were administrated to a sample of 158 Chinese middle school students through a Tri-Phase Flexibility Assessment, in which the students were asked to solve each equation, generate additional strategies, and evaluate own multiple strategies. Confirmatory factor analysis supported a two-factor model of potential and practical flexibility. Satisfactory internal consistency was found for the measures. Additional validity evidence included the significant association with flexibility measured with the previous method. Potential flexibility and practical flexibility were found to be distinct but related. The theoretical and practical implications of the concepts and their measures of potential flexibility and practical flexibility are discussed.

Financial Incentives and Cervical Cancer Screening Participation in Ontario's Primary Care Practice Models.

PubMed

Pendrith, Ciara; Thind, Amardeep; Zaric, Gregory S; Sarma, Sisira

2016-08-01

The primary objective of this paper is to compare cervical cancer screening rates of family physicians in Ontario's two dominant reformed practice models, Family Health Group (FHG) and Family Health Organization (FHO), and traditional fee-for-service (FFS) model. Both reformed models formally enrol patients and offer extensive pay-for-performance incentives; however, they differ by remuneration for core services (FHG is FFS; FHO is capitated). The secondary objective is to estimate the average and marginal costs of screening in each model. Using administrative data on 7,298 family physicians and their 2,083,633 female patients aged 35-69 eligible for cervical cancer screening in 2011, we assessed screening rates after adjusting for patient and physician characteristics. Predicted screening rates, fees and bonus payments were used to estimate the average and marginal costs of cervical cancer screening. Adjusted screening rates were highest in the FHG (81.9%), followed by the FHO (79.6%), and then the traditional FFS model (74.2%). The cost of a cervical cancer screening was $18.30 in the FFS model. The estimated average cost of screening in the FHGs and FHOs were $29.71 and $35.02, respectively, while the corresponding marginal costs were $33.05 and $39.06. We found significant differences in cervical cancer screening rates across Ontario's primary care practice models. Cervical screening rates were significantly higher in practice models eligible for incentives (FHGs and FHOs) than the traditional FFS model. However, the average and marginal cost of screening were lowest in the traditional FFS model and highest in the FHOs. Copyright © 2016 Longwoods Publishing.

The Athletic Trainer's Role in Modifying Nutritional Behaviors of Adolescent Athletes: Putting Theory into Practice

PubMed Central

Hackman, Robert M.; Katra, Jane E.; Geertsen, Susan M.

1992-01-01

Nutritional practices influence athletic performance and recovery from injury. The athletic trainer is ideally positioned to effect dietary changes with adolescent athletes—a group at high-risk for nutritional imbalances. Research shows that young adults generally do not change dietary practices when given factual nutrition and health information. This article provides a variety of behavior change strategies, based on models derived from health education and health psychology, which are likely to influence dietary choices. Promoting self-efficacy by enhancing perception of choice and control, peer modeling, cooperative support networks, goal-setting techniques, and behavioral self-monitoring may provide the motivational framework necessary to enhance dietary compliance. Dietary behavior change techniques are a valuable part of an athletic trainer's resources. PMID:16558172

The impact of primary care reform on health system performance in Canada: a systematic review.

PubMed

Carter, Renee; Riverin, Bruno; Levesque, Jean-Frédéric; Gariepy, Geneviève; Quesnel-Vallée, Amélie

2016-07-30

We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices

PubMed Central

Sinsky, Christine A.; Willard-Grace, Rachel; Schutzbank, Andrew M.; Sinsky, Thomas A.; Margolius, David; Bodenheimer, Thomas

2013-01-01

We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life’s vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice. PMID:23690328

A test of inflated zeros for Poisson regression models.

PubMed

He, Hua; Zhang, Hui; Ye, Peng; Tang, Wan

2017-01-01

Excessive zeros are common in practice and may cause overdispersion and invalidate inference when fitting Poisson regression models. There is a large body of literature on zero-inflated Poisson models. However, methods for testing whether there are excessive zeros are less well developed. The Vuong test comparing a Poisson and a zero-inflated Poisson model is commonly applied in practice. However, the type I error of the test often deviates seriously from the nominal level, rendering serious doubts on the validity of the test in such applications. In this paper, we develop a new approach for testing inflated zeros under the Poisson model. Unlike the Vuong test for inflated zeros, our method does not require a zero-inflated Poisson model to perform the test. Simulation studies show that when compared with the Vuong test our approach not only better at controlling type I error rate, but also yield more power.

A Resource-Based Modelling Framework to Assess Habitat Suitability for Steppe Birds in Semiarid Mediterranean Agricultural Systems

PubMed Central

Cardador, Laura; De Cáceres, Miquel; Bota, Gerard; Giralt, David; Casas, Fabián; Arroyo, Beatriz; Mougeot, François; Cantero-Martínez, Carlos; Moncunill, Judit; Butler, Simon J.; Brotons, Lluís

2014-01-01

European agriculture is undergoing widespread changes that are likely to have profound impacts on farmland biodiversity. The development of tools that allow an assessment of the potential biodiversity effects of different land-use alternatives before changes occur is fundamental to guiding management decisions. In this study, we develop a resource-based model framework to estimate habitat suitability for target species, according to simple information on species’ key resource requirements (diet, foraging habitat and nesting site), and examine whether it can be used to link land-use and local species’ distribution. We take as a study case four steppe bird species in a lowland area of the north-eastern Iberian Peninsula. We also compare the performance of our resource-based approach to that obtained through habitat-based models relating species’ occurrence and land-cover variables. Further, we use our resource-based approach to predict the effects that change in farming systems can have on farmland bird habitat suitability and compare these predictions with those obtained using the habitat-based models. Habitat suitability estimates generated by our resource-based models performed similarly (and better for one study species) than habitat based-models when predicting current species distribution. Moderate prediction success was achieved for three out of four species considered by resource-based models and for two of four by habitat-based models. Although, there is potential for improving the performance of resource-based models, they provide a structure for using available knowledge of the functional links between agricultural practices, provision of key resources and the response of organisms to predict potential effects of changing land-uses in a variety of context or the impacts of changes such as altered management practices that are not easily incorporated into habitat-based models. PMID:24667825

Paying for quality not quantity: a wisconsin health maintenance organization proposes an incentive model for reimbursement of chiropractic services.

PubMed

Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy

2012-07-01

The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one HMO that aims to transition from fee-for-service to a pay-for-performance and quality reporting for reimbursement for chiropractic care. This model is theoretically based on the combination of a fee-for-service payment, pay for participation (NCQA Back Pain Recognition Program payment), meaningful use of electronic health record payment, and pay for reporting (PQRS-BPMG payment). Evaluation of this model needs to be implemented to determine if it will achieve its intended goals. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Retrieval practice enhances the accessibility but not the quality of memory.

PubMed

Sutterer, David W; Awh, Edward

2016-06-01

Numerous studies have demonstrated that retrieval from long-term memory (LTM) can enhance subsequent memory performance, a phenomenon labeled the retrieval practice effect. However, the almost exclusive reliance on categorical stimuli in this literature leaves open a basic question about the nature of this improvement in memory performance. It has not yet been determined whether retrieval practice improves the probability of successful memory retrieval or the quality of the retrieved representation. To answer this question, we conducted three experiments using a mixture modeling approach (Zhang & Luck, 2008) that provides a measure of both the probability of recall and the quality of the recalled memories. Subjects attempted to memorize the color of 400 unique shapes. After every 10 images were presented, subjects either recalled the last 10 colors (the retrieval practice condition) by clicking on a color wheel with each shape as a retrieval cue or they participated in a control condition that involved no further presentations (Experiment 1) or restudy of the 10 shape/color associations (Experiments 2 and 3). Performance in a subsequent delayed recall test revealed a robust retrieval practice effect. Subjects recalled a significantly higher proportion of items that they had previously retrieved relative to items that were untested or that they had restudied. Interestingly, retrieval practice did not elicit any improvement in the precision of the retrieved memories. The same empirical pattern also was observed following delays of greater than 24 hours. Thus, retrieval practice increases the probability of successful memory retrieval but does not improve memory quality.

A tale of four practices.

PubMed

Miller-Day, Michelle; Applequist, Janelle; Zabokrtsky, Keri; Dalton, Alexandra; Kellom, Katherine; Gabbay, Robert; Cronholm, Peter F

2017-09-18

Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction. Findings Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion. Originality/value Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.

Temporal evolution modeling of hydraulic and water quality performance of permeable pavements

NASA Astrophysics Data System (ADS)

Huang, Jian; He, Jianxun; Valeo, Caterina; Chu, Angus

2016-02-01

A mathematical model for predicting hydraulic and water quality performance in both the short- and long-term is proposed based on field measurements for three types of permeable pavements: porous asphalt (PA), porous concrete (PC), and permeable inter-locking concrete pavers (PICP). The model was applied to three field-scale test sites in Calgary, Alberta, Canada. The model performance was assessed in terms of hydraulic parameters including time to peak, peak flow and water balance and a water quality variable (the removal rate of total suspended solids). A total of 20 simulated storm events were used for model calibration and verification processes. The proposed model can simulate the outflow hydrographs with a coefficient of determination (R2) ranging from 0.762 to 0.907, and normalized root-mean-square deviation (NRMSD) ranging from 13.78% to 17.83%. Comparison of the time to peak flow, peak flow, runoff volume and TSS removal rates between the measured and modeled values in model verification phase had a maximum difference of 11%. The results demonstrate that the proposed model is capable of capturing the temporal dynamics of the pavement performance. Therefore, the model has great potential as a practical modeling tool for permeable pavement design and performance assessment.

An ICAI architecture for troubleshooting in complex, dynamic systems

NASA Technical Reports Server (NTRS)

Fath, Janet L.; Mitchell, Christine M.; Govindaraj, T.

1990-01-01

Ahab, an intelligent computer-aided instruction (ICAI) program, illustrates an architecture for simulator-based ICAI programs to teach troubleshooting in complex, dynamic environments. The architecture posits three elements of a computerized instructor: the task model, the student model, and the instructional module. The task model is a prescriptive model of expert performance that uses symptomatic and topographic search strategies to provide students with directed problem-solving aids. The student model is a descriptive model of student performance in the context of the task model. This student model compares the student and task models, critiques student performance, and provides interactive performance feedback. The instructional module coordinates information presented by the instructional media, the task model, and the student model so that each student receives individualized instruction. Concept and metaconcept knowledge that supports these elements is contained in frames and production rules, respectively. The results of an experimental evaluation are discussed. They support the hypothesis that training with an adaptive online system built using the Ahab architecture produces better performance than training using simulator practice alone, at least with unfamiliar problems. It is not sufficient to develop an expert strategy and present it to students using offline materials. The training is most effective if it adapts to individual student needs.

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.

A sensitivity analysis of regional and small watershed hydrologic models

NASA Technical Reports Server (NTRS)

Ambaruch, R.; Salomonson, V. V.; Simmons, J. W.

1975-01-01

Continuous simulation models of the hydrologic behavior of watersheds are important tools in several practical applications such as hydroelectric power planning, navigation, and flood control. Several recent studies have addressed the feasibility of using remote earth observations as sources of input data for hydrologic models. The objective of the study reported here was to determine how accurately remotely sensed measurements must be to provide inputs to hydrologic models of watersheds, within the tolerances needed for acceptably accurate synthesis of streamflow by the models. The study objective was achieved by performing a series of sensitivity analyses using continuous simulation models of three watersheds. The sensitivity analysis showed quantitatively how variations in each of 46 model inputs and parameters affect simulation accuracy with respect to five different performance indices.

Loudspeakers: Modeling and control

NASA Astrophysics Data System (ADS)

Al-Ali, Khalid Mohammad

This thesis documented a comprehensive study of loudspeaker modeling and control. A lumped-parameter model for a voice-coil loudspeaker in a vented enclosure was presented that derived from a consideration of physical principles. In addition, a low-frequency (20 Hz to 100 Hz), feedback control method designed to improve the nonlinear performance of the loudspeaker and a suitable performance measure for use in design and evaluation were proposed. Data from experiments performed on a variety of actual loudspeakers confirmed the practicality of the theory developed in this work. The lumped-parameter loudspeaker model, although simple, captured much of the nonlinear behavior of the loudspeaker. In addition, the model formulation allowed a straightforward application of modern control system methods and lent itself well to modern parametric identification techniques. The nonlinear performance of the loudspeaker system was evaluated using a suitable distortion measure that was proposed and compared with other distortion measures currently used in practice. Furthermore, the linearizing effect of feedback using a linear controller (both static and dynamic) was studied on a class of nonlinear systems. The results illustrated that the distortion reduction was potentially significant and a useful upper bound on the closed-loop distortion was found based on the sensitivity function of the system's linearization. A feedback scheme based on robust control theory was chosen for application to the loudspeaker system. Using the pressure output of the loudspeaker system for feedback, the technique offered significant advantages over those previously attempted. Illustrative examples were presented that proved the applicability of the theory developed in this dissertation to a variety of loudspeaker systems. The examples included a vented loudspeaker model and actual loudspeakers enclosed in both vented and sealed configurations. In each example, predictable and measurable distortion reduction at the output of the closed-loop system was recorded.

Real-time simulation of a Doubly-Fed Induction Generator based wind power system on eMEGASimRTM Real-Time Digital Simulator

NASA Astrophysics Data System (ADS)

Boakye-Boateng, Nasir Abdulai

The growing demand for wind power integration into the generation mix prompts the need to subject these systems to stringent performance requirements. This study sought to identify the required tools and procedures needed to perform real-time simulation studies of Doubly-Fed Induction Generator (DFIG) based wind generation systems as basis for performing more practical tests of reliability and performance for both grid-connected and islanded wind generation systems. The author focused on developing a platform for wind generation studies and in addition, the author tested the performance of two DFIG models on the platform real-time simulation model; an average SimpowerSystemsRTM DFIG wind turbine, and a detailed DFIG based wind turbine using ARTEMiSRTM components. The platform model implemented here consists of a high voltage transmission system with four integrated wind farm models consisting in total of 65 DFIG based wind turbines and it was developed and tested on OPAL-RT's eMEGASimRTM Real-Time Digital Simulator.

JPL Thermal Design Modeling Philosophy and NASA-STD-7009 Standard for Models and Simulations - A Case Study

NASA Technical Reports Server (NTRS)

Avila, Arturo

2011-01-01

The Standard JPL thermal engineering practice prescribes worst-case methodologies for design. In this process, environmental and key uncertain thermal parameters (e.g., thermal blanket performance, interface conductance, optical properties) are stacked in a worst case fashion to yield the most hot- or cold-biased temperature. Thus, these simulations would represent the upper and lower bounds. This, effectively, represents JPL thermal design margin philosophy. Uncertainty in the margins and the absolute temperatures is usually estimated by sensitivity analyses and/or by comparing the worst-case results with "expected" results. Applicability of the analytical model for specific design purposes along with any temperature requirement violations are documented in peer and project design review material. In 2008, NASA released NASA-STD-7009, Standard for Models and Simulations. The scope of this standard covers the development and maintenance of models, the operation of simulations, the analysis of the results, training, recommended practices, the assessment of the Modeling and Simulation (M&S) credibility, and the reporting of the M&S results. The Mars Exploration Rover (MER) project thermal control system M&S activity was chosen as a case study determining whether JPL practice is in line with the standard and to identify areas of non-compliance. This paper summarizes the results and makes recommendations regarding the application of this standard to JPL thermal M&S practices.

Performance Evaluation of Analog Beamforming with Hardware Impairments for mmW Massive MIMO Communication in an Urban Scenario.

PubMed

Gimenez, Sonia; Roger, Sandra; Baracca, Paolo; Martín-Sacristán, David; Monserrat, Jose F; Braun, Volker; Halbauer, Hardy

2016-09-22

The use of massive multiple-input multiple-output (MIMO) techniques for communication at millimeter-Wave (mmW) frequency bands has become a key enabler to meet the data rate demands of the upcoming fifth generation (5G) cellular systems. In particular, analog and hybrid beamforming solutions are receiving increasing attention as less expensive and more power efficient alternatives to fully digital precoding schemes. Despite their proven good performance in simple setups, their suitability for realistic cellular systems with many interfering base stations and users is still unclear. Furthermore, the performance of massive MIMO beamforming and precoding methods are in practice also affected by practical limitations and hardware constraints. In this sense, this paper assesses the performance of digital precoding and analog beamforming in an urban cellular system with an accurate mmW channel model under both ideal and realistic assumptions. The results show that analog beamforming can reach the performance of fully digital maximum ratio transmission under line of sight conditions and with a sufficient number of parallel radio-frequency (RF) chains, especially when the practical limitations of outdated channel information and per antenna power constraints are considered. This work also shows the impact of the phase shifter errors and combiner losses introduced by real phase shifter and combiner implementations over analog beamforming, where the former ones have minor impact on the performance, while the latter ones determine the optimum number of RF chains to be used in practice.

Scholarship of Practice in the Care of People with Dementia: Creating the Future Through Collaborative Efforts.

PubMed

Forsyth, Kirsty; Melton, Jane; Raber, Christine; Burke, Janice P; Piersol, Catherine Verrier

2015-01-01

A scholarship of practice approach sets the stage for collaborative partnerships across academic and clinical practice settings that result in positive gains for all stakeholders. These gains include an enhanced ability to generate and apply relevant evidence in practice, disseminate knowledge and innovation, and ensure best practice is relevant to and effective for, people receiving services and their caregivers. This paper discusses national and international examples of collaborative, research-based practice initiatives that have implemented a scholarship of practice approach. The exemplars described here are framed within the Model of Human Occupation, which addresses the importance of volition, habits, roles, environment, and performance capacities in facilitating engagement in occupation for people with dementia. Research that focuses on how therapists adopt and use evidence in practice, as well as the opportunities and challenges for supporting therapists and their use of theory and evidence are discussed.

Modeling Perceptual Decision Processes

DTIC Science & Technology

2014-09-17

Ratcliff, & Wagenmakers, in press). Previous research suggests that playing action video games improves performance on sensory, perceptual, and...estimate the contribution of several underlying psychological processes. Their analysis indicated that playing action video games leads to faster...third condition in which no video games were played at all. Behavioral data and diffusion model parameters showed similar practice effects for the

From Theory to Air Force Practice: Applications and Non-Binary Extensions of Probabilistic Model-Building Genetic Algorithms

DTIC Science & Technology

2006-05-31

dynamics (MD) and kinetic Monte Carlo ( KMC ) procedures. In 2D surface modeling our calculations project speedups of 9 orders of magnitude at 300 degrees...programming is used to perform customized statistical mechanics by bridging the different time scales of MD and KMC quickly and well. Speedups in

Rethinking High School Principal Compensation Practices: An Analysis of Salaries in South Carolina and Theoretical Models

ERIC Educational Resources Information Center

Newman, Tim A.

2012-01-01

This study described the current state of principal salaries in South Carolina and compared the salaries of similar size schools by specific report card performance and demographic variables. Based on the findings, theoretical models were proposed, and comparisons were made with current salary data. School boards, human resource personnel and…

Creating single-copy genetic circuits

PubMed Central

Lee, Jeong Wook; Gyorgy, Andras; Cameron, D. Ewen; Pyenson, Nora; Choi, Kyeong Rok; Way, Jeffrey C.; Silver, Pamela A.; Del Vecchio, Domitilla; Collins, James J.

2017-01-01

SUMMARY Synthetic biology is increasingly used to develop sophisticated living devices for basic and applied research. Many of these genetic devices are engineered using multi-copy plasmids, but as the field progresses from proof-of-principle demonstrations to practical applications, it is important to develop single-copy synthetic modules that minimize consumption of cellular resources and can be stably maintained as genomic integrants. Here we use empirical design, mathematical modeling and iterative construction and testing to build single-copy, bistable toggle switches with improved performance and reduced metabolic load that can be stably integrated into the host genome. Deterministic and stochastic models led us to focus on basal transcription to optimize circuit performance and helped to explain the resulting circuit robustness across a large range of component expression levels. The design parameters developed here provide important guidance for future efforts to convert functional multi-copy gene circuits into optimized single-copy circuits for practical, real-world use. PMID:27425413

Preparing nursing students for the future: Development and implementation of an Australian Bachelor of Nursing programme with a community health focus.

PubMed

Cooper, Simon; Cant, Robyn; Browning, Mark; Robinson, Eddie

2014-01-01

This paper focuses on changes in the educational preparation of undergraduate nurses in line with contemporary primary and preventative healthcare models. We evaluated a new Australian nursing and community care degree programme using focus groups with 38 students in their first years of study, and quantitative performance data (regarding entry, performance and course attrition). Four main themes were identified related to students' course experience: 'I think community health should be an elective'; 'Focus on relevance to practice'; 'Teaching by non-nursing academics' and 'Access to support during transition to university.' Overall pass rates were 94% (first year) and 97% (second year) with a low 11% attrition rate. We conclude that based on prior experiences and stereotypical views, students may be ambivalent about the inclusion of primary and preventative care models which nevertheless are essential to enhance practice and to prepare the future nursing workforce.

Projecting technology change to improve space technology planning and systems management

NASA Astrophysics Data System (ADS)

Walk, Steven Robert

2011-04-01

Projecting technology performance evolution has been improving over the years. Reliable quantitative forecasting methods have been developed that project the growth, diffusion, and performance of technology in time, including projecting technology substitutions, saturation levels, and performance improvements. These forecasts can be applied at the early stages of space technology planning to better predict available future technology performance, assure the successful selection of technology, and improve technology systems management strategy. Often what is published as a technology forecast is simply scenario planning, usually made by extrapolating current trends into the future, with perhaps some subjective insight added. Typically, the accuracy of such predictions falls rapidly with distance in time. Quantitative technology forecasting (QTF), on the other hand, includes the study of historic data to identify one of or a combination of several recognized universal technology diffusion or substitution patterns. In the same manner that quantitative models of physical phenomena provide excellent predictions of system behavior, so do QTF models provide reliable technological performance trajectories. In practice, a quantitative technology forecast is completed to ascertain with confidence when the projected performance of a technology or system of technologies will occur. Such projections provide reliable time-referenced information when considering cost and performance trade-offs in maintaining, replacing, or migrating a technology, component, or system. This paper introduces various quantitative technology forecasting techniques and illustrates their practical application in space technology and technology systems management.

Health beliefs related to breast self-examination in a sample of Turkish women.

PubMed

Nahcivan, Nursen O; Secginli, Selda

2007-03-01

To examine health beliefs and sociodemographic and breast cancer-related variables influencing breast self-examination (BSE) practice. Descriptive, cross-sectional. Two vocational training centers in Istanbul, Turkey. 438 women were selected using a convenience sampling method. Participants had not had breast cancer and were not currently pregnant or breast-feeding. The mean age of participants was 33.51 years (range = 18-67). Willing participants were asked to complete a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scale. The sample was categorized into two groups: performers (i.e., women who performed BSE at least occasionally) and non-performers (i.e., women who had never performed BSE). Perceived susceptibility to and seriousness of breast cancer, perceived benefits of and barriers to BSE, confidence in the ability to perform BSE, health motivation, and frequency of BSE practice. Significant differences between performers and non-performers correlated to age, marital status, health insurance, regular gynecologic visits, and education about breast cancer and BSE. The mean scores of perceived benefits and confidence were noticeably higher in performers. Stepwise logistic regression analysis yielded three significant predictor variables. Women who had more confidence in their ability to perform BSE, had health insurance, and were informed about breast cancer were more likely to practice BSE. Women in Turkey are at great risk for advanced breast cancer and metastatic spread because of their lack of knowledge. Nurses must provide information on breast cancer etiology, risks, prevention, and detection. To promote BSE practice among Turkish women, tailored health education and health promotion programs should be developed based on a specific understanding of women's health beliefs.

User acceptance of mobile commerce: an empirical study in Macau

NASA Astrophysics Data System (ADS)

Lai, Ivan K. W.; Lai, Donny C. F.

2014-06-01

This study aims to examine the positive and negative factors that can significantly explain user acceptance of mobile commerce (m-commerce) in Macau. A technology acceptance model for m-commerce with five factors is constructed. The proposed model is tested using data collected from 219 respondents. Confirmatory factor analysis is performed to examine the reliability and validity of the model, and structural equation modelling is performed to access the relationship between behaviour intention and each factor. The acceptance of m-commerce is influenced by factors including performance expectancy, social influence, facilitating conditions and privacy concern; while effort expectancy is insignificant in this case. The results of the study are useful for m-commerce service providers to adjust their strategies for promoting m-commerce services. This study contributes to the practice by providing a user technology acceptance model for m-commerce that can be used as a foundation for future research.

Wind tunnel model surface gauge for measuring roughness

NASA Technical Reports Server (NTRS)

Vorburger, T. V.; Gilsinn, D. E.; Teague, E. C.; Giauque, C. H. W.; Scire, F. E.; Cao, L. X.

1987-01-01

The optical inspection of surface roughness research has proceeded along two different lines. First, research into a quantitative understanding of light scattering from metal surfaces and into the appropriate models to describe the surfaces themselves. Second, the development of a practical instrument for the measurement of rms roughness of high performance wind tunnel models with smooth finishes. The research is summarized, with emphasis on the second avenue of research.

Preoperative Planning in Orthopaedic Surgery. Current Practice and Evolving Applications.

PubMed

Atesok, Kivanc; Galos, David; Jazrawi, Laith M; Egol, Kenneth A

2015-12-01

Preoperative planning is an essential prerequisite for the success of orthopaedic procedures. Traditionally, the exercise has involved the written down, step by step "blueprint" of the surgical procedure. Preoperative planning of the technical aspects of the orthopaedic procedure has been performed on hardcopy radiographs using various methods such as copying the radiographic image on tracing papers to practice the planned interventions. This method has become less practical due to variability in radiographic magnification and increasing implementation of digital imaging systems. Advances in technology along with recognition of the importance of surgical safety protocols resulted in widespread changes in orthopaedic preoperative planning approaches. Nowadays, perioperative "briefings" have gained particular importance and novel planning methods have started to integrate into orthopaedic practice. These methods include using software that enables surgeons to perform preoperative planning on digital radiographs and to construct 3D digital models or prototypes of various orthopaedic pathologies from a patient's CT scans to practice preoperatively. Evidence-to-date suggests that preoperative planning and briefings are effective means of favorably influencing the outcomes of orthopaedic procedures.

Laparoscopic Common Bile Duct Exploration Four-Task Training Model: Construct Validity

PubMed Central

Otaño, Natalia; Rodríguez, Omaira; Sánchez, Renata; Benítez, Gustavo; Schweitzer, Michael

2012-01-01

Background: Training models in laparoscopic surgery allow the surgical team to practice procedures in a safe environment. We have proposed the use of a 4-task, low-cost inert model to practice critical steps of laparoscopic common bile duct exploration. Methods: The performance of 3 groups with different levels of expertise in laparoscopic surgery, novices (A), intermediates (B), and experts (C), was evaluated using a low-cost inert model in the following tasks: (1) intraoperative cholangiography catheter insertion, (2) transcystic exploration, (3) T-tube placement, and (4) choledochoscope management. Kruskal-Wallis and Mann-Whitney tests were used to identify differences among the groups. Results: A total of 14 individuals were evaluated: 5 novices (A), 5 intermediates (B), and 4 experts (C). The results involving intraoperative cholangiography catheter insertion were similar among the 3 groups. As for the other tasks, the expert had better results than the other 2, in which no significant differences occurred. The proposed model is able to discriminate among individuals with different levels of expertise, indicating that the abilities that the model evaluates are relevant in the surgeon's performance in CBD exploration. Conclusions: Construct validity for tasks 2 and 3 was demonstrated. However, task 1 was no capable of distinguishing between groups, and task 4 was not statistically validated. PMID:22906323

Enhancing a rainfall-runoff model to assess the impacts of BMPs and LID practices on storm runoff.

PubMed

Liu, Yaoze; Ahiablame, Laurent M; Bralts, Vincent F; Engel, Bernard A

2015-01-01

Best management practices (BMPs) and low impact development (LID) practices are increasingly being used as stormwater management techniques to reduce the impacts of urban development on hydrology and water quality. To assist planners and decision-makers at various stages of development projects (planning, implementation, and evaluation), user-friendly tools are needed to assess the effectiveness of BMPs and LID practices. This study describes a simple tool, the Long-Term Hydrologic Impact Assessment-LID (L-THIA-LID), which is enhanced with additional BMPs and LID practices, improved approaches to estimate hydrology and water quality, and representation of practices in series (meaning combined implementation). The tool was used to evaluate the performance of BMPs and LID practices individually and in series with 30 years of daily rainfall data in four types of idealized land use units and watersheds (low density residential, high density residential, industrial, and commercial). Simulation results were compared with the results of other published studies. The simulated results showed that reductions in runoff volume and pollutant loads after implementing BMPs and LID practices, both individually and in series, were comparable with the observed impacts of these practices. The L-THIA-LID 2.0 model is capable of assisting decision makers in evaluating environmental impacts of BMPs and LID practices, thereby improving the effectiveness of stormwater management decisions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessing the effectiveness of a clinical instructor online training module as measured by student perception and sustained best practices.

PubMed

Engelhard, Chalee; Seo, Kay Kyeong-Ju

2015-01-01

Due to current scrutiny of physical therapy (PT) clinical education, clinical education models require revisions with close examination of current practice, including best practices in clinical instructor (CI) education. Unfortunately, depth of research currently available to support these revisions is minimal, particularly in areas of research that investigate maintaining recently taught skills in CI training and students' perceived CI effectiveness following training. This study's purpose was to explore these areas. CIs (n=21) were assigned to either a control or treatment group. Treatment group-CIs completed an online module prior to supervising a Doctor of Physical Therapy (DPT) student during a 9-week clinical rotation and then participated in data collection activities following the rotation. Data from control group-CIs established a baseline. Data from students' assessments of their CIs' performances yielded qualitative themes demonstrating differentiated learning environments and module-taught best practices for treatment group-students. Quantitative findings did not make a distinction between the two student groups. Lastly, treatment group-CIs maintained best practices after an inactive period. This study suggests CIs were able to maintain best practices using just-in-time education, distributed clinical practice, and reflection. By continuing examination of online CI education, PT clinical education can move toward new models through evidence-based CI best practices.

Real-time robustness evaluation of regression based myoelectric control against arm position change and donning/doffing.

PubMed

Hwang, Han-Jeong; Hahne, Janne Mathias; Müller, Klaus-Robert

2017-01-01

There are some practical factors, such as arm position change and donning/doffing, which prevent robust myoelectric control. The objective of this study is to precisely characterize the impacts of the two representative factors on myoelectric controllability in practical control situations, thereby providing useful references that can be potentially used to find better solutions for clinically reliable myoelectric control. To this end, a real-time target acquisition task was performed by fourteen subjects including one individual with congenital upper-limb deficiency, where the impacts of arm position change, donning/doffing and a combination of both factors on control performance was systematically evaluated. The changes in online performance were examined with seven different performance metrics to comprehensively evaluate various aspects of myoelectric controllability. As a result, arm position change significantly affects offline prediction accuracy, but not online control performance due to real-time feedback, thereby showing no significant correlation between offline and online performance. Donning/doffing was still problematic in online control conditions. It was further observed that no benefit was attained when using a control model trained with multiple position data in terms of arm position change, and the degree of electrode shift caused by donning/doffing was not severely associated with the degree of performance loss under practical conditions (around 1 cm electrode shift). Since this study is the first to concurrently investigate the impacts of arm position change and donning/doffing in practical myoelectric control situations, all findings of this study provide new insights into robust myoelectric control with respect to arm position change and donning/doffing.

Real-time robustness evaluation of regression based myoelectric control against arm position change and donning/doffing

PubMed Central

Hahne, Janne Mathias; Müller, Klaus-Robert

2017-01-01

There are some practical factors, such as arm position change and donning/doffing, which prevent robust myoelectric control. The objective of this study is to precisely characterize the impacts of the two representative factors on myoelectric controllability in practical control situations, thereby providing useful references that can be potentially used to find better solutions for clinically reliable myoelectric control. To this end, a real-time target acquisition task was performed by fourteen subjects including one individual with congenital upper-limb deficiency, where the impacts of arm position change, donning/doffing and a combination of both factors on control performance was systematically evaluated. The changes in online performance were examined with seven different performance metrics to comprehensively evaluate various aspects of myoelectric controllability. As a result, arm position change significantly affects offline prediction accuracy, but not online control performance due to real-time feedback, thereby showing no significant correlation between offline and online performance. Donning/doffing was still problematic in online control conditions. It was further observed that no benefit was attained when using a control model trained with multiple position data in terms of arm position change, and the degree of electrode shift caused by donning/doffing was not severely associated with the degree of performance loss under practical conditions (around 1 cm electrode shift). Since this study is the first to concurrently investigate the impacts of arm position change and donning/doffing in practical myoelectric control situations, all findings of this study provide new insights into robust myoelectric control with respect to arm position change and donning/doffing. PMID:29095846

Prospective safety performance evaluation on construction sites.

PubMed

Wu, Xianguo; Liu, Qian; Zhang, Limao; Skibniewski, Miroslaw J; Wang, Yanhong

2015-05-01

This paper presents a systematic Structural Equation Modeling (SEM) based approach for Prospective Safety Performance Evaluation (PSPE) on construction sites, with causal relationships and interactions between enablers and the goals of PSPE taken into account. According to a sample of 450 valid questionnaire surveys from 30 Chinese construction enterprises, a SEM model with 26 items included for PSPE in the context of Chinese construction industry is established and then verified through the goodness-of-fit test. Three typical types of construction enterprises, namely the state-owned enterprise, private enterprise and Sino-foreign joint venture, are selected as samples to measure the level of safety performance given the enterprise scale, ownership and business strategy are different. Results provide a full understanding of safety performance practice in the construction industry, and indicate that the level of overall safety performance situation on working sites is rated at least a level of III (Fair) or above. This phenomenon can be explained that the construction industry has gradually matured with the norms, and construction enterprises should improve the level of safety performance as not to be eliminated from the government-led construction industry. The differences existing in the safety performance practice regarding different construction enterprise categories are compared and analyzed according to evaluation results. This research provides insights into cause-effect relationships among safety performance factors and goals, which, in turn, can facilitate the improvement of high safety performance in the construction industry. Copyright © 2015 Elsevier Ltd. All rights reserved.

A statistical model of operational impacts on the framework of the bridge crane

NASA Astrophysics Data System (ADS)

Antsev, V. Yu; Tolokonnikov, A. S.; Gorynin, A. D.; Reutov, A. A.

2017-02-01

The technical regulations of the Customs Union demands implementation of the risk analysis of the bridge cranes operation at their design stage. The statistical model has been developed for performance of random calculations of risks, allowing us to model possible operational influences on the bridge crane metal structure in their various combination. The statistical model is practically actualized in the software product automated calculation of risks of failure occurrence of bridge cranes.

Linear model correction: A method for transferring a near-infrared multivariate calibration model without standard samples.

PubMed

Liu, Yan; Cai, Wensheng; Shao, Xueguang

2016-12-05

Calibration transfer is essential for practical applications of near infrared (NIR) spectroscopy because the measurements of the spectra may be performed on different instruments and the difference between the instruments must be corrected. For most of calibration transfer methods, standard samples are necessary to construct the transfer model using the spectra of the samples measured on two instruments, named as master and slave instrument, respectively. In this work, a method named as linear model correction (LMC) is proposed for calibration transfer without standard samples. The method is based on the fact that, for the samples with similar physical and chemical properties, the spectra measured on different instruments are linearly correlated. The fact makes the coefficients of the linear models constructed by the spectra measured on different instruments are similar in profile. Therefore, by using the constrained optimization method, the coefficients of the master model can be transferred into that of the slave model with a few spectra measured on slave instrument. Two NIR datasets of corn and plant leaf samples measured with different instruments are used to test the performance of the method. The results show that, for both the datasets, the spectra can be correctly predicted using the transferred partial least squares (PLS) models. Because standard samples are not necessary in the method, it may be more useful in practical uses. Copyright © 2016 Elsevier B.V. All rights reserved.

The relationship between physician participation in continuing professional development programs and physician in-practice peer assessments.

PubMed

Wenghofer, Elizabeth F; Marlow, Bernard; Campbell, Craig; Carter, Lorraine; Kam, Sophia; McCauley, William; Hill, Lori

2014-06-01

To investigate the relationship between physicians' performance, as evaluated through in-practice peer assessments, and their participation in continuing professional development (CPD). The authors examined the predictive effects of participating in the CPD programs of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada one year before in-practice peer assessments conducted by the medical regulatory authority in Ontario, Canada, in 2008-2009. Two multivariate logistic regression models were used to determine whether physicians who reported participating in any CPD and group-based, assessment-based, and/or self-directed CPD activities were more or less likely to receive satisfactory assessments than physicians who had not. All models were adjusted for the effects of sex, age, specialty certification, practice location, number of patient visits per week, hours worked per week, and international medical graduate status. A total of 617 physicians were included in the study. Analysis revealed that physicians who reported participating in any CPD activities were significantly more likely (odds ratio [OR] = 2.5; P = .021) to have satisfactory assessments than those who had not. In addition, physicians participating in group-based CPD activities were more likely to have satisfactory assessments than those who did not (OR = 2.4; P = .016). There is encouraging evidence supporting a positive predictive association between participating in CPD and performance on in-practice peer assessments. The findings have potential implications for policies which require physicians to participate in programs of lifelong learning.

Performance improvement CME for quality: challenges inherent to the process.

PubMed

Vakani, Farhan Saeed; O'Beirne, Ronan

2015-01-01

The purpose of this paper is to discuss the perspective debates upon the real-time challenges for a three-staged Performance Improvement Continuing Medical Education (PI-CME) model, an innovative and potential approach for future CME, to inform providers to think, prepare and to act proactively. In this discussion, the challenges associated for adopting the American Medical Association's three-staged PI-CME model are reported. Not many institutions in USA are using a three-staged performance improvement model and then customizing it to their own healthcare context for the specific targeted audience. They integrate traditional CME methods with performance and quality initiatives, and linking with CME credits. Overall the US health system is interested in a structured PI-CME model with the potential to improve physicians practicing behaviors. Knowing the dearth of evidence for applying this structured performance improvement methodology into the design of CME activities, and the lack of clarity on challenges inherent to the process that learners and providers encounter. This paper establishes all-important first step to render the set of challenges for a three-staged PI-CME model.

The Hybrid Management Model: Influences of Organizational Structure and IT Project Management Practices on the Performance of Federal IT Projects

ERIC Educational Resources Information Center

Neves, Celine A.

2012-01-01

The federal government spends much money on information technology (IT) projects each year, yet numerous IT projects continue to underperform. For instance, in Fiscal Year 2008, OMB and federal agencies identified approximately 413 IT projects ($25.2 billion) as being poorly planned, poorly performing, or both. Agencies struggle to implement sound…

Teachers as Strategic Classroom Leaders: The Relationship of Their Cognitive and Behavioral Agility to Student Outcomes and Performance Evaluations

ERIC Educational Resources Information Center

Warkentien, Michael

2016-01-01

The purpose of this non-experimental study was to determine whether teacher cognitive and behavioral agility relates to student achievement as measured by their value-added model (VAM) score and their performance evaluation measured through the Marzano instructional practice (IP) framework, and whether that relationship is moderated by contextual…

Requisite Competencies Reported by New York State School Business Officials: Models of Shared Viewpoint

ERIC Educational Resources Information Center

Loper, Wayne Robert

2012-01-01

This study examined the essential skill sets needed to effectively perform as a school business official in New York State. This study surveyed 132 practicing school business officials across New York State and created a needs-based assessment of the competencies required to successfully perform as a New York State school business official. In…

The Big 5: The Evolution of the Performance Systems Model

ERIC Educational Resources Information Center

Tosti, Donald T.

2005-01-01

Human Performance Technology (HPT) consists of a few principles and a host of applications. The power of HPT comes from the fact that it is fundamental to an understanding of all forms of purposeful activity, ranging from the actions of an individual to the actions of an international organization. As a practical discipline, HPT began some 40…

Performing at the Top of One's Musical Game

PubMed Central

Hatfield, Johannes L.

2016-01-01

The purpose of the present mixed method study was to investigate personal benefits, perceptions, and the effect of a 15-week sport psychological skills training program adapted for musicians. The program was individually tailored for six music performance students with the objective of facilitating the participants' instrumental practice and performance. The participants learnt techniques such as goal setting, attentional focus, arousal regulation, imagery, and acceptance training/self-talk. Zimmerman's (1989) cyclical model of self-regulated learning was applied as a theoretical frame for the intervention. The present study's mixed-method approach (i.e., quan+ QUAL) included effect size, semi-structured interviews, a research log, and practice diaries of the participants (Creswell, 2009). Thematic analysis revealed that participants had little or no experience concerning planning and goal setting in regard to instrumental practice. Concentration, volition, and physical pain were additional issues that the participants struggled with at the time of pre-intervention. The study found that psychological skills training (with special emphasis on planning and goal setting) facilitated cyclical self-regulated learning patterns in the participants. In essence, the intervention was found to facilitate the participants' concentration, self-observation, self-efficacy, and coping in the face of failure. The appliance of practice journals facilitated the participants‘ self-observation, self-evaluation, and awareness of instrumental practice. Finally, the psychological skills intervention reduced participants' worry and anxiety in performance situations. An 8-month follow up interview revealed that the participants were still actively applying psychological skills. PMID:27679586

Microvascular anastomosis simulation using a chicken thigh model: Interval versus massed training.

PubMed

Schoeff, Stephen; Hernandez, Brian; Robinson, Derek J; Jameson, Mark J; Shonka, David C

2017-11-01

To compare the effectiveness of massed versus interval training when teaching otolaryngology residents microvascular suturing on a validated microsurgical model. Otolaryngology residents were placed into interval (n = 7) or massed (n = 7) training groups. The interval group performed three separate 30-minute practice sessions separated by at least 1 week, and the massed group performed a single 90-minute practice session. Both groups viewed a video demonstration and recorded a pretest prior to the first training session. A post-test was administered following the last practice session. At an academic medical center, 14 otolaryngology residents were assigned using stratified randomization to interval or massed training. Blinded evaluators graded performance using a validated microvascular Objective Structured Assessment of Technical Skill tool. The tool is comprised of two major components: task-specific score (TSS) and global rating scale (GRS). Participants also received pre- and poststudy surveys to compare subjective confidence in multiple aspects of microvascular skill acquisition. Overall, all residents showed increased TSS and GRS on post- versus pretest. After completion of training, the interval group had a statistically significant increase in both TSS and GRS, whereas the massed group's increase was not significant. Residents in both groups reported significantly increased levels of confidence after completion of the study. Self-directed learning using a chicken thigh artery model may benefit microsurgical skills, competence, and confidence for resident surgeons. Interval training results in significant improvement in early development of microvascular anastomosis skills, whereas massed training does not. NA. Laryngoscope, 127:2490-2494, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Studies in Software Cost Model Behavior: Do We Really Understand Cost Model Performance?

NASA Technical Reports Server (NTRS)

Lum, Karen; Hihn, Jairus; Menzies, Tim

2006-01-01

While there exists extensive literature on software cost estimation techniques, industry practice continues to rely upon standard regression-based algorithms. These software effort models are typically calibrated or tuned to local conditions using local data. This paper cautions that current approaches to model calibration often produce sub-optimal models because of the large variance problem inherent in cost data and by including far more effort multipliers than the data supports. Building optimal models requires that a wider range of models be considered while correctly calibrating these models requires rejection rules that prune variables and records and use multiple criteria for evaluating model performance. The main contribution of this paper is to document a standard method that integrates formal model identification, estimation, and validation. It also documents what we call the large variance problem that is a leading cause of cost model brittleness or instability.

A Consensus Model: Shifting assessment practices in dietetics tertiary education.

PubMed

Bacon, Rachel; Kellett, Jane; Dart, Janeane; Knight-Agarwal, Cathy; Mete, Rebecca; Ash, Susan; Palermo, Claire

2018-02-21

The aim of this research was to evaluate a Consensus Model for competency-based assessment. An evaluative case study was used to allow a holistic examination of a constructivist-interpretivist programmatic model of assessment. Using a modified Delphi process, the competence of all 29 students enrolled in their final year of a Master of Nutrition and Dietetics course was assessed by a panel (with expertise in competency-based assessment; industry and academic representation) from a course e-portfolio (that included the judgements of student performance made by worksite educators) and a panel interview. Data were triangulated with assessments from a capstone internship. Qualitative descriptive studies with worksite educators (focus groups n = 4, n = 5, n = 8) and students (personal interviews n = 29) explored stakeholder experiences analysed using thematic analysis. Panel consensus was achieved for all cases by the third-round and corroborated by internship outcomes. For 34% of students this differed to the 'interpretations' of their performance made by their worksite educator/s. Emerging qualitative themes from stakeholder data found the model: (i) supported sustainable assessment practices; (ii) shifted the power relationship between students and worksite educators and (iii) provided a fair method to assess competence. To maximise benefits, more refinement, resources and training are required. This research questions competency-based assessment practices based on discrete placement units and supports a constructivist-interpretivist programmatic approach where evidence across a whole course of study is considered by a panel of assessors. © 2018 Dietitians Association of Australia.

Estimation and prediction under local volatility jump-diffusion model

NASA Astrophysics Data System (ADS)

Kim, Namhyoung; Lee, Younhee

2018-02-01

Volatility is an important factor in operating a company and managing risk. In the portfolio optimization and risk hedging using the option, the value of the option is evaluated using the volatility model. Various attempts have been made to predict option value. Recent studies have shown that stochastic volatility models and jump-diffusion models reflect stock price movements accurately. However, these models have practical limitations. Combining them with the local volatility model, which is widely used among practitioners, may lead to better performance. In this study, we propose a more effective and efficient method of estimating option prices by combining the local volatility model with the jump-diffusion model and apply it using both artificial and actual market data to evaluate its performance. The calibration process for estimating the jump parameters and local volatility surfaces is divided into three stages. We apply the local volatility model, stochastic volatility model, and local volatility jump-diffusion model estimated by the proposed method to KOSPI 200 index option pricing. The proposed method displays good estimation and prediction performance.

Bus operator safety : critical issues examination and model practices.

DOT National Transportation Integrated Search

2014-01-01

In this study, researchers at the National Center for Transit Research performed a multi-topic comprehensive : examination of bus operator-related critical safety and personal security issues. The goals of this research : effort were to: : 1. Identif...

Cognitive load in distributed and massed practice in virtual reality mastoidectomy simulation.

PubMed

Andersen, Steven Arild Wuyts; Mikkelsen, Peter Trier; Konge, Lars; Cayé-Thomasen, Per; Sørensen, Mads Sølvsten

2016-02-01

Cognitive load theory states that working memory is limited. This has implications for learning and suggests that reducing cognitive load (CL) could promote learning and skills acquisition. This study aims to explore the effect of repeated practice and simulator-integrated tutoring on CL in virtual reality (VR) mastoidectomy simulation. Prospective trial. Forty novice medical students performed 12 repeated virtual mastoidectomy procedures in the Visible Ear Simulator: 21 completed distributed practice with practice blocks spaced in time and 19 participants completed massed practice (all practices performed in 1 day). Participants were randomized for tutoring with the simulator-integrated tutor function. Cognitive load was estimated by measuring reaction time in a secondary task. Data were analyzed using linear mixed models for repeated measurements. The mean reaction time increased by 37% during the procedure compared with baseline, demonstrating that the procedure placed substantial cognitive demands. Repeated practice significantly lowered CL in the distributed practice group but not in massed practice group. In addition, CL was found to be further increased by 10.3% in the later and more complex stages of the procedure. The simulator-integrated tutor function did not have an impact on CL. Distributed practice decreased CL in repeated VR mastoidectomy training more consistently than was seen in massed practice. This suggests a possible effect of skills and memory consolidation occurring over time. To optimize technical skills learning, training should be organized as time-distributed practice rather than as a massed block of practice, which is common in skills-training courses. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Closing the research to practice gap in children's mental health: structures, solutions, and strategies.

PubMed

Jensen, Peter S; Foster, Michael

2010-03-01

Failure to apply research on effective interventions spans all areas of medicine, including children's mental health services. This article examines the policy, structural, and economic problems in which this gap originates. We identify four steps to close this gap. First, the field should develop scientific measures of the research-practice gap. Second, payors should link incentives to outcomes-based performance measures. Third, providers and others should develop improved understanding and application of effective dissemination and business models. Fourth, efforts to link EBP to clinical practice should span patient/consumers, providers, practices, plans, and purchasers. The paper discusses each of these in turn and relates them to fundamental problems of service delivery.

Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

PubMed

Vogel, Wendy H

2016-01-01

Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring.

Performance Evaluation and Improvement of Ferroelectric Field-Effect Transistor Memory

NASA Astrophysics Data System (ADS)

Yu, Hyung Suk

Flash memory is reaching scaling limitations rapidly due to reduction of charge in floating gates, charge leakage and capacitive coupling between cells which cause threshold voltage fluctuations, short retention times, and interference. Many new memory technologies are being considered as alternatives to flash memory in an effort to overcome these limitations. Ferroelectric Field-Effect Transistor (FeFET) is one of the main emerging candidates because of its structural similarity to conventional FETs and fast switching speed. Nevertheless, the performance of FeFETs have not been systematically compared and analyzed against other competing technologies. In this work, we first benchmark the intrinsic performance of FeFETs and other memories by simulations in order to identify the strengths and weaknesses of FeFETs. To simulate realistic memory applications, we compare memories on an array structure. For the comparisons, we construct an accurate delay model and verify it by benchmarking against exact HSPICE simulations. Second, we propose an accurate model for FeFET memory window since the existing model has limitations. The existing model assumes symmetric operation voltages but it is not valid for the practical asymmetric operation voltages. In this modeling, we consider practical operation voltages and device dimensions. Also, we investigate realistic changes of memory window over time and retention time of FeFETs. Last, to improve memory window and subthreshold swing, we suggest nonplanar junctionless structures for FeFETs. Using the suggested structures, we study the dimensional dependences of crucial parameters like memory window and subthreshold swing and also analyze key interference mechanisms.

Conceptual uncertainty in crystalline bedrock: Is simple evaluation the only practical approach?

USGS Publications Warehouse

Geier, J.; Voss, C.I.; Dverstorp, B.

2002-01-01

A simple evaluation can be used to characterize the capacity of crystalline bedrock to act as a barrier to release radionuclides from a nuclear waste repository. Physically plausible bounds on groundwater flow and an effective transport-resistance parameter are estimated based on fundamental principles and idealized models of pore geometry. Application to an intensively characterized site in Sweden shows that, due to high spatial variability and uncertainty regarding properties of transport paths, the uncertainty associated with the geological barrier is too high to allow meaningful discrimination between good and poor performance. Application of more complex (stochastic-continuum and discrete-fracture-network) models does not yield a significant improvement in the resolution of geological barrier performance. Comparison with seven other less intensively characterized crystalline study sites in Sweden leads to similar results, raising a question as to what extent the geological barrier function can be characterized by state-of-the art site investigation methods prior to repository construction. A simple evaluation provides a simple and robust practical approach for inclusion in performance assessment.

Conceptual uncertainty in crystalline bedrock: Is simple evaluation the only practical approach?

USGS Publications Warehouse

Geier, J.; Voss, C.I.; Dverstorp, B.

2002-01-01

A simple evaluation can be used to characterise the capacity of crystalline bedrock to act as a barrier to releases of radionuclides from a nuclear waste repository. Physically plausible bounds on groundwater flow and an effective transport-resistance parameter are estimated based on fundamental principles and idealised models of pore geometry. Application to an intensively characterised site in Sweden shows that, due to high spatial variability and uncertainty regarding properties of transport paths, the uncertainty associated with the geological barrier is too high to allow meaningful discrimination between good and poor performance. Application of more complex (stochastic-continuum and discrete-fracture-network) models does not yield a significant improvement in the resolution of geologic-barrier performance. Comparison with seven other less intensively characterised crystalline study sites in Sweden leads to similar results, raising a question as to what extent the geological barrier function can be characterised by state-of-the art site investigation methods prior to repository construction. A simple evaluation provides a simple and robust practical approach for inclusion in performance assessment.

An introductory pharmacy practice experience based on a medication therapy management service model.

PubMed

Agness, Chanel F; Huynh, Donna; Brandt, Nicole

2011-06-10

To implement and evaluate an introductory pharmacy practice experience (IPPE) based on the medication therapy management (MTM) service model. Patient Care 2 is an IPPE that introduces third-year pharmacy students to the MTM service model. Students interacted with older adults to identify medication-related problems and develop recommendations using core MTM elements. Course outcome evaluations were based on number of documented medication-related problems, recommendations, and student reviews. Fifty-seven older adults participated in the course. Students identified 52 medication-related problems and 66 medical problems, and documented 233 recommendations relating to health maintenance and wellness, pharmacotherapy, referrals, and education. Students reported having adequate experience performing core MTM elements. Patient Care 2 may serve as an experiential learning model for pharmacy schools to teach the core elements of MTM and provide patient care services to the community.

Identification Approach to Alleviate Effects of Unmeasured Heat Gains for MIMO Building Thermal Systems

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

Cai, Jie; Kim, Donghun; Braun, James E.

It is important to have practical methods for constructing a good mathematical model for a building's thermal system for energy audits, retrofit analysis and advanced building controls, e.g. model predictive control. Identification approaches based on semi-physical model structures are popular in building science for those purposes. However conventional gray box identification approaches applied to thermal networks would fail when significant unmeasured heat gains present in estimation data. Although this situation is very common and practical, there has been little research to tackle this issue in building science. This paper presents an overall identification approach to alleviate influences of unmeasured disturbances,more » and hence to obtain improved gray-box building models. The approach was applied to an existing open space building and the performance is demonstrated.« less

A Flexible framework for forward and inverse modeling of stormwater control measures

NASA Astrophysics Data System (ADS)

Aflaki, S.; Massoudieh, A.

2016-12-01

Models that allow for design considerations of green infrastructure (GI) practices to control stormwater runoff and associated contaminants have received considerable attention in recent years. While popular, generally, the GI models are relatively simplistic. However, GI model predictions are being relied upon by many municipalities and State/Local agencies to make decisions about grey vs. green infrastructure improvement planning. Adding complexity to GI modeling frameworks may preclude their use in simpler urban planning situations. Therefore, the goal here was to develop a sophisticated, yet flexible tool that could be used by design engineers and researchers to capture and explore the effect of design factors and properties of the media used in the performance of GI systems at a relatively small scale. We deemed it essential to have a flexible GI modeling tool that is capable of simulating GI system components and specific biophysical processes affecting contaminants such as reactions, and particle-associated transport accurately while maintaining a high degree of flexibly to account for the myriad of GI alternatives. The mathematical framework for a stand-alone GI performance assessment tool has been developed and will be demonstrated. The process-based model framework developed here can be used to model a diverse range of GI practices such as green roof, retention pond, bioretention, infiltration trench, permeable pavement and other custom-designed combinatory systems. Four demonstration applications covering a diverse range of systems will be presented. The example applications include a evaluating hydraulic performance of a complex bioretention system, hydraulic analysis of porous pavement system, flow colloid-facilitated transport, reactive transport and groundwater recharge underneath an infiltration pond and finally reactive transport and bed-sediment interactions in a wetland system will be presented.

Establishment and outcomes of a model primary care pharmacy service system.

PubMed

Carmichael, Jannet M; Alvarez, Autumn; Chaput, Ryan; DiMaggio, Jennifer; Magallon, Heather; Mambourg, Scott

2004-03-01

The establishment and outcomes of a model primary care pharmacy service system are described. A primary care pharmacy practice model was established at a government health care facility in March 1996. The original objective was to establish a primary pharmacy practice model that would demonstrate improved patient outcomes and maximize the pharmacist's contributions to drug therapy. Since its inception, many improvements have been realized and supported by advanced computer and automated systems, expanded disease state management practices, and unique practitioner and administrative support. Many outcomes studies have been performed on the pharmacist-initiated and -managed clinics, leading to improved patient care and conveying the quality-conscious and cost-effective role pharmacists can play as independent practitioners in this environment. These activities demonstrate cutting-edge leadership in health-system pharmacy. Redesign has been used to improve consistent access to a medication expert and has significantly improved the quality of patient care while easing physicians' workload without increasing health care costs. A system using pharmacists as independent practitioners to promote primary care has achieved high-quality and cost-effective patient care.

Using data to improve medical practice by measuring processes and outcomes of care.

PubMed

Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K

2000-12-01

The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not Mandatory)" and "Create the Guiding Coalition. (A Small, Devoted Group of People Can Change the World)." Over the long term, we must transform thousands of local practice cultures so that useful data are used every day in countless ways to assist clinicians, support staff, patients, families, and communities.

Cued recall from image and sentence memory: a shift from episodic to identical elements representation.

PubMed

Rickard, Timothy C; Bajic, Daniel

2006-07-01

The applicability of the identical elements (IE) model of arithmetic fact retrieval (T. C. Rickard, A. F. Healy, & L. E. Bourne, 1994) to cued recall from episodic (image and sentence) memory was explored in 3 transfer experiments. In agreement with results from arithmetic, speedup following even minimal practice recalling a missing word from an episodically bound word triplet did not transfer positively to other cued recall items involving the same triplet. The shape of the learning curve further supported a shift from episode-based to IE-based recall, extending some models of skill learning to cued recall practice. In contrast with previous findings, these results indicate that a form of representation that is independent of the original episodic memory underlies cued-recall performance following minimal practice. Copyright 2006 APA, all rights reserved.

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions

PubMed Central

2017-01-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy. PMID:29209469

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.

PubMed

Nantha, Yogarabindranath Swarna

2017-11-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

Work-family enrichment and job performance: a constructive replication of affective events theory.

PubMed

Carlson, Dawn; Kacmar, K Michele; Zivnuska, Suzanne; Ferguson, Merideth; Whitten, Dwayne

2011-07-01

Based on affective events theory (AET), we hypothesize a four-step model of the mediating mechanisms of positive mood and job satisfaction in the relationship between work-family enrichment and job performance. We test this model for both directions of enrichment (work-to-family and family-to-work). We used two samples to test the model using structural equation modeling. Results from Study 1, which included 240 full-time employees, were replicated in Study 2, which included 189 matched subordinate-supervisor dyads. For the work-to-family direction, results from both samples support our conceptual model and indicate mediation of the enrichment-performance relationship for the work-to-family direction of enrichment. For the family-to-work direction, results from the first sample support our conceptual model but results from the second sample do not. Our findings help elucidate mixed findings in the enrichment and job performance literatures and contribute to an understanding of the mechanisms linking these concepts. We conclude with a discussion of the practical and theoretical implications of our findings.

Applying Risk Prediction Models to Optimize Lung Cancer Screening: Current Knowledge, Challenges, and Future Directions.

PubMed

Sakoda, Lori C; Henderson, Louise M; Caverly, Tanner J; Wernli, Karen J; Katki, Hormuzd A

2017-12-01

Risk prediction models may be useful for facilitating effective and high-quality decision-making at critical steps in the lung cancer screening process. This review provides a current overview of published lung cancer risk prediction models and their applications to lung cancer screening and highlights both challenges and strategies for improving their predictive performance and use in clinical practice. Since the 2011 publication of the National Lung Screening Trial results, numerous prediction models have been proposed to estimate the probability of developing or dying from lung cancer or the probability that a pulmonary nodule is malignant. Respective models appear to exhibit high discriminatory accuracy in identifying individuals at highest risk of lung cancer or differentiating malignant from benign pulmonary nodules. However, validation and critical comparison of the performance of these models in independent populations are limited. Little is also known about the extent to which risk prediction models are being applied in clinical practice and influencing decision-making processes and outcomes related to lung cancer screening. Current evidence is insufficient to determine which lung cancer risk prediction models are most clinically useful and how to best implement their use to optimize screening effectiveness and quality. To address these knowledge gaps, future research should be directed toward validating and enhancing existing risk prediction models for lung cancer and evaluating the application of model-based risk calculators and its corresponding impact on screening processes and outcomes.

Functional Fault Modeling Conventions and Practices for Real-Time Fault Isolation

NASA Technical Reports Server (NTRS)

Ferrell, Bob; Lewis, Mark; Perotti, Jose; Oostdyk, Rebecca; Brown, Barbara

2010-01-01

The purpose of this paper is to present the conventions, best practices, and processes that were established based on the prototype development of a Functional Fault Model (FFM) for a Cryogenic System that would be used for real-time Fault Isolation in a Fault Detection, Isolation, and Recovery (FDIR) system. The FDIR system is envisioned to perform health management functions for both a launch vehicle and the ground systems that support the vehicle during checkout and launch countdown by using a suite of complimentary software tools that alert operators to anomalies and failures in real-time. The FFMs were created offline but would eventually be used by a real-time reasoner to isolate faults in a Cryogenic System. Through their development and review, a set of modeling conventions and best practices were established. The prototype FFM development also provided a pathfinder for future FFM development processes. This paper documents the rationale and considerations for robust FFMs that can easily be transitioned to a real-time operating environment.

Effects of New Funding Models for Patient-Centered Medical Homes on Primary Care Practice Finances and Services: Results of a Microsimulation Model.

PubMed

Basu, Sanjay; Phillips, Russell S; Song, Zirui; Landon, Bruce E; Bitton, Asaf

2016-09-01

We assess the financial implications for primary care practices of participating in patient-centered medical home (PCMH) funding initiatives. We estimated practices' changes in net revenue under 3 PCMH funding initiatives: increased fee-for-service (FFS) payments, traditional FFS with additional per-member-per-month (PMPM) payments, or traditional FFS with PMPM and pay-for-performance (P4P) payments. Net revenue estimates were based on a validated microsimulation model utilizing national practice surveys. Simulated practices reflecting the national range of practice size, location, and patient population were examined under several potential changes in clinical services: investments in patient tracking, communications, and quality improvement; increased support staff; altered visit templates to accommodate longer visits, telephone visits or electronic visits; and extended service delivery hours. Under the status quo of traditional FFS payments, clinics operate near their maximum estimated possible net revenue levels, suggesting they respond strongly to existing financial incentives. Practices gained substantial additional net annual revenue per full-time physician under PMPM or PMPM plus P4P payments ($113,300 per year, 95% CI, $28,500 to $198,200) but not under increased FFS payments (-$53,500, 95% CI, -$69,700 to -$37,200), after accounting for costs of meeting PCMH funding requirements. Expanding services beyond minimum required levels decreased net revenue, because traditional FFS revenues decreased. PCMH funding through PMPM payments could substantially improve practice finances but will not offer sufficient financial incentives to expand services beyond minimum requirements for PCMH funding. © 2016 Annals of Family Medicine, Inc.

International Nursing: Constructing an Advanced Practice Registered Nurse Practice Model in the UAE: Using Innovation to Address Cultural Implications and Challenges in an International Enterprise.

PubMed

Behrens, Sue A

Despite utilization of the advanced practice registered nurse (APRN) in the United States health care system, there is little information about the introduction, utilization, and challenges of the APRN role globally, especially in the Middle East. This article will look at how one hospital in the United Arab Emirates introduced the APRN role to a health care environment of a country where it has not been recognized historically. Cultural challenges and barriers for the implementation of the role include regulatory, societal, and institutional. Innovation and collaboration are necessary to address these challenges and barriers and to pave the way for a successful advanced practice model pilot, as well as for the future use of the role. Innovation is also one of the key performance indicators for the country's health care. However, the idea of advanced practice is a new concept that has been outside the mainstream health care practice for the United Arab Emirates. To help with the implementation, a road map was developed to outline the steps necessary to provide a safe practice environment. The plan included aligning with the ministry of health nursing and midwifery council, as well as the Health Authority of Abu Dhabi, to help them learn more about the US model of advanced practice, along with benefits, and outcomes of the role. Developing the role of the APRN will benefit the future state of the health care infrastructure for not only the United Arab Emirates but throughout the Middle East.

Application of multivariate Gaussian detection theory to known non-Gaussian probability density functions

NASA Astrophysics Data System (ADS)

Schwartz, Craig R.; Thelen, Brian J.; Kenton, Arthur C.

1995-06-01

A statistical parametric multispectral sensor performance model was developed by ERIM to support mine field detection studies, multispectral sensor design/performance trade-off studies, and target detection algorithm development. The model assumes target detection algorithms and their performance models which are based on data assumed to obey multivariate Gaussian probability distribution functions (PDFs). The applicability of these algorithms and performance models can be generalized to data having non-Gaussian PDFs through the use of transforms which convert non-Gaussian data to Gaussian (or near-Gaussian) data. An example of one such transform is the Box-Cox power law transform. In practice, such a transform can be applied to non-Gaussian data prior to the introduction of a detection algorithm that is formally based on the assumption of multivariate Gaussian data. This paper presents an extension of these techniques to the case where the joint multivariate probability density function of the non-Gaussian input data is known, and where the joint estimate of the multivariate Gaussian statistics, under the Box-Cox transform, is desired. The jointly estimated multivariate Gaussian statistics can then be used to predict the performance of a target detection algorithm which has an associated Gaussian performance model.

Of Models and Mechanisms: Towards an Understanding of How Theatre-Making Works as an "Intervention" in Individual Health and Wellness

ERIC Educational Resources Information Center

Etheridge Woodson, Stephani; Szkupinski Quiroga, Seline; Underiner, Tamara; Farid Karimi, Robert

2017-01-01

Growing from a multi-year and multidisciplinary research and applied arts investigative team based in North America, this essay presents a model of how performative engagements contribute to individual behavioural change in wellness practices. To be even more specific, this essay analyses and theorises the mechanisms involved in the application of…

Educational Support for Low-Performing Students in Mathematics: The Three-Tier Support Model in Finnish Lower Secondary Schools

ERIC Educational Resources Information Center

Ekstam, Ulrika; Linnanmäki, Karin; Aunio, Pirjo

2015-01-01

In 2011, there was a legislative reform regarding educational support in Finland, with a focus on early identification, differentiation and flexible arrangement of support using a multi-professional approach, the three-tier support model. The main aim of this study was to investigate what educational support practices are used with low-performing…

Intentions of Chiropractic Interns Regarding use of Health Promotion in Practice: Applying Theory of Reasoned Action to Identify Attitudes, Beliefs, and Influencing Factors

PubMed Central

Evans, Marion W.; Ndetan, Harrison; Williams, Ronald D.

2009-01-01

Purpose: The theory of reasoned action is a health behavioral theory that has been used to predict personal health behaviors and intentions as well as those of providers delivering health care. The purpose of this study was to determine interns' future practices regarding the use of health promotion using this model to develop survey questions and to determine attitudes and perceived influences on their prospective behaviors in general, toward the use of health promotion once in practice. Methods: Across the course of one year, all graduating interns at a chiropractic college were queried with a 20 question survey designed using the theory of reasoned action. Frequencies and inferential statistics were performed including prediction modeling using logistic regression. Results: A majority (>85%) of interns indicated they would use health promotion in practice. Differences were noted based on perceived skill levels, perception of educational emphasis, various normative beliefs, and gender. Conclusion: Most interns will use some form of health promotion in practice. Normative influences including those seen as key influencers are as powerful a predictor as perceived education or skill levels on future practice of health promotion. PMID:19390679

Intentions of Chiropractic Interns Regarding use of Health Promotion in Practice: Applying Theory of Reasoned Action to Identify Attitudes, Beliefs, and Influencing Factors.

PubMed

Evans, Marion W; Ndetan, Harrison; Williams, Ronald D

2009-01-01

The theory of reasoned action is a health behavioral theory that has been used to predict personal health behaviors and intentions as well as those of providers delivering health care. The purpose of this study was to determine interns' future practices regarding the use of health promotion using this model to develop survey questions and to determine attitudes and perceived influences on their prospective behaviors in general, toward the use of health promotion once in practice. Across the course of one year, all graduating interns at a chiropractic college were queried with a 20 question survey designed using the theory of reasoned action. Frequencies and inferential statistics were performed including prediction modeling using logistic regression. A majority (>85%) of interns indicated they would use health promotion in practice. Differences were noted based on perceived skill levels, perception of educational emphasis, various normative beliefs, and gender. Most interns will use some form of health promotion in practice. Normative influences including those seen as key influencers are as powerful a predictor as perceived education or skill levels on future practice of health promotion.

Manage indirect practice expense the way you practice medicine: with information.

PubMed

Zeller, T L; Senagore, A J; Siegel, G

1999-05-01

Surgeons are increasingly faced with the pressures of maintaining the highest quality of patient care, while at the same time maintaining financial viability. The purpose of this project was to provide a framework for analyzing practice costs for colorectal surgeons using an activity-based cost accounting model. A survey of 11 practices that were diverse in terms of geography, managed care penetration, academic vs. private practice style, and case distribution was performed. In activity-based costing the assignment of typical costs such as staff salaries are assigned to the appropriate business process. The business processes employed in this study were service patients in the office, perform in-office procedures, schedule cases in facilities, service patients in the hospital, insurance authorization, maintain medical records, billing, collections, resolve billing disputes, interaction with third parties, maintain professional education, sustain and manage the practice, maintain the facility, teaching and research, and performing drug studies. The final step is to assign the cost associated with all appropriate business processes to the appropriate cost object. The cost objects in this study were defined as a charge office visit, no-charge office visit, charge hospital visit, in-office procedures, in-facility procedures, and performing drug studies. The data were then analyzed to allow a comparison of four similar practices within the study group. The data demonstrated that the cost of seeing a charge office visit ranged from $55 to $105. Similarly, the cost of seeing a no-charge office visit during the global period ranged from $43 to $100. The study analyzed possible explanations for the wide variability in these costs. It is essential that physicians clearly understand the sources of expenses generated by the operation of their practices. A clear comprehension of costs will lead colorectal surgeons to make appropriate decisions regarding such important issues as office staffing ratios, office square footage, and instrumentation acquisitions.

Effects of surface area and inflow on the performance of stormwater best management practices with uncertainty analysis.

PubMed

Park, Daeryong; Roesner, Larry A

2013-09-01

The performance of stormwater best management practices (BMPs) is affected by BMP geometric and hydrologic factors. The objective of this study was to investigate the effect of BMP surface area and inflow on BMP performance using the k-C* model with uncertainty analysis. Observed total suspended solids (TSS) from detention basins and retention ponds data sets in the International Stormwater BMP Database were used to build and evaluate the model. Detention basins are regarded as dry ponds because they do not always have water, whereas retention ponds have a permanent pool and are considered wet ponds. In this study, Latin hypercube sampling (LHS) was applied to consider uncertainty in both influent event mean concentration (EMC), C(in), and the areal removal constant, k. The latter was estimated from the hydraulic loading rate, q, through use of a power function relationship. Results show that effluent EMC, C(out), decreased as inflow decreased and as BMP surface area increased in both detention basins and retention ponds. However, the change in C(out), depending on inflow and BMP surface area for detention basins, differed from the change in C(out) for retention ponds. Specifically, C(in) was more dominantly associated with the performance of the k-C* model of detention basins than were BMP surface area and inflow. For retention ponds, however, results suggest that BMP surface area and inflow both influenced changes in C(out) as well as C(in). These results suggest that sensitive factors in the performance of the k-C* model are limited to C(in) for detention basins, whereas BMP surface area, inflow, and C(in) are important for retention ponds.

Can GPs audit their ability to detect psychological distress? One approach and some unresolved issues.

PubMed Central

Howe, A

1998-01-01

BACKGROUND: General practitioners (GPs) should be able to detect psychological distress in their patients. However, there is much evidence of underperformance in this area. The principle of clinical audit is the identification of underperformance and amelioration of its causes, but there appear to be few evaluated models of audit in this area of clinical practice. AIM: To evaluate the feasibility of auditing GPs' performance as detectors of psychological distress. Specific objectives were to test a model of the audit cycle in the detection of psychological distress by GPs; to research GP perceptions of prior audit activity in this area and the validity of the instruments used to measure GP performance; and to research GP perceptions of the value of this specific approach to the audit of their performance and the particular value of different aspects of the model in terms of its impact on clinician behaviour. METHOD: Prospective controlled study of an audit cycle of GP detection of psychological distress. Nineteen GP principals used a self-directed educational intervention involving measurement of their performance, followed by data feedback and review of selected videotaped consultations. Qualitative data on GP views of audit in this area of clinical activity were collected before and after the quantitative data collection. RESULTS: The study shows that the GP cohort had not previously considered auditing their performance as detectors of psychological distress. They found the instruments of measurement and the model of audit acceptable. However, they also suggested modifications that might be educationally more effective and make the audit more practical. These included smaller patient numbers and more peer contact. The implications of the study for a definitive model of audit in this area are discussed. CONCLUSION: Effective audit of GP performance in detection of psychological distress is possible using validated instruments, and GP performance can be improved by educational intervention. GPs in this study appear more motivated by individual case studies and reflection through video analysis on undiagnosed patients than by quantitative data feedback on their performance. This study therefore supports other evidence that clinical audit has most impact when quantitative data is coupled with clinical examples derived from patient review. PMID:9604413

Can GPs audit their ability to detect psychological distress? One approach and some unresolved issues.

PubMed

Howe, A

1998-01-01

General practitioners (GPs) should be able to detect psychological distress in their patients. However, there is much evidence of underperformance in this area. The principle of clinical audit is the identification of underperformance and amelioration of its causes, but there appear to be few evaluated models of audit in this area of clinical practice. To evaluate the feasibility of auditing GPs' performance as detectors of psychological distress. Specific objectives were to test a model of the audit cycle in the detection of psychological distress by GPs; to research GP perceptions of prior audit activity in this area and the validity of the instruments used to measure GP performance; and to research GP perceptions of the value of this specific approach to the audit of their performance and the particular value of different aspects of the model in terms of its impact on clinician behaviour. Prospective controlled study of an audit cycle of GP detection of psychological distress. Nineteen GP principals used a self-directed educational intervention involving measurement of their performance, followed by data feedback and review of selected videotaped consultations. Qualitative data on GP views of audit in this area of clinical activity were collected before and after the quantitative data collection. The study shows that the GP cohort had not previously considered auditing their performance as detectors of psychological distress. They found the instruments of measurement and the model of audit acceptable. However, they also suggested modifications that might be educationally more effective and make the audit more practical. These included smaller patient numbers and more peer contact. The implications of the study for a definitive model of audit in this area are discussed. Effective audit of GP performance in detection of psychological distress is possible using validated instruments, and GP performance can be improved by educational intervention. GPs in this study appear more motivated by individual case studies and reflection through video analysis on undiagnosed patients than by quantitative data feedback on their performance. This study therefore supports other evidence that clinical audit has most impact when quantitative data is coupled with clinical examples derived from patient review.

Discrete-time pilot model. [human dynamics and digital simulation

NASA Technical Reports Server (NTRS)

Cavalli, D.

1978-01-01

Pilot behavior is considered as a discrete-time process where the decision making has a sequential nature. This model differs from both the quasilinear model which follows from classical control theory and from the optimal control model which considers the human operator as a Kalman estimator-predictor. An additional factor considered is that the pilot's objective may not be adequately formulated as a quadratic cost functional to be minimized, but rather as a more fuzzy measure of the closeness with which the aircraft follows a reference trajectory. All model parameters, in the digital program simulating the pilot's behavior, were successfully compared in terms of standard-deviation and performance with those of professional pilots in IFR configuration. The first practical application of the model was in the study of its performance degradation when the aircraft model static margin decreases.

A practical model of thin disk regenerative amplifier based on analytical expression of ASE lifetime

NASA Astrophysics Data System (ADS)

Zhou, Huang; Chyla, Michal; Nagisetty, Siva Sankar; Chen, Liyuan; Endo, Akira; Smrz, Martin; Mocek, Tomas

2017-12-01

In this paper, a practical model of a thin disk regenerative amplifier has been developed based on an analytical approach, in which Drew A. Copeland [1] had evaluated the loss rate of the upper state laser level due to ASE and derived the analytical expression of the effective life-time of the upper-state laser level by taking the Lorentzian stimulated emission line-shape and total internal reflection into account. By adopting the analytical expression of effective life-time in the rate equations, we have developed a less numerically intensive model for predicting and analyzing the performance of a thin disk regenerative amplifier. Thanks to the model, optimized combination of various parameters can be obtained to avoid saturation, period-doubling bifurcation or first pulse suppression prior to experiments. The effective life-time due to ASE is also analyzed against various parameters. The simulated results fit well with experimental data. By fitting more experimental results with numerical model, we can improve the parameters of the model, such as reflective factor which is used to determine the weight of boundary reflection within the influence of ASE. This practical model will be used to explore the scaling limits imposed by ASE of the thin disk regenerative amplifier being developed in HiLASE Centre.

Not of One Mind: Mental Models of Clinical Practice Guidelines in the Veterans Health Administration

PubMed Central

Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A; Moore, Frank I

2005-01-01

Objective The purpose of this paper is to present differences in mental models of clinical practice guidelines (CPGs) among 15 Veterans Health Administration (VHA) facilities throughout the United States. Data Sources Two hundred and forty-four employees from 15 different VHA facilities across four service networks around the country were invited to participate. Participants were selected from different levels throughout each service setting from primary care personnel to facility leadership. Study Design This qualitative study used purposive sampling, a semistructured interview process for data collection, and grounded theory techniques for analysis. Data Collection A semistructured interview was used to collect information on participants' mental models of CPGs, as well as implementation strategies and barriers in their facility. Findings Analysis of these interviews using grounded theory techniques indicated that there was wide variability in employees' mental models of CPGs. Findings also indicated that high-performing facilities exhibited both (a) a clear, focused shared mental model of guidelines and (b) a tendency to use performance feedback as a learning opportunity, thus suggesting that a shared mental model is a necessary but not sufficient step toward successful guideline implementation. Conclusions We conclude that a clear shared mental model of guidelines, in combination with a learning orientation toward feedback are important components for successful guideline implementation and improved quality of care. PMID:15960693

Optimization methods of pulse-to-pulse alignment using femtosecond pulse laser based on temporal coherence function for practical distance measurement

NASA Astrophysics Data System (ADS)

Liu, Yang; Yang, Linghui; Guo, Yin; Lin, Jiarui; Cui, Pengfei; Zhu, Jigui

2018-02-01

An interferometer technique based on temporal coherence function of femtosecond pulses is demonstrated for practical distance measurement. Here, the pulse-to-pulse alignment is analyzed for large delay distance measurement. Firstly, a temporal coherence function model between two femtosecond pulses is developed in the time domain for the dispersive unbalanced Michelson interferometer. Then, according to this model, the fringes analysis and the envelope extraction process are discussed. Meanwhile, optimization methods of pulse-to-pulse alignment for practical long distance measurement are presented. The order of the curve fitting and the selection of points for envelope extraction are analyzed. Furthermore, an averaging method based on the symmetry of the coherence function is demonstrated. Finally, the performance of the proposed methods is evaluated in the absolute distance measurement of 20 μ m with path length difference of 9 m. The improvement of standard deviation in experimental results shows that these approaches have the potential for practical distance measurement.

WHO expert committee on specifications for pharmaceutical preparations. Fortieth report.

PubMed

2006-01-01

This report presents the recommendations of an international group of experts convened by the World Health Organization to consider matters concerning the quality assurance of pharmaceuticals and specifications for drug substances and dosage forms. The report is complemented by a number of annexes. These include: a list of available International Chemical Reference Substances and International Infrared Spectra; supplementary guidelines on good manufacturing practices for heating, ventilation and air-conditioning systems for non-sterile pharmaceutical dosage forms; updated supplementary guidelines on good manufacturing practices for the manufacture of herbal medicines; supplementary guidelines on good manufacturing practices for validation; good distribution practices for pharmaceutical products; a model quality assurance system for procurement agencies (recommendations for quality assurance systems focusing on prequalification of products and manufacturers, purchasing, storage and distribution of pharmaceutical products); multisource (generic) pharmaceutical products: guidelines on registration requirements to establish interchangeability; a proposal to waive in vivo bioequivalence requirements for WHO Model List of Essential Medicines immediate-release, solid oral dosage forms; and additional guidance for organizations performing in vivo bioequivalence studies.

Abrupt strategy change underlies gradual performance change: Bayesian hierarchical models of component and aggregate strategy use.

PubMed

Wynton, Sarah K A; Anglim, Jeromy

2017-10-01

While researchers have often sought to understand the learning curve in terms of multiple component processes, few studies have measured and mathematically modeled these processes on a complex task. In particular, there remains a need to reconcile how abrupt changes in strategy use can co-occur with gradual changes in task completion time. Thus, the current study aimed to assess the degree to which strategy change was abrupt or gradual, and whether strategy aggregation could partially explain gradual performance change. It also aimed to show how Bayesian methods could be used to model the effect of practice on strategy use. To achieve these aims, 162 participants completed 15 blocks of practice on a complex computer-based task-the Wynton-Anglim booking (WAB) task. The task allowed for multiple component strategies (i.e., memory retrieval, information reduction, and insight) that could also be aggregated to a global measure of strategy use. Bayesian hierarchical models were used to compare abrupt and gradual functions of component and aggregate strategy use. Task completion time was well-modeled by a power function, and global strategy use explained substantial variance in performance. Change in component strategy use tended to be abrupt, whereas change in global strategy use was gradual and well-modeled by a power function. Thus, differential timing of component strategy shifts leads to gradual changes in overall strategy efficiency, and this provides one reason for why smooth learning curves can co-occur with abrupt changes in strategy use. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Age-related practice effects across longitudinal neuropsychological assessments in older people with schizophrenia.

PubMed

Granholm, Eric; Link, Peter; Fish, Scott; Kraemer, Helena; Jeste, Dilip

2010-09-01

The relationship between aging and practice effects on longitudinal neuropsychological assessments was investigated in middle-aged and older people with schizophrenia and healthy controls. Older people with schizophrenia (n = 107; M age = 56.1) and age-comparable nonpsychiatric controls (n = 107; M age = 57.7) were scheduled to receive annual assessments on a comprehensive battery of neuropsychological tests for an average of 2.5 years (range 11 months to 4 years). Mixed-model analyses were used to separately examine the effects of practice and age on test performance. Number of prior assessments (practice) was associated with significant performance improvement across assessments, whereas older age was associated with significant decline in performance. The groups did not differ significantly in extent of age-related cognitive decline, but a three-way interaction among group, age, and practice was found, such that greater age-related decline in practice effects were found for older people with schizophrenia relative to nonpsychiatric participants. This study did not find any evidence of neurodegenerative age-related decline in neuropsychological abilities in middle-aged and older people with schizophrenia, but older age was associated with diminished ability to benefit from repeated exposure to cognitive tasks in people with schizophrenia. Cognitive impairment in schizophrenia may combine with cognitive decline associated with normal aging to reduce practice effects in older patients. These findings have important implications for the design of studies examining the longitudinal trajectory of cognitive functioning across the life span of people with schizophrenia, as well as clinical trials that attempt to demonstrate cognitive enhancement in these individuals. Copyright 2010 APA, all rights reserved.

Clinical experience with vestibular schwannomas: epidemiology, symptomatology, diagnosis, and surgical results.

PubMed

Tos, M; Charabi, S; Thomsen, J

1998-01-01

The Danish model for vestibular schwannoma (VS) surgery has been influenced by some historical otological events, taking its origin in the fact that the first attempt to remove CPA tumors was performed by an otologist in 1916. In approximately 50 years VS surgery was performed by neurosurgeons in a decentralized model. Highly specialized neuro- and otosurgeons have been included in our team since the early beginning of the centralized Danish model of VS surgery in 1976. Our surgical practice has always been performed on the basis of known and proven knowledge, but we spared no effort to search for innovative procedures. The present paper reflects the experience we have gained in two decades of VS surgery. Our studies on the incidence, symptomatology, diagnosis, expectancy and surgical results are presented.

A practical model for economic evaluation of tissue-engineered therapies.

PubMed

Tan, Tien-En; Peh, Gary S L; Finkelstein, Eric A; Mehta, Jodhbir S

2015-01-01

Tissue-engineered therapies are being developed across virtually all fields of medicine. Some of these therapies are already in clinical use, while others are still in clinical trials or the experimental phase. Most initial studies in the evaluation of new therapies focus on demonstration of clinical efficacy. However, cost considerations or economic viability are just as important. Many tissue-engineered therapies have failed to be impactful because of shortcomings in economic competitiveness, rather than clinical efficacy. Furthermore, such economic viability studies should be performed early in the process of development, before significant investment has been made. Cost-minimization analysis combined with sensitivity analysis is a useful model for the economic evaluation of new tissue-engineered therapies. The analysis can be performed early in the development process, and can provide valuable information to guide further investment and research. The utility of the model is illustrated with the practical real-world example of tissue-engineered constructs for corneal endothelial transplantation. The authors have declared no conflicts of interest for this article. © 2015 Wiley Periodicals, Inc.

Design of set-point weighting PIλ + Dμ controller for vertical magnetic flux controller in Damavand tokamak.

PubMed

Rasouli, H; Fatehi, A

2014-12-01

In this paper, a simple method is presented for tuning weighted PI(λ) + D(μ) controller parameters based on the pole placement controller of pseudo-second-order fractional systems. One of the advantages of this controller is capability of reducing the disturbance effects and improving response to input, simultaneously. In the following sections, the performance of this controller is evaluated experimentally to control the vertical magnetic flux in Damavand tokamak. For this work, at first a fractional order model is identified using output-error technique in time domain. For various practical experiments, having desired time responses for magnetic flux in Damavand tokamak, is vital. To approach this, at first the desired closed loop reference models are obtained based on generalized characteristic ratio assignment method in fractional order systems. After that, for the identified model, a set-point weighting PI(λ) + D(μ) controller is designed and simulated. Finally, this controller is implemented on digital signal processor control system of the plant to fast/slow control of magnetic flux. The practical results show appropriate performance of this controller.

Especial skill effect across age and performance level: the nature and degree of generalization.

PubMed

Czyż, S H; Breslin, G; Kwon, O; Mazur, M; Kobiałka, K; Pizlo, Z

2013-01-01

It has been claimed that an especial skill emerges after massive amounts of basketball practice. Despite this no direct evidence is available to support this claim. The authors aimed to shed light on this question. Thirty-seven male basketball players took part representing four groups: 2 groups of senior players, a cadet group, and a group of juniors. Players performed free throw shots from 7 distances including shots from the free throw line (15 ft). It was shown that an especial skill was present in senior players, but not in junior players who had only 3 years of playing experience. The authors present a descriptive model of especial skill and express it using the formalism of a hierarchical Bayesian model to fit the data and estimate the parameters. This model can account not only for the results, which indicate the presence and a substantial degree of generalizability of especial skill to nearby distances, but also for results of the original study on especial skill where it was proposed that specificity in practice leads to the emergence of the especial skill.

Modeling the behavior of an earthquake base-isolated building.

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

Coveney, V. A.; Jamil, S.; Johnson, D. E.

1997-11-26

Protecting a structure against earthquake excitation by supporting it on laminated elastomeric bearings has become a widely accepted practice. The ability to perform accurate simulation of the system, including FEA of the bearings, would be desirable--especially for key installations. In this paper attempts to model the behavior of elastomeric earthquake bearings are outlined. Attention is focused on modeling highly-filled, low-modulus, high-damping elastomeric isolator systems; comparisons are made between standard triboelastic solid model predictions and test results.

Modeling and Simulation of HVAC Faulty Operations and Performance Degradation due to Maintenance Issues

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

Wang, Liping; Hong, Tianzhen

Almost half of the total energy used in the U.S. buildings is consumed by heating, ventilation and air conditionings (HVAC) according to EIA statistics. Among various driving factors to energy performance of building, operations and maintenance play a significant role. Many researches have been done to look at design efficiencies and operational controls for improving energy performance of buildings, but very few study the impacts of HVAC systems maintenance. Different practices of HVAC system maintenance can result in substantial differences in building energy use. If a piece of HVAC equipment is not well maintained, its performance will degrade. If sensorsmore » used for control purpose are not calibrated, not only building energy usage could be dramatically increased, but also mechanical systems may not be able to satisfy indoor thermal comfort. Properly maintained HVAC systems can operate efficiently, improve occupant comfort, and prolong equipment service life. In the paper, maintenance practices for HVAC systems are presented based on literature reviews and discussions with HVAC engineers, building operators, facility managers, and commissioning agents. We categorize the maintenance practices into three levels depending on the maintenance effort and coverage: 1) proactive, performance-monitored maintenance; 2) preventive, scheduled maintenance; and 3) reactive, unplanned or no maintenance. A sampled list of maintenance issues, including cooling tower fouling, boiler/chiller fouling, refrigerant over or under charge, temperature sensor offset, outdoor air damper leakage, outdoor air screen blockage, outdoor air damper stuck at fully open position, and dirty filters are investigated in this study using field survey data and detailed simulation models. The energy impacts of both individual maintenance issue and combined scenarios for an office building with central VAV systems and central plant were evaluated by EnergyPlus simulations using three approaches: 1) direct modeling with EnergyPlus, 2) using the energy management system feature of EnergyPlus, and 3) modifying EnergyPlus source code. The results demonstrated the importance of maintenance for HVAC systems on energy performance of buildings. The research is intended to provide a guideline to help practitioners and building operators to gain the knowledge of maintaining HVAC systems in efficient operations, and prioritize HVAC maintenance work plan. The paper also discusses challenges of modeling building maintenance issues using energy simulation programs.« less

Computation of unsteady turbomachinery flows: Part 2—LES and hybrids

NASA Astrophysics Data System (ADS)

Tucker, P. G.

2011-10-01

The choice of turbulence model can have a strong impact on results for many turbomachinery zones. Palliative corrections to them and also transition modeling can have a further profound solution impact. The spectral gaps necessary for theoretically valid URANS solutions are also lacking in certain turbomachinery zones. Large Eddy Simulation (LES) alleviates the serious area of turbulence modeling uncertainty but with an extreme increase in computational cost. However, there seems a lack of validation data to explore in depth the performance of LES and thus strategies to refine it. LES best practices are needed. Although LES is, obviously, much less model dependent than RANS, grids currently used for more practical simulations are clearly insufficiently fine for the LES model and numerical schemes not to be playing an excessively strong role. Very few turbomachinery simulations make use of properly constructed, correlated turbulence inflow. Even if this is attempted, most measurement sets are incomplete and lack an adequate basis for modeling this inflow. Gas turbines are highly complex coupled systems and hence inflow and outflow boundary condition specification needs to go beyond just synthesizing turbulent structures and preventing their reflection. Despite the strong limitations of the dissipative Smagorinsky model, it still sees the most wide spread use, generally, in excessively dissipative flow solvers. Monotone Integrated LES (MILES) related approaches, hybrid LES-RANS and more advanced LES models seem to have an equal but subservient frequency of use in turbomachinery applications. Clearly the introduction of a RANS layer can have a substantial accuracy penalty. However, it does allow LES to be rationally used, albeit in a diluted sense for industrial applications. The Reynolds numbers found in turbomachinery are substantial. However, in certain areas evidence suggests they will not be enough to ensure a long inertial subrange and hence the use of standard LES modeling practices. Despite the excessively coarse grids used in much of the LES work reviewed, with essentially RANS based codes, meaningful results are often gained. This can perhaps be attributed to the choice of cases, these being ones for which RANS modeling gives extremely poor performance. It is a concern that for practical turbomachinery LES studies grid densities used tend to have an Reynolds number scaling to a strong negative power.

Microsimulation of the Impact of Access Management Practices to Pedestrians

DOT National Transportation Integrated Search

2018-12-31

The study applied microsimulation to analyze the impact of access management (AM) to the operational performances of vehicles and pedestrians. A conceptual model was developed in VISSIM and VISWALK to examine the effect of access and signals density ...

Self Evaluation of Organizations.

ERIC Educational Resources Information Center

Pooley, Richard C.

Evaluation within human service organizations is defined in terms of accepted evaluation criteria, with reasonable expectations shown and structured into a model of systematic evaluation practice. The evaluation criteria of program effort, performance, adequacy, efficiency and process mechanisms are discussed, along with measurement information…

The Standard of Care: Legal History and Definitions: the Bad and Good News

PubMed Central

Moffett, Peter; Moore, Gregory

2011-01-01

The true meaning of the term “the standard of care” is a frequent topic of discussion among emergency physicians as they evaluate and perform care on patients. This article, using legal cases and dictums, reviews the legal history and definitions of the standard of care. The goal is to provide the working physician with a practical and useful model of the standard of care to help guide daily practice. PMID:21691483

Do we need animal hands-on courses for transplantation surgery?

PubMed

Golriz, Mohammad; Hafezi, Mohammadreza; Garoussi, Camelia; Fard, Nassim; Arvin, Jalal; Fonouni, Hamidreza; Nickkholgh, Arash; Kulu, Yakob; Frongia, Giovani; Schemmer, Peter; Mehrabi, Arianeb

2013-01-01

Transplantation surgery requires many years of training. This study evaluates and presents the results of our recent four-yr animal hands-on courses of transplantation surgery on participants' training. Since 2008, five two-d hands-on courses of transplantation surgery were performed on swine models at our department. Sixty-one participants were asked to answer three questionnaires (pre-course, immediate post-course, subsequent post-course). The questions pertained to their past education, expectations, and evaluation of our courses, as well as our course's effectiveness in advancing their surgical abilities. The results were analyzed, compared and are presented herein. On average, 1.8 multiorgan procurements, 2.3 kidney, 1.5 liver, and 0.7 pancreas transplantations were performed by each participant. 41.7% of participants considered their previous practical training only satisfactory; 85% hoped for more opportunities to practice surgery; 73.3% evaluated our courses as very good; and 95.8% believed that our courses had fulfilled their expectations. 66% found the effectiveness of our course in advancing their surgical abilities very good; 30% good, and 4% satisfactory. Animal hands-on courses of transplantation surgery are one of the best options to learn and practice different operations and techniques in a near to clinical simulated model. Regular participation in such courses with a focus on practical issues can provide optimal opportunities for trainees with the advantage of direct mentoring and feedback. © 2013 John Wiley & Sons A/S.

Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner—quantitative findings

PubMed Central

Cooper, Simon; O'Carroll, Judith; Jenkin, Annie; Badger, Beryl

2007-01-01

Objective To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods A 12 month (2005–6) mixed methods clinical case study in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multiprofessional emergency care practitioners (ECPs); interviews with 45 ECPs and stakeholders; and an audit of 611 patients. Results Quantitative observational ratings indicated that the higher the leadership rating the greater the communication ability (p⩽0.001) and teamwork (p⩽0.001), and the higher grade ECPs were rated more highly on their leadership performance. From the patient audit, influences and outputs of collaborative practice are revealed: mean time on scene was 47 mins; 62% were not conveyed; 38% were referred, mainly to accident and emergency; ECPs claimed to make the referral decision in 87% of cases with a successful referral in 96% of cases; and in 66% of cases ECPs claimed that their intervention prevented an acute trust admission. The qualitative interview findings, final collaborative model and recommendations are reported in another paper. Conclusions The collaborative performance of ECPs varies, but the ECPs' role does appear to have an impact on collaborative practices and patient care. Final recommendations are reported with the qualitative results elsewhere. PMID:17711938

A model for teaching and learning spinal thrust manipulation and its effect on participant confidence in technique performance

PubMed Central

Wise, Christopher H.; Schenk, Ronald J.; Lattanzi, Jill Black

2016-01-01

Background Despite emerging evidence to support the use of high velocity thrust manipulation in the management of lumbar spinal conditions, utilization of thrust manipulation among clinicians remains relatively low. One reason for the underutilization of these procedures may be related to disparity in training in the performance of these techniques at the professional and post professional levels. Purpose To assess the effect of using a new model of active learning on participant confidence in the performance of spinal thrust manipulation and the implications for its use in the professional and post-professional training of physical therapists. Methods A cohort of 15 DPT students in their final semester of entry-level professional training participated in an active training session emphasizing a sequential partial task practice (SPTP) strategy in which participants engaged in partial task practice over several repetitions with different partners. Participants’ level of confidence in the performance of these techniques was determined through comparison of pre- and post-training session surveys and a post-session open-ended interview. Results The increase in scores across all items of the individual pre- and post-session surveys suggests that this model was effective in changing overall participant perception regarding the effectiveness and safety of these techniques and in increasing student confidence in their performance. Interviews revealed that participants greatly preferred the SPTP strategy, which enhanced their confidence in technique performance. Conclusion Results indicate that this new model of psychomotor training may be effective at improving confidence in the performance of spinal thrust manipulation and, subsequently, may be useful for encouraging the future use of these techniques in the care of individuals with impairments of the spine. Inasmuch, this method of instruction may be useful for training of physical therapists at both the professional and post-professional levels. PMID:27559284

A peer learning intervention for nursing students in clinical practice education: A quasi-experimental study.

PubMed

Pålsson, Ylva; Mårtensson, Gunilla; Swenne, Christine Leo; Ädel, Eva; Engström, Maria

2017-04-01

Studies of peer learning indicate that the model enables students to practice skills useful in their future profession, such as communication, cooperation, reflection and independence. However, so far most studies have used a qualitative approach and none have used a quasi-experimental design to study effects of nursing students' peer learning in clinical practice. To investigate the effects of peer learning in clinical practice education on nursing students' self-rated performance. Quasi-experimental. The study was conducted during nursing students' clinical practice. All undergraduate nursing students (n=87) attending their first clinical practice were approached. Seventy students out of 87 answered the questionnaires at both baseline and follow-up (42 of 46 in the intervention group and 28 of 39 in the comparison group). During the first two weeks of the clinical practice period, all students were supervised traditionally. Thereafter, the intervention group received peer learning the last two weeks, and the comparison group received traditional supervision. Questionnaire data were collected on nursing students' self-rated performance during the second (baseline) and last (follow-up) week of their clinical practice. Self-efficacy was improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. For the other self-rated variables/tests, there were no differences in changes over time between the groups. Studying each group separately, the intervention group significantly improved on thirteen of the twenty variables/tests over time and the comparison group improved on four. The results indicate that peer learning is a useful method which improves nursing students' self-efficacy to a greater degree than traditional supervision does. Regarding the other self-rated performance variables, no interaction effects were found. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Artificial neural networks applied to forecasting time series.

PubMed

Montaño Moreno, Juan J; Palmer Pol, Alfonso; Muñoz Gracia, Pilar

2011-04-01

This study offers a description and comparison of the main models of Artificial Neural Networks (ANN) which have proved to be useful in time series forecasting, and also a standard procedure for the practical application of ANN in this type of task. The Multilayer Perceptron (MLP), Radial Base Function (RBF), Generalized Regression Neural Network (GRNN), and Recurrent Neural Network (RNN) models are analyzed. With this aim in mind, we use a time series made up of 244 time points. A comparative study establishes that the error made by the four neural network models analyzed is less than 10%. In accordance with the interpretation criteria of this performance, it can be concluded that the neural network models show a close fit regarding their forecasting capacity. The model with the best performance is the RBF, followed by the RNN and MLP. The GRNN model is the one with the worst performance. Finally, we analyze the advantages and limitations of ANN, the possible solutions to these limitations, and provide an orientation towards future research.

Use of technology to facilitate physical activity in children with autism spectrum disorders: A pilot study.

PubMed

Bittner, Melissa D; Rigby, B Rhett; Silliman-French, Lisa; Nichols, David L; Dillon, Suzanna R

2017-08-01

Deficits in social behavior and communication skills are correlated with reduced gross motor skills in children with autism spectrum disorders (ASD). The ExerciseBuddy application (EB app) was designed to communicate these motor skills to those with ASD and integrates evidence-based practices such as visual support and video modeling supported by The National Professional Development Center on Autism Spectrum Disorders. The purpose of this study was to determine the effectiveness of the EB app in facilitating increased physiologic responses to physical activity via a continuous measurement of energy expenditure and heart rate versus practice-style teaching methods in children with ASD. Six children, ages 5 to 10years, diagnosed with ASD were recruited. Each participant performed a variety of locomotor or object control skills as defined by the Test of Gross Motor Development-2 once per week for 4weeks. Motor skills were communicated and demonstrated using either practice-style teaching methods or the instructional section of the EB app. Energy expenditure and heart rate were measured continuously during each 12-minute session. A Wilcoxon signed-rank test was performed to assess any differences between the use of the app and practice-style teaching methods. The use of the EB app elicited greater values for peak energy expenditure (p=0.043) and peak heart rate response (p=0.028) while performing locomotor skills but no differences were observed while performing object control skills. Similarities were observed with average physiologic responses between the use of the EB app and practice-style teaching methods. The use of the EB app may allow for a greater peak physiologic response during more dynamic movements and a similar average cardiovascular and metabolic response when compared to practice-style teaching methods in children with ASD. Published by Elsevier Inc.

Automatic reactor model synthesis with genetic programming.

PubMed

Dürrenmatt, David J; Gujer, Willi

2012-01-01

Successful modeling of wastewater treatment plant (WWTP) processes requires an accurate description of the plant hydraulics. Common methods such as tracer experiments are difficult and costly and thus have limited applicability in practice; engineers are often forced to rely on their experience only. An implementation of grammar-based genetic programming with an encoding to represent hydraulic reactor models as program trees should fill this gap: The encoding enables the algorithm to construct arbitrary reactor models compatible with common software used for WWTP modeling by linking building blocks, such as continuous stirred-tank reactors. Discharge measurements and influent and effluent concentrations are the only required inputs. As shown in a synthetic example, the technique can be used to identify a set of reactor models that perform equally well. Instead of being guided by experience, the most suitable model can now be chosen by the engineer from the set. In a second example, temperature measurements at the influent and effluent of a primary clarifier are used to generate a reactor model. A virtual tracer experiment performed on the reactor model has good agreement with a tracer experiment performed on-site.

The Evolution of Comprehensive Musicianship through Performance (CMP)--A Model for Teaching Performing with Understanding in the Ensemble Setting

ERIC Educational Resources Information Center

Sindberg, Laura K.

2009-01-01

Principles and practices of comprehensive musicianship have occupied a place in music education for many years. Many of these initiatives descended from educational reform efforts begun in the post-Sputnik era. In 1977, a group of music educators gathered on the campus of a small Midwestern college to explore new possibilities for comprehensive…

Implement balanced scorecard to translate strategic plan into actionable objectives.

PubMed

2004-09-01

Faced with challenges ranging from declining reimbursement to staff shortages, health care organizations--integrated delivery systems, physician group practices, disease management providers, and others--increasingly are turning to general business models to map out step-by-step action plans for performance measurement and process improvement. Creating a "balanced scorecard" is an obvious starting point for assessing and improving clinical and financial performance.

The making of expert clinicians: reflective practice.

PubMed

Maestre, J M; Szyld, D; Del Moral, I; Ortiz, G; Rudolph, J W

2014-05-01

Debriefing is a rigorous reflection process which helps trainees recognize and resolve clinical and behavioral dilemmas raised by a clinical case. This approach emphasizes eliciting trainees'assumptions about the situation and their reasons for performing as they did (mental models). It analyses their impact on actions, to understand if it is necessary to maintain them or construct new ones that may lead to better performance in the future. It blends evidence and theory from education research, the social and cognitive sciences, and experience drawn from conducting and teaching debriefing to clinicians worldwide, on how to improve professional effectiveness through "reflective practice". Copyright © 2013 Elsevier España, S.L. All rights reserved.

Using simulators to teach pediatric airway procedures in an international setting.

PubMed

Schwartz, Marissa A; Kavanagh, Katherine R; Frampton, Steven J; Bruce, Iain A; Valdez, Tulio A

2018-01-01

There has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology. The objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting. Pediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale. Participants reported significant subjective improvement in confidence level after use of the simulation models (p < 0.05). Participants reported realistic representations of human anatomy and pathology. The models' tissue mechanics were adequate to practice operative technique including the ability to incise, suture, and suspend models. The pediatric laryngeal models demonstrate high quality anatomy, which is easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment. Copyright © 2017 Elsevier B.V. All rights reserved.

Complete-block scheduling for advanced pharmacy practice experiences.

PubMed

Hatton, Randy C; Weitzel, Kristin W

2013-12-01

An innovative approach to meeting increased student demand for advanced pharmacy practice experiences (APPEs) is described, including lessons learned during a two-year pilot project. To achieve more efficient allocation of preceptor resources, the University of Florida College of Pharmacy (UFCOP) adopted a new APPE rotation model in which 20 pharmacy students per year complete all required and elective APPEs at one practice site, an affiliated academic medical center. Relative to the prevailing model of experiential training for Pharm.D. students, the "complete-block scheduling" model offers a number of potential benefits to students, preceptors, and the pharmacy school. In addition to potentially reduced student housing expenses and associated conveniences, complete-block scheduling may enable (1) more efficient use of teaching resources, (2) increased collaboration among preceptors, (3) greater continuity and standardization of educational experiences, and (4) enhanced opportunities for students to engage in longer and more complex research projects. The single-site APPE rotation model also can provide value to the training site by enabling the extension of clinical pharmacy services; for example, UFCOP students perform anticoagulation monitoring and discharge medication counseling at the host institution. Despite logistical and other challenges encountered during pilot testing of the new scheduling model, the program has been well received by students and preceptors alike. Complete-block APPE scheduling is a viable model for some health systems to consider as a means of streamlining experiential education practices and helping to ensure high-quality clinical rotations for Pharm.D. students.

A quasi-Monte-Carlo comparison of parametric and semiparametric regression methods for heavy-tailed and non-normal data: an application to healthcare costs.

PubMed

Jones, Andrew M; Lomas, James; Moore, Peter T; Rice, Nigel

2016-10-01

We conduct a quasi-Monte-Carlo comparison of the recent developments in parametric and semiparametric regression methods for healthcare costs, both against each other and against standard practice. The population of English National Health Service hospital in-patient episodes for the financial year 2007-2008 (summed for each patient) is randomly divided into two equally sized subpopulations to form an estimation set and a validation set. Evaluating out-of-sample using the validation set, a conditional density approximation estimator shows considerable promise in forecasting conditional means, performing best for accuracy of forecasting and among the best four for bias and goodness of fit. The best performing model for bias is linear regression with square-root-transformed dependent variables, whereas a generalized linear model with square-root link function and Poisson distribution performs best in terms of goodness of fit. Commonly used models utilizing a log-link are shown to perform badly relative to other models considered in our comparison.

Current practices of laparoscopic inguinal hernia repair: a population-based analysis.

PubMed

Trevisonno, M; Kaneva, P; Watanabe, Y; Fried, G M; Feldman, L S; Andalib, A; Vassiliou, M C

2015-10-01

The selection of a laparoscopic approach for inguinal hernias varies among surgeons. It is unclear what is being done in actual practice. The purpose of this study was to report practice patterns for treatment of inguinal hernias among Quebec surgeons, and to identify factors that may be associated with the choice of operative approach. We studied a population-based cohort of patients who underwent an inguinal hernia repair between 2007 and 2011 in Quebec, Canada. A generalized linear model was used to identify predictors associated with the selection of a laparoscopic approach. 49,657 inguinal hernias were repaired by 478 surgeons. Laparoscopic inguinal hernia repair (LIHR) was used in 8 % of all cases. LIHR was used to repair 28 % of bilateral hernias, 10 % of recurrent hernias, 6 % of unilateral hernias, and 4 % of incarcerated hernias. 268 (56 %) surgeons did not perform any laparoscopic repairs, and 11 (2 %) surgeons performed more than 100 repairs. These 11 surgeons performed 61 % of all laparoscopic cases. Patient factors significantly associated with having LIHR included younger age, fewer comorbidities, bilateral hernias, and recurrent hernias. An open approach is favored for all clinical scenarios, even for situations where published guidelines recommend a laparoscopic approach. Surgeons remain divided on the best technique for inguinal hernia repair: while more than half never perform LIHR, the small proportion who perform many use the technique for a large proportion of their cases. There appears to be a gap between the best practices put forth in guidelines and what surgeons are doing in actual practice. Identification of barriers to the broader uptake of LIHR may help inform the design of educational programs to train those who have the desire to offer this technique for certain cases, and have the volume to overcome the learning curve.

Practitioner Gender and Quality of Care in Ambulatory Cardiology Practices: A Report From the National Cardiovascular Data Practice Innovation and Clinical Excellence (PINNACLE) Registry.

PubMed

Gupta, Dipti; Tang, Fengming; Masoudi, Frederick A; Jones, Philip G; Chan, Paul S; Daugherty, Stacie L

Some studies suggest that female practitioners are more likely to provide guideline-concordant care than male practitioners; however, little is known about the role of practitioner gender in cardiology. The aim of the study was to measure the association between practitioner gender and adherence to the cardiovascular performance measures in the American College of Cardiology's ambulatory Practice Innovation and Clinical Excellence Registry. Patients with at least 1 outpatient visit with a unique practitioner were included. Among eligible patients, adherence to 7 guideline-supported performance measures for coronary artery disease, heart failure, and atrial fibrillation over 12 months after registry entry was compared by practitioner gender using hierarchical models adjusting for practitioner type (physicians vs advance practice practitioners) and number of visits. The study cohort included 1493 individual practitioners who saw 769 139 patients; 80% of practitioners were men. Male practitioners were more often physicians compared with female practitioners (98.2% vs 43.7%, P < .01). Accounting for practitioner category and visit frequency, guideline adherence rates were similar by practitioner gender for all measures with the exception of marginally higher rates for coronary artery disease performance measures for male practitioners compared with female practitioners (antiplatelet: rate ratio [RR] = 1.06; 95% confidence interval [CI], 1.03-1.09; β-blockers: RR = 1.06; 95% CI, 1.01-1.10; and lipid-lowering drug: RR = 1.07; 95% CI, 1.04-1.10) and atrial fibrillation (oral anticoagulants: RR = 1.05; 95% CI, 1.01-1.09). Male practitioners marginally outperformed their female counterparts in ambulatory practices enrolled in a voluntary cardiovascular performance improvement registry program. Overall low adherence to some performance measures suggests room for improvement among all practitioners.

Mountain bicycle frame testing as an example of practical implementation of hybrid simulation using RTFEM

NASA Astrophysics Data System (ADS)

Mucha, Waldemar; Kuś, Wacław

2018-01-01

The paper presents a practical implementation of hybrid simulation using Real Time Finite Element Method (RTFEM). Hybrid simulation is a technique for investigating dynamic material and structural properties of mechanical systems by performing numerical analysis and experiment at the same time. It applies to mechanical systems with elements too difficult or impossible to model numerically. These elements are tested experimentally, while the rest of the system is simulated numerically. Data between the experiment and numerical simulation are exchanged in real time. Authors use Finite Element Method to perform the numerical simulation. The following paper presents the general algorithm for hybrid simulation using RTFEM and possible improvements of the algorithm for computation time reduction developed by the authors. The paper focuses on practical implementation of presented methods, which involves testing of a mountain bicycle frame, where the shock absorber is tested experimentally while the rest of the frame is simulated numerically.

The nature of excellent clinicians at an academic health science center: a qualitative study.

PubMed

Mahant, Sanjay; Jovcevska, Vesna; Wadhwa, Anupma

2012-12-01

To understand the nature of excellent clinicians at an academic health science center by exploring how and why excellent clinicians achieve high performance. From 2008 to 2010, the authors conducted a qualitative study using a grounded theory approach. Members of the Clinical Advisory Committee in the Department of Pediatrics at the University of Toronto nominated peers whom they saw as excellent clinicians. The authors then conducted in-depth interviews with the most frequently nominated clinicians. They audio-recorded and transcribed the interviews and coded the transcripts to identify emergent themes. From interviews with 13 peer-nominated, excellent clinicians, a model emerged. Dominant themes fell into three categories: (1) core philosophy, (2) deliberate activities, and (3) everyday practice. Excellent clinicians are driven by a core philosophy defined by high intrinsic motivation and passion for patient care and humility. They refine their clinical skills through two deliberate activities-reflective clinical practice and scholarship. Their high performance in everyday practice is characterized by clinical skills and cognitive ability, people skills, engagement, and adaptability. A rich theory emerged explaining how excellent clinicians, driven by a core philosophy and engaged in deliberate activities, achieve high performance in everyday practice. This theory of the nature of excellent clinicians provides a holistic perspective of individual performance, informs medical education, supports faculty career development, and promotes clinical excellence in the culture of academic medicine.

School physics teacher class management, laboratory practice, student engagement, critical thinking, cooperative learning and use of simulations effects on student performance

NASA Astrophysics Data System (ADS)

Riaz, Muhammad

The purpose of this study was to examine how simulations in physics class, class management, laboratory practice, student engagement, critical thinking, cooperative learning, and use of simulations predicted the percentage of students achieving a grade point average of B or higher and their academic performance as reported by teachers in secondary school physics classes. The target population consisted of secondary school physics teachers who were members of Science Technology, Engineeering and,Mathematics Teachers of New York City (STEMteachersNYC) and American Modeling Teachers Association (AMTA). They used simulations in their physics classes in the 2013 and 2014 school years. Subjects for this study were volunteers. A survey was constructed based on a literature review. Eighty-two physics teachers completed the survey about instructional practice in physics. All respondents were anonymous. Classroom management was the only predictor of the percent of students achieving a grade point average of B or higher in high school physics class. Cooperative learning, use of simulations, and student engagement were predictors of teacher's views of student academic performance in high school physics class. All other variables -- class management, laboratory practice, critical thinking, and teacher self-efficacy -- were not predictors of teacher's views of student academic performance in high school physics class. The implications of these findings were discussed and recommendations for physics teachers to improve student learning were presented.

Bayesian semiparametric estimation of covariate-dependent ROC curves

PubMed Central

Rodríguez, Abel; Martínez, Julissa C.

2014-01-01

Receiver operating characteristic (ROC) curves are widely used to measure the discriminating power of medical tests and other classification procedures. In many practical applications, the performance of these procedures can depend on covariates such as age, naturally leading to a collection of curves associated with different covariate levels. This paper develops a Bayesian heteroscedastic semiparametric regression model and applies it to the estimation of covariate-dependent ROC curves. More specifically, our approach uses Gaussian process priors to model the conditional mean and conditional variance of the biomarker of interest for each of the populations under study. The model is illustrated through an application to the evaluation of prostate-specific antigen for the diagnosis of prostate cancer, which contrasts the performance of our model against alternative models. PMID:24174579

Reflect and learn together - when two supervisors interact in the learning support process of nurse education.

PubMed

Berglund, Mia; Sjögren, Reet; Ekebergh, Margaretha

2012-03-01

To describe the importance of supervisors working together in supporting the learning process of nurse students through reflective caring science supervision. A supervision model has been developed in order to meet the need for interweaving theory and practice. The model is characterized by learning reflection in caring science. A unique aspect of the present project was that the student groups were led by a teacher and a nurse. Data were collected through interviews with the supervisors. The analysis was performed with a phenomenological approach. The results showed that theory and practice can be made more tangible and interwoven by using two supervisors in a dual supervision. The essential structure is built on the constituents 'Reflection as Learning Support', 'Interweaving Caring Science with the Patient's Narrative', 'The Student as a Learning Subject' and 'The Learning Environment of Supervision'. The study concludes that supervision in pairs provides unique possibilities for interweaving and developing theory and practice. The supervision model offers unique opportunities for cooperation, for the development of theory and practice and for the development of the professional roll of nurses and teachers. © 2012 Blackwell Publishing Ltd.

["Flipped classroom" teaching model into the curriculum of Theories of Different Schools of Acupuncture and Moxibustion:exploration and practice].

PubMed

Liu, Mailan; Yuan, Yiqin; Chang, Xiaorong; Tang, Yulan; Luo, Jian; Li, Nan; Yu, Jie; Yang, Qianyun; Liu, Mi

2016-08-12

The "flipped classroom" teaching model practiced in the teaching of Theories of Different Schools of Acupuncture and Moxibustion curriculum was introduced. Firstly, the roles and responsibilities of teachers were clarified, indicating teachers provided examples and lectures, and a comprehensive assessment system was established. Secondly, the "flipped classroom" teaching model was split into online learning, classroom learning and offline learning. Online learning aimed at forming a study report by a wide search of relevant information, which was submitted to teachers for review and assessment. Classroom learning was designed to communicate study ideas among students and teachers. Offline learning was intended to revise and improve the study report and refined learning methods. Lastly, the teaching practice effects of "flip classroom" were evaluated by comprehensive rating and questionnaire assessment, which assessed the overall performance of students and overall levels of paper; the learning ability was enhanced, and the interest and motivation of learning were also improved. Therefore, "flipped classroom" teaching mode was suitable for the curriculum of Theories of Different Schools of Acupuncture and Moxibustion , and could be recommended into the teaching practice of related curriculum of acupuncture and tuina.

External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study.

PubMed

Lamain-de Ruiter, Marije; Kwee, Anneke; Naaktgeboren, Christiana A; de Groot, Inge; Evers, Inge M; Groenendaal, Floris; Hering, Yolanda R; Huisjes, Anjoke J M; Kirpestein, Cornel; Monincx, Wilma M; Siljee, Jacqueline E; Van 't Zelfde, Annewil; van Oirschot, Charlotte M; Vankan-Buitelaar, Simone A; Vonk, Mariska A A W; Wiegers, Therese A; Zwart, Joost J; Franx, Arie; Moons, Karel G M; Koster, Maria P H

2016-08-30

 To perform an external validation and direct comparison of published prognostic models for early prediction of the risk of gestational diabetes mellitus, including predictors applicable in the first trimester of pregnancy.  External validation of all published prognostic models in large scale, prospective, multicentre cohort study.  31 independent midwifery practices and six hospitals in the Netherlands.  Women recruited in their first trimester (<14 weeks) of pregnancy between December 2012 and January 2014, at their initial prenatal visit. Women with pre-existing diabetes mellitus of any type were excluded.  Discrimination of the prognostic models was assessed by the C statistic, and calibration assessed by calibration plots.  3723 women were included for analysis, of whom 181 (4.9%) developed gestational diabetes mellitus in pregnancy. 12 prognostic models for the disorder could be validated in the cohort. C statistics ranged from 0.67 to 0.78. Calibration plots showed that eight of the 12 models were well calibrated. The four models with the highest C statistics included almost all of the following predictors: maternal age, maternal body mass index, history of gestational diabetes mellitus, ethnicity, and family history of diabetes. Prognostic models had a similar performance in a subgroup of nulliparous women only. Decision curve analysis showed that the use of these four models always had a positive net benefit.  In this external validation study, most of the published prognostic models for gestational diabetes mellitus show acceptable discrimination and calibration. The four models with the highest discriminative abilities in this study cohort, which also perform well in a subgroup of nulliparous women, are easy models to apply in clinical practice and therefore deserve further evaluation regarding their clinical impact. 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.

System equivalent model mixing

NASA Astrophysics Data System (ADS)

Klaassen, Steven W. B.; van der Seijs, Maarten V.; de Klerk, Dennis

2018-05-01

This paper introduces SEMM: a method based on Frequency Based Substructuring (FBS) techniques that enables the construction of hybrid dynamic models. With System Equivalent Model Mixing (SEMM) frequency based models, either of numerical or experimental nature, can be mixed to form a hybrid model. This model follows the dynamic behaviour of a predefined weighted master model. A large variety of applications can be thought of, such as the DoF-space expansion of relatively small experimental models using numerical models, or the blending of different models in the frequency spectrum. SEMM is outlined, both mathematically and conceptually, based on a notation commonly used in FBS. A critical physical interpretation of the theory is provided next, along with a comparison to similar techniques; namely DoF expansion techniques. SEMM's concept is further illustrated by means of a numerical example. It will become apparent that the basic method of SEMM has some shortcomings which warrant a few extensions to the method. One of the main applications is tested in a practical case, performed on a validated benchmark structure; it will emphasize the practicality of the method.

Relations among student attention behaviors, teacher practices, and beginning word reading skill.

PubMed

Sáez, Leilani; Folsom, Jessica Sidler; Al Otaiba, Stephanie; Schatschneider, Christopher

2012-01-01

The role of student attention for predicting kindergarten word reading was investigated among 432 students. Using Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scale behavior rating scores, the authors conducted an exploratory factor analysis, which yielded three distinct factors that reflected selective attention. In this study, the authors focused on the role of one of these factors, which they labeled attention-memory, for predicting reading performance. Teacher ratings of attention-memory predicted word reading above and beyond the contribution of phonological awareness and vocabulary knowledge. In addition, the relations between four teacher practices and attention ratings for predicting reading performance were examined. Using hierarchical linear modeling, the authors found significant interactions between student attention and teacher practices observed during literacy instruction. In general, as ratings of attention improved, better kindergarten word reading performance was associated with high levels of classroom behavior management. However, better word reading performance was not associated with high levels of teacher task orienting. A significant three-way interaction was also found among attention, individualized instruction, and teacher task redirections. The role of regulating kindergarten student attention to support beginning word reading skill development is discussed.

Path modeling of knowledge, attitude and practice toward palliative care consultation service among Taiwanese nursing staff: a cross-sectional study.

PubMed

Pan, Hsueh-Hsing; Shih, Hsiu-Ling; Wu, Li-Fen; Hung, Yu-Chun; Chu, Chi-Ming; Wang, Kwua-Yun

2017-08-17

The Taiwanese government has promoted palliative care consultation services (PCCS) to support terminally ill patients in acute ward settings to receive palliative care since 2005. Such an intervention can enhance the quality of life and dignity of terminally ill patients. However, research focusing on the relationship between the knowledge, attitude and practice of a PCCS using path modelling in nursing staff is limited. Therefore, the aim of this study was to elucidate the effect of path modeling on the knowledge, attitude and practice toward PCCS in Taiwanese nursing staff. This was a cross-sectional, descriptive study design using convenience sampling. Data collected included demographics, knowledge, attitude and practice as measured by the PCCS inventory (KAP-PCCSI). Two hundred and eighty-four nursing staff from a medical center in northern Taiwan participated in the study in 2013. We performed descriptive statistics, regression analysis, and path modeling using SPSS 19.0 and set p < 0.05 as the statistical significance threshold. The results showed that the identical factor significantly associated with knowledge, attitude, and practice toward PCCS among nurses was the frequency of contact with PCCS. In addition, higher level of knowledge toward PCCS was associated with working in haematology and oncology wards, and participation in education related to palliative care. A more positive attitude toward PCCS was associated with working in a haematology and oncology ward, and experience of friends or relatives dying. Higher level of practice toward PCCS was associated with nurses who participated in education related to palliative care. In the path modeling, we found that holders of a master's degree indirectly positive affected practice toward PCCS. Possession of a bachelor degree or above, being single, working within a haematology and oncology ward, and frequency of contact with PCCS positively affected practice toward PCCS. Based on this study, it is proposed that consultation with PCCS has a positive impact on the care of terminally ill patients. Encouragement of staff to undertake further education can improve the practice of ward staff providing palliative care.

Statistical analysis of target acquisition sensor modeling experiments

NASA Astrophysics Data System (ADS)

Deaver, Dawne M.; Moyer, Steve

2015-05-01

The U.S. Army RDECOM CERDEC NVESD Modeling and Simulation Division is charged with the development and advancement of military target acquisition models to estimate expected soldier performance when using all types of imaging sensors. Two elements of sensor modeling are (1) laboratory-based psychophysical experiments used to measure task performance and calibrate the various models and (2) field-based experiments used to verify the model estimates for specific sensors. In both types of experiments, it is common practice to control or measure environmental, sensor, and target physical parameters in order to minimize uncertainty of the physics based modeling. Predicting the minimum number of test subjects required to calibrate or validate the model should be, but is not always, done during test planning. The objective of this analysis is to develop guidelines for test planners which recommend the number and types of test samples required to yield a statistically significant result.

Mixed-effects location and scale Tobit joint models for heterogeneous longitudinal data with skewness, detection limits, and measurement errors.

PubMed

Lu, Tao

2017-01-01

The joint modeling of mean and variance for longitudinal data is an active research area. This type of model has the advantage of accounting for heteroscedasticity commonly observed in between and within subject variations. Most of researches focus on improving the estimating efficiency but ignore many data features frequently encountered in practice. In this article, we develop a mixed-effects location scale joint model that concurrently accounts for longitudinal data with multiple features. Specifically, our joint model handles heterogeneity, skewness, limit of detection, measurement errors in covariates which are typically observed in the collection of longitudinal data from many studies. We employ a Bayesian approach for making inference on the joint model. The proposed model and method are applied to an AIDS study. Simulation studies are performed to assess the performance of the proposed method. Alternative models under different conditions are compared.

On testing models for the pressure-strain correlation of turbulence using direct simulations

NASA Technical Reports Server (NTRS)

Speziale, Charles G.; Gatski, Thomas B.; Sarkar, Sutanu

1992-01-01

Direct simulations of homogeneous turbulence have, in recent years, come into widespread use for the evaluation of models for the pressure-strain correlation of turbulence. While work in this area has been beneficial, the increasingly common practice of testing the slow and rapid parts of these models separately in uniformly strained turbulent flows is shown in this paper to be unsound. For such flows, the decomposition of models for the total pressure-strain correlation into slow and rapid parts is ambiguous. Consequently, when tested in this manner, misleading conclusions can be drawn about the performance of pressure-strain models. This point is amplified by illustrative calculations of homogeneous shear flow where other pitfalls in the evaluation of models are also uncovered. More meaningful measures for testing the performance of pressure-strain models in uniformly strained turbulent flows are proposed and the implications for turbulence modeling are discussed.

Bayesian belief network modelling of chlorine disinfection for human pathogenic viruses in municipal wastewater.

PubMed

Carvajal, Guido; Roser, David J; Sisson, Scott A; Keegan, Alexandra; Khan, Stuart J

2017-02-01

Chlorine disinfection of biologically treated wastewater is practiced in many locations prior to environmental discharge or beneficial reuse. The effectiveness of chlorine disinfection processes may be influenced by several factors, such as pH, temperature, ionic strength, organic carbon concentration, and suspended solids. We investigated the use of Bayesian multilayer perceptron (BMLP) models as efficient and practical tools for compiling and analysing free chlorine and monochloramine virus disinfection performance as a multivariate problem. Corresponding to their relative susceptibility, Adenovirus 2 was used to assess disinfection by monochloramine and Coxsackievirus B5 was used for free chlorine. A BMLP model was constructed to relate key disinfection conditions (CT, pH, turbidity) to observed Log Reduction Values (LRVs) for these viruses at constant temperature. The models proved to be valuable for incorporating uncertainty in the chlor(am)ination performance estimation and interpolating between operating conditions. Various types of queries could be performed with this model including the identification of target CT for a particular combination of LRV, pH and turbidity. Similarly, it was possible to derive achievable LRVs for combinations of CT, pH and turbidity. These queries yielded probability density functions for the target variable reflecting the uncertainty in the model parameters and variability of the input variables. The disinfection efficacy was greatly impacted by pH and to a lesser extent by turbidity for both types of disinfections. Non-linear relationships were observed between pH and target CT, and turbidity and target CT, with compound effects on target CT also evidenced. This work demonstrated that the use of BMLP models had considerable ability to improve the resolution and understanding of the multivariate relationships between operational parameters and disinfection outcomes for wastewater treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

A model for prediction of STOVL ejector dynamics

NASA Technical Reports Server (NTRS)

Drummond, Colin K.

1989-01-01

A semi-empirical control-volume approach to ejector modeling for transient performance prediction is presented. This new approach is motivated by the need for a predictive real-time ejector sub-system simulation for Short Take-Off Verticle Landing (STOVL) integrated flight and propulsion controls design applications. Emphasis is placed on discussion of the approximate characterization of the mixing process central to thrust augmenting ejector operation. The proposed ejector model suggests transient flow predictions are possible with a model based on steady-flow data. A practical test case is presented to illustrate model calibration.

The impact of preventive maintenance practices on manufacturing performance: A proposed model for SMEs in Malaysia

NASA Astrophysics Data System (ADS)

Lazim, Halim Mad; Taib, Che Azlan; Lamsali, Hendrik; Saleh, Mohamed Najib; Subramaniam, Chandrakantan

2016-08-01

Preventive maintenance (PM) plays important role to avoid or mitigate potential stoppages and disruptions of equipment or machinery from occurring in daily operations. PM emphasized total employee involvement and it is important for companies as well as Small and Medium Sized Enterprises (SMEs). SME sectors contribution to the Malaysian economy makes up 95% of the total manufacturers, however PM remain relatively lacking. The ability, reliability and effective maintenance management is highly important in order to achieve desired manufacturing performance. Therefore, organizational capability in planning, controlling, implementing and monitoring PM activities is important. Furthermore, empirical evidence on the potential impact of PM practices towards manufacturing performance with organizational capability as a moderating effect is still limited and indecisive. Henceforth, this paper aims to explore and investigate potential relationships between PM practices and manufacturing performance moderated by organizational capability in the contact of Malaysian SMEs in the manufacturing sector. Correspondently, the study intends to propose a new research framework and hypotheses to examine the abovementioned relationships. The proposed framework includes PM team, PM strategy and planned maintenance as the determinants, while organizational capability serves as the moderating variable. Manufacturing performance will be viewed in terms of innovation and financial factors. Proposed research direction and conclusion are discussed at the end of the study.

Electric sail elliptic displaced orbits with advanced thrust model

NASA Astrophysics Data System (ADS)

Niccolai, Lorenzo; Quarta, Alessandro A.; Mengali, Giovanni

2017-09-01

This paper analyzes the performance of an Electric Solar Wind Sail for generating and maintaining an elliptic, heliocentric, displaced non-Keplerian orbit. In this sense, this paper extends and completes recent studies regarding the performances of an Electric Solar Wind Sail that covers a circular, heliocentric, displaced orbit of given characteristics. The paper presents the general equations that describe the elliptic orbit maintenance in terms of both spacecraft attitude and performance requirements, when a refined thrust model (recently proposed for the preliminary mission design) is taken into account. In particular, the paper also discusses some practical applications on particular mission scenarios in which an analytic solution of the governing equations has been found.

Relative resilience to noise of standard and sequential approaches to measurement-based quantum computation

NASA Astrophysics Data System (ADS)

Gallagher, C. B.; Ferraro, A.

2018-05-01

A possible alternative to the standard model of measurement-based quantum computation (MBQC) is offered by the sequential model of MBQC—a particular class of quantum computation via ancillae. Although these two models are equivalent under ideal conditions, their relative resilience to noise in practical conditions is not yet known. We analyze this relationship for various noise models in the ancilla preparation and in the entangling-gate implementation. The comparison of the two models is performed utilizing both the gate infidelity and the diamond distance as figures of merit. Our results show that in the majority of instances the sequential model outperforms the standard one in regard to a universal set of operations for quantum computation. Further investigation is made into the performance of sequential MBQC in experimental scenarios, thus setting benchmarks for possible cavity-QED implementations.

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

PubMed

Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

2015-01-01

With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.

Development of a Decision Model for Selection of Appropriate Timely Delivery Techniques for Highway Projects

DOT National Transportation Integrated Search

2009-04-01

"The primary umbrella method used by the Oregon Department of Transportation (ODOT) to ensure on-time performance in standard construction contracting is liquidated damages. The assessment value is usually a matter of some judgment. In practice...

Student Body Composition and School Performance: Evidence from Norway.

ERIC Educational Resources Information Center

Bonesronning, Hans

1996-01-01

Investigates the relationship between student achievement gains and student body composition in Norwegian uppersecondary schools, using a multilevel model considering assignment of students to departments. Estimates a reference frontier to identify best school practices and efficient and inefficient departments. Student achievement varies…

Achieving excellence in community health centers: implications for health reform.

PubMed

Gurewich, Deborah; Capitman, John; Sirkin, Jenna; Traje, Diana

2012-02-01

Existing studies tell us little about care quality variation within the community health center (CHC) delivery system. They also tell us little about the organizational conditions associated with CHCs that deliver especially high quality care. The purpose of this study was to examine the operational practices associated with a sample of high performing CHCs. Qualitative case studies of eight CHCs identified as delivering high-quality care relative to other CHCs were used to examine operational practices, including systems to facilitate care access, manage patient care, and monitor performance. Four common themes emerged that may contribute to high performance. At the same time, important differences across health centers were observed, reflecting differences in local environments and CHC capacity. In the development of effective, community-based models of care, adapting care standards to meet the needs of local conditions may be important.

Measuring the effectiveness and impact of an open innovation platform.

PubMed

Carroll, Glenn P; Srivastava, Sanjay; Volini, Adam S; Piñeiro-Núñez, Marta M; Vetman, Tatiana

2017-05-01

Today, most pharmaceutical companies complement their traditional R&D models with some variation on the Open Innovation (OI) approach in an effort to better access global scientific talent, ideas and hypotheses. Traditional performance indicators that measure economic returns from R&D through commercialization are often not applicable to the practical assessment of these OI approaches, particularly within the context of early drug discovery. This leaves OI programs focused on early R&D without a standard assessment framework from which to evaluate overall performance. This paper proposes a practical dashboard for such assessment, encompassing quantitative and qualitative elements, to enable decision-making and improvement of future performance. The use of this dashboard is illustrated using real-time data from the Lilly Open Innovation Drug Discovery (OIDD) program. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

What can family medicine practices do to facilitate knowledge management?

PubMed

Orzano, A John; Ohman-Strickland, Pamela A; Patel, Meghal

2008-01-01

Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics. To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM. We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role). Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes of these effects were not substantially changed even when practice members perceived their practice environment as more chaotic. Steps to facilitate KM should be considered when evaluating more intensive and costly organizational solutions for enhancing family medicine practice performance.

Multipayer patient-centered medical home implementation guided by the chronic care model.

PubMed

Gabbay, Robert A; Bailit, Michael H; Mauger, David T; Wagner, Edward H; Siminerio, Linda

2011-06-01

A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives. Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016). During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients. Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.

Evaluation of emotion-based messages designed to motivate Hispanic and Asian parents of early adolescents to engage in calcium-rich food and beverage parenting practices.

PubMed

Banna, Jinan Corinne; Reicks, Marla; Gunther, Carolyn; Richards, Rickelle; Bruhn, Christine; Cluskey, Mary; Wong, Siew Sun; Misner, Scottie; Hongu, Nobuko; Johnston, N Paul

2016-08-01

Setting healthful beverage expectations, making calcium-rich foods and beverages (CRF/B) available, and role modeling are parenting practices promoting calcium intake among early adolescents. This study aimed to evaluate emotion-based messages designed to motivate parents of early adolescents to perform these practices. Emotion-based messages were developed for each parenting practice and tested in 35 parents from 5 states. Findings were used to modify messages and develop a survey administered via Amazon MechanicalTurk to a convenience sample of Asian (n = 166) and Hispanic (n = 184) parents of children 10-13 years. Main outcome measures were message comprehension, motivation, relevance, acceptability, and novelty. Engagement in the parenting practices was also assessed. Message comprehension was acceptable for the majority of parents. Most also agreed that messages were motivational (setting healthful beverage expectations (69.0%), making CRF/B available (67.4%), and role modeling (80.0%)), relevant and acceptable. About 30-50% indicated they had not seen the information before. Many parents indicated they were already engaging in the practices (> 70%). No racial/ethnic differences were observed for responses to messages or engaging in parenting practices. Results indicate that emotion-based messages designed to motivate parents to engage in parenting practices that promote calcium intake among early adolescents were motivating, relevant, and acceptable.

Standard operating procedures for sows and piglets in farrowing and lactation in Japanese commercial herds.

PubMed

Ichikawa, Hiroki; Koketsu, Yuzo

2012-11-01

The objectives of the present study were to advance the development of standard operating procedures for sows and piglets during farrowing and lactation in Japanese herds by surveying management procedures and to examine the relationships between the procedures and herd reproductive performance. In 2009, 115 herds using the same recording system were asked to complete a questionnaire about their management procedures. Data from 96 (83.5%) returned questionnaires were coordinated with the respective herd reproductive performance. The participating herds were classified into two groups based on the upper 25th percentile of pigs weaned per mated female per year: high-performing (>23.8 pigs) or ordinary herds. ANOVA was used to compare the procedures between two herd groups. Modeling with backward elimination was performed to establish the most important procedures for herd performance. More high-performing herds practiced farrowing induction and high-performing herds also had a higher percentage of farrowing-induced sows than ordinary herds (P<0.05). Modeling showed that herds feeding lactating sows with dietary fiber had 1.4% lower preweaning mortality risk than those that did not (P<0.05). Herds practicing fostering techniques or using nurse sows had 0.2 kg heavier average pig weaning weight than those not using these procedures (P<0.05). There was no association between pigs born alive and any of the surveyed management procedures. Based on these results, we recommend improving performances in breeding herds by feeding lactating sows with dietary fiber, performing fostering techniques and using nurse sows.

An approach to facilitate healthcare professionals' readiness to support technology use in everyday life for persons with dementia.

PubMed

Malinowsky, Camilla; Rosenberg, Lena; Nygård, Louise

2014-05-01

Everyday technologies (ETs) like microwave ovens and automatic telephone services as well as assistive technologies (ATs) are often used in the performance of everyday activities. As a consequence, the ability to manage technology is important. This pilot study aimed to clarify the applicability of a model for knowledge translation to support healthcare professionals, to support technology use among older adults with dementia and their significant others. An additional aim was to explore the process of translating the model into practice. The applicability of the model (comprising a one-day course, including introduction and provision of tools, followed by interviews during and after a period of practice) was clarified for 11 healthcare professionals using a constant comparative approach. The content of the model gave the participants an eye-opening experience of technology use among persons with dementia. They also described how they had incorporated the model as a new way of thinking which supported and inspired new investigations and collaborations with colleagues and significant others. This study provided an applicable model of how research knowledge about technology use can be translated into clinical practice and be used by healthcare professionals to support the use of technology for persons with dementia.

A model of destination image promotion with a case study of Nanjing, P. R. China

Treesearch

Xiang Li; Hans Vogelsong

2003-01-01

Destination image has long been a popular research topic in tourism studies. However, methods used to integrate image in real marketing practice and evaluating the market performance in a systematic way are still puzzling to practitioners. A destination image promotion model is proposed in this paper as an effort to solve the problem. The roles of some major factors...

Modeling and Explaining Content: Definition, Research Support, and Measurement of the "ETS"® National Observational Teaching Examination (NOTE) Assessment Series. Research Memorandum No. RM-16-07

ERIC Educational Resources Information Center

Stickler, Leslie; Sykes, Gary

2016-01-01

This report reviews the scholarly and research evidence supporting the construct labeled modeling and explaining content (MEC), which is measured via a performance assessment in the "ETS"® National Observational Teaching Examination (NOTE) assessment series. This construct involves practices at the heart of teaching that deal with how…

A Constraints-Led Perspective to Understanding Skill Acquisition and Game Play: A Basis for Integration of Motor Learning Theory and Physical Education Praxis?

ERIC Educational Resources Information Center

Renshaw, Ian; Chow, Jia Yi; Davids, Keith; Hammond, John

2010-01-01

Background: In order to design appropriate environments for performance and learning of movement skills, physical educators need a sound theoretical model of the learner and of processes of learning. In physical education, this type of modelling informs the organisation of learning environments and effective and efficient use of practice time. An…

Transfer of Learning from Practicing Microvascular Anastomosis on Silastic Tubes to Rat Abdominal Aorta.

PubMed

Mokhtari, Pooneh; Tayebi Meybodi, Ali; Lawton, Michael T; Payman, Andre; Benet, Arnau

2017-12-01

Learning to perform microvascular anastomosis is difficult. Laboratory practice models using artificial vessels are frequently used for this purpose. However, the efficacy of such practice models has not been objectively assessed for the performance of microvascular anastomosis during live surgical settings. This study was conducted to assess the transfer of learning from practicing microvascular anastomosis on tubes to anastomosing rat abdominal aorta. Ten surgeons without any experience in microvascular anastomosis were randomly assigned to an experimental or a control group. Both groups received didactic and visual training on end-to-end microvascular anastomosis. The experimental group received 24 sessions of hands-on training on microanastomosis using Silastic tubes. Next, both groups underwent recall tests on weeks 1, 2, and 8 after training. The recall test consisted of completing an end-to-end anastomosis on the rat's abdominal aorta. Anastomosis score, the time to complete the anastomosis, and the average time to place 1 stitch on the vessel perimeter were compared between the 2 groups. Compared with the control group, the experimental group did significantly better in terms of anastomosis score, total time, and per-stitch time. The measured variables showed stability and did not change significantly between the 3 recall tests. The skill of microvascular anastomosis is transferred from practicing on Silastic tubes to rat's abdominal aorta. Considering the relative advantages of Silastic tubes to live rodent surgeries, such as lower cost and absence of ethical issues, our results support the widespread use of Silastic tubes in training programs for microvascular anastomosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Strength and conditioning practices in rowing.

PubMed

Gee, Thomas I; Olsen, Peter D; Berger, Nicolas J; Golby, Jim; Thompson, Kevin G

2011-03-01

There is limited published research on the practices of strength and conditioning (S &C) coaches in Great Britain. Information about training program design would be useful in developing models of good practice and ecologically valid intervention studies. The aim of this research was to quantify the training practices of coaches responsible for the S&C of rowing athletes. A questionnaire was developed that consisted of 6 sections: (a) personal details, (b) physical testing, (c) strength and power development, (d) flexibility development, (e) unique aspects of the program, and (f) any further relevant comments regarding the athletes prescribed training program. Twenty-two rowing and 10 S&C coaches with an average of 10.5 ± 7.2 years' experience agreed to complete the questionnaire. Approximately, 34% coached rowers of Olympic standard, 34% coached national standard, 3% coached regional standard, 19% coached club standard, and 10% coached university standard rowers. All coaches agreed that strength training enhanced rowing performance and the majority (74%) indicated that athletes' strength trained 2-3 times a week. Almost all coaches (94%) reported their rowers performed strength training, with 81% using Olympic lifting, and 91% employing a periodized training model. The clean (63%) and squat (27%) were rated the most important prescribed exercises. Approximately 50% of coaches used plyometrics such as depth jumps, box drills, and standing jumps. Ninety-four percent indicated they conducted physical testing on their rowers, typically assessing cardiovascular endurance (80%), muscular power (70%), muscular strength (70%), and anaerobic capacity (57%). This research represents the only published survey to date on the S&C practices in rowing within Great Britain.

[THE ALTERNATIVE MODEL IN TRAINING FOR OPERATION MANAGEMENT ON LUMBAR SPINE].

PubMed

Zakondyrin, D E

2015-01-01

The authors proposed to use a lumbar part of calf carcass as a new biological model for training of basic practical skills in order to perform the neurosurgical operative interventions on the spine. The proximity of anatomico-surgical parameters of given model and human cavader lumbar spine was estimated. The study proved the possibility of use of lumbar part of calf carcass for training techniques of transpedicular fixation and microdiskectomy in lumbar part.

Validity and Practitality of Acid-Base Module Based on Guided Discovery Learning for Senior High School

NASA Astrophysics Data System (ADS)

Yerimadesi; Bayharti; Jannah, S. M.; Lufri; Festiyed; Kiram, Y.

2018-04-01

This Research and Development(R&D) aims to produce guided discovery learning based module on topic of acid-base and determine its validity and practicality in learning. Module development used Four D (4-D) model (define, design, develop and disseminate).This research was performed until development stage. Research’s instruments were validity and practicality questionnaires. Module was validated by five experts (three chemistry lecturers of Universitas Negeri Padang and two chemistry teachers of SMAN 9 Padang). Practicality test was done by two chemistry teachers and 30 students of SMAN 9 Padang. Kappa Cohen’s was used to analyze validity and practicality. The average moment kappa was 0.86 for validity and those for practicality were 0.85 by teachers and 0.76 by students revealing high category. It can be concluded that validity and practicality was proven for high school chemistry learning.

Modelling municipal solid waste generation: a review.

PubMed

Beigl, Peter; Lebersorger, Sandra; Salhofer, Stefan

2008-01-01

The objective of this paper is to review previously published models of municipal solid waste generation and to propose an implementation guideline which will provide a compromise between information gain and cost-efficient model development. The 45 modelling approaches identified in a systematic literature review aim at explaining or estimating the present or future waste generation using economic, socio-demographic or management-orientated data. A classification was developed in order to categorise these highly heterogeneous models according to the following criteria--the regional scale, the modelled waste streams, the hypothesised independent variables and the modelling method. A procedural practice guideline was derived from a discussion of the underlying models in order to propose beneficial design options concerning regional sampling (i.e., number and size of observed areas), waste stream definition and investigation, selection of independent variables and model validation procedures. The practical application of the findings was demonstrated with two case studies performed on different regional scales, i.e., on a household and on a city level. The findings of this review are finally summarised in the form of a relevance tree for methodology selection.

The Comparative Study of Metacognition: Sharper Paradigms, Safer Inferences

PubMed Central

Smith, J. David; Beran, Michael J.; Couchman, Justin J.; Coutinho, Mariana V. C.

2015-01-01

Results that point to animals’ metacognitive capacity bear a heavy burden given the potential for competing behavioral descriptions. This article uses formal models to evaluate the force of these descriptions. One example is that many existing studies have directly rewarded so-called “uncertainty” responses. Modeling confirms that this practice is an interpretative danger because it supports associative processes and encourages simpler interpretations. Another example is that existing studies raise the concern that animals avoid difficult stimuli not because of uncertainty monitored but because of aversion given error-causing or reinforcement-lean stimuli. Modeling also justifies this concern and shows that this problem is not addressed by the common practice of comparing performance on Chosen and Forced trials. The models and related discussion have utility for metacognition researchers and theorists broadly because they specify the experimental operations that will best indicate a metacognitive capacity in humans or animals by eliminating alternative behavioral accounts. PMID:18792496

Effect of simultaneous model observation and self-modeling of volleyball skill acquisition.

PubMed

Barzouka, Karolina; Bergeles, Nikolaos; Hatziharistos, Dimitris

2007-02-01

This study examined the effect of feedback with simultaneous skilled model observation and self-modeling on volleyball skill acquisition. 53 pupils 12 to 15 years old formed two experimental groups and one control group who followed an intervention program with 12 practice sessions for acquisition and retention of how to receive a ball. Groups received different types of feedback before and in the middle of each practice session. Reception performance outcome (score) and technique in every group were assessed before and at the end of the intervention program and during the retention phase. A 3 (Group) x 3 (Measurement Period) multivariate analysis of variance with repeated measures was applied to investigate differences. Results showed equivalent improvement in all three groups at the end of the intervention program. In conclusion, types of augmented feedback from the physical education teacher are effective in acquisition and retention of the skill for reception in volleyball.