Adaptation and cross-cultural validation of the United States Primary Care Assessment Tool (expanded version) for use in South Africa.

PubMed

Bresick, Graham; Sayed, Abdul-Rauf; le Grange, Cynthia; Bhagwan, Susheela; Manga, Nayna

2015-06-19

Measuring primary care is important for health sector reform. The Primary Care Assessment Tool (PCAT) measures performance of elements essential for cost-effective care. Following minor adaptations prior to use in Cape Town in 2011, a few findings indicated a need to improve the content and cross-cultural validity for wider use in South Africa (SA). This study aimed to validate the United States of America-developed PCAT before being used in a baseline measure of primary care performance prior to major reform. Public sector primary care clinics, users, practitioners and managers in urban and rural districts in the Western Cape Province. Face value evaluation of item phrasing and a combination of Delphi and Nominal Group Technique (NGT) methods with an expert panel and user focus group were used to obtain consensus on content relevant to SA. Original and new domains and items with > = 70% agreement were included in the South African version--ZA PCAT. All original PCAT domains achieved consensus on inclusion. One new domain, the primary healthcare (PHC) team, was added. Three of 95 original items achieved < 70% agreement, that is consensus to exclude as not relevant to SA; 19 new items were added. A few items needed minor rephrasing with local healthcare jargon. The demographic section was adapted to local socio-economic conditions. The adult PCAT was translated into isiXhosa and Afrikaans. The PCAT is a valid measure of primary care performance in SA. The PHC team domain is an important addition, given its emphasis in PHC re-engineering. A combination of Delphi and NGT methods succeeded in obtaining consensus on a multi-domain, multi-item instrument in a resource-constrained environment.

Long-term & short-term measures of roadway snow and ice control performance : final report.

DOT National Transportation Integrated Search

2016-07-08

The primary performance measures for RSIC programs by state DOTs are 1) operating speed recovery time and 2) time to achieve bare pavement. There is a continued need for objective, outcome-based performance metrics for RSIC operations. The overall go...

Better Measurement for Performance Improvement in Low- and Middle-Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection.

PubMed

Veillard, Jeremy; Cowling, Krycia; Bitton, Asaf; Ratcliffe, Hannah; Kimball, Meredith; Barkley, Shannon; Mercereau, Laure; Wong, Ethan; Taylor, Chelsea; Hirschhorn, Lisa R; Wang, Hong

2017-12-01

Policy Points: Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC). The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement. Results from the initial PHC performance assessments in low- and middle-income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross-country comparisons and peer learning to improve PHC. New indicators and sources of data are needed to better understand PHC system performance in LMICs. The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low- and middle-income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released. The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross-referenced against indicators available from international sources, and evaluated through 2 separate modified Delphi processes, consisting of online surveys and in-person facilitated discussions with experts. The PHCPI conceptual framework builds on the current understanding of PHC system performance through an expanded emphasis on the role of service delivery. The first set of performance indicators, 36 Vital Signs, facilitates comparisons across countries and over time. The second set, 56 Diagnostic Indicators, elucidates underlying drivers of performance. Key challenges include a lack of available data for several indicators and a lack of validated indicators for important dimensions of quality PHC. The availability of data is critical to assessing PHC performance, particularly patient experience and quality of care. The PHCPI will continue to develop and test additional performance assessment instruments, including composite indices and national performance dashboards. Through country engagement, the PHCPI will further refine its instruments and engage with governments to better design and finance primary health care reforms. © 2017 Milbank Memorial Fund.

Learning primary care in medical school: does specialty or geographic location of the teaching site make a difference?

PubMed

Irigoyen, M M; Kurth, R J; Schmidt, H J

1999-05-01

The Liaison Committee on Medical Education mandates a core curriculum in primary care but does not specify its content or structure. In this study, we explored the question of whether primary care specialty or geographic location affects student learning and satisfaction. From 1994 to 1996, 294 third-year medical students at one medical school in New York state were randomly assigned to multiple teaching sites for a required 5-week primary care clerkship. Independent predictor variables were primary care specialty of the preceptor (family medicine, medicine, pediatrics, or joint medicine and pediatrics) and geographic location of the site (urban, suburban, rural). Outcome measures included four areas of student satisfaction, one of patient volume, and two of student performance. Primary care specialty had no detectable association with the outcome measures, except for a lower rating of patient diversity in pediatric experiences (P <0.001). Geographic location of the site had a significant association with all measures of student satisfaction and patient volume (all P values <0.001). Students at rural sites rated the experience more highly and saw on average 15 more patients per rotation. Ratings of student satisfaction remained high after adjusting for patient volume. Primary care specialty and geographic location did not influence student performance in the clerkship or scores on standardized patient examination. Rural geographic location of teaching site, but not primary care specialty, was associated with higher student satisfaction. However, higher student satisfaction ratings did not correspond to better student performance. Provided that all sites meet the screening criteria for inclusion in a teaching program, these findings support the continued development of high-quality, heterogeneous, interdisciplinary, primary care experiences.

Sensitivity Analysis for Steady State Groundwater Flow Using Adjoint Operators

NASA Astrophysics Data System (ADS)

Sykes, J. F.; Wilson, J. L.; Andrews, R. W.

1985-03-01

Adjoint sensitivity theory is currently being considered as a potential method for calculating the sensitivity of nuclear waste repository performance measures to the parameters of the system. For groundwater flow systems, performance measures of interest include piezometric heads in the vicinity of a waste site, velocities or travel time in aquifers, and mass discharge to biosphere points. The parameters include recharge-discharge rates, prescribed boundary heads or fluxes, formation thicknesses, and hydraulic conductivities. The derivative of a performance measure with respect to the system parameters is usually taken as a measure of sensitivity. To calculate sensitivities, adjoint sensitivity equations are formulated from the equations describing the primary problem. The solution of the primary problem and the adjoint sensitivity problem enables the determination of all of the required derivatives and hence related sensitivity coefficients. In this study, adjoint sensitivity theory is developed for equations of two-dimensional steady state flow in a confined aquifer. Both the primary flow equation and the adjoint sensitivity equation are solved using the Galerkin finite element method. The developed computer code is used to investigate the regional flow parameters of the Leadville Formation of the Paradox Basin in Utah. The results illustrate the sensitivity of calculated local heads to the boundary conditions. Alternatively, local velocity related performance measures are more sensitive to hydraulic conductivities.

Radon Levels in Nurseries and Primary Schools in Bragança District-Preliminary Assessment.

PubMed

Sousa, S I V; Branco, P T B S; Nunes, R A O; Alvim-Ferraz, M C M; Martins, F G

2015-01-01

Lung cancer has been associated with radon concentration even at low levels such as those found in dwellings. This study aimed to (i) determine radon diurnal variations in three nurseries and one primary school in the Bragança district (north of Portugal) and (ii) compare radon concentrations with legislated standards and assess the legislated procedures. Radon was measured in three nurseries and a primary school in a rural area with nongranite soil. Measurements were performed continuously to examine differences between occupation and nonoccupation periods. Indoor temperature and relative humidity were also measured continuously. A great variability was found in radon concentrations between the microenvironments examined. Radon concentrations surpassed by severalfold the recommended guidelines and thresholds, and excessive levels of health concern were sporadically found (361.5-753.5 Bq m(-3)). Thus, it is of importance to perform a national campaign on radon measurements and to reduce exposure.

Assessment of Age-Related Differences in Functional Capacity Using the Virtual Reality Functional Capacity Assessment Tool (VRFCAT)

PubMed Central

Atkins, A.S.; Stroescu, I.; Spagnola, N.B.; Davis, V.G.; Patterson, T.D.; Narasimhan, M.; Harvey, P.D.; Keefe, R.S.E.

2015-01-01

Clinical trials for primary prevention and early intervention in preclinical AD require measures of functional capacity with improved sensitivity to deficits in healthier, non-demented individuals. To this end, the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) was developed as a direct performance-based assessment of functional capacity that is sensitive to changes in function across multiple populations. Using a realistic virtual reality environment, the VRFCAT assesses a subject's ability to complete instrumental activities associated with a shopping trip. The present investigation represents an initial evaluation of the VRFCAT as a potential co-primary measure of functional capacity in healthy aging and preclinical MCI/AD by examining test-retest reliability and associations with cognitive performance in healthy young and older adults. The VRFCAT was compared and contrasted with the UPSA-2-VIM, a traditional performance-based assessment utilizing physical props. Results demonstrated strong age-related differences in performance on each VRFCAT outcome measure, including total completion time, total errors, and total forced progressions. VRFCAT performance showed strong correlations with cognitive performance across both age groups. VRFCAT Total Time demonstrated good test-retest reliability (ICC=.80 in young adults; ICC=.64 in older adults) and insignificant practice effects, indicating the measure is suitable for repeated testing in healthy populations. Taken together, these results provide preliminary support for the VRFCAT as a potential measure of functionally relevant change in primary prevention and preclinical AD/MCI trials. PMID:26618145

Quality of Type II Diabetes Care in Primary Health Care Centers in Kuwait: Employment of a Diabetes Quality Indicator Set (DQIS).

PubMed

Badawi, Dalia; Saleh, Shadi; Natafgi, Nabil; Mourad, Yara; Behbehani, Kazem

2015-01-01

Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from that developed by the National Diabetes Quality Improvement Alliance and the International Diabetes Federation. Five key care domains/measures were employed: (1) Blood glucose level measurement, (2) Cholesterol level measurement, (3) Blood pressure measurement, (4) Kidney function testing and (5) Smoking status check. The sample included the four major primary health care centers with the highest case load in Kuwait City, 4,241 patients in 2012 and 3,211 in 2010. Findings revealed the applicability and utility of employing performance indicators for diabetes care in Kuwait. Furthermore, findings revealed that many of the primary health care centers have achieved noteworthy improvement in diabetes care between 2010 and 2012, with the exception of smoking status check. The DQIS can help policymakers identify performance gaps and investigate key system roadblocks related to diabetes care in Kuwait.

A Meta-Analysis of Adult-Rated Child Personality and Academic Performance in Primary Education

ERIC Educational Resources Information Center

Poropat, Arthur E.

2014-01-01

Background: Personality is reliably associated with academic performance, but personality measurement in primary education can be problematic. Young children find it difficult to accurately self-rate personality, and dominant models of adult personality may be inappropriate for children. Aims: This meta-analysis was conducted to determine the…

Executive Functions as Predictors of School Performance and Social Relationships: Primary and Secondary School Students.

PubMed

Zorza, Juan Pablo; Marino, Julián; Acosta Mesas, Alberto

2016-05-12

This study examined the relationship between executive functions (EFs) and school performance in primary and secondary school students aged 8 to 13 years (N = 146, M = 10.4, 45.8% girls). EFs were evaluated using the Trail Making Test (TMT), Verbal Fluency (VF), and the Stroop Test. Students' GPAs and teachers' assessment of academic skills were used to measure school performance. To evaluate the students' social behavior, participants were asked to rate all their classmates' prosocial behavior and nominate three students with whom they preferred to do school activities; teachers also provided evaluations of students' social skills. EF measures explained 41% (p = .003, f 2 = .694) of variability in school performance and 29% (p = .005, f 2 = .401) of variance in social behavior in primary school students. The predictive power of EFs was found to be lower for secondary school students, although the TMT showed significant prediction and explained 13% (p = .004, f 2 = .149) of variance in school performance and 15% (p = .008, f 2 = .176) in peer ratings of prosocial behavior. This paper discusses the relevance of EFs in the school environment and their different predictive power in primary and secondary school students.

Analysis of target wavefront error for secondary mirror of a spaceborne telescope

NASA Astrophysics Data System (ADS)

Chang, Shenq-Tsong; Lin, Wei-Cheng; Kuo, Ching-Hsiang; Chan, Chia-Yen; Lin, Yu-Chuan; Huang, Ting-Ming

2014-09-01

During the fabrication of an aspherical mirror, the inspection of the residual wavefront error is critical. In the program of a spaceborne telescope development, primary mirror is made of ZERODUR with clear aperture of 450 mm. The mass is 10 kg after lightweighting. Deformation of mirror due to gravity is expected; hence uniform supporting measured by load cells has been applied to reduce the gravity effect. Inspection has been taken to determine the residual wavefront error at the configuration of mirror face upwards. Correction polishing has been performed according to the measurement. However, after comparing with the data measured by bench test while the primary mirror is at a configuration of mirror face horizontal, deviations have been found for the two measurements. Optical system that is not able to meet the requirement is predicted according to the measured wavefront error by bench test. A target wavefront error of secondary mirror is therefore analyzed to correct that of primary mirror. Optical performance accordingly is presented.

Photonic Doppler velocimetry probe designed with stereo imaging

NASA Astrophysics Data System (ADS)

Malone, Robert M.; Cata, Brian M.; Daykin, Edward P.; Esquibel, David L.; Frogget, Brent C.; Holtkamp, David B.; Kaufman, Morris I.; McGillivray, Kevin D.; Palagi, Martin J.; Pazuchanics, Peter; Romero, Vincent T.; Sorenson, Danny S.

2014-09-01

During the fabrication of an aspherical mirror, the inspection of the residual wavefront error is critical. In the program of a spaceborne telescope development, primary mirror is made of ZERODUR with clear aperture of 450 mm. The mass is 10 kg after lightweighting. Deformation of mirror due to gravity is expected; hence uniform supporting measured by load cells has been applied to reduce the gravity effect. Inspection has been taken to determine the residual wavefront error at the configuration of mirror face upwards. Correction polishing has been performed according to the measurement. However, after comparing with the data measured by bench test while the primary mirror is at a configuration of mirror face horizontal, deviations have been found for the two measurements. Optical system that is not able to meet the requirement is predicted according to the measured wavefront error by bench test. A target wavefront error of secondary mirror is therefore analyzed to correct that of primary mirror. Optical performance accordingly is presented.

More than a score: a qualitative study of ancillary benefits of performance measurement.

PubMed

Powell, Adam A; White, Katie M; Partin, Melissa R; Halek, Krysten; Hysong, Sylvia J; Zarling, Edwin; Kirsh, Susan R; Bloomfield, Hanna E

2014-08-01

Prior research has examined clinical effects of performance measurement systems. To the extent that non-clinical effects have been researched, the focus has been on negative unintended consequences. Yet, these same systems may also have ancillary benefits for patients and providers--that is, benefits that extend beyond improvements on clinical measures. The purpose of this study is to identify and describe potential ancillary benefits of performance measures as perceived by primary care staff and facility leaders in a large US healthcare system. In-person individual semistructured interviews were conducted with 59 primary care staff and facility leaders at four Veterans Health Administration facilities. Transcribed interviews were coded and organised into thematic categories. Interviewed staff observed that local performance measurement implementation practices can result in increased patient knowledge and motivation. These effects on patients can lead to improved performance scores and additional ancillary benefits. Performance measurement implementation can also directly result in ancillary benefits for the patients and providers. Patients may experience greater satisfaction with care and psychosocial benefits associated with increased provider-patient communication. Ancillary benefits of performance measurement for providers include increased pride in individual or organisational performance and greater confidence that one's practice is grounded in evidence-based medicine. A comprehensive understanding of the effects of performance measurement systems needs to incorporate ancillary benefits as well as effects on clinical performance scores and negative unintended consequences. Although clinical performance has been the focus of most evaluations of performance measurement to date, both patient care and provider satisfaction may improve more rapidly if all three categories of effects are considered when designing and evaluating performance measurement systems. 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.

The impact of occupational therapy in Parkinson's disease: a randomized controlled feasibility study.

PubMed

Sturkenboom, Ingrid H; Graff, Maud J; Borm, George F; Veenhuizen, Yvonne; Bloem, Bastiaan R; Munneke, Marten; Nijhuis-van der Sanden, Maria W

2013-02-01

To evaluate the feasibility of a randomized controlled trial including process and potential impact of occupational therapy in Parkinson's disease. Process and outcome were quantitatively and qualitatively evaluated in an exploratory multicentre, two-armed randomized controlled trial at three months. Forty-three community-dwelling patients with Parkinson's disease and difficulties in daily activities, their primary caregivers and seven occupational therapists. Ten weeks of home-based occupational therapy according to the Dutch guidelines of occupational therapy in Parkinson's disease versus no occupational therapy in the control group. Process evaluation measured accrual, drop-out, intervention delivery and protocol adherence. Primary outcome measures of patients assessed daily functioning: Canadian Occupational Performance Measure (COPM) and Assessment of Motor and Process Skills. Primary outcome for caregivers was caregiver burden: Zarit Burden Inventory. Participants' perspectives of the intervention were explored using questionnaires and in-depth interviews. Inclusion was 23% (43/189), drop-out 7% (3/43) and unblinding of assessors 33% (13/40). Full intervention protocol adherence was 74% (20/27), but only 60% (71/119) of baseline Canadian Occupational Performance Measure priorities were addressed in the intervention. The outcome measures revealed negligible to small effects in favour of the intervention group. Almost all patients and caregivers of the intervention group were satisfied with the results. They perceived: 'more grip on the situation' and used 'practical advices that make life easier'. Therapists were satisfied, but wished for a longer intervention period. The positive perceived impact of occupational therapy warrants a large-scale trial. Adaptations in instructions and training are needed to use the Canadian Occupational Performance Measure as primary outcome measure.

Quantitative research regarding performance measures for intermodal freight transportation : executive summary

DOT National Transportation Integrated Search

1995-10-01

The primary objective of this study is to provide information relative to the development of a set of performance measures for intermodal freight transportation. To accomplish this objective, data was collected, processed, and analyzed on the basis o...

Understanding performance management in primary care.

PubMed

Rogan, Lisa; Boaden, Ruth

2017-02-13

Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

Validation of a Visual-Spatial Secondary Task to Assess Automaticity in Laparoscopic Skills.

PubMed

Castillo, Richard; Alvarado, Juan; Moreno, Pablo; Billeke, Pablo; Martínez, Carlos; Varas, Julián; Jarufe, Nicolás

2017-12-26

Our objective was to assess reliability and validity of a visual-spatial secondary task (VSST) as a method to measure automaticity on a basic simulated laparoscopic skill model. In motor skill acquisition, expertise is defined by automaticity. The highest level of performance with less cognitive and attentional resources characterizes this stage, allowing experts to perform multiple tasks. Conventional validated parameters as operative time, objective assessment skills scales (OSATS), and movement economy, are insufficient to distinguish if an individual has reached the more advanced learning phases, such as automaticity. There is literature about using a VSST as an attention indicator that correlates with the automaticity level. Novices with completed and approved Fundamentals of Laparoscopic Surgery course, and laparoscopy experts were enrolled for an experimental study and measured under dual tasks conditions. Each participant performed the test giving priority to the primary task while at the same time they responded to a VSST. The primary task consisted of 4 interrupted laparoscopic stitches (ILS) on a bench-model. The VSST was a screen that showed different patterns that the surgeon had to recognize and press a pedal while doing the stitches (PsychoPsy software, Python, MacOS). Novices were overtrained on ILS until they reach at least 100 repetitions and then were retested. Participants were video recorded and then assessed by 2 blinded evaluators who measured operative time and OSATS. These scores were considered indicators of quality for the primary task. The VSST performance was measured by the detectability index (DI), which is a ratio between correct and wrong detections. A reliable evaluation was defined as two measures of DI with less than 10% of difference, maintaining the cutoff scores for performance on the primary task (operative time <110 seg and OSATS >17 points). Novices (n = 11) achieved reliable measure of the test after 2 (2-5) repetitions on the preassessment and 3.75 (2-5) on the postassessment (p = 0.04); whereas laparoscopy experts (n = 4) did it after 3.5 (3-4) repetitions. Proficiency cutoff scores for the primary task were achieved on every measure for novices (prepost overtraining) and experts. Expert performance on VSST was DI 0.78 (0.69-0.87). Novice performance was significantly better on postassessment (DI-pre 0.48 [0.06-0.71] vs DI-post 0.78 [0.48-0.95], p = 0.003). Overtraining consisted in 140 (100-210) repetitions of ILS for all novices, made in 8 hours (3-15). By categorizing DI based on expert performance, novices with DI-post >0.65 achieved better OSATS score and less operative time than novices with DI-post<0.65 (p = 0.007 y, p = 0.089, respectively). Measuring automaticity is feasible using a VSST. This instrument is reliable and has a face, content and construct validity. A DI over 0.65 may be a cutoff point correlated with high standard performance on the primary task. This instrument measures performance on laparoscopic skills, and along with conventional indicators, would better define advance levels of expertise. More studies are required applying this VSST to achieve external validity by reproducing our results. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

APMS 3.0 Flight Analyst Guide: Aviation Performance Measuring System

NASA Technical Reports Server (NTRS)

Jay, Griff; Prothero, Gary; Romanowski, Timothy; Lynch, Robert; Lawrence, Robert; Rosenthal, Loren

2004-01-01

The Aviation Performance Measuring System (APMS) is a method-embodied in software-that uses mathematical algorithms and related procedures to analyze digital flight data extracted from aircraft flight data recorders. APMS consists of an integrated set of tools used to perform two primary functions: a) Flight Data Importation b) Flight Data Analysis.

The measurement of the cosmic ray primary energy spectrum at 1016-1018 eV with the KASCADE-Grande experiment

NASA Astrophysics Data System (ADS)

Cantoni, Elena; Apel, W. D.; Arteaga-Velázquez, J. C.; Bekk, K.; Bertaina, M.; Blümer, J.; Bozdog, H.; Brancus, I. M.; Buchholz, P.; Chiavassa, A.; Cossavella, F.; Daumiller, K.; de Souza, V.; di Pierro, F.; Doll, P.; Engel, R.; Engler, J.; Finger, M.; Fuhrmann, D.; Ghia, P. L.; Gils, H. J.; Glasstetter, R.; Grupen, C.; Haungs, A.; Heck, D.; Hörandel, J. R.; Huege, T.; Isar, P. G.; Kampert, K.-H.; Kang, D.; Kickelbick, D.; Klages, H. O.; Link, K.; Łuczak, P.; Ludwig, M.; Mathes, H. J.; Mayer, H. J.; Melissas, M.; Milke, J.; Mitrica, B.; Morello, C.; Navarra, G.; Nehls, S.; Oehlschläger, J.; Ostapchenko, S.; Over, S.; Palmieri, N.; Petcu, M.; Pierog, T.; Rebel, H.; Roth, M.; Schieler, H.; Schröder, F. G.; Sima, O.; Toma, G.; Trinchero, G. C.; Ulrich, H.; Weindl, A.; Wochele, J.; Wommer, M.; Zabierowski, J.

2011-03-01

The KASCADE-Grande experiment operates at Karlsruhe Institute of Technology (KIT) in Germany. It's aim is the study of the primary cosmic radiation, through Extensive Air Shower detection, in the range 1016-1018 eV. Here, measurements are of main interest to understand the high energy evolution of cosmic radiation: a change in the slope of the heavy primary spectrum is expected (as measured at lower energies for lighter primaries) as a possible confirmation of the predicted astrophysical mechanisms; moreover, in this range the transition from galactic to extragalactic radiation is supposed to take place and the observations could clarify the features of this transition, putting the basis for the interpretation of the data at the highest energies. For these tasks KASCADE-Grande fulfills very well the requirements, both concerning the acceptance and the experimental performances. The experiment is constituted by two co-operating arrays of detectors: the KASCADE array, with its 252 detectors in a dense grid of 200×200 m2 and the Grande array, made of 37 detectors arranged on a wider area of 700×700 m2. The Grande array samples the total charged particles size of the air shower, while the KASCADE array provides the muon size In this contribution, KASCADE-Grande measurement of the cosmic ray primary energy spectrum is presented. The exploited technique, calibrated with simulations, combines the charged particles component and muon component on a shower by shower basis, performing the energy estimation of each primary event. Other techniques are also performed, for a better evaluation of systematics and a check of consistency of the hadronic interaction model used in simulations.

A pump monitoring approach to irrigation pumping plant testing

USDA-ARS?s Scientific Manuscript database

The conventional approach for evaluating irrigation pumping plant performance has been an instantaneous spot measurement approach. Using this method, the tester measures the necessary work and energy use parameters to determine overall pumping plant performance. The primary limitation of this appr...

Self-Reported Disability: Association With Lower Extremity Performance and Other Determinants in Older Adults Attending Primary Care.

PubMed

Silva, Anabela G; Queirós, Alexandra; Sa-Couto, Pedro; Rocha, Nelson P

2015-12-01

Measurement of function usually involves the use of both performance-based and self-report instruments. However, the relationship between both types of measures is not yet completely understood, in particular for older adults attending primary care. The main objective of the study was to investigate the association between the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the Short Physical Performance Battery (SPPB) for older adults at primary care. A secondary objective was to determine the influence of sociodemographic and health-related variables on this relationship. This was a cross-sectional study. A total of 504 participants aged 60 years and older from 18 different primary care centers underwent a one-session assessment including: sociodemographic variables, comorbidities, performance, self-reported disability, pain, depressive symptoms, and physical activity. Performance was assessed using the SPPB, and self-reported disability was assessed using the WHODAS 2.0. The correlation between WHODAS 2.0 and SPPB scores was strong (r=.65). Regression analysis showed that the SPPB total score explained 41.7% of the variance in WHODAS 2.0 scores (adjusted R(2)=41.6%). A second model including the SPPB subtests (balance, gait, and sit-to-stand), depressive symptoms, number of pain sites, pain intensity, and level of physical activity explained 61.7% of the variance in WHODAS 2.0 scores (adjusted R(2)=60.4%). No model improvement was found when considering the 6 WHODAS 2.0 individual domains. The cross-sectional nature of the study does not allow inferences on causal relationships. This study's findings confirm that self-report and performance-based measures relate to different aspects of functioning. Further study is needed to determine if primary care interventions targeting lower extremity performance and depressive symptoms improve self-reported disability. © 2015 American Physical Therapy Association.

Measuring Primary Students' Graph Interpretation Skills via a Performance Assessment: A Case Study in Instrument Development

ERIC Educational Resources Information Center

Peterman, Karen; Cranston, Kayla A.; Pryor, Marie; Kermish-Allen, Ruth

2015-01-01

This case study was conducted within the context of a place-based education project that was implemented with primary school students in the USA. The authors and participating teachers created a performance assessment of standards-aligned tasks to examine 6-10-year-old students' graph interpretation skills as part of an exploratory research…

Primary Schools and Network Governance: A Policy Analysis of Reception Baseline Assessment

ERIC Educational Resources Information Center

Roberts-Holmes, Guy; Bradbury, Alice

2017-01-01

Primary school reception baseline assessment was designed to produce a single "baseline" data figure on the basis of which young children's progress across primary school could be measured and accounted for. This paper suggests that within the context of punitive performativity, head teachers might be considered "irresponsible"…

On the measurement of pilot perceptual workload - A comparison of assessment techniques addressing sensitivity and intrusion issues

NASA Technical Reports Server (NTRS)

Casali, J. G.; Wierwille, W. W.

1984-01-01

A flight simulator-based study was conducted to examine fourteen distinct mental workload estimation measures, including opinion, secondary task, physiological, and primary task measures. Both the relative sensitivity of the measures to changes in mental workload and the differential intrusion of the changes on primary task performance were assessed. The flight task was varied in difficulty by manipulation of the presentation rate and complexity of a hazard-perception task that required each of 48 licensed pilots to rely heavily on their perceptual abilities. Three rating scales (Modified Cooper-Harper, Multi-descriptor, and Workload-Compensation-Interference/Technical Effectiveness), two secondary task measures (time estimation and tapping regularity), one physiological measure (respiration frequency), and one primary task measure (danger-condition response time) were reliable indicants of workload changes. Recommendations for applying the workload measures are presented.

Private sector data for performance management.

DOT National Transportation Integrated Search

2011-07-01

This report examines and analyzes technical and institutional issues associated with the use of private sector travel time and speed data for public sector performance management. The primary data needs for congestion performance measures are outline...

Comparison of workload measures on computer-generated primary flight displays

NASA Technical Reports Server (NTRS)

Nataupsky, Mark; Abbott, Terence S.

1987-01-01

Four Air Force pilots were used as subjects to assess a battery of subjective and physiological workload measures in a flight simulation environment in which two computer-generated primary flight display configurations were evaluated. A high- and low-workload task was created by manipulating flight path complexity. Both SWAT and the NASA-TLX were shown to be effective in differentiating the high and low workload path conditions. Physiological measures were inconclusive. A battery of workload measures continues to be necessary for an understanding of the data. Based on workload, opinion, and performance data, it is fruitful to pursue research with a primary flight display and a horizontal situation display integrated into a single display.

Improved perceptual-motor performance measurement system

NASA Technical Reports Server (NTRS)

Parker, J. F., Jr.; Reilly, R. E.

1969-01-01

Battery of tests determines the primary dimensions of perceptual-motor performance. Eighteen basic measures range from simple tests to sophisticated electronic devices. Improved system has one unit for the subject containing test display and response elements, and one for the experimenter where test setups, programming, and scoring are accomplished.

Predicting story goodness performance from cognitive measures following traumatic brain injury.

PubMed

Lê, Karen; Coelho, Carl; Mozeiko, Jennifer; Krueger, Frank; Grafman, Jordan

2012-05-01

This study examined the prediction of performance on measures of the Story Goodness Index (SGI; Lê, Coelho, Mozeiko, & Grafman, 2011) from executive function (EF) and memory measures following traumatic brain injury (TBI). It was hypothesized that EF and memory measures would significantly predict SGI outcomes. One hundred sixty-seven individuals with TBI participated in the study. Story retellings were analyzed using the SGI protocol. Three cognitive measures--Delis-Kaplan Executive Function System (D-KEFS; Delis, Kaplan, & Kramer, 2001) Sorting Test, Wechsler Memory Scale--Third Edition (WMS-III; Wechsler, 1997) Working Memory Primary Index (WMI), and WMS-III Immediate Memory Primary Index (IMI)--were entered into a multiple linear regression model for each discourse measure. Two sets of regression analyses were performed, the first with the Sorting Test as the first predictor and the second with it as the last. The first set of regression analyses identified the Sorting Test and IMI as the only significant predictors of performance on measures of the SGI. The second set identified all measures as significant predictors when evaluating each step of the regression function. The cognitive variables predicted performance on the SGI measures, although there were differences in the amount of explained variance. The results (a) suggest that storytelling ability draws on a number of underlying skills and (b) underscore the importance of using discrete cognitive tasks rather than broad cognitive indices to investigate the cognitive substrates of discourse.

Criteria pollutant and acid aerosol characterization study, Catano, Puerto Rico

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

Edgerton, E.S.; Harlos, D.P.; Sune, J.M.

1995-07-01

The primary objective of the Catano Criteria Pollutant and Acid Aerosol Characterization Study (CPAACS) was to measure criteria pollutant concentrations and acid aerosol concentrations in and around the Ward of Catano, Puerto Rico, during the summer of 1994. Continuous air sampling for criteria pollutants was performed at three fixed stations and one moobile station that was deployed to four locations. Air samples for acid aerosol analyses and particulate matter measurements were collected at three sites. Semicontinuous sulfate analysis was performed at the primary site. Continuous measurements of wind speed, wind direction, temperature, and relative humidity were also made at eachmore » site. The study was conducted from June 1 through September 30, 1994.« less

National Assessment Program--Science Literacy Year 6 Technical Report, 2006

ERIC Educational Resources Information Center

Wu, Margaret; Donovan, Jenny; Hutton, Penny; Lennon, Melissa

2008-01-01

In July 2001, the Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA) agreed to the development of assessment instruments and key performance measures for reporting on student skills, knowledge and understandings in primary science. It directed the newly established Performance Measurement and Reporting Taskforce…

National Assessment Program--Science Literacy Year 6 School Release Materials, 2006

ERIC Educational Resources Information Center

Donovan, Jenny; Hutton, Penny; Lennon, Melissa; O'Connor, Gayl; Morrissey, Noni

2008-01-01

In July 2001, the Ministerial Council on Education, Employment, Training and Youth Affairs (MCEETYA) agreed to the development of assessment instruments and key performance measures for reporting on student skills, knowledge and understandings in primary science. It directed the newly established Performance Measurement and Reporting Taskforce…

Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries

PubMed Central

McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

2013-01-01

Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5,000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (−$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk. PMID:23780467

The prevalence and severity of oral impacts on daily performances in Thai primary school children

PubMed Central

Gherunpong, Sudaduang; Tsakos, Georgios; Sheiham, Aubrey

2004-01-01

Background Traditional methods of measuring oral health mainly use clinical dental indices and have been complemented by oral health related quality of life (OHRQoL) measures. Most OHRQoL studies have been on adults and elderly populations. There are no systematic OHRQoL studies of a population-based sample of children. The objective of this study was to assess the prevalence, characteristics and severity of oral impacts in primary school children. Methods Cross-sectional study of all 1126 children aged 11–12 years in a municipal area of Suphanburi province, Thailand. An OHRQoL measure, Child-Oral Impacts on Daily Performances index (Child-OIDP) was used to assess oral impacts. Children were also clinically examined and completed a self-administered questionnaire about demographic information and oral behaviours. Results 89.8% of children had one or more oral impacts. The median impact score was 7.6 and mean score was 8.8. Nearly half (47.0%) of the children with impacts had impacts at very little or little levels of intensity. Most (84.8%) of those with impacts had 1–4 daily performances affected (out of 8 performances). Eating was the most common performance affected (72.9%). The severity of impacts was high for eating and smiling and low for study and social contact performances. The main clinical causes of impacts were sensitive tooth (27.9%), oral ulcers (25.8%), toothache (25.1%) and an exfoliating primary tooth (23.4%). Conclusions The study reveals that oral health impacts on quality of life in Thai primary school children. Oral impacts were prevalent, but not severe. The impacts mainly related to difficulty eating and smiling. Toothache, oral ulcers and natural processes contributed largely to the incidence of oral impacts. PMID:15476561

Delivery system integration and health care spending and quality for Medicare beneficiaries.

PubMed

McWilliams, J Michael; Chernew, Michael E; Zaslavsky, Alan M; Hamed, Pasha; Landon, Bruce E

2013-08-12

The Medicare accountable care organization (ACO) programs rely on delivery system integration and health care provider risk sharing to lower spending while improving quality of care. To compare spending and quality between larger and smaller provider groups and examine how size-related differences vary by 2 factors considered central to ACO performance: group primary care orientation and financial risk sharing by health care providers. Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to health care provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (≥5000 assigned beneficiaries) and Pioneer (≥15,000) ACO programs and distinguished hospital-based from independent groups. We assessed the primary care orientation of larger groups' specialty mix and used health maintenance organization market penetration and data from the Community Tracking Study to measure the extent of financial risk accepted by different types of provider groups in different areas for managed care patients. We estimated linear regression models comparing spending and quality between larger and smaller health care provider groups, allowing size-related differences to vary by measures of group primary care orientation and risk sharing. Spending and quality measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference, +$849), higher 30-day readmission rates (+1.3 percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (-$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where health care providers accepted greater risk.

Cortical neuroanatomic correlates of symptom severity in primary progressive aphasia

PubMed Central

Sapolsky, D.; Bakkour, A.; Negreira, A.; Nalipinski, P.; Weintraub, S.; Mesulam, M.-M.; Caplan, D.; Dickerson, B.C.

2010-01-01

Objective: To test the validity and reliability of a new measure of clinical impairment in primary progressive aphasia (PPA), the Progressive Aphasia Severity Scale (PASS), and to investigate relationships with MRI-based cortical thickness biomarkers for localizing and quantifying the severity of anatomic abnormalities. Methods: Patients with PPA were rated using the PASS and underwent performance-based language testing and MRI scans that were processed for cortical thickness measures. Results: The level of impairment in PASS fluency, syntax/grammar, and word comprehension showed strong specific correlations with performance-based measures of these domains of language, and demonstrated high interrater reliability. Left inferior frontal thinning correlated with impairment in fluency and grammar/syntax, while left temporopolar thinning correlated with impairment in word comprehension. Discriminant function analysis demonstrated that a combination of left inferior frontal, left temporopolar, and left superior temporal sulcal thickness separated the 3 PPA subtypes from each other with 100% accuracy (87% accuracy in a leave-one-out analysis). Conclusions: The PASS, a novel measure of the severity of clinical impairment within domains of language typically affected in PPA, demonstrates reliable and valid clinical-behavioral properties. Furthermore, the presence of impairment in individual PASS domains demonstrates specific relationships with focal abnormalities in particular brain regions and the severity of impairment is strongly related to the severity of anatomic abnormality within the relevant brain region. These anatomic imaging biomarkers perform well in classifying PPA subtypes. These data provide robust support for the value of this novel clinical measure and the new imaging measure as markers for potential use in clinical research and trials in PPA. GLOSSARY AD = Alzheimer disease; BDAE = Boston Diagnostic Aphasia Examination; CDR = Clinical Dementia Rating; CSB = Cambridge Semantic Battery; ICC = intraclass correlation coefficient; NACC UDS = National Alzheimer's Coordinating Center Uniform Data Set; OC = older control participants; PASS = Progressive Aphasia Severity Scale; PPA = primary progressive aphasia; PPA-G = agrammatic primary progressive aphasia; PPA-L = logopenic primary progressive aphasia; PPA-S = semantic primary progressive aphasia; ROI = region of interest; WAB = Western Aphasia Battery. PMID:20660866

Looking Under the Streetlight? A Framework for Differentiating Performance Measures by Level of Care in a Value-Based Payment Environment

PubMed Central

Van Such, Monica B.; Nesse, Robert E.; Dilling, James A.; Swensen, Stephen J.; Thompson, Kristine M.; Orlowski, Janis M.; Santrach, Paula J.

2017-01-01

The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices. In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias. With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions. PMID:28353502

Looking Under the Streetlight? A Framework for Differentiating Performance Measures by Level of Care in a Value-Based Payment Environment.

PubMed

Naessens, James M; Van Such, Monica B; Nesse, Robert E; Dilling, James A; Swensen, Stephen J; Thompson, Kristine M; Orlowski, Janis M; Santrach, Paula J

2017-07-01

The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices.In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias.With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions.

Quality of asthma care under different primary care models in Canada: a population-based study.

PubMed

To, Teresa; Guan, Jun; Zhu, Jingqin; Lougheed, M Diane; Kaplan, Alan; Tamari, Itamar; Stanbrook, Matthew B; Simatovic, Jacqueline; Feldman, Laura; Gershon, Andrea S

2015-02-14

Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models. Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators. All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group. Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.

Raised visual detection thresholds depend on the level of complexity of cognitive foveal loading.

PubMed

Plainis, S; Murray, I J; Chauhan, K

2001-01-01

The objective of the study was to measure the interactions between visual thresholds for a simple light (the secondary task) presented peripherally and a simultaneously performed cognitive task (the primary task) presented foveally The primary task was highly visible but varied according to its cognitive complexity. Interactions between the tasks were determined by measuring detection thresholds for the peripheral task and accuracy of performance of the foveal task. Effects were measured for 5, 10, 20, and 30 deg eccentricity of the peripherally presented light and for three levels of cognitive complexity. Mesopic conditions (0.5 lx) were used. As expected, the concurrent presentation of the foveal cognitive task reduced peripheral sensitivity. Moreover, performance of the foveal task was adversely affected when conducting the peripheral task. Performance on both tasks was reduced as the level of complexity of the cognitive task increased. There were qualitative differences in task interactions between the central 10 deg and at greater eccentricities. Within 10 deg there was a disproportionate effect of eccentricity, previously interpreted as the 'tunnel-vision' model of visual field narrowing. Interactions outside 10 deg were less affected by eccentricity. These results are discussed in terms of the known neurophysiological characteristics of the primary visual pathway.

Developing safety performance measures for roundabout applications in the state of Oregon.

DOT National Transportation Integrated Search

2013-04-01

This report documents the research effort to quantify the safety performance of roundabouts in the State of Oregon. : The primary goal of this research is to provide the Oregon Department of Transportation (ODOT) with safety : performance functions (...

[Schizophrenia Cognition Rating Scale Japanese version (SCoRS-J) as a co-primary measure assessing cognitive function in schizophrenia].

PubMed

Kaneda, Yasuhiro; Ueoka, Yoshinori; Sumiyoshi, Tomiki; Yasui-Furukori, Norio; Ito, Toru; Higuchi, Yuko; Suzuki, Michio; Ohmori, Tetsuro

2011-11-01

The assessment of cognitive function is important for patients with schizophrenia because cognitive impairment is a core feature of the disease, and is a major determinant of functional outcome. To implement a practical assessment tool, we previously developed the Japanese-language version of the Brief Assessment of Cognition in Schizophrenia that objectively measures cognitive domains relevant to outcome. Meanwhile, the U.S. Food and Drug Administration took the position that a drug to improve coghition should show changes on an additional measure (a co-primary), in addition to an accepted consensus cognitive performance measure that is considered functionally meaningful. Thus, four potential co-primary measures, two measures of functional capacity and two interview-based measures of cognition, were evaluated for psychometric properties and validity. The Schizophrenia Cognition Rating Scale (SCoRS) is one of the interview-based measures of cognition. It consists of 20 questions to measure attention, memory, reasoning and problem solving, working memory, language production, and motor skills, which are related to day-to-day functioning. University of California at San Diego Performance-Based Skills Assessment (UPSA) is one of the measures of functional capacity. For its clinical application, we developed the Japanese-language version of the SCoRS (SCoRS-J) and UPSA (UPSA-J) through back-translation into English.

Neutron activation analysis: A primary method of measurement

NASA Astrophysics Data System (ADS)

Greenberg, Robert R.; Bode, Peter; De Nadai Fernandes, Elisabete A.

2011-03-01

Neutron activation analysis (NAA), based on the comparator method, has the potential to fulfill the requirements of a primary ratio method as defined in 1998 by the Comité Consultatif pour la Quantité de Matière — Métrologie en Chimie (CCQM, Consultative Committee on Amount of Substance — Metrology in Chemistry). This thesis is evidenced in this paper in three chapters by: demonstration that the method is fully physically and chemically understood; that a measurement equation can be written down in which the values of all parameters have dimensions in SI units and thus having the potential for metrological traceability to these units; that all contributions to uncertainty of measurement can be quantitatively evaluated, underpinning the metrological traceability; and that the performance of NAA in CCQM key-comparisons of trace elements in complex matrices between 2000 and 2007 is similar to the performance of Isotope Dilution Mass Spectrometry (IDMS), which had been formerly designated by the CCQM as a primary ratio method.

Experimental comparison between performance of the PM and LPM methods in computed radiography

NASA Astrophysics Data System (ADS)

Kermani, Aboutaleb; Feghhi, Seyed Amir Hossein; Rokrok, Behrouz

2018-07-01

The scatter downgrades the image quality and reduces its information efficiency in quantitative measurement usages when creating projections with ionizing radiation. Therefore, the variety of methods have been applied for scatter reduction and correction of the undesirable effects. As new approaches, the ordinary and localized primary modulation methods have already been used individually through experiments and simulations in medical and industrial computed tomography, respectively. The aim of this study is the evaluation of capabilities and limitations of these methods in comparison with each other. For this mean, the ordinary primary modulation has been implemented in computed radiography for the first time and the potential of both methods has been assessed in thickness measurement as well as scatter to primary signal ratio determination. The comparison results, based on the experimental outputs which obtained using aluminum specimens and continuous X-ray spectra, are to the benefit of the localized primary modulation method because of improved accuracy and higher performance especially at the edges.

Infrastructure performance of irrigation canal to irrigation efficiency of irrigation area of Candi Limo in Mojokerto District

NASA Astrophysics Data System (ADS)

Kisnanto, S.; Hadiani, R. R. R.; Ikhsan, C.

2018-03-01

Performance is a measure of infrastructure success in delivering the benefits corresponding it’s design implementation. Debit efficiency is a comparison between outflow debit and inflow debit. Irrigation canal performance is part of the overall performance aspects of an irrigation area. The greater of the canal performance will be concluded that the canal is increasingly able to meet the planned benefits, need to be seen its comparison between the performance and debit efficiency of the canal. The existing problems in the field that the value of the performance of irrigation canals are not always comparable to the debit efficiency. This study was conducted to describe the relationship between the performance of the canal to the canal debit efficiency. The study was conducted at Candi Limo Irrigation Area in Mojokerto Disctrict under the authority of Pemerintahan Provinsi Jawa Timur. The primary canal and secondary canal are surveyed to obtain data. The physical condition of the primary and secondary canals into the material of this study also. Primary and secondary canal performance based on the physical condition in the field. Measurement inflow and outflow debit into the data for the calculation of the debit efficiency. The instrument used in this study such as the current meter for debit measurements in the field as a solution when there is a building measure in the field were damaged, also using the meter and the camera. Permen PU No.32 is used to determine the value of the performance of the canal, while the efficiency analysis to calculate a comparison value between outflow and inflow debit. The process of data running processing by performing the measurement and calculation of the performance of the canal, the canal debit efficiency value calculation, and display a graph of the relationship between the value of the performance with the debit efficiency in each canal. The expected results of this study that the performance value on the primary canal in the range of 0 to 100 % with debit efficiency value in the range of 0 to 100 %, while for the secondary canal 1 has a performance range between 0 to 100% with efficiency ranges between 0 to 100%, the performance of the secondary canals 2 ranges between 0 to 100% with efficiencies ranging from 0 to 100%, the secondary canal 3 performance ranges between 0 to 100% efficiency ranges between 0 to 100%, the secondary canal 4 performance ranges between 0 to 100% efficiency ranges between 0 to 100% and secondary canals 5 performance ranges between 0 to 100% efficiency ranges between 0 to 100%. For the tendency to expect from the performance and efficiency of the debit canal can have a proportional clockwise or counterclockwise, which amount can be random. The tendency to be graphed the relationship between performance and efficiency of the debit of each segment studied canal.

Patient–Physician Connectedness and Quality of Primary Care

PubMed Central

Atlas, Steven J.; Grant, Richard W.; Ferris, Timothy G.; Chang, Yuchiao; Barry, Michael J.

2010-01-01

Background Valid measurement of physician performance requires accurate identification of patients for whom a physician is responsible. Among all patients seen by a physician, some will be more strongly connected to their physician than others, but the effect of connectedness on measures of physician performance is not known. Objective To determine whether patient–physician connectedness affects measures of clinical performance. Design Population-based cohort study. Setting Academic network of 4 community health centers and 9 hospital-affiliated primary care practices. Patients 155 590 adults with 1 or more visits to a study practice from 2003 to 2005. Measurements A validated algorithm was used to connect patients to either 1 of 181 physicians or 1 of 13 practices in which they received most of their care. Performance measures included breast, cervical, and colorectal cancer screening in eligible patients; hemoglobin A1c measurement and control in patients with diabetes; and low-density lipoprotein cholesterol measurement and control in patients with diabetes and coronary artery disease. Results Overall, 92 315 patients (59.3%) were connected to a specific physician, whereas 53 669 patients (34.5%) were connected only to a specific practice and 9606 patients (6.2%) could not be connected to a physician or practice. The proportion of patients in a practice who could be connected to a physician varied markedly (45.6% to 71.2% of patients per practice; P < 0.001). Physician-connected patients were significantly more likely than practice-connected patients to receive guideline-consistent care (for example, adjusted mammography rates were 78.1% vs. 65.9% [P < 0.001] and adjusted hemoglobin A1c rates were 90.3% vs. 74.9% [P < 0.001]). Receipt of preventive care varied more by whether patients were more or less connected to a physician than by race or ethnicity. Limitation Patient–physician connectedness was assessed in 1 primary care network. Conclusion Patients seen in primary care practices seem to be variably connected with a specific physician, and less connected patients are less likely to receive guideline-consistent care. PMID:19258560

Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study.

PubMed

Steinberg, Martin; Leoutsakos, Jeannie-Marie Sheppard; Podewils, Laura Jean; Lyketsos, C G

2009-07-01

To determine the feasibility and efficacy of a home-based exercise intervention program to improve the functional performance of patients with Alzheimer's Disease (AD). Twenty-seven home-dwelling patients with AD were randomized to either an exercise intervention program delivered by their caregivers or a home safety assessment control. Measures of functional performance (primary), cognition, neuropsychiatric symptoms, quality of life and caregiver burden (secondary) were obtained at baseline and at 6 and 12 weeks following randomization. For each outcome measure, intent-to-treat analyses using linear random effects models were performed. Feasibility and adverse events were also assessed. Adherence to the exercise program was good. On the primary outcomes (functional performance) patients in the exercise group demonstrated a trend for improved performance on measures of hand function and lower extremity strength. On secondary outcome measures, trends toward worse depression and lower quality of life ratings were noted. The physical exercise intervention developed for the study, delivered by caregivers to home-dwelling patients with AD, was feasible and was associated with a trend for improved functional performance in this group of frail patients. Given the limited efficacy to date of pharmacotherapies for AD, further study of exercise intervention, in a variety of care setting, is warranted.

A limit on the diffuse gamma-rays measured with KASCADE-Grande

NASA Astrophysics Data System (ADS)

Kang, D.; Apel, W. D.; Arteaga-Velázquez, J. C.; Bekk, K.; Bertaina, M.; Blümer, J.; Bozdog, H.; Brancus, I. M.; Cantoni, E.; Chiavassa, A.; Cossavella, F.; Daumiller, K.; de Souza, V.; Di Pierro, F.; Doll, P.; Engel, R.; Feng, Z.; Fuhrmann, D.; Gherghel-Lascu, A.; Gils, H. J.; Glasstetter, R.; Grupen, C.; Haungs, A.; Heck, D.; Hörandel, J. R.; Huber, D.; Huege, T.; Kampert, K. H.; Klages, H. O.; Link, K.; Łuczak, P.; Mathes, H. J.; Mayer, H. J.; Milke, J.; Mitrica, B.; Morello, C.; Oehlschläger, J.; Ostapchenko, S.; Palmieri, N.; Petcu, M.; Pierog, T.; Rebel, H.; Roth, M.; Schieler, H.; Schoo, S.; Schröder, F.; Sima, O.; Toma, G.; Trinchero, G. C.; Ulrich, H.; Weindl, A.; Wochele, J.; Zabierowski, J.

2015-08-01

Using data measured by the KASCADE-Grande air shower array, an upper limit to the flux of ultra-high energy gamma-rays in the primary cosmic-ray flux is determined. KASCADE-Grande measures the electromagnetic and muonic components for individual air showers in the energy range from 10 PeV up to 1 EeV. The analysis is performed by selecting air showers with low muon contents. A preliminary result on the 90% C.L. upper limit to the relative intensity of gamma-ray with respect to cosmic ray primaries is presented and compared with limits reported by other measurements.

SOURCE APPORTIONMENT OF PRIMARY AND SECONDARY CARBONACEOUS AEROSOL IN THE UNITED STATES USING MODELS AND MEASUREMENTS

EPA Science Inventory

In this presentation, three diagnostic evaluation methods of model performance for carbonaceous aerosol are reviewed. The EC-tracer method is used to distinguish primary and secondary carbon, radiocarbon data are used to distinguish fossil-fuel and contemporary carbon, and organ...

Preventive care quality of Medicare Accountable Care Organizations: Associations of organizational characteristics with performance

PubMed Central

Albright, Benjamin B.; Lewis, Valerie A.; Ross, Joseph S.; Colla, Carrie H.

2015-01-01

Background Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for eight measures of preventive care quality. Objectives To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. Design Cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Results Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified two underlying factors among eight measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. Conclusions ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration. PMID:26759974

Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance.

PubMed

Albright, Benjamin B; Lewis, Valerie A; Ross, Joseph S; Colla, Carrie H

2016-03-01

Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. This is a cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified 2 underlying factors among 8 measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.

Analysis and testing of high entrainment single nozzle jet pumps with variable mixing tubes

NASA Technical Reports Server (NTRS)

Hickman, K. E.; Hill, P. G.; Gilbert, G. B.

1972-01-01

An analytical model was developed to predict the performance characteristics of axisymmetric single-nozzle jet pumps with variable area mixing tubes. The primary flow may be subsonic or supersonic. The computer program uses integral techniques to calculate the velocity profiles and the wall static pressures that result from the mixing of the supersonic primary jet and the subsonic secondary flow. An experimental program was conducted to measure mixing tube wall static pressure variations, velocity profiles, and temperature profiles in a variable area mixing tube with a supersonic primary jet. Static pressure variations were measured at four different secondary flow rates. These test results were used to evaluate the analytical model. The analytical results compared well to the experimental data. Therefore, the analysis is believed to be ready for use to relate jet pump performance characteristics to mixing tube design.

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.

Keep it simple? Predicting primary health care costs with clinical morbidity measures

PubMed Central

Brilleman, Samuel L.; Gravelle, Hugh; Hollinghurst, Sandra; Purdy, Sarah; Salisbury, Chris; Windmeijer, Frank

2014-01-01

Models of the determinants of individuals’ primary care costs can be used to set capitation payments to providers and to test for horizontal equity. We compare the ability of eight measures of patient morbidity and multimorbidity to predict future primary care costs and examine capitation payments based on them. The measures were derived from four morbidity descriptive systems: 17 chronic diseases in the Quality and Outcomes Framework (QOF); 17 chronic diseases in the Charlson scheme; 114 Expanded Diagnosis Clusters (EDCs); and 68 Adjusted Clinical Groups (ACGs). These were applied to patient records of 86,100 individuals in 174 English practices. For a given disease description system, counts of diseases and sets of disease dummy variables had similar explanatory power. The EDC measures performed best followed by the QOF and ACG measures. The Charlson measures had the worst performance but still improved markedly on models containing only age, gender, deprivation and practice effects. Comparisons of predictive power for different morbidity measures were similar for linear and exponential models, but the relative predictive power of the models varied with the morbidity measure. Capitation payments for an individual patient vary considerably with the different morbidity measures included in the cost model. Even for the best fitting model large differences between expected cost and capitation for some types of patient suggest incentives for patient selection. Models with any of the morbidity measures show higher cost for more deprived patients but the positive effect of deprivation on cost was smaller in better fitting models. PMID:24657375

Primary care quality: community health center and health maintenance organization.

PubMed

Shi, Leiyu; Starfield, Barbara; Xu, Jiahong; Politzer, Robert; Regan, Jerrilyn

2003-08-01

This study compares the primary health care quality of community health centers (CHCs) and health maintenance organizations (HMOs) in South Carolina to elucidate the quality of CHC performance relative to mainstream settings such as the HMO. Mail surveys were used to obtain data from 350 randomly selected HMO users. Surveys with follow-up interviews were conducted to obtain data from 540 randomly selected CHC users. A validated adult primary care assessment tool was used in both surveys. Multivariate analyses were performed to assess the association of health care setting (HMO versus CHC) with primary care quality while controlling for sociodemographic and health care characteristics. After controlling for sociodemographic and health care use measures, CHC patients demonstrated higher scores in several primary care domains (ongoing care, coordination of service, comprehensiveness, and community orientation) as well as total primary care performance. Users of CHC are more likely than HMO users to rate their primary health care provider as good, except in the area of ease of first contact. The positive rating of the CHC is particularly impressive after taking into account that many CHC users have characteristics associated with poorer ratings of care.

Achieving Value in Primary Care: The Primary Care Value Model.

PubMed

Rollow, William; Cucchiara, Peter

2016-03-01

The patient-centered medical home (PCMH) model provides a compelling vision for primary care transformation, but studies of its impact have used insufficiently patient-centered metrics with inconsistent results. We propose a framework for defining patient-centered value and a new model for value-based primary care transformation: the primary care value model (PCVM). We advocate for use of patient-centered value when measuring the impact of primary care transformation, recognition, and performance-based payment; for financial support and research and development to better define primary care value-creating activities and their implementation; and for use of the model to support primary care organizations in transformation. © 2016 Annals of Family Medicine, Inc.

Improving the quality of primary care by allocating performance-based targets, in a diverse insured population.

PubMed

Peled, Ronit; Porath, Avi; Wilf-Miron, Rachel

2016-11-21

Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcare Services (MHS), the second largest Israeli HMO, launched its Performance Measurement System (PMS) based on clinical quality indicators. A unique module was built in the PMS to adjust for case mix while tailoring targets to the local units. This article presents the concept and formulas developed to adjust targets to the units' current performance, and analyze change in clinical indicators over a six year period, between sub-population groups. Six process and intermediate outcome indicators, representing screening for breast and colorectal cancer and care for patients with diabetes and cardiovascular disease, were selected and analyzed for change over time (2003-2009) in overall performance, as well as the difference between the lowest and the highest socio-economic ranks (SERs) and Arab and non-Arab members. MHS demonstrated a significant improvement in the selected indicators over the years. Performance of members from low SERs and Arabs improved to a greater extent, as compared to members from high ranks and non-Arabs, respectively. The performance measurement system, with its module for tailoring of units' targets, served as a managerial vehicle for bridging existing gaps by allocating more resources to lower performing units. This concept was proven effective in improving performance while reducing disparities between diverse population groups.

Written language impairments in primary progressive aphasia: a reflection of damage to central semantic and phonological processes.

PubMed

Henry, Maya L; Beeson, Pélagie M; Alexander, Gene E; Rapcsak, Steven Z

2012-02-01

Connectionist theories of language propose that written language deficits arise as a result of damage to semantic and phonological systems that also support spoken language production and comprehension, a view referred to as the "primary systems" hypothesis. The objective of the current study was to evaluate the primary systems account in a mixed group of individuals with primary progressive aphasia (PPA) by investigating the relation between measures of nonorthographic semantic and phonological processing and written language performance and by examining whether common patterns of cortical atrophy underlie impairments in spoken versus written language domains. Individuals with PPA and healthy controls were administered a language battery, including assessments of semantics, phonology, reading, and spelling. Voxel-based morphometry was used to examine the relation between gray matter volumes and language measures within brain regions previously implicated in semantic and phonological processing. In accordance with the primary systems account, our findings indicate that spoken language performance is strongly predictive of reading/spelling profile in individuals with PPA and suggest that common networks of critical left hemisphere regions support central semantic and phonological processes recruited for spoken and written language.

A primary method for the complex calibration of a hydrophone from 1 Hz to 2 kHz

NASA Astrophysics Data System (ADS)

Slater, W. H.; E Crocker, S.; Baker, S. R.

2018-02-01

A primary calibration method is demonstrated to obtain the magnitude and phase of the complex sensitivity for a hydrophone at frequencies between 1 Hz and 2 kHz. The measurement is performed in a coupler reciprocity chamber (‘coupler’) a closed test chamber where time harmonic oscillations in pressure can be achieved and the reciprocity conditions required for a primary calibration can be realized. Relevant theory is reviewed and the reciprocity parameter updated for the complex measurement. Systematic errors and corrections for magnitude are reviewed and more added for phase. The combined expanded uncertainties of the magnitude and phase of the complex sensitivity at 1 Hz were 0.1 dB re 1 V μ Pa-1 and  ± 1\\circ , respectively. Complex sensitivity, sensitivity magnitude, and phase measurements are presented on an example primary reference hydrophone.

Performance of the Primary Mirror Center-of-Curvature Optical Metrology System during Cryogenic Testing of the JWST Pathfinder Telescope

NASA Technical Reports Server (NTRS)

Hadaway, James B.; Wells, Conrad; Olczak, Gene; Waldman, Mark; Whitman, Tony; Cosentino, Joseph; Connolly, Mark; Chaney, David; Telfer, Randal

2016-01-01

The JWST primary mirror consists of 18 1.5 m hexagonal segments, each with 6-DoF and RoC adjustment. The telescope will be tested at its cryogenic operating temperature at Johnson Space Center. The testing will include center-of-curvature measurements of the PM, using the Center-of-Curvature Optical Assembly (COCOA) and the Absolute Distance Meter Assembly (ADMA). The performance of these metrology systems, including hardware, software, procedures, was assessed during two cryogenic tests at JSC, using the JWST Pathfinder telescope. This paper describes the test setup, the testing performed, and the resulting metrology system performance.

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.

Effect of accreditation on the quality of chronic disease management: a comparative observational study.

PubMed

van Doorn-Klomberg, Arna L; Braspenning, Jozé C C; Wolters, René J; Bouma, Margriet; Wensing, Michel

2014-11-04

Practice accreditation is widely used to assess and improve quality of healthcare providers. Little is known about its effectiveness, particularly in primary care. In this study we examined the effect of accreditation on quality of care regarding diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). A comparative observational study with two cohorts was performed. We included 138 Dutch family practices that participated in the national accreditation program for primary care. A first cohort of 69 practices was measured at start and completion of a 3-year accreditation program. A second cohort of 69 practices was included and measured simultaneously with the final measurement of the first cohort. In separate multilevel regression analyses, we compared both within-group changes in the first cohort and between-groups differences at follow-up (first cohort) and start (second cohort). Outcome measures consisted of 24 systematically developed indicators of quality of care in targeted chronic diseases. In the within-group comparison, we found improvements on 6 indicators related to diabetes (feet examination, cholesterol measurement, lipid lowering medication prescription) and COPD (spirometry performance, stop smoking advice). In the between-groups comparison we found that first cohort practices performed better on 4 indicators related to diabetes (cholesterol outcome) and CVD (blood pressure outcome, smoke status registration, glucose measurement). Improvements of the quality of primary care for patients with chronic diseases were found, but few could be attributed to the accreditation program. Further development of accreditation is needed to enhance its effectiveness on chronic disease management.

Environmental lead exposure among primary school children in Shebin El-Kom District, Menoufiya Governorate, Egypt.

PubMed

Abdel Rasoul, G M; Al-Batanony, M A; Mahrous, O A; Abo-Salem, M E; Gabr, H M

2012-10-01

Lead still remains an important problem for poor, inner-city, ethnic minority children, with a particular emphasis on lead paint and dust. In Egypt, there is no national survey about the prevalence of elevated blood lead level among children. To assess the environmental lead level as well as to determine blood lead level among primary school children and find out its relationship with their intelligent quotient (IQ), hemoglobin level, hearing impairment and school performance. 190 primary school children from rural and urban areas were selected and their blood lead levels (BLL), hemoglobin concentrations, IQ, hearing threshold and school performance were measured. Also, environmental lead level was measured in the school and home. The mean value of environmental lead (μg/m3) in urban schools air was significantly higher than that in rural areas. BLL had a significant negative correlation with hemoglobin level and IQ; it was positively correlated with the hearing threshold. With increasing BLL, the school performance of children decreased significantly. Exposure to lead would deteriorate IQ, school performance and hearing level of school children. Even in the absence of overt clinical manifestations of lead toxicity, lead intoxication should be among differential diagnosis in children presenting anemia, intellectual impairment, poor academic performance and hearing impairment.

Oral Narrative Performance of African American Prekindergartners Who Speak Nonmainstream American English

ERIC Educational Resources Information Center

Terry, Nicole Patton; Mills, Monique T.; Bingham, Gary E.; Mansour, Souraya; Marencin, Nancy

2013-01-01

Purpose: This study had 4 primary purposes: (a) to describe the oral narrative performance of typically developing African American prekindergarten children with commonly used macro- and microstructure measures; (b) to examine the concurrent and (c) predictive relations between narrative performance, spoken dialect use, vocabulary, and story…

Reading While Listening: A Linear Model of Selective Attention

ERIC Educational Resources Information Center

Martin, Maryanne

1977-01-01

Two experiments are described. One measured performance of subjects on pairs of concurrent verbal tasks, monitoring sentences for certain items while reading. Secondary task performance combined with a primary task is proportional to its performance in isolation. The second experiment checked certain results of the first. (CHK)

Comparative evaluation of twenty pilot workload assessment measure using a psychomotor task in a moving base aircraft simulator

NASA Technical Reports Server (NTRS)

Connor, S. A.; Wierwille, W. W.

1983-01-01

A comparison of the sensitivity and intrusion of twenty pilot workload assessment techniques was conducted using a psychomotor loading task in a three degree of freedom moving base aircraft simulator. The twenty techniques included opinion measures, spare mental capacity measures, physiological measures, eye behavior measures, and primary task performance measures. The primary task was an instrument landing system (ILS) approach and landing. All measures were recorded between the outer marker and the middle marker on the approach. Three levels (low, medium, and high) of psychomotor load were obtained by the combined manipulation of windgust disturbance level and simulated aircraft pitch stability. Six instrument rated pilots participated in four seasons lasting approximately three hours each.

Introducing a laparoscopic simulation training and credentialing program in gynaecology: an observational study.

PubMed

Janssens, Sarah; Beckmann, Michael; Bonney, Donna

2015-08-01

Simulation training in laparoscopic surgery has been shown to improve surgical performance. To describe the implementation of a laparoscopic simulation training and credentialing program for gynaecology registrars. A pilot program consisting of protected, supervised laparoscopic simulation time, a tailored curriculum and a credentialing process, was developed and implemented. Quantitative measures assessing simulated surgical performance were measured over the simulation training period. Laparoscopic procedures requiring credentialing were assessed for both the frequency of a registrar being the primary operator and the duration of surgery and compared to a presimulation cohort. Qualitative measures regarding quality of surgical training were assessed pre- and postsimulation. Improvements were seen in simulated surgical performance in efficiency domains. Operative time for procedures requiring credentialing was reduced by 12%. Primary operator status in the operating theatre for registrars was unchanged. Registrar assessment of training quality improved. The introduction of a laparoscopic simulation training and credentialing program resulted in improvements in simulated performance, reduced operative time and improved registrar assessment of the quality of training. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Improving Primary Care Residents' Proficiency in the Diagnosis of Skin Cancer

PubMed Central

Gerbert, Barbara; Bronstone, Amy; Wolff, Mimi; Maurer, Toby; Berger, Timothy; Pantilat, Steven; McPhee, Stephen J

1998-01-01

OBJECTIVE To determine whether a brief, multicomponent intervention could improve the skin cancer diagnosis and evaluation planning performance of primary care residents to a level equivalent to that of dermatologists. PARTICIPANTS Fifty-two primary care residents (26 in the control group and 26 in the intervention group) and 13 dermatologists completed a pretest and posttest. DESIGN A randomized, controlled trial with pretest and posttest measurements of residents' ability to diagnose and make evaluation plans for lesions indicative of skin cancer. INTERVENTION The intervention included face-to-face feedback sessions focusing on residents' performance deficiencies; an interactive seminar including slide presentations, case examples, and live demonstrations; and the Melanoma Prevention Kit including a booklet, magnifying tool, measuring tool, and skin color guide. MEASUREMENTS AND MAIN RESULTS We compared the abilities of a control and an intervention group of primary care residents, and a group of dermatologists to diagnose and make evaluation plans for six categories of skin lesions including three types of skin cancer—malignant melanoma, squamous cell carcinoma, and basal cell carcinoma. At posttest, both the intervention and control group demonstrated improved performance, with the intervention group revealing significantly larger gains. The intervention group showed greater improvement than the control group across all six diagnostic categories (a gain of 13 percentage points vs 5, p < .05), and in evaluation planning for malignant melanoma (a gain of 46 percentage points vs 36, p < .05) and squamous cell carcinoma (a gain of 42 percentage points vs 21, p < .01). The intervention group performed as well as the dermatologists on five of the six skin cancer diagnosis and evaluation planning scores with the exception of the diagnosis of basal cell carcinoma. CONCLUSIONS Primary care residents can diagnose and make evaluation plans for cancerous skin lesions, including malignant melanoma, at a level equivalent to that of dermatologists if they receive relevant, targeted education. PMID:9502368

Measurements of microhardness during transient horizontal directional solidification of Al-Rich Al-Cu alloys: Effect of thermal parameters, primary dendrite arm spacing and Al2Cu intermetallic phase

NASA Astrophysics Data System (ADS)

Barros, André Santos; Magno, Igor Alexsander; Souza, Fabrício Andrade; Mota, Carlos Alberto; Moreira, Antonio Luciano; Silva, Maria Adrina; Rocha, Otávio Lima

2015-05-01

In this work, the effect of the growth rate (VL) and cooling rate (TR), primary dendritic arm spacing (λ1) and Al2Cu intermetallic phase on the microhardness was investigated during transient horizontal directional solidification of Al-3wt%Cu and Al-8wt%Cu alloys. Microstructural characterization of the investigated alloys was performed using traditional techniques of metallography, optical and SEM microscopy and X-Ray diffraction. The microhardness evolution as a function of the thermal and microstructural parameters (VL, TR, and λ1) was evaluated using power and Hall-Petch type experimental laws, which were compared with other laws in the literature. In order to examine the effect of the Al2Cu intermetallic phase, microhardness measurements were performed in interdendritic regions. Finally, a comparative analysis was performed between the experimental data of this work and theoretical models from the literature that have been proposed to predict primary dendrite arm spacing, which have been tested in numerous works considering upward directional solidification.

Measurement Properties of Performance-Specific Pain Ratings of Patients Awaiting Total Joint Arthroplasty as a Consequence of Osteoarthritis

PubMed Central

Stratford, Paul W.; Kennedy, Deborah M.; Woodhouse, Linda J.; Spadoni, Gregory

2008-01-01

Purpose: To estimate the test–retest reliability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain sub-scale and performance-specific assessments of pain, as well as the association between these measures for patients awaiting primary total hip or knee arthroplasty as a consequence of osteoarthritis. Methods: A total of 164 patients awaiting unilateral primary hip or knee arthroplasty completed four performance measures (self-paced walk, timed up and go, stair test, six-minute walk) and the WOMAC. Scores for 22 of these patients provided test–retest reliability data. Estimates of test–retest reliability (Type 2,1 intraclass correlation coefficient [ICC] and standard error of measurement [SEM]) and the association between measures were examined. Results: ICC values for individual performance-specific pain ratings were between 0.70 and 0.86; SEM values were between 0.97 and 1.33 pain points. ICC estimates for the four-item performance pain ratings and the WOMAC pain sub-scale were 0.82 and 0.57 respectively. The correlation between the sum of the pain scores for the four performance measures and the WOMAC pain sub-scale was 0.62. Conclusion: Reliability estimates for the performance-specific assessments of pain using the numeric pain rating scale were consistent with values reported for patients with a spectrum of musculoskeletal conditions. The reliability estimate for the WOMAC pain sub-scale was lower than typically reported in the literature. The level of association between the WOMAC pain sub-scale and the various performance-specific pain scales suggests that the scores can be used interchangeably when applied to groups but not for individual patients. PMID:20145758

Quality indicators for the detection and management of chronic kidney disease in primary care in Canada derived from a modified Delphi panel approach.

PubMed

Tu, Karen; Bevan, Lindsay; Hunter, Katie; Rogers, Jess; Young, Jacqueline; Nesrallah, Gihad

2017-01-01

The detection and management of chronic kidney disease lies within primary care; however, performance measures applicable in the Canadian context are lacking. We sought to develop a set of primary care quality indicators for chronic kidney disease in the Canadian setting and to assess the current state of the disease's detection and management in primary care. We used a modified Delphi panel approach, involving 20 panel members from across Canada (10 family physicians, 7 nephrologists, 1 patient, 1 primary care nurse and 1 pharmacist). Indicators identified from peer-reviewed and grey literature sources were subjected to 3 rounds of voting to develop a set of quality indicators for the detection and management of chronic kidney disease in the primary care setting. The final indicators were applied to primary care electronic medical records in the Electronic Medical Record Administrative data Linked Database (EMRALD) to assess the current state of primary care detection and management of chronic kidney disease in Ontario. Seventeen indicators made up the final list, with 1 under the category Prevalence, Incidence and Mortality; 4 under Screening, Diagnosis and Risk Factors; 11 under Management; and 1 under Referral to a Specialist. In a sample of 139 993 adult patients not on dialysis, 6848 (4.9%) had stage 3 or higher chronic kidney disease, with the average age of patients being 76.1 years (standard deviation [SD] 11.0); 62.9% of patients were female. Diagnosis and screening for chronic kidney disease were poorly performed. Only 27.1% of patients with stage 3 or higher disease had their diagnosis documented in their cumulative patient profile. Albumin-creatinine ratio testing was only performed for 16.3% of patients with a low estimated glomerular filtration rate (eGFR) and for 28.5% of patients with risk factors for chronic kidney disease. Family physicians performed relatively better with the management of chronic kidney disease, with 90.4% of patients with stage 3 or higher disease having an eGFR performed in the previous 18 months and 83.1% having a blood pressure recorded in the previous 9 months. We propose a set of measurable indicators to evaluate the quality of the management of chronic kidney disease in primary care. These indicators may be used to identify opportunities to improve current practice in Canada.

Online physician ratings fail to predict actual performance on measures of quality, value, and peer review.

PubMed

Daskivich, Timothy J; Houman, Justin; Fuller, Garth; Black, Jeanne T; Kim, Hyung L; Spiegel, Brennan

2018-04-01

Patients use online consumer ratings to identify high-performing physicians, but it is unclear if ratings are valid measures of clinical performance. We sought to determine whether online ratings of specialist physicians from 5 platforms predict quality of care, value of care, and peer-assessed physician performance. We conducted an observational study of 78 physicians representing 8 medical and surgical specialties. We assessed the association of consumer ratings with specialty-specific performance scores (metrics including adherence to Choosing Wisely measures, 30-day readmissions, length of stay, and adjusted cost of care), primary care physician peer-review scores, and administrator peer-review scores. Across ratings platforms, multivariable models showed no significant association between mean consumer ratings and specialty-specific performance scores (β-coefficient range, -0.04, 0.04), primary care physician scores (β-coefficient range, -0.01, 0.3), and administrator scores (β-coefficient range, -0.2, 0.1). There was no association between ratings and score subdomains addressing quality or value-based care. Among physicians in the lowest quartile of specialty-specific performance scores, only 5%-32% had consumer ratings in the lowest quartile across platforms. Ratings were consistent across platforms; a physician's score on one platform significantly predicted his/her score on another in 5 of 10 comparisons. Online ratings of specialist physicians do not predict objective measures of quality of care or peer assessment of clinical performance. Scores are consistent across platforms, suggesting that they jointly measure a latent construct that is unrelated to performance. Online consumer ratings should not be used in isolation to select physicians, given their poor association with clinical performance.

Introducing care pathway commissioning to primary dental care: measuring performance.

PubMed

Harris, R; Bridgman, C; Ahmad, M; Bowes, L; Haley, R; Saleem, S; Singh, R; Taylor, S

2011-12-09

Care pathways have been used in a variety of ways: firstly to support quality improvement through standardising clinical processes, but also for secondary purposes, by purchasers of healthcare, to monitor activity and health outcomes and to commission services. This paper focuses on reporting a secondary use of care pathways: to commission and monitor performance of primary dental care services. Findings of a project involving three dental practices implementing a system based on rating patients according to their risk of disease and need for care are outlined. Data from surgery-based clinical databases and interviews from commissioners and providers are reported. The use of both process and outcome key performance indicators in this context is discussed, as well as issues which arise such as attributability of outcome measures and strategic approaches to improving quality of care.

Impact of student ethnicity and primary childhood language on communication skill assessment in a clinical performance examination.

PubMed

Fernandez, Alicia; Wang, Frances; Braveman, Melissa; Finkas, Lindsay K; Hauer, Karen E

2007-08-01

Clinical performance examinations (CPX) with standardized patients (SPs) have become a preferred method to assess communication skills in US medical schools. Little is known about how trainees' backgrounds impact CPX performance. The objective of this paper is to examine the impact of student ethnicity, primary childhood language, and experience of diversity on the communication scores of a high-stakes CPX using SPs. This research was designed as an observational study. The participants of this study were third-year medical students at one US medical school. The measurements used in this study were CPX scores from mandatory exam, student demographics and experience with diversity measured by self-report on a survey, and Medical College Admission Test (MCAT) and United States Medical Licensing Examination (USMLE) scores. A total of 135 students participated. Asian and black students scored lower than white students on the communication portion of the CPX by approximately half a standard deviation (Asian, 67.4%; black, 64.4%; white, 69.4%, p < .05). There were no differences by ethnicity on history/physical exam scores. Multivariate analysis controlling for MCAT verbal scores reduced ethnic differences in communication scores (Asian-white mean differences = 1.95, p = 0.02), but Asian-white differences were eliminated only after sequential models included primary childhood language (difference = 0.57, p = 0.6). Even after controlling for English language knowledge as measured in MCAT verbal scores, speaking a primary childhood language other than English is associated with lower CPX communication scores for Asian students. While poorer communication skills cannot be ruled out, SP exams may contain measurement bias associated with differences in childhood language or culture. Caution is indicated when interpreting CPX communication scores among diverse examinees.

Working memory impairment and cardiovascular hyperarousal in young primary insomniacs.

PubMed

Cellini, Nicola; de Zambotti, Massimiliano; Covassin, Naima; Sarlo, Michela; Stegagno, Luciano

2014-02-01

We investigated memory performance and cardiovascular activity in 13 primary insomniacs (PI) compared to 13 good sleepers (GS). Cardiovascular and hemodynamic measures, including heart rate, pre-ejection period, and blood pressure, were continuously recorded at rest and during two memory tasks. PI showed working memory impairment under high cognitive load, but performed as well as GS in an easy memory task. In addition, PI exhibited markers of hyperarousal both at rest and during the execution of the two tasks. However, we failed to find a clear-cut relationship between cardiovascular hyperarousal and cognitive performance in insomniacs. Our data provide further evidence of both cognitive impairment and cardiovascular hyperarousal in primary insomnia, while not supporting the hypothesis of hyperarousal as a compensatory mechanism to overcome cognitive challenges.

Internal Performance of Several Divergent-Shroud Ejector Nozzles with High Divergence Angles

NASA Technical Reports Server (NTRS)

Trout, Arthur M.; Papell, S. Stephen; Povolny, John H.

1957-01-01

Nine divergent-shroud ejector configurations were investigated to determine the effect of shroud divergence angle on ejector internal performance. Unheated dry air was used for both the primary and secondary flows. The decrease in the design-point thrust coefficient with increasing flow divergence angle (angle measured from primary exit to shroud exit) followed very closely a simple relation involving the cosine of the angle. This indicates that design-point thrust performance for divergent-shroud ejectors can be predicted with reasonable accuracy within the range investigated. The decrease in design-point thrust coefficient due to increasing the flow divergence engle from 120deg to 30deg (half-singles) was approximately 6 percent. Ejector air-handling characteristics and the primary-nozzle flow coefficient were not significantly affected by change in shroud divergence angle.

Entrainment and thrust augmentation in pulsatile ejector flows

NASA Technical Reports Server (NTRS)

Sarohia, V.; Bernal, L.; Bui, T.

1981-01-01

This study comprised direct thrust measurements, flow visualization by use of a spark shadowgraph technique, and mean and fluctuating velocity measurements with a pitot tube and linearized constant temperature hot-wire anemometry respectively. A gain in thrust of as much as 10 to 15% was observed for the pulsatile ejector flow as compared to the steady flow configuration. From the velocity profile measurements, it is concluded that this enhanced augmentation for pulsatile flow as compared to a nonpulsatile one was accomplished by a corresponding increased entrainment by the primary jet flow. It is also concluded that the augmentation and total entrainment by a constant area ejector critically depends upon the inlet geometry of the ejector. Experiments were performed to evaluate the influence of primary jet to ejector area ratio, ejector length, and presence of a diffuser on pulsatile ejector performance.

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.

Towards a balanced performance measurement system in a public health care organization.

PubMed

Yuen, Peter P; Ng, Artie W

2012-01-01

This article attempts to devise an integrated performance measurement framework to assess the Hong Kong Hospital Authority (HA) management system by harnessing previous performance measurement systems. An integrated evaluative framework based on the balanced score card (BSC) was developed and applied using the case study method and longitudinal data to evaluate the HA's performance management system. The authors unveil evolving HA performance indicators (P1). Despite the HA staffs explicit quality emphasis, cost control remains the primary focus in their performance measurements. RESEARCH LHNITATIONS/IMPLICATIONS: Data used in this study are from secondary sources, disclosed mostly by HA staff. This study shows public sector staff often attach too much importance to cost control and easily measurable activities at the expense of quality and other less easily measurable attributes'. A balanced performance measurement system, linked to health targets, with a complementary budgeting process that supports pertinent resource allocation is yet to be implemented in Hong Kong's public hospitals.

Comprehensiveness of care from the patient perspective: comparison of primary healthcare evaluation instruments.

PubMed

Haggerty, Jeannie L; Beaulieu, Marie-Dominique; Pineault, Raynald; Burge, Frederick; Lévesque, Jean-Frédéric; Santor, Darcy A; Bouharaoui, Fatima; Beaulieu, Christine

2011-12-01

Comprehensiveness relates both to scope of services offered and to a whole-person clinical approach. Comprehensive services are defined as "the provision, either directly or indirectly, of a full range of services to meet most patients' healthcare needs"; whole-person care is "the extent to which a provider elicits and considers the physical, emotional and social aspects of a patient's health and considers the community context in their care." Among instruments that evaluate primary healthcare, two had subscales that mapped to comprehensive services and to the community component of whole-person care: the Primary Care Assessment Tool - Short Form (PCAT-S) and the Components of Primary Care Index (CPCI, a limited measure of whole-person care). To examine how well comprehensiveness is captured in validated instruments that evaluate primary healthcare from the patient's perspective. 645 adults with at least one healthcare contact in the previous 12 months responded to six instruments that evaluate primary healthcare. Scores were normalized for descriptive comparison. Exploratory and confirmatory (structural equation modelling) factor analysis examined fit to operational definition, and item response theory analysis examined item performance on common constructs. Over one-quarter of respondents had missing responses on services offered or doctor's knowledge of the community. The subscales did not load on a single factor; comprehensive services and community orientation were examined separately. The community orientation subscales did not perform satisfactorily. The three comprehensive services subscales fit very modestly onto two factors: (1) most healthcare needs (from one provider) (CPCI Comprehensive Care, PCAT-S First-Contact Utilization) and (2) range of services (PCAT-S Comprehensive Services Available). Individual item performance revealed several problems. Measurement of comprehensiveness is problematic, making this attribute a priority for measure development. Range of services offered is best obtained from providers. Whole-person care is not addressed as a separate construct, but some dimensions are covered by attributes such as interpersonal communication and relational continuity.

Development of a Primary Standard for Calibration of [18F]FDG Activity Measurement Systems

NASA Astrophysics Data System (ADS)

Capogni, M.; DeFelice, P.; Fazio, A.; Simonelli, F.; D'Ursi, V.; Pecorale, A.; Giliberti, C.; Abbas, K.

2006-05-01

The 18F national primary standard was developed by the INMRI-ENEA using the 4πβ Liquid Scintillation Spectrometry Method with 3H-Standard Efficiency Tracing. Measurements were performed at JRCIspra under a scientific collaboration between the Institute for Health and Consumer Production, the Amersham Health and the National Institute for Occupational Safety and Prevention (ISPESL). The goal of the work was to calibrate, with minimum uncertainty, the INMRI-ENEA transfer standard portable well-type ionisation chamber as well as other JRC-Ispra and Amersham Health reference Ionising Chambers used for FDG activity measurement.

Using the Fennema-Sherman Mathematics Attitude Scales with lower-primary teachers

NASA Astrophysics Data System (ADS)

Ren, Lixin; Green, Jennifer L.; Smith, Wendy M.

2016-06-01

The Fennema-Sherman Mathematics Attitude Scales (FSMAS) are among the most popular instruments used in studies of attitudes toward mathematics. However, the FSMAS has been mainly used among student populations and rarely used with teachers. In the present study, three scales from the FSMAS— Confidence, Effectance Motivation, and Anxiety—were revised and used with lower-primary (kindergarten to third grade) teachers. This study includes three parts: (1) a pilot study to ensure the modifications made to the FSMAS were appropriate to use with teachers, (2) confirmatory factor analyses to assess the factor structure of the revised FSMAS with 225 lower-primary teachers, and (3) measurement invariance analyses using data from a similar sample of 171 lower-primary teachers to examine whether the revised FSMAS measures each construct in the same way as in the previous sample. The final three-factor model, after removing three problematic items, achieves acceptable model fit, with each construct meeting all conditions for strict measurement invariance. Additionally, repeated measures analyses were performed on data collected from 39 in-service lower-primary teachers who participated in an elementary mathematics specialist program to examine the use of the revised FSMAS in program evaluation. Overall results suggest that researchers and program evaluators may use the revised FSMAS to reliably measure lower-primary teachers' mathematical attitudes, and it can be a valuable tool for evaluating the effectiveness of professional development programs.

Balance performance and self-perceived handicap among dizzy patients in primary health care.

PubMed

Hansson, Eva Ekvall; Månsson, Nils-Ove; Håkansson, Anders

2005-12-01

To study the diagnostic panorama at a primary health care centre where the physiotherapist is specialized in dizziness. To study balance measures of dizzy patients as well as measures of self-perceived handicap and to analyse whether these measures correlate. Retrospective study of computerized medical records. A primary health care centre in Malmö, Sweden. A total of 119 patients with dizziness, 73 women and 46 men, aged from 22 to 90 years. Diagnoses according to specified criteria. Four balance measures: tandem standing, standing on one leg, walking in a figure of eight, and walking heel to toe on a line. The Dizziness Handicap Inventory (DHI). Six different groups of diagnoses were found: multisensory dizziness, peripheral vestibular disorder, dizziness as a symptom caused by whiplash-associated disorder, unspecific dizziness, phobic postural vertigo, and dizziness of cervical origin. The group with multisensory dizziness performed poorer on the balance measures than the other groups. The group with phobic postural vertigo had the highest total scores on DHI, while the vestibular group had the lowest total score. Subjects over 65 years old had more disturbances in balance, but a lower level of self-perceived handicap, than subjects aged 65 or younger. DHI did not correlate with any of the balance measures. Self-perceived handicap, measured with DHI, and disturbed balance measured with clinical methods, do not necessarily correlate. Elderly patients with dizziness seem to have more disturbances in balance than younger patients but a lower level of self-perceived handicap.

Chief Complaint-Based Performance Measures: A New Focus For Acute Care Quality Measurement

PubMed Central

Griffey, Richard T; Pines, Jesse M.; Farley, Heather L.; Phelan, Michael P; Beach, Christopher; Schuur, Jeremiah D; Venkatesh, Arjun K.

2014-01-01

Performance measures are increasingly important to guide meaningful quality improvement efforts and value-based reimbursement. Populations included in most current hospital performance measures are defined by recorded diagnoses using International Disease Classification (ICD)-9 codes in administrative claims data. While the diagnosis-centric approach allows the assessment of disease-specific quality, it fails to measure one of the primary functions of emergency department (ED) care which involves diagnosing, risk-stratifying, and treating patients’ potentially life-threatening conditions based on symptoms (i.e. chief complaints). In this paper we propose chief complaint-based quality measures as a means to enhance the evaluation of quality and value in emergency care. We discuss the potential benefits of chief-complaint based measures, describe opportunities to mitigate challenges, propose an example measure set, and present several recommendations to advance this paradigm in ED-based performance measurement. PMID:25443989

Whole Building Cost and Performance Measurement: Data Collection Protocol Revision 2

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

Fowler, Kimberly M.; Spees, Kathleen L.; Kora, Angela R.

2009-03-27

This protocol was written for the Department of Energy’s Federal Energy Management Program (FEMP) to be used by the public as a tool for assessing building cost and performance measurement. The primary audiences are sustainable design professionals, asset owners, building managers, and research professionals within the Federal sector. The protocol was developed based on the need for measured performance and cost data on sustainable design projects. Historically there has not been a significant driver in the public or private sector to quantify whole building performance in comparable terms. The deployment of sustainable design into the building sector has initiated manymore » questions on the performance and operational cost of these buildings.« less

College Transfer Performance: A Methodology for Equitable Measurement and Comparison

ERIC Educational Resources Information Center

Bahr, Peter Riley; Hom, Willard; Perry, Patrick

2005-01-01

Accountability in performance is a subject of increasing attention and concern for community colleges. In California, much attention has been focused on student transfers from the community colleges to four-year institutions as a primary facet of institutional performance. This focus often leads to comparisons of transfer rates between colleges…

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey

PubMed Central

Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L

2012-01-01

Objectives Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Design/setting Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Main outcome measures Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Results Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. Conclusions While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would ‘cream-skim’ by not enrolling patients from vulnerable socio-demographic groups. PMID:22626735

Decrease in the Photosynthetic Performance of Temperate Grassland Species Does Not Lead to a Decline in the Gross Primary Production of the Ecosystem

PubMed Central

Digrado, Anthony; de la Motte, Louis G.; Bachy, Aurélie; Mozaffar, Ahsan; Schoon, Niels; Bussotti, Filippo; Amelynck, Crist; Dalcq, Anne-Catherine; Fauconnier, Marie-Laure; Aubinet, Marc; Heinesch, Bernard; du Jardin, Patrick; Delaplace, Pierre

2018-01-01

Plants, under stressful conditions, can proceed to photosynthetic adjustments in order to acclimatize and alleviate the detrimental impacts on the photosynthetic apparatus. However, it is currently unclear how adjustment of photosynthetic processes under environmental constraints by plants influences CO2 gas exchange at the ecosystem-scale. Over a 2-year period, photosynthetic performance of a temperate grassland ecosystem was characterized by conducting frequent chlorophyll fluorescence (ChlF) measurements on three primary grassland species (Lolium perenne L., Taraxacum sp., and Trifolium repens L.). Ecosystem photosynthetic performance was estimated from measurements performed on the three dominant grassland species weighed based on their relative abundance. In addition, monitoring CO2 fluxes was performed by eddy covariance. The highest decrease in photosynthetic performance was detected in summer, when environmental constraints were combined. Dicot species (Taraxacum sp. and T. repens) presented the strongest capacity to up-regulate PSI and exhibited the highest electron transport efficiency under stressful environmental conditions compared with L. perenne. The decline in ecosystem photosynthetic performance did not lead to a reduction in gross primary productivity, likely because increased light energy was available under these conditions. The carbon amounts fixed at light saturation were not influenced by alterations in photosynthetic processes, suggesting photosynthesis was not impaired. Decreased photosynthetic performance was associated with high respiration flux, but both were influenced by temperature. Our study revealed variation in photosynthetic performance of a grassland ecosystem responded to environmental constraints, but alterations in photosynthetic processes appeared to exhibit a negligible influence on ecosystem CO2 fluxes. PMID:29459875

MEASUREMENT OF HYDRAULIC CONDUCTIVITY DISTRIBUTIONS: A MANUAL OF PRACTICE

EPA Science Inventory

The ability of hydrologists to perform field measurements of aquifer hydraulic properties must be enhanced in order to significantly improve the capacity to solve groundwater contamination problems at Superfund and other sites. The primary purpose of this manual is to provide ne...

MEASUREMENT OF HYDRAULIC CONDUCTIVITY DISTRIBUTIONS: A MANUAL OF PRACTICE

EPA Science Inventory

The ability of hydrologists to perform field measurements of aquifer hydraulic properties must be enhanced in order to significantly improve the capacity to solve groundwater contamination problems at Superfund and other sites. he primary purpose of this manual is to provide new ...

Measuring the economic contribution of the freight industry to the Maryland economy : [research summary].

DOT National Transportation Integrated Search

2015-05-01

The primary objective was to measure the economic contributions of the freight : industry to the Maryland economy and to develop a freight economic output (FECO) : index that tracks the economic performance of the freight industry over time.

Analytical performance, agreement and user-friendliness of six point-of-care testing urine analysers for urinary tract infection in general practice

PubMed Central

Schot, Marjolein J C; van Delft, Sanne; Kooijman-Buiting, Antoinette M J; de Wit, Niek J; Hopstaken, Rogier M

2015-01-01

Objective Various point-of-care testing (POCT) urine analysers are commercially available for routine urine analysis in general practice. The present study compares analytical performance, agreement and user-friendliness of six different POCT urine analysers for diagnosing urinary tract infection in general practice. Setting All testing procedures were performed at a diagnostic centre for primary care in the Netherlands. Urine samples were collected at four general practices. Primary and secondary outcome measures Analytical performance and agreement of the POCT analysers regarding nitrite, leucocytes and erythrocytes, with the laboratory reference standard, was the primary outcome measure, and analysed by calculating sensitivity, specificity, positive and negative predictive value, and Cohen's κ coefficient for agreement. Secondary outcome measures were the user-friendliness of the POCT analysers, in addition to other characteristics of the analysers. Results The following six POCT analysers were evaluated: Uryxxon Relax (Macherey Nagel), Urisys 1100 (Roche), Clinitek Status (Siemens), Aution 11 (Menarini), Aution Micro (Menarini) and Urilyzer (Analyticon). Analytical performance was good for all analysers. Compared with laboratory reference standards, overall agreement was good, but differed per parameter and per analyser. Concerning the nitrite test, the most important test for clinical practice, all but one showed perfect agreement with the laboratory standard. For leucocytes and erythrocytes specificity was high, but sensitivity was considerably lower. Agreement for leucocytes varied between good to very good, and for the erythrocyte test between fair and good. First-time users indicated that the analysers were easy to use. They expected higher productivity and accuracy when using these analysers in daily practice. Conclusions The overall performance and user-friendliness of all six commercially available POCT urine analysers was sufficient to justify routine use in suspected urinary tract infections in general practice. PMID:25986635

Singapore Primary Students' Pursuit of Multiple Achievement Goals: A Latent Profile Analysis

ERIC Educational Resources Information Center

Ning, Hoi Kwan

2018-01-01

Based on measures of approach and avoidance mastery and performance goals delineated in the 2 × 2 achievement goal framework, this study utilized a person-centered approach to examine Singapore primary students' (N = 819) multiple goals pursuit in the general school context. Latent profile analysis identified six types of students with distinct…

Effects of intermittent theta-burst stimulation on practice-related changes in fast finger movements in healthy subjects.

PubMed

Agostino, Rocco; Iezzi, Ennio; Dinapoli, Loredana; Suppa, Antonio; Conte, Antonella; Berardelli, Alfredo

2008-08-01

In this paper we investigated the effects of intermittent theta-burst stimulation (iTBS) applied to the primary motor cortex on practice-related changes in motor performance. Seventeen healthy subjects underwent two experimental sessions, one testing real iTBS and the other testing sham iTBS. Before and after both iTBS sessions, the subjects practiced fast right index-finger abductions for a few minutes. As measures of cortical excitability we calculated resting motor threshold and motor-evoked potential amplitude. As measures of practice-related changes we evaluated the mean movement amplitude, peak velocity and peak acceleration values for each block. When subjects practiced the movement task, the three variables measuring practice-related changes improved to a similar extent during real and sham iTBS whereas cortical excitability increased only during real iTBS. In a further group of five healthy subjects we investigated the effect of real and sham iTBS on changes in motor performance after a longer task practice and found no significant changes in motor performance and retention after real and sham iTBS. From our results overall we conclude that in healthy subjects iTBS applied to the primary motor cortex leaves practice-related changes in an index finger abduction task unaffected. We suggest that iTBS delivered over the primary motor cortex is insufficient to alter motor performance because early motor learning probably engages a wide cortical and subcortical network.

Comparative Analysis of Three-Dimensional Nasal Shape of Casts from Patients With Unilateral Cleft Lip and Palate Treated at Two Institutions Following Rotation Advancement Only (Iowa) or Nasoalveolar Molding and Rotation Advancement in Conjunction With Primary Rhinoplasty (New York).

PubMed

Hosseinian, Banafsheh; Rubin, Marcie S; Clouston, Sean A P; Almaidhan, Asma; Shetye, Pradip R; Cutting, Court B; Grayson, Barry H

2018-01-01

To compare 3-dimensional nasal symmetry in patients with UCLP who had either rotation advancement alone or nasoalveolar molding (NAM) followed by rotation advancement in conjunction with primary nasal repair. Pilot retrospective cohort study. Nasal casts of 23 patients with UCLP from 2 institutions were analyzed; 12 in the rotation advancement only group (Iowa) and 11 in the NAM, rotation advancement with primary nasal repair group (New York). Casts from patients aged 6 to 18 years were scanned using the 3Shape scanner and 3-dimensional analysis of nasal symmetry performed using 3dMD Vultus software, Version 2507, 3dMD, Atlanta, GA. Cleft and noncleft side columellar height, nasal dome height, alar base width, and nasal projection were linearly measured. Inter- and intragroup analyses were performed using t tests and paired t tests as appropriate. A statistically significant difference in mean-scaled 3-dimensional asymmetry index was found between groups with group 1 having a larger measure of asymmetry (4.69 cm 3 ) than group 2 (2.56 cm 3 ; P = .02). Intergroup analysis performed on the most sensitive linear measure, alar base width, revealed significantly less asymmetry on average in group 2 than in group 1 ( P = .013). This study suggests the NAM followed by rotation advancement in conjunction with primary nasal repair approach may result in less nasal asymmetry compared to rotation advancement alone.

Effect of a checklist on advanced trauma life support task performance during pediatric trauma resuscitation.

PubMed

Kelleher, Deirdre C; Carter, Elizabeth A; Waterhouse, Lauren J; Parsons, Samantha E; Fritzeen, Jennifer L; Burd, Randall S

2014-10-01

Advanced Trauma Life Support (ATLS) has been shown to improve outcomes related to trauma resuscitation; however, omissions from this protocol persist. The objective of this study was to evaluate the effect of a trauma resuscitation checklist on performance of ATLS tasks. Video recordings of resuscitations of children sustaining blunt or penetrating injuries at a Level I pediatric trauma center were reviewed for completion and timeliness of ATLS primary and secondary survey tasks, with and without checklist use. Patient and resuscitation characteristics were obtained from the trauma registry. Data were collected during two 4-month periods before (n = 222) and after (n = 213) checklist implementation. The checklist contained 50 items and included four sections: prearrival, primary survey, secondary survey, and departure plan. Five primary survey ATLS tasks (cervical spine immobilization, oxygen administration, palpating pulses, assessing neurologic status, and exposing the patient) and nine secondary survey ATLS tasks were performed more frequently (p ≤ 0.01 for all) and vital sign measurements were obtained faster (p ≤ 0.01 for all) after the checklist was implemented. When controlling for patient and event-specific characteristics, primary and secondary survey tasks overall were more likely to be completed (odds ratio [OR] = 2.66, primary survey; OR = 2.47, secondary survey; p < 0.001 for both) and primary survey tasks were performed faster (p < 0.001) after the checklist was implemented. Implementation of a trauma checklist was associated with greater ATLS task performance and with increased frequency and speed of primary and secondary survey task completion. © 2014 by the Society for Academic Emergency Medicine.

Mental Health Screening in Primary Care: A Comparison of 3 Brief Measures of Psychological Distress

PubMed Central

Cano, Annmarie; Sprafkin, Robert P.; Scaturo, Douglas J.; Lantinga, Larry J.; Fiese, Barbara H.; Brand, Frank

2001-01-01

Background: The current study compared 3 brief mental health screening measures in a sample of older patients in a primary care outpatient setting. Previous mental health screening research has been conducted primarily with younger patients, often with only 1 screening measure, thereby limiting the generalizability of findings. In addition, measures have not yet been compared in terms of their ability to discriminate between cases and noncases of psychiatric disorder. Method: One hundred thirty-four male patients attending their appointments at a primary care clinic in a Department of Veterans Affairs Medical Center participated in this study. Participants completed the General Health Questionnaire-12 (GHQ-12), the Symptom Checklist-10 (SCL-10), and the Primary Care Evaluation of Mental Disorders screening questionnaire and interview. Results: Receiver operating characteristic analysis yielded the optimum cutoff scores on each brief mental health screening measure and showed that all 3 measures discriminated well between cases and noncases of psychiatric disorders. The 3 measures performed slightly better in terms of discriminating between cases and noncases of mood or anxiety disorders than between cases and noncases of any psychiatric disorder. There were no significant differences between the measures' abilities to accurately identify cases and noncases of disorder. Conclusion: Primary care physicians are encouraged to use brief mental health screening measures with their patients, since many report symptoms of psychological distress and disorder. It is recommended that the SCL-10 and GHQ-12 be used to detect mood or anxiety disorders in patients such as these because of the accuracy and brevity of these measures. PMID:15014574

Children's Exposure to Radon in Nursery and Primary Schools.

PubMed

Branco, Pedro T B S; Nunes, Rafael A O; Alvim-Ferraz, Maria C M; Martins, Fernando G; Sousa, Sofia I V

2016-03-30

The literature proves an evident association between indoor radon exposure and lung cancer, even at low doses. This study brings a new approach to the study of children's exposure to radon by aiming to evaluate exposure to indoor radon concentrations in nursery and primary schools from two districts in Portugal (Porto and Bragança), considering different influencing factors (occupation patterns, classroom floor level, year of the buildings' construction and soil composition of the building site), as well as the comparison with IAQ standard values for health protection. Fifteen nursery and primary schools in the Porto and Bragança districts were considered: five nursery schools for infants and twelve for pre-schoolers (seven different buildings), as well as eight primary schools. Radon measurements were performed continuously. The measured concentrations depended on the building occupation, classroom floor level and year of the buildings' construction. Although they were in general within the Portuguese legislation for IAQ, exceedances to international standards were found. These results point out the need of assessing indoor radon concentrations not only in primary schools, but also in nursery schools, never performed in Portugal before this study. It is important to extend the study to other microenvironments like homes, and in time to estimate the annual effective dose and to assess lifetime health risks.

Children’s Exposure to Radon in Nursery and Primary Schools

PubMed Central

Branco, Pedro T. B. S.; Nunes, Rafael A. O.; Alvim-Ferraz, Maria C. M.; Martins, Fernando G.; Sousa, Sofia I. V.

2016-01-01

The literature proves an evident association between indoor radon exposure and lung cancer, even at low doses. This study brings a new approach to the study of children’s exposure to radon by aiming to evaluate exposure to indoor radon concentrations in nursery and primary schools from two districts in Portugal (Porto and Bragança), considering different influencing factors (occupation patterns, classroom floor level, year of the buildings’ construction and soil composition of the building site), as well as the comparison with IAQ standard values for health protection. Fifteen nursery and primary schools in the Porto and Bragança districts were considered: five nursery schools for infants and twelve for pre-schoolers (seven different buildings), as well as eight primary schools. Radon measurements were performed continuously. The measured concentrations depended on the building occupation, classroom floor level and year of the buildings’ construction. Although they were in general within the Portuguese legislation for IAQ, exceedances to international standards were found. These results point out the need of assessing indoor radon concentrations not only in primary schools, but also in nursery schools, never performed in Portugal before this study. It is important to extend the study to other microenvironments like homes, and in time to estimate the annual effective dose and to assess lifetime health risks. PMID:27043596

Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: design of a prospective cohort study.

PubMed

Karel, Yasmaine H J M; Scholten-Peeters, Wendy G M; Thoomes-de Graaf, Marloes; Duijn, Edwin; Ottenheijm, Ramon P G; van den Borne, Maaike P J; Koes, Bart W; Verhagen, Arianne P; Dinant, Geert-Jan; Tetteroo, Eric; Beumer, Annechien; van Broekhoven, Joost B; Heijmans, Marcel

2013-02-11

Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated with poor outcome. Most shoulder complaints in this group are categorized as non-specific. Musculoskeletal ultrasound might be a useful imaging method to detect subgroups of patients with subacromial disorders.This article describes the design of a prospective cohort study evaluating the influence of known prognostic and possible prognostic factors, such as findings from musculoskeletal ultrasound outcome and working alliance, on the recovery of shoulder pain. Also, to assess the usual physiotherapy care for shoulder pain and examine the inter-rater reliability of musculoskeletal ultrasound between radiologists and physiotherapists for patients with shoulder pain. A prospective cohort study including an inter-rater reliability study. Patients presenting in primary care physiotherapy practice with shoulder pain are enrolled. At baseline validated questionnaires are used to measure patient characteristics, disease-specific characteristics and social factors. Physical examination is performed according to the expertise of the physiotherapists. Follow-up measurements will be performed 6, 12 and 26 weeks after inclusion. Primary outcome measure is perceived recovery, measured on a 7-point Likert scale. Logistic regression analysis will be used to evaluate the association between prognostic factors and recovery. The ShoCoDiP (Shoulder Complaints and using Diagnostic ultrasound in Physiotherapy practice) cohort study will provide information on current management of patients with shoulder pain in primary care, provide data to develop a prediction model for shoulder pain in primary care and to evaluate whether musculoskeletal ultrasound can improve prognosis.

Individual Differences in Secondary Task Performance.

DTIC Science & Technology

1980-09-01

applied than in the experimental literature (e.g. Brown, 1968). The assertion that primary and secondary tasks compete for mental resources has a further...Subjects were paid $8.00 for participation in two 1 -hour sessions. Bonus points were awarded on the basis of performance in the experimental tasks...the experimental measures are presented in Table 3. Reliabilities, shown in the diagonal, are based on correlations between measures from Day 1 and Day

Influence of the measurement location on the resistance index in the umbilical arteries: a hemodynamic approach.

PubMed

Vieyres, P; Durand, A; Patat, F; Descamps, P; Gregoire, J M; Pourcelot, D; Pourcelot, L

1991-12-01

A computer model was used to study the primary factors generating the reduction in resistance index, (S-D)/S, values observed by ultrasonic Doppler measurements in the umbilical artery, from the fetal insertion to the placental insertion (S represents the amplitude of the systolic peak and D the amplitude of the diastolic peak). This hemodynamic approach shows that the placental resistance is the primary factor, the viscosity and the cord length playing secondary roles. Clinically, the position of the measurement along the cord is an important factor. To increase the sensitivity of the index, the Doppler measurement must be performed near the fetal insertion, whereas a measurement near the placental insertion will make the Doppler examination more specific.

Performance-based measures and behavioral ratings of executive function in diagnosing attention-deficit/hyperactivity disorder in children.

PubMed

Tan, Alexander; Delgaty, Lauren; Steward, Kayla; Bunner, Melissa

2018-04-16

Deficits in real-world executive functioning (EF) are a frequent characteristic of attention-deficit/hyperactivity disorder (ADHD). However, the predictive value of using performance-based and behavioral rating measures of EF when diagnosing ADHD remains unclear. The current study investigates the use of performance-based EF measures and a parent-report questionnaire with established ecological validity and clinical utility when diagnosing ADHD. Participants included 21 healthy controls, 21 ADHD-primary inattentive, and 21 ADHD-combined type subjects aged 6-15 years. A brief neuropsychological battery was administered to each subject including common EF assessment measures. Significant differences were not found between groups on most performance-based EF measures, whereas significant differences (p < 0.05) were found on most parent-report behavioral rating scales. Furthermore, performance-based measures did not predict group membership above chance levels. Results further support differences in predictive value of EF performance-based measures compared to parent-report questionnaires when diagnosing ADHD. Further research must investigate the relationship between performance-based and behavioral rating measures when assessing EF in ADHD.

Latest Developments in the Matrics Process

PubMed Central

Green, Michael Foster; Nuechterlein, Keith H

2010-01-01

The Measurement and Treatment Research to Improve Cognition in Schizophrenia Research process has led to several developments in the assessment of cognitive functioning for schizophrenia-treatment studies. The first development was the development of a consensus cognitive battery and a United States Food and Drug Administration-endorsed research design. Since the development of the cognitive battery, interest has been spurred in clinical trials in different countries and the development of co-primary functional outcomes measures for these. The MATRICS Consensus Cognitive Battery has been translated into 11 different languages and is being translated into even more. A study has been completed that compared the usefulness of multiple potential co-primary measures, suggesting that the University of California San Diego Performance-Based skills assessment, version II (UPSA-II) is the most suitable for studies conducted in English. These findings suggest that reliable performance-based measures that are easy to administer and highly correlated with cognitive functioning are now available for use in treatment studies. PMID:20622946

Coordinate metrology of a primary surface composite panel from the Large Millimeter Telescope

NASA Astrophysics Data System (ADS)

Gale, David M.; Lucero Álvarez, Maribel; Cabrera Cuevas, Lizeth; Leon-Huerta, Andrea; Arizmendi Reyes, Edgar; Icasio Hernández, Octavio; Castro Santos, David; Hernández Ríos, Emilio; Tecuapetla Sosa, Esteban; Tzile Torres, Carlos; Viliesid Alonso, Miguel

2016-07-01

The Large Millimeter Telescope (LMT) is a single-dish fully-steerable radio telescope presently operating with a 32.5 m parabolic primary reflector, in the process of extension to 50 m. The project is managed by the Instituto Nacional de Astrofísica, Óptica y Electrónica (INAOE) in México, and the University of Massachusetts Amherst, USA. A laminated surface panel from the LMT primary reflector has been subjected to a surface measurement assay at Mexico's National Metrology Center (CENAM). Data obtained using a coordinate measuring machine and laser tracker owned by CENAM is compared with measurements using an identical model laser tracker and the photogrammetry technique, the latter systems owned and operated by the LMT. All measurements were performed within the controlled metrology environment at CENAM. The measurement exercise is intended to prepare the groundwork for converting this spare surface panel into a calibrated work-piece. The establishment of a calibrated work-piece provides quality assurance for metrology through measurement traceability. It also simplifies the evaluation of measurement uncertainty for coordinate metrology procedures used by the LMT project during reflector surface qualification.

Neural correlates of working memory performance in primary insomnia.

PubMed

Drummond, Sean P A; Walker, Matthew; Almklov, Erin; Campos, Manuel; Anderson, Dane E; Straus, Laura D

2013-09-01

To examine neural correlates of working memory performance in patients with primary insomnia (PIs) compared with well-matched good sleepers (GSs). Twenty-five PIs and 25 GSs underwent functional MRI while performing an N-back working memory task. VA hospital sleep laboratory and University-based functional imaging center. 25 PIs, 25 GSs. N/A. Although PIs did not differ from GSs in cognitive performance, PIs showed the expected differences from GSs in both self-reported and objective sleep measures. PIs, relative to GSs, showed reduced activation of task-related working memory regions. This manifested both as an overall reduction in activation of task-related regions and specifically as reduced modulation of right dorsolateral prefrontal cortex with increasing task difficulty. Similarly, PIs showed reduced modulation (i.e., reduced deactivation) of default mode regions with increasing task difficulty, relative to GSs. However, PIs showed intact performance. These data establish a profile of abnormal neural function in primary insomnia, reflected both in reduced engagement of task-appropriate brain regions and an inability to modulate task-irrelevant (i.e., default mode) brain areas during working memory performance. These data have implications for better understanding the neuropathophysiology of the well established, yet little understood, discrepancy between ubiquitous subjective cognitive complaints in primary insomnia and the rarely found objective deficits during testing.

Computational modeling of colorimetric primary transducer for metrological assurance in additive manufacturing

NASA Astrophysics Data System (ADS)

Skliarov, Volodymyr

2018-03-01

Many additive manufacturing (AM) systems are based on laser technology. The advantage of laser technology is that it provides a high-intensity and high-collimation energy beam that can be controlled. Since AM requires that the material on each layer has to be solid or connected to the previous one, the energy of laser radiation is exactly the needed technical tool for the processing of the material. AM uses two types of laser processing: cutting and heating. One of the most popular (common) types of measurements in the field of laser metrology is the control of the energy parameters of the sources of laser radiation. At present, calorimeters provide the highest accuracy of absolute measurements of laser radiation in the power range from several watts to tens of kilowatts. The main elements that determine the accuracy of reproduction, maintenance and transfer of the unit of laser power are the primary measuring converters (PMCs), which are the part of the equipment of the national primary measurement standards of Ukraine. A significant contribution to the uncertainty budget of the primary measuring calorimetric converter is the unbalanced replacement of laser radiation by the heat flux that calibrates this converter. The heterogeneous internal structure of the calorimetric primary converter, the nonlinearity of processes occurring in it, and the multifactorial process of its calibration substantially complicate the development of primary measuring converters. The purpose of this paper is to simulate the thermal field of the primary converter for maximum reduction of the uncertainty of calibration. The presented research is a part of the scientific work that NSC "Institute of Metrology" carries out under COOMET and EMPIRE projects. The modeling was performed in the academic version of ANSYS.

A longitudinal analysis of sex differences in math and spatial skills in primary school age children☆

PubMed Central

Lachance, Jennifer A.; Mazzocco, Michèle M.M.

2009-01-01

We report on a longitudinal study designed to assess possible sex differences in math achievement, math ability, and math-related tasks during the primary school age years. Participants included over 200 children from one public school district. Annual assessments included measures of math ability, math calculation achievement scores, rapid naming and decoding tasks, visual perception tests, visual motor tasks, and reading skills. During select years of the study we also administered tests of counting and math facts skills. We examined whether girls or boys were overrepresented among the bottom or top performers on any of these tasks, relative to their peers, and whether growth rates or predictors of math-related skills differed for boys and girls. Our findings support the notion that sex differences in math are minimal or nonexistent on standardized psychometric tests routinely given in assessments of primary school age children. There was no persistent finding suggesting a male or female advantage in math performance overall, during any single year of the study, or in any one area of math or spatial skills. Growth rates for all skills, and early correlates of later math performance, were comparable for boys and girls. The findings fail to support either persistent or emerging sex differences on non-specialized math ability measures during the primary school age years. PMID:20463851

Measuring What High-Achieving Students Know and Can Do on Entry to School: PIPS 2002-2008

ERIC Educational Resources Information Center

Wildy, Helen; Styles, Irene

2011-01-01

Anecdotal evidence from teachers in Western Australia suggested that increasing numbers of on-entry students have been performing at high levels over recent years on the Performance Indicators in Primary Schools Baseline Assessment (PIPS-BLA). This paper reports the results of an investigation into the performance of high-scoring students. Data…

Care of adults with developmental disabilities: Effects of a continuing education course for primary care providers.

PubMed

Balogh, Robert; Wood, Jessica; Lunsky, Yona; Isaacs, Barry; Ouellette-Kuntz, Hélène; Sullivan, William

2015-07-01

To evaluate the effects of an interdisciplinary, guideline-based continuing education course on measures related to the care of adults with developmental disabilities (DD). Before-and-after study with a control group. Ontario. Forty-seven primary care providers (physicians, registered nurses, and nurse practitioners). Participants either only received reference material about primary care of people with DD (control group) or participated in a continuing education course on primary care of people with DD in addition to receiving the reference material (intervention group). Participants reported on 5 key measures related to care of adults with DD: frequency of using guidelines, frequency of performing periodic health examinations, frequency of assessing patients who present with behaviour changes, level of comfort while caring for adults with DD, and knowledge of primary care related to adults with DD. Over time, the intervention group showed significant increases in 4 of the 5 key measures of care compared with the control group: the frequency of guideline use (P < .001), frequency of assessment of patients' behaviour change (P = .03), comfort level in caring for people with DD (P = .01), and knowledge of primary care related to adults with DD (P = .01). A continuing education course on primary care of adults with DD is a useful interdisciplinary model to train health professionals who provide primary care services to these patients.

Turbulent Mixing of Primary and Secondary Flow Streams in a Rocket-Based Combined Cycle Engine

NASA Technical Reports Server (NTRS)

Cramer, J. M.; Greene, M. U.; Pal, S.; Santoro, R. J.; Turner, Jim (Technical Monitor)

2002-01-01

This viewgraph presentation gives an overview of the turbulent mixing of primary and secondary flow streams in a rocket-based combined cycle (RBCC) engine. A significant RBCC ejector mode database has been generated, detailing single and twin thruster configurations and global and local measurements. On-going analysis and correlation efforts include Marshall Space Flight Center computational fluid dynamics modeling and turbulent shear layer analysis. Potential follow-on activities include detailed measurements of air flow static pressure and velocity profiles, investigations into other thruster spacing configurations, performing a fundamental shear layer mixing study, and demonstrating single-shot Raman measurements.

JWST center of curvature test method and results

NASA Astrophysics Data System (ADS)

Saif, Babak; Chaney, David; Greenfield, Perry; Van Gorkom, Kyle; Brooks, Keira; Hack, Warren; Bluth, Marcel; Bluth, Josh; Sanders, James; Smith, Koby; Carey, Larkin; Chaung, Sze; Keski-Kuha, Ritva; Feinberg, Lee; Tournois, Severine; Smith, W. Scott; Kradinov, Vladimir

2017-09-01

The James Webb Space Telescope (JWST) recently saw the completion of the assembly process for the Optical Telescope Element and Integrated Science Instrument Module (OTIS). This integration effort was performed at Goddard Space Flight Center (GSFC) in Greenbelt, Maryland. In conjunction with this assembly process a series of vibration and acoustic tests were performed. To help assure the telescope's primary mirror was not adversely impacted by this environmental testing an optical center of curvature (CoC) test was performed to measure changes in the mirror's optical performance. The primary is a 6.5 meter diameter mirror consisting of 18 individual hexagonal segments. Each segment is an off-axis asphere. There are a total of three prescriptions repeated six times each. As part of the CoC test each segment was individually measured using a high-speed interferometer (HSI) designed and built specifically for this test. This interferometer is capable of characterizing both static and dynamic characteristics of the mirrors. The latter capability was used, with the aid of a vibration stinger applying a low-level input force, to measure the dynamic characteristic changes of the PM backplane structure. This paper describes the CoC test setup, an innovative alignment method, and both static and dynamic test results.

Determinants of School Efficiency: The Case of Primary Schools in the State of Geneva, Switzerland

ERIC Educational Resources Information Center

Huguenin, Jean-Marc

2015-01-01

Purpose: The purpose of this paper is: to measure school technical efficiency and to identify the determinants of primary school performance. Design/Methodology/Approach: A two-stage data envelopment analysis (DEA) of school efficiency is conducted. At the first stage, DEA is employed to calculate an individual efficiency score for each school. At…

Primary Teachers' Conceptions about the Concept of Volume: The Case of Volume-Measurable Objects

ERIC Educational Resources Information Center

Saiz, Mariana

2003-01-01

In this paper part of the results obtained by a research project called "Primary Teachers' Thinking about the Concept of Volume and its Teaching", performed from 1997 to 2001, are reported. This paper focuses in one of the two main objectives of the aforementioned research: To describe the mental object volume of the participant…

Modelling size-fractionated primary production in the Atlantic Ocean from remote sensing

NASA Astrophysics Data System (ADS)

Brewin, Robert J. W.; Tilstone, Gavin H.; Jackson, Thomas; Cain, Terry; Miller, Peter I.; Lange, Priscila K.; Misra, Ankita; Airs, Ruth L.

2017-11-01

Marine primary production influences the transfer of carbon dioxide between the ocean and atmosphere, and the availability of energy for the pelagic food web. Both the rate and the fate of organic carbon from primary production are dependent on phytoplankton size. A key aim of the Atlantic Meridional Transect (AMT) programme has been to quantify biological carbon cycling in the Atlantic Ocean and measurements of total primary production have been routinely made on AMT cruises, as well as additional measurements of size-fractionated primary production on some cruises. Measurements of total primary production collected on the AMT have been used to evaluate remote-sensing techniques capable of producing basin-scale estimates of primary production. Though models exist to estimate size-fractionated primary production from satellite data, these have not been well validated in the Atlantic Ocean, and have been parameterised using measurements of phytoplankton pigments rather than direct measurements of phytoplankton size structure. Here, we re-tune a remote-sensing primary production model to estimate production in three size fractions of phytoplankton (<2 μm, 2-10 μm and >10 μm) in the Atlantic Ocean, using measurements of size-fractionated chlorophyll and size-fractionated photosynthesis-irradiance experiments conducted on AMT 22 and 23 using sequential filtration-based methods. The performance of the remote-sensing technique was evaluated using: (i) independent estimates of size-fractionated primary production collected on a number of AMT cruises using 14C on-deck incubation experiments and (ii) Monte Carlo simulations. Considering uncertainty in the satellite inputs and model parameters, we estimate an average model error of between 0.27 and 0.63 for log10-transformed size-fractionated production, with lower errors for the small size class (<2 μm), higher errors for the larger size classes (2-10 μm and >10 μm), and errors generally higher in oligotrophic waters. Application to satellite data in 2007 suggests the contribution of cells <2 μm and >2 μm to total primary production is approximately equal in the Atlantic Ocean.

Reconstruction of primary vertices at the ATLAS experiment in Run 1 proton-proton collisions at the LHC.

PubMed

Aaboud, M; Aad, G; Abbott, B; Abdallah, J; Abdinov, O; Abeloos, B; Aben, R; AbouZeid, O S; Abraham, N L; Abramowicz, H; Abreu, H; Abreu, R; Abulaiti, Y; Acharya, B S; Adamczyk, L; Adams, D L; Adelman, J; Adomeit, S; Adye, T; Affolder, A A; Agatonovic-Jovin, T; Agricola, J; Aguilar-Saavedra, J A; Ahlen, S P; Ahmadov, F; Aielli, G; Akerstedt, H; Åkesson, T P A; Akimov, A V; Alberghi, G L; Albert, J; Albrand, S; Verzini, M J Alconada; Aleksa, M; Aleksandrov, I N; Alexa, C; Alexander, G; Alexopoulos, T; Alhroob, M; Ali, B; Aliev, M; Alimonti, G; Alison, J; Alkire, S P; Allbrooke, B M M; Allen, B W; Allport, P P; Aloisio, A; Alonso, A; Alonso, F; Alpigiani, C; Alstaty, M; Gonzalez, B Alvarez; Piqueras, D Álvarez; Alviggi, M G; Amadio, B T; Amako, K; Coutinho, Y Amaral; Amelung, C; Amidei, D; Santos, S P Amor Dos; Amorim, A; Amoroso, S; Amundsen, G; Anastopoulos, C; Ancu, L S; Andari, N; Andeen, T; Anders, C F; Anders, G; Anders, J K; Anderson, K J; Andreazza, A; Andrei, V; Angelidakis, S; Angelozzi, I; Anger, P; Angerami, A; Anghinolfi, F; Anisenkov, A V; Anjos, N; Annovi, A; Antel, C; Antonelli, M; Antonov, A; Anulli, F; Aoki, M; Bella, L Aperio; Arabidze, G; Arai, Y; Araque, J P; Arce, A T H; Arduh, F A; Arguin, J-F; Argyropoulos, S; Arik, M; Armbruster, A J; Armitage, L J; Arnaez, O; Arnold, H; Arratia, M; Arslan, O; Artamonov, A; Artoni, G; Artz, S; Asai, S; Asbah, N; Ashkenazi, A; Åsman, B; Asquith, L; Assamagan, K; Astalos, R; Atkinson, M; Atlay, N B; Augsten, K; Avolio, G; Axen, B; Ayoub, M K; Azuelos, G; Baak, M A; Baas, A E; Baca, M J; Bachacou, H; Bachas, K; Backes, M; Backhaus, M; Bagiacchi, P; Bagnaia, P; Bai, Y; Baines, J T; Baker, O K; Baldin, E M; Balek, P; Balestri, T; Balli, F; Balunas, W K; Banas, E; Banerjee, Sw; Bannoura, A A E; Barak, L; Barberio, E L; Barberis, D; Barbero, M; Barillari, T; Barisits, M-S; Barklow, T; Barlow, N; Barnes, S L; Barnett, B M; Barnett, R M; Barnovska-Blenessy, Z; Baroncelli, A; Barone, G; Barr, A J; Navarro, L Barranco; Barreiro, F; da Costa, J Barreiro Guimarães; Bartoldus, R; Barton, A E; Bartos, P; Basalaev, A; Bassalat, A; Bates, R L; Batista, S J; Batley, J R; Battaglia, M; Bauce, M; Bauer, F; Bawa, H S; Beacham, J B; Beattie, M D; Beau, T; Beauchemin, P H; Bechtle, P; Beck, H P; Becker, K; Becker, M; Beckingham, M; Becot, C; Beddall, A J; Beddall, A; Bednyakov, V A; Bedognetti, M; Bee, C P; Beemster, L J; Beermann, T A; Begel, M; Behr, J K; Belanger-Champagne, C; Bell, A S; Bella, G; Bellagamba, L; Bellerive, A; Bellomo, M; Belotskiy, K; Beltramello, O; Belyaev, N L; Benary, O; Benchekroun, D; Bender, M; Bendtz, K; Benekos, N; Benhammou, Y; Noccioli, E Benhar; Benitez, J; Benjamin, D P; Bensinger, J R; Bentvelsen, S; Beresford, L; Beretta, M; Berge, D; Kuutmann, E Bergeaas; Berger, N; Beringer, J; Berlendis, S; Bernard, N R; Bernius, C; Bernlochner, F U; Berry, T; Berta, P; Bertella, C; Bertoli, G; Bertolucci, F; Bertram, I A; Bertsche, C; Bertsche, D; Besjes, G J; Bylund, O Bessidskaia; Bessner, M; Besson, N; Betancourt, C; Bethke, S; Bevan, A J; Bhimji, W; Bianchi, R M; Bianchini, L; Bianco, M; Biebel, O; Biedermann, D; Bielski, R; Biesuz, N V; Biglietti, M; De Mendizabal, J Bilbao; Bilokon, H; Bindi, M; Binet, S; Bingul, A; Bini, C; Biondi, S; Bjergaard, D M; Black, C W; Black, J E; Black, K M; Blackburn, D; Blair, R E; Blanchard, J-B; Blanco, J E; Blazek, T; Bloch, I; Blocker, C; Blum, W; Blumenschein, U; Blunier, S; Bobbink, G J; Bobrovnikov, V S; Bocchetta, S S; Bocci, A; Bock, C; Boehler, M; Boerner, D; Bogaerts, J A; Bogavac, D; Bogdanchikov, A G; Bohm, C; Boisvert, V; Bokan, P; Bold, T; Boldyrev, A S; Bomben, M; Bona, M; Boonekamp, M; Borisov, A; Borissov, G; Bortfeldt, J; Bortoletto, D; Bortolotto, V; Boscherini, D; Bosman, M; Sola, J D Bossio; Boudreau, J; Bouffard, J; Bouhova-Thacker, E V; Boumediene, D; Bourdarios, C; Boutle, S K; Boveia, A; Boyd, J; Boyko, I R; Bracinik, J; Brandt, A; Brandt, G; Brandt, O; Bratzler, U; Brau, B; Brau, J E; Braun, H M; Madden, W D Breaden; Brendlinger, K; Brennan, A J; Brenner, L; Brenner, R; Bressler, S; Bristow, T M; Britton, D; Britzger, D; Brochu, F M; Brock, I; Brock, R; Brooijmans, G; Brooks, T; Brooks, W K; Brosamer, J; Brost, E; Broughton, J H; de Renstrom, P A Bruckman; Bruncko, D; Bruneliere, R; Bruni, A; Bruni, G; Bruni, L S; Brunt, B H; Bruschi, M; Bruscino, N; Bryant, P; Bryngemark, L; Buanes, T; Buat, Q; Buchholz, P; Buckley, A G; Budagov, I A; Buehrer, F; Bugge, M K; Bulekov, O; Bullock, D; Burckhart, H; Burdin, S; Burgard, C D; Burghgrave, B; Burka, K; Burke, S; Burmeister, I; Burr, J T P; Busato, E; Büscher, D; Büscher, V; Bussey, P; Butler, J M; Buttar, C M; Butterworth, J M; Butti, P; Buttinger, W; Buzatu, A; Buzykaev, A R; Urbán, S Cabrera; Caforio, D; Cairo, V M; Cakir, O; Calace, N; Calafiura, P; Calandri, A; Calderini, G; Calfayan, P; Callea, G; Caloba, L P; Lopez, S Calvente; Calvet, D; Calvet, S; Calvet, T P; Toro, R Camacho; Camarda, S; Camarri, P; Cameron, D; Armadans, R Caminal; Camincher, C; Campana, S; Campanelli, M; Camplani, A; Campoverde, A; Canale, V; Canepa, A; Bret, M Cano; Cantero, J; Cantrill, R; Cao, T; Garrido, M D M Capeans; Caprini, I; Caprini, M; Capua, M; Caputo, R; Carbone, R M; Cardarelli, R; Cardillo, F; Carli, I; Carli, T; Carlino, G; Carminati, L; Caron, S; Carquin, E; Carrillo-Montoya, G D; Carter, J R; Carvalho, J; Casadei, D; Casado, M P; Casolino, M; Casper, D W; Castaneda-Miranda, E; Castelijn, R; Castelli, A; Gimenez, V Castillo; Castro, N F; Catinaccio, A; Catmore, J R; Cattai, A; Caudron, J; Cavaliere, V; Cavallaro, E; Cavalli, D; Cavalli-Sforza, M; Cavasinni, V; Ceradini, F; Alberich, L Cerda; Cerio, B C; Cerqueira, A S; Cerri, A; Cerrito, L; Cerutti, F; Cerv, M; Cervelli, A; Cetin, S A; Chafaq, A; Chakraborty, D; Chan, S K; Chan, Y L; Chang, P; Chapman, J D; Charlton, D G; Chatterjee, A; Chau, C C; Barajas, C A Chavez; Che, S; Cheatham, S; Chegwidden, A; Chekanov, S; Chekulaev, S V; Chelkov, G A; Chelstowska, M A; Chen, C; Chen, H; Chen, K; Chen, S; Chen, S; Chen, X; Chen, Y; Cheng, H C; Cheng, H J; Cheng, Y; Cheplakov, A; Cheremushkina, E; Moursli, R Cherkaoui El; Chernyatin, V; Cheu, E; Chevalier, L; Chiarella, V; Chiarelli, G; Chiodini, G; Chisholm, A S; Chitan, A; Chizhov, M V; Choi, K; Chomont, A R; Chouridou, S; Chow, B K B; Christodoulou, V; Chromek-Burckhart, D; Chudoba, J; Chuinard, A J; Chwastowski, J J; Chytka, L; Ciapetti, G; Ciftci, A K; Cinca, D; Cindro, V; Cioara, I A; Ciocca, C; Ciocio, A; Cirotto, F; Citron, Z H; Citterio, M; Ciubancan, M; Clark, A; Clark, B L; Clark, M R; Clark, P J; Clarke, R N; Clement, C; Coadou, Y; Cobal, M; Coccaro, A; Cochran, J; Coffey, L; Colasurdo, L; Cole, B; Colijn, A P; Collot, J; Colombo, T; Compostella, G; Muiño, P Conde; Coniavitis, E; Connell, S H; Connelly, I A; Consorti, V; Constantinescu, S; Conti, G; Conventi, F; Cooke, M; Cooper, B D; Cooper-Sarkar, A M; Cormier, K J R; Cornelissen, T; Corradi, M; Corriveau, F; Corso-Radu, A; Cortes-Gonzalez, A; Cortiana, G; Costa, G; Costa, M J; Costanzo, D; Cottin, G; Cowan, G; Cox, B E; Cranmer, K; Crawley, S J; Cree, G; Crépé-Renaudin, S; Crescioli, F; Cribbs, W A; Ortuzar, M Crispin; Cristinziani, M; Croft, V; Crosetti, G; Donszelmann, T Cuhadar; Cummings, J; Curatolo, M; Cúth, J; Cuthbert, C; Czirr, H; Czodrowski, P; D'amen, G; D'Auria, S; D'Onofrio, M; De Sousa, M J Da Cunha Sargedas; Via, C Da; Dabrowski, W; Dado, T; Dai, T; Dale, O; Dallaire, F; Dallapiccola, C; Dam, M; Dandoy, J R; Dang, N P; Daniells, A C; Dann, N S; Danninger, M; Hoffmann, M Dano; Dao, V; Darbo, G; Darmora, S; Dassoulas, J; Dattagupta, A; Davey, W; David, C; Davidek, T; Davies, M; Davison, P; Dawe, E; Dawson, I; Daya-Ishmukhametova, R K; De, K; de Asmundis, R; De Benedetti, A; De Castro, S; De Cecco, S; De Groot, N; de Jong, P; De la Torre, H; De Lorenzi, F; De Maria, A; De Pedis, D; De Salvo, A; De Sanctis, U; De Santo, A; De Regie, J B De Vivie; Dearnaley, W J; Debbe, R; Debenedetti, C; Dedovich, D V; Dehghanian, N; Deigaard, I; Del Gaudio, M; Del Peso, J; Del Prete, T; Delgove, D; Deliot, F; Delitzsch, C M; 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2017-01-01

This paper presents the method and performance of primary vertex reconstruction in proton-proton collision data recorded by the ATLAS experiment during Run 1 of the LHC. The studies presented focus on data taken during 2012 at a centre-of-mass energy of [Formula: see text] TeV. The performance has been measured as a function of the number of interactions per bunch crossing over a wide range, from one to seventy. The measurement of the position and size of the luminous region and its use as a constraint to improve the primary vertex resolution are discussed. A longitudinal vertex position resolution of about [Formula: see text] is achieved for events with high multiplicity of reconstructed tracks. The transverse position resolution is better than [Formula: see text] and is dominated by the precision on the size of the luminous region. An analytical model is proposed to describe the primary vertex reconstruction efficiency as a function of the number of interactions per bunch crossing and of the longitudinal size of the luminous region. Agreement between the data and the predictions of this model is better than 3% up to seventy interactions per bunch crossing.

Reconstruction of primary vertices at the ATLAS experiment in Run 1 proton-proton collisions at the LHC

NASA Astrophysics Data System (ADS)

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D. St.; Stabile, A.; Stamen, R.; Stamm, S.; Stanecka, E.; Stanek, R. W.; Stanescu, C.; Stanescu-Bellu, M.; Stanitzki, M. M.; Stapnes, S.; Starchenko, E. A.; Stark, G. H.; Stark, J.; Stark, S. H.; Staroba, P.; Starovoitov, P.; Stärz, S.; Staszewski, R.; Steinberg, P.; Stelzer, B.; Stelzer, H. J.; Stelzer-Chilton, O.; Stenzel, H.; Stewart, G. A.; Stillings, J. A.; Stockton, M. C.; Stoebe, M.; Stoicea, G.; Stolte, P.; Stonjek, S.; Stradling, A. R.; Straessner, A.; Stramaglia, M. E.; Strandberg, J.; Strandberg, S.; Strandlie, A.; Strauss, M.; Strizenec, P.; Ströhmer, R.; Strom, D. M.; Stroynowski, R.; Strubig, A.; Stucci, S. A.; Stugu, B.; Styles, N. A.; Su, D.; Su, J.; Suchek, S.; Sugaya, Y.; Suk, M.; Sulin, V. V.; Sultansoy, S.; Sumida, T.; Sun, S.; Sun, X.; Sundermann, J. E.; Suruliz, K.; Susinno, G.; Sutton, M. R.; Suzuki, S.; Svatos, M.; Swiatlowski, M.; Sykora, I.; Sykora, T.; Ta, D.; Taccini, C.; Tackmann, K.; Taenzer, J.; Taffard, A.; Tafirout, R.; Taiblum, N.; Takai, H.; Takashima, R.; Takeshita, T.; Takubo, Y.; Talby, M.; Talyshev, A. A.; Tan, K. G.; Tanaka, J.; Tanaka, R.; Tanaka, S.; Tannenwald, B. B.; Araya, S. Tapia; Tapprogge, S.; Tarem, S.; Tartarelli, G. F.; Tas, P.; Tasevsky, M.; Tashiro, T.; Tassi, E.; Delgado, A. Tavares; Tayalati, Y.; Taylor, A. C.; Taylor, G. N.; Taylor, P. T. E.; Taylor, W.; Teischinger, F. A.; Teixeira-Dias, P.; Temple, D.; Kate, H. Ten; Teng, P. K.; Teoh, J. J.; Tepel, F.; Terada, S.; Terashi, K.; Terron, J.; Terzo, S.; Testa, M.; Teuscher, R. J.; Theveneaux-Pelzer, T.; Thomas, J. P.; Thomas-Wilsker, J.; Thompson, E. N.; Thompson, P. D.; Thompson, A. S.; Thomsen, L. A.; Thomson, E.; Thomson, M.; Tibbetts, M. J.; Torres, R. E. Ticse; Tikhomirov, V. O.; Tikhonov, Yu. A.; Timoshenko, S.; Tipton, P.; Tisserant, S.; Todome, K.; Todorov, T.; Todorova-Nova, S.; Tojo, J.; Tokár, S.; Tokushuku, K.; Tolley, E.; Tomlinson, L.; Tomoto, M.; Tompkins, L.; Toms, K.; Tong, B.; Torrence, E.; Torres, H.; Pastor, E. Torró; Toth, J.; Touchard, F.; Tovey, D. R.; Trefzger, T.; Tricoli, A.; Trigger, I. M.; Trincaz-Duvoid, S.; Tripiana, M. F.; Trischuk, W.; Trocmé, B.; Trofymov, A.; Troncon, C.; Trottier-McDonald, M.; Trovatelli, M.; Truong, L.; Trzebinski, M.; Trzupek, A.; Tseng, J. C.-L.; Tsiareshka, P. V.; Tsipolitis, G.; Tsirintanis, N.; Tsiskaridze, S.; Tsiskaridze, V.; Tskhadadze, E. G.; Tsui, K. M.; Tsukerman, I. I.; Tsulaia, V.; Tsuno, S.; Tsybychev, D.; Tudorache, A.; Tudorache, V.; Tuna, A. N.; Tupputi, S. A.; Turchikhin, S.; Turecek, D.; Turgeman, D.; Turra, R.; Turvey, A. J.; Tuts, P. M.; Tyndel, M.; Ucchielli, G.; Ueda, I.; Ughetto, M.; Ukegawa, F.; Unal, G.; Undrus, A.; Unel, G.; Ungaro, F. C.; Unno, Y.; Unverdorben, C.; Urban, J.; Urquijo, P.; Urrejola, P.; Usai, G.; Usanova, A.; Vacavant, L.; Vacek, V.; Vachon, B.; Valderanis, C.; Santurio, E. Valdes; Valencic, N.; Valentinetti, S.; Valero, A.; Valéry, L.; Valkar, S.; Vallecorsa, S.; Ferrer, J. A. Valls; Van Den Wollenberg, W.; Van Der Deijl, P. C.; van der Geer, R.; van der Graaf, H.; van Eldik, N.; van Gemmeren, P.; Van Nieuwkoop, J.; van Vulpen, I.; van Woerden, M. C.; Vanadia, M.; Vandelli, W.; Vanguri, R.; Vaniachine, A.; Vankov, P.; Vardanyan, G.; Vari, R.; Varnes, E. W.; Varol, T.; Varouchas, D.; Vartapetian, A.; Varvell, K. E.; Vasquez, J. G.; Vazeille, F.; Schroeder, T. Vazquez; Veatch, J.; Veloce, L. M.; Veloso, F.; Veneziano, S.; Ventura, A.; Venturi, M.; Venturi, N.; Venturini, A.; Vercesi, V.; Verducci, M.; Verkerke, W.; Vermeulen, J. C.; Vest, A.; Vetterli, M. C.; Viazlo, O.; Vichou, I.; Vickey, T.; Boeriu, O. E. Vickey; Viehhauser, G. H. A.; Viel, S.; Vigani, L.; Vigne, R.; Villa, M.; Perez, M. Villaplana; Vilucchi, E.; Vincter, M. G.; Vinogradov, V. B.; Vittori, C.; Vivarelli, I.; Vlachos, S.; Vlasak, M.; Vogel, M.; Vokac, P.; Volpi, G.; Volpi, M.; von der Schmitt, H.; von Toerne, E.; Vorobel, V.; Vorobev, K.; Vos, M.; Voss, R.; Vossebeld, J. H.; Vranjes, N.; Milosavljevic, M. Vranjes; Vrba, V.; Vreeswijk, M.; Vuillermet, R.; Vukotic, I.; Vykydal, Z.; Wagner, P.; Wagner, W.; Wahlberg, H.; Wahrmund, S.; Wakabayashi, J.; Walder, J.; Walker, R.; Walkowiak, W.; Wallangen, V.; Wang, C.; Wang, C.; Wang, F.; Wang, H.; Wang, H.; Wang, J.; Wang, J.; Wang, K.; Wang, R.; Wang, S. M.; Wang, T.; Wang, T.; Wang, W.; Wang, X.; Wanotayaroj, C.; Warburton, A.; Ward, C. P.; Wardrope, D. R.; Washbrook, A.; Watkins, P. M.; Watson, A. T.; Watson, M. F.; Watts, G.; Watts, S.; Waugh, B. M.; Webb, S.; Weber, M. S.; Weber, S. W.; Webster, J. S.; Weidberg, A. R.; Weinert, B.; Weingarten, J.; Weiser, C.; Weits, H.; Wells, P. S.; Wenaus, T.; Wengler, T.; Wenig, S.; Wermes, N.; Werner, M.; Werner, M. D.; Werner, P.; Wessels, M.; Wetter, J.; Whalen, K.; Whallon, N. L.; Wharton, A. M.; White, A.; White, M. J.; White, R.; Whiteson, D.; Wickens, F. J.; Wiedenmann, W.; Wielers, M.; Wienemann, P.; Wiglesworth, C.; Wiik-Fuchs, L. A. M.; Wildauer, A.; Wilk, F.; Wilkens, H. G.; Williams, H. H.; Williams, S.; Willis, C.; Willocq, S.; Wilson, J. A.; Wingerter-Seez, I.; Winklmeier, F.; Winston, O. J.; Winter, B. T.; Wittgen, M.; Wittkowski, J.; Wolter, M. W.; Wolters, H.; Worm, S. D.; Wosiek, B. K.; Wotschack, J.; Woudstra, M. J.; Wozniak, K. W.; Wu, M.; Wu, M.; Wu, S. L.; Wu, X.; Wu, Y.; Wyatt, T. R.; Wynne, B. M.; Xella, S.; Xu, D.; Xu, L.; Yabsley, B.; Yacoob, S.; Yakabe, R.; Yamaguchi, D.; Yamaguchi, Y.; Yamamoto, A.; Yamamoto, S.; Yamanaka, T.; Yamauchi, K.; Yamazaki, Y.; Yan, Z.; Yang, H.; Yang, H.; Yang, Y.; Yang, Z.; Yao, W.-M.; Yap, Y. C.; Yasu, Y.; Yatsenko, E.; Wong, K. H. Yau; Ye, J.; Ye, S.; Yeletskikh, I.; Yen, A. L.; Yildirim, E.; Yorita, K.; Yoshida, R.; Yoshihara, K.; Young, C.; Young, C. J. S.; Youssef, S.; Yu, D. R.; Yu, J.; Yu, J. M.; Yu, J.; Yuan, L.; Yuen, S. P. Y.; Yusuff, I.; Zabinski, B.; Zaidan, R.; Zaitsev, A. M.; Zakharchuk, N.; Zalieckas, J.; Zaman, A.; Zambito, S.; Zanello, L.; Zanzi, D.; Zeitnitz, C.; Zeman, M.; Zemla, A.; Zeng, J. C.; Zeng, Q.; Zengel, K.; Zenin, O.; Ženiš, T.; Zerwas, D.; Zhang, D.; Zhang, F.; Zhang, G.; Zhang, H.; Zhang, J.; Zhang, L.; Zhang, R.; Zhang, R.; Zhang, X.; Zhang, Z.; Zhao, X.; Zhao, Y.; Zhao, Z.; Zhemchugov, A.; Zhong, J.; Zhou, B.; Zhou, C.; Zhou, L.; Zhou, L.; Zhou, M.; Zhou, N.; Zhu, C. G.; Zhu, H.; Zhu, J.; Zhu, Y.; Zhuang, X.; Zhukov, K.; Zibell, A.; Zieminska, D.; Zimine, N. I.; Zimmermann, C.; Zimmermann, S.; Zinonos, Z.; Zinser, M.; Ziolkowski, M.; Živković, L.; Zobernig, G.; Zoccoli, A.; Nedden, M. zur; Zwalinski, L.

2017-05-01

This paper presents the method and performance of primary vertex reconstruction in proton-proton collision data recorded by the ATLAS experiment during Run 1 of the LHC. The studies presented focus on data taken during 2012 at a centre-of-mass energy of √{s} = 8 TeV. The performance has been measured as a function of the number of interactions per bunch crossing over a wide range, from one to seventy. The measurement of the position and size of the luminous region and its use as a constraint to improve the primary vertex resolution are discussed. A longitudinal vertex position resolution of about 30μm is achieved for events with high multiplicity of reconstructed tracks. The transverse position resolution is better than 20μm and is dominated by the precision on the size of the luminous region. An analytical model is proposed to describe the primary vertex reconstruction efficiency as a function of the number of interactions per bunch crossing and of the longitudinal size of the luminous region. Agreement between the data and the predictions of this model is better than 3% up to seventy interactions per bunch crossing.

Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries.

PubMed

Bitton, Asaf; Ratcliffe, Hannah L; Veillard, Jeremy H; Kress, Daniel H; Barkley, Shannon; Kimball, Meredith; Secci, Federica; Wong, Ethan; Basu, Lopa; Taylor, Chelsea; Bayona, Jaime; Wang, Hong; Lagomarsino, Gina; Hirschhorn, Lisa R

2017-05-01

Primary health care (PHC) has been recognized as a core component of effective health systems since the early part of the twentieth century. However, despite notable progress, there remains a large gap between what individuals and communities need, and the quality and effectiveness of care delivered. The Primary Health Care Performance Initiative (PHCPI) was established by an international consortium to catalyze improvements in PHC delivery and outcomes in low- and middle-income countries through better measurement and sharing of effective models and practices. PHCPI has developed a framework to illustrate the relationship between key financing, workforce, and supply inputs, and core primary health care functions of first-contact accessibility, comprehensiveness, coordination, continuity, and person-centeredness. The framework provides guidance for more effective assessment of current strengths and gaps in PHC delivery through a core set of 25 key indicators ("Vital Signs"). Emerging best practices that foster high-performing PHC system development are being codified and shared around low- and high-income countries. These measurement and improvement approaches provide countries and implementers with tools to assess the current state of their PHC delivery system and to identify where cross-country learning can accelerate improvements in PHC quality and effectiveness.

Reconstruction of primary vertices at the ATLAS experiment in Run 1 proton–proton collisions at the LHC

DOE PAGES

Aaboud, M.; Aad, G.; Abbott, B.; ...

2017-05-19

This paper presents the method and performance of primary vertex reconstruction in proton–proton collision data recorded by the ATLAS experiment during Run 1 of the LHC. The studies presented focus on data taken during 2012 at a centre-of-mass energy of √s = 8 TeV. The performance has been measured as a function of the number of interactions per bunch crossing over a wide range, from one to seventy. The measurement of the position and size of the luminous region and its use as a constraint to improve the primary vertex resolution are discussed. A longitudinal vertex position resolution of aboutmore » 30 μm is achieved for events with high multiplicity of reconstructed tracks. The transverse position resolution is better than 20 μm and is dominated by the precision on the size of the luminous region. An analytical model is proposed to describe the primary vertex reconstruction efficiency as a function of the number of interactions per bunch crossing and of the longitudinal size of the luminous region. Agreement between the data and the predictions of this model is better than 3% up to seventy interactions per bunch crossing.« less

Cognitive function in children with primary dystonia before and after deep brain stimulation.

PubMed

Owen, Tamsin; Gimeno, Hortensia; Selway, Richard; Lin, Jean-Pierre

2015-01-01

Dystonia is characterised by involuntary movements (twisting, writhing and jerking) and postures. The effects of deep brain stimulation (DBS) surgery on the motor aspect of primary dystonias have been well reported, however, there is a paucity of research investigating its impact on cognitive function, particularly in childhood dystonia. We performed a follow-up of cognitive function in children with primary dystonia following DBS pallidal surgery. Cognitive function was measured in a cohort of 13 children with primary or primary plus dystonia who had undergone DBS surgery using a retrospective case series design. Baseline pre-DBS neuropsychological measures were compared to scores obtained at least one year following DBS. Cognitive function was assessed using standardised measures of intellectual ability and memory. All children demonstrated improvements with regard to dystonia reduction, as measured by the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Overall, cognition remained stable following DBS in the majority of the cohort. Individual case analysis revealed improvements in some domains of cognitive function in eight members of the cohort and a deterioration of certain domains in four. Cognition largely remained stable in children with primary/primary plus dystonia following DBS surgery, although further research with a larger sample is necessary to explore this statistically. Notwithstanding the limitations of a small size, this preliminary data has potentially positive implications for the impact of DBS on cognitive functioning within a paediatric population. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

The effects of organization on medical utilization: an analysis of service line organization.

PubMed

Byrne, Margaret M; Charns, Martin P; Parker, Victoria A; Meterko, Mark M; Wray, Nelda P

2004-01-01

To determine whether clinical service lines in primary care and mental health reduces inpatient and urgent care utilization. All VHA medical centers were surveyed to determine whether service lines had been established in primary care or mental health care prior to the beginning of fiscal year 1997 (FY97). Facility-level data on medical utilization from Veterans Health Affairs (VHA) administrative databases were used for descriptive and multivariate regression analyses of utilization and of changes in measures between FY97 and FY98. Nine primary care-related and 5 mental health-related variables were analyzed. Primary care and mental health service lines had been established in approximately half of all facilities. Service lines varied in duration and extent of restructuring. Mere presence of a service line had no positive and several negative effects on measured outcome variables. More detailed analyses showed that some types of service lines have statistically significant and mostly negative effects on both mental health and primary care-related measures. Newly implemented service lines had significantly less improvement in measures over time than facilities with no service line. Health care organizations are implementing innovative organizational structures in hopes of improving quality of care and reducing resource utilization. We found that service lines in primary care and mental health may lead to an initial period of disruption, with little evidence of a beneficial effect on performance for longer duration service lines.

Validating the Use of "D" for Measuring Lexical Diversity in Low-Income Kindergarten Children

ERIC Educational Resources Information Center

Lai, Stephanie A.; Schwanenflugel, Paula J.

2016-01-01

Purpose: Children from low--socioeconomic status families often perform poorly on standardized vocabulary assessments. The primary purpose of the study was to determine whether lexical diversity as measured by "D" (Malvern, Richards, Chipere, & Durán, 2004) serves as a valid measure of vocabulary in at-risk, low-income, predominantly…

The strength of primary care in Europe: an international comparative study.

PubMed

Kringos, Dionne; Boerma, Wienke; Bourgueil, Yann; Cartier, Thomas; Dedeu, Toni; Hasvold, Toralf; Hutchinson, Allen; Lember, Margus; Oleszczyk, Marek; Rotar Pavlic, Danica; Svab, Igor; Tedeschi, Paolo; Wilm, Stefan; Wilson, Andrew; Windak, Adam; Van der Zee, Jouke; Groenewegen, Peter

2013-11-01

A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Evaluation of strength of primary care in Europe. International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations. Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries. Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.

A Scanning Transmission Electron Microscopy Method for Determining Manganese Composition in Welding Fume as a Function of Primary Particle Size

PubMed Central

Richman, Julie D.; Livi, Kenneth J.T.; Geyh, Alison S.

2011-01-01

Increasing evidence suggests that the physicochemical properties of inhaled nanoparticles influence the resulting toxicokinetics and toxicodynamics. This report presents a method using scanning transmission electron microscopy (STEM) to measure the Mn content throughout the primary particle size distribution of welding fume particle samples collected on filters for application in exposure and health research. Dark field images were collected to assess the primary particle size distribution and energy-dispersive X-ray and electron energy loss spectroscopy were performed for measurement of Mn composition as a function of primary particle size. A manual method incorporating imaging software was used to measure the primary particle diameter and to select an integration region for compositional analysis within primary particles throughout the size range. To explore the variation in the developed metric, the method was applied to 10 gas metal arc welding (GMAW) fume particle samples of mild steel that were collected under a variety of conditions. The range of Mn composition by particle size was −0.10 to 0.19 %/nm, where a positive estimate indicates greater relative abundance of Mn increasing with primary particle size and a negative estimate conversely indicates decreasing Mn content with size. However, the estimate was only statistically significant (p<0.05) in half of the samples (n=5), which all had a positive estimate. In the remaining samples, no significant trend was measured. Our findings indicate that the method is reproducible and that differences in the abundance of Mn by primary particle size among welding fume samples can be detected. PMID:21625364

A Scanning Transmission Electron Microscopy Method for Determining Manganese Composition in Welding Fume as a Function of Primary Particle Size.

PubMed

Richman, Julie D; Livi, Kenneth J T; Geyh, Alison S

2011-06-01

Increasing evidence suggests that the physicochemical properties of inhaled nanoparticles influence the resulting toxicokinetics and toxicodynamics. This report presents a method using scanning transmission electron microscopy (STEM) to measure the Mn content throughout the primary particle size distribution of welding fume particle samples collected on filters for application in exposure and health research. Dark field images were collected to assess the primary particle size distribution and energy-dispersive X-ray and electron energy loss spectroscopy were performed for measurement of Mn composition as a function of primary particle size. A manual method incorporating imaging software was used to measure the primary particle diameter and to select an integration region for compositional analysis within primary particles throughout the size range. To explore the variation in the developed metric, the method was applied to 10 gas metal arc welding (GMAW) fume particle samples of mild steel that were collected under a variety of conditions. The range of Mn composition by particle size was -0.10 to 0.19 %/nm, where a positive estimate indicates greater relative abundance of Mn increasing with primary particle size and a negative estimate conversely indicates decreasing Mn content with size. However, the estimate was only statistically significant (p<0.05) in half of the samples (n=5), which all had a positive estimate. In the remaining samples, no significant trend was measured. Our findings indicate that the method is reproducible and that differences in the abundance of Mn by primary particle size among welding fume samples can be detected.

Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.

PubMed

Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L; Roland, Martin

2012-08-01

Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.

Evaluation of Low-Cost Mitigation Measures Implemented to Improve Air Quality in Nursery and Primary Schools.

PubMed

Sá, Juliana P; Branco, Pedro T B S; Alvim-Ferraz, Maria C M; Martins, Fernando G; Sousa, Sofia I V

2017-05-31

Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO₂, CO, NO₂, O₃, CH₂O, total volatile organic compounds (VOC), PM₁, PM 2.5 , PM 10 , Total Suspended Particles (TSP) and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO) were found for PM 2.5 , PM 10 , CO₂ and CH₂O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO₂. However, mitigation measures were not always sufficient to decrease the pollutants' concentrations till values considered safe to protect human health.

Strategic performance management: development of a performance measurement system at the Mayo Clinic.

PubMed

Curtright, J W; Stolp-Smith, S C; Edell, E S

2000-01-01

Managing and measuring performance become exceedingly complex as healthcare institutions evolve into integrated health systems comprised of hospitals, outpatient clinics and surgery centers, nursing homes, and home health services. Leaders of integrated health systems need to develop a methodology and system that align organizational strategies with performance measurement and management. To meet this end, multiple healthcare organizations embrace the performance-indicators reporting system known as a "balanced scorecard" or a "dashboard report." This discrete set of macrolevel indicators gives senior management a fast but comprehensive glimpse of the organization's performance in meeting its quality, operational, and financial goals. The leadership of outpatient operations for Mayo Clinic in Rochester, Minnesota built on this concept by creating a performance management and measurement system that monitors and reports how well the organization achieves its performance goals. Internal stakeholders identified metrics to measure performance in each key category. Through these metrics, the organization links Mayo Clinic's vision, primary value, core principles, and day-to-day operations by monitoring key performance indicators on a weekly, monthly, or quarterly basis.

Community Health Centers and Private Practice Performance on Ambulatory Care Measures

PubMed Central

Goldman, L. Elizabeth; Chu, Philip W.; Tran, Huong; Stafford, Randall S.

2013-01-01

Background The 2010 Affordable Care Act relies on Federally Qualified Health Centers (FQHC) and FQHC look-alikes (look-alikes) to provide care for newly insured patients, but ties increased funding to demonstrated quality and efficiency. Purpose To compare FQHC and look-alike physician performance with private practice primary care physicians (PCPs) on ambulatory care quality measures. Methods The study was a cross-sectional analysis of visits in the 2006–2008 National Ambulatory Medical Care Survey. Performance of FQHCs and Look-alikes on 18 quality measures was compared with private practice PCPs. Data analysis was completed in 2011. Results Compared to private practice PCPs, FQHCs and look-alikes performed better on 6 measures (p<0.05), worse on diet counseling in at-risk adolescents (26 % vs. 36%, p=0.05), and no differently on 11 measures. Higher performance occurred in: ACE inhibitors use for congestive heart failure (51% vs. 37%, p=0.004); aspirin use in coronary artery disease (CAD) (57% vs. 44%, p=0.004); beta blocker use for CAD (59% vs. 47%, p=0.01); no use of benzodiazepines in depression (91% vs. 84%, p=0.008); blood pressure screening (90% vs. 86%, p<0.001); and screening electrocardiogram (EKG) avoidance in low-risk patients (99% vs. 93%, p<0.001). Adjusting for patient characteristics yielded similar results except private practice PCPs no longer performed better on any measures. Conclusions FQHCs and look-alikes demonstrated equal or better performance than private practice primary care physicians on select quality measures despite serving patients with more chronic disease and socioeconomic complexity. These findings can provide policymakers with some reassurance as to the quality of chronic disease and preventive care at Federally Qualified Health Centers and Federally Qualified Health Center look-alikes, as they plan to use these health centers to serve 20 million newly insured individuals. PMID:22813678

Developmental dynamics between mathematical performance, task motivation, and teachers' goals during the transition to primary school.

PubMed

Aunola, Kaisa; Leskinen, Esko; Nurmi, Jari-Erik

2006-03-01

It has been suggested that children's learning motivation and interest in a particular subject play an important role in their school performance, particularly in mathematics. However, few cross-lagged longitudinal studies have been carried out to investigate the prospective relationships between academic achievement and task motivation. Moreover, the role that the classroom context plays in this development is largely unknown. The aim of the study was to investigate the developmental dynamics of maths-related motivation and mathematical performance during children's transition to primary school. The role of teachers' pedagogical goals and classroom characteristics on this development was also investigated. A total of 196 Finnish children were examined four times: (0) in October during their preschool year; (1) in October and (2) April during their first grade of primary school; and (3) in October during their second grade. Children's mathematical performance was tested at each measurement point. Task motivation was examined at measurement points 2, 3, and 4 using the Task-value scale for children. First-grade teachers were interviewed in November about their pedagogical goals and classroom characteristics. The results showed that children's mathematical performance and related task motivation formed a cumulative developmental cycle: a high level of maths performance at the beginning of the first grade increased subsequent task motivation towards mathematics, which further predicted a high level of maths performance at the beginning of the second grade. The level of maths-related task motivation increased in those classrooms where the teachers emphasized motivation or self-concept development as their most important pedagogical goal.

MULTI-SITE PERFORMANCE EVALUATIONS OF CANDIDATE METHODOLOGIES FOR DETERMINING COARSE PARTICULATE MATTER (PMC) CONCENTRATIONS

EPA Science Inventory

Comprehensive field studies were conducted to evaluate the performance of sampling methods for measuring the coarse fraction of PM10 in ambient air. Five separate sampling approaches were evaluated at each of three sampling sites. As the primary basis of comparison, a discret...

Effects of Primary Power Transmission Lines on the Performance of Loran-C Receivers in Experimental Terrestrial Applications

DOT National Transportation Integrated Search

1979-07-01

Tests were conducted to measure the effect generated by high-voltage transmission lines with and without supervisory carrier signals on the performance of typical LORAN-C receivers which might be used for land vehicle applications of the LORAN-C Navi...

Active control of continuous air jet with bifurcated synthetic jets

NASA Astrophysics Data System (ADS)

Dančová, Petra; Vít, Tomáš; Jašíková, Darina; Novosád, Jan

The synthetic jets (SJs) have many significant applications and the number of applications is increasing all the time. In this research the main focus is on the primary flow control which can be used effectively for the heat transfer increasing. This paper deals with the experimental research of the effect of two SJs worked in the bifurcated mode used for control of an axisymmetric air jet. First, the control synthetic jets were measured alone. After an adjustment, the primary axisymmetric jet was added in to the system. For comparison, the primary flow without synthetic jets control was also measured. All experiments were performed using PIV method whereby the synchronization between synthetic jets and PIV system was necessary to do.

Relationship among team dynamics, care coordination and perception of safety culture in primary care.

PubMed

Blumenthal, Karen J; Chien, Alyna T; Singer, Sara J

2018-05-18

There remains a need to improve patient safety in primary care settings. Studies have demonstrated that creating high-performing teams can improve patient safety and encourage a safety culture within hospital settings, but little is known about this relationship in primary care. To examine how team dynamics relate to perceptions of safety culture in primary care and whether care coordination plays an intermediating role. This is a cross-sectional survey study with 63% response (n = 1082). The study participants were attending clinicians, resident physicians and other staff who interacted with patients from 19 primary care practices affiliated with Harvard Medical School. Three domains corresponding with our main measures: team dynamics, care coordination and safety culture. All items were measured on a 5-point Likert scale. We used linear regression clustered by practice site to assess the relationship between team dynamics and perceptions of safety culture. We also performed a mediation analysis to determine the extent to which care coordination explains the relationship between perceptions of team dynamics and of safety culture. For every 1-point increase in overall team dynamics, there was a 0.76-point increase in perception of safety culture [95% confidence interval (CI) 0.70-0.82, P < 0.001]. Care coordination mediated the relationship between team dynamics and the perception of safety culture. Our findings suggest there is a relationship between team dynamics, care coordination and perceptions of patient safety in a primary care setting. To make patients safer, we may need to pay more attention to how primary care providers work together to coordinate care.

Comparative study of the retinal nerve fibre layer thickness performed with optical coherence tomography and GDx scanning laser polarimetry in patients with primary open-angle glaucoma.

PubMed

Wasyluk, Jaromir T; Jankowska-Lech, Irmina; Terelak-Borys, Barbara; Grabska-Liberek, Iwona

2012-03-01

We compared the parameters of retinal nerve fibre layer in patients with advanced glaucoma with the use of different OCT (Optical Coherence Tomograph) devices in relation to analogical measurements performed with GDx VCC (Nerve Fiber Analyzer with Variable Corneal Compensation) scanning laser polarimetry. Study subjects had advanced primary open-angle glaucoma, previously treated conservatively, diagnosed and confirmed by additional examinations (visual field, ophthalmoscopy of optic nerve, gonioscopy), A total of 10 patients were enrolled (9 women and 1 man), aged 18-70 years of age. Nineteen eyes with advanced glaucomatous neuropathy were examined. 1) Performing a threshold perimetry Octopus, G2 strategy and ophthalmoscopy of optic nerve to confirm the presence of advanced primary open-angle glaucoma; 2) performing a GDx VCC scanning laser polarimetry of retinal nerve fibre layer; 3) measuring the retinal nerve fibre layer thickness with 3 different optical coherence tomographs. The parameters of the retinal nerve fibre layer thickness are highly correlated between the GDx and OCT Stratus and 3D OCT-1000 devices in mean retinal nerve fibre layer thickness, retinal nerve fibre layer thickness in the upper sector, and correlation of NFI (GDx) with mean retinal nerve fibre layer thickness in OCT examinations. Absolute values of the retinal nerve fibre layer thickness (measured in µm) differ significantly between GDx and all OCT devices. Examination with OCT devices is a sensitive diagnostic method of glaucoma, with good correlation with the results of GDx scanning laser polarimetry of the patients.

Parent ratings of working memory are uniquely related to performance-based measures of secondary memory but not primary memory.

PubMed

Ralph, Kathryn J; Gibson, Bradley S; Gondoli, Dawn M

2018-03-06

Existing evidence suggests that performance- and rating-based measures of working memory (WM) correlate poorly. Although some researchers have interpreted this evidence as suggesting that these measures may be assessing distinct cognitive constructs, another possibility is that rating-based measures are related to some but not all theoretically motivated performance-based measures. The current study distinguished between performance-based measures of primary memory (PM) and secondary memory (SM), and examined the relation between each of these components of WM and parent-ratings on the WM subscale of the Behavior Rating Inventory of Executive Function (BRIEF-WM). Because SM and BRIEF-WM scores have both been associated with group differences in attention-deficit/hyperactivity disorder (ADHD), it was hypothesized that SM scores would be uniquely related to parent-rated BRIEF-WM scores. Participants were a sample of 77 adolescents with and without an ADHD diagnosis, aged 11 to 15 years, from a midwestern school district. Participant scores on verbal and spatial immediate free recall tasks were used to estimate both PM and SM capacities. Partial correlation analyses were used to evaluate the extent to which estimates of PM and SM were uniquely related parent-rated BRIEF-WM scores. Both verbal and spatial SM scores were significantly related to parent-rated BRIEF-WM scores, when corresponding PM scores were controlled. Higher verbal and spatial SM scores were associated with less frequent parent-report of WM-related failures in their child's everyday life. However, neither verbal nor spatial PM scores significantly related to parent-rated BRIEF-WM scores, when corresponding SM scores were controlled. The current study suggested that previously observed low correlations between performance- and rating-based measures of WM may result from use of performance-based WM measures that do not capture the unique contributions of PM and SM components of WM.

An Examination of Performance-Based Teacher Evaluation Systems in Five States. Summary. Issues & Answers. REL 2012-No. 129

ERIC Educational Resources Information Center

Shakman, Karen; Riordan, Julie; Sanchez, Maria Teresa; Cook, Kyle DeMeo; Fournier, Richard; Brett, Jessica

2012-01-01

This study reports on performance-based teacher evaluation systems in five states that have implemented such systems. It investigates two primary research questions: (1) What are the key characteristics of state-level performance-based teacher evaluation systems in the study states?; and (2) How do state teacher evaluation measures, the teaching…

White-Light Optical Information Processing and Holography.

DTIC Science & Technology

1984-06-22

Processing, Image Deblurring , Source Encoding, Signal Sampling, Coherence Measurement, Noise Performance, / Pseudocolor Encoding. , ’ ’ * .~ 10.ASS!RACT...o 2.1 Broad Spectral Band Color Image Deblurring .. . 4 2.2 Noise Performance ...... ...... .. . 4 2.3 Pseudocolor Encoding with Three Primary...spectra. This technique is particularly suitable for linear smeared color image deblurring . 2.2 Noise Performance In this period, we have also

Reporting trends and outcomes in ST-segment-elevation myocardial infarction national hospital quality assessment programs.

PubMed

McCabe, James M; Kennedy, Kevin F; Eisenhauer, Andrew C; Waldman, Howard M; Mort, Elizabeth A; Pomerantsev, Eugene; Resnic, Frederic S; Yeh, Robert W

2014-01-14

For patients who undergo primary percutaneous coronary intervention (PCI) for ST-segment-elevation myocardial infarction, the door-to-balloon time is an important performance measure reported to the Centers for Medicare & Medicaid Services (CMS) and tied to hospital quality assessment and reimbursement. We sought to assess the use and impact of exclusion criteria associated with the CMS measure of door-to-balloon time in primary PCI. All primary PCI-eligible patients at 3 Massachusetts hospitals (Brigham and Women's, Massachusetts General, and North Shore Medical Center) were evaluated for CMS reporting status. Rates of CMS reporting exclusion were the primary end points of interest. Key secondary end points were between-group differences in patient characteristics, door-to-balloon times, and 1-year mortality rates. From 2005 to 2011, 26% (408) of the 1548 primary PCI cases were excluded from CMS reporting. This percentage increased over the study period from 13.9% in 2005 to 36.7% in the first 3 quarters of 2011 (P<0.001). The most frequent cause of exclusion was for a diagnostic dilemma such as a nondiagnostic initial ECG, accounting for 31.2% of excluded patients. Although 95% of CMS-reported cases met door-to-balloon time goals in 2011, this was true of only 61% of CMS-excluded cases and consequently 82.6% of all primary PCI cases performed that year. The 1-year mortality for CMS-excluded patients was double that of CMS-included patients (13.5% versus 6.6%; P<0.001). More than a quarter of patients who underwent primary PCI were excluded from hospital quality reports collected by CMS, and this percentage has grown substantially over time. These findings may have significant implications for our understanding of process improvement in primary PCI and mechanisms for reimbursement through Medicare.

Role of auditory non-verbal working memory in sentence repetition for bilingual children with primary language impairment.

PubMed

Ebert, Kerry Danahy

2014-01-01

Sentence repetition performance is attracting increasing interest as a valuable clinical marker for primary (or specific) language impairment (LI) in both monolingual and bilingual populations. Multiple aspects of memory appear to contribute to sentence repetition performance, but non-verbal memory has not yet been considered. To explore the relationship between a measure of non-verbal auditory working memory (NVWM) and sentence repetition performance in a sample of bilingual children with LI. Forty-seven school-aged Spanish-English bilingual children with LI completed sentence repetition and non-word repetition tasks in both Spanish and English as well as an NVWM task. Hierarchical multiple linear regression was used to predict sentence repetition in each language using age, non-word repetition and NVWM. NVWM predicted unique variance in sentence repetition performance in both languages after accounting for chronological age and language-specific phonological memory, as measured by non-word repetition. Domain-general memory resources play a unique role in sentence repetition performance in children with LI. Non-verbal working memory weaknesses may contribute to the poor performance of children with LI on sentence repetition tasks. © 2014 Royal College of Speech and Language Therapists.

The Role of Auditory Nonverbal Working Memory in Sentence Repetition for Bilingual Children with Primary Language Impairment

PubMed Central

Ebert, Kerry Danahy

2015-01-01

Background Sentence repetition performance is attracting increasing interest as a valuable clinical marker for Primary (or Specific) Language Impairment (LI) in both monolingual and bilingual populations. Multiple aspects of memory appear to contribute to sentence repetition performance, but nonverbal memory has not yet been considered. Aims The purpose of this study was to explore the relationship between a measure of nonverbal auditory working memory (NVWM) and sentence repetition performance in a sample of bilingual children with LI. Methods & Procedures Forty-seven school-aged Spanish-English bilingual children with LI completed sentence repetition and nonword repetition tasks in both Spanish and English as well as an NVWM task. Hierarchical multiple linear regression was used to predict sentence repetition in each language using age, nonword repetition, and NVWM. Outcomes & Results NVWM predicted unique variance in sentence repetition performance in both languages after accounting for chronological age and language-specific phonological memory, as measured by nonword repetition. Conclusions & Implications Domain-general memory resources play a unique role in sentence repetition performance in children with LI. Nonverbal working memory weaknesses may contribute to the poor performance of children with LI on sentence repetition tasks. PMID:24894308

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

PubMed Central

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

2015-01-01

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

Public and Private School Distinction, Regional Development Differences, and Other Factors Influencing the Success of Primary School Students in Turkey

ERIC Educational Resources Information Center

Sulku, Seher Nur; Abdioglu, Zehra

2015-01-01

This study investigates the factors influencing the success of students in primary schools in Turkey. TIMSS 2011 data for Turkey, measuring the success of eighth-grade students in the field of mathematics, were used in an econometric analysis, performed using classical linear regression models. Two hundred thirty-nine schools participated in the…

Predictive factors of user acceptance on the primary educational mathematics aids product

NASA Astrophysics Data System (ADS)

Hidayah, I.; Margunani; Dwijanto

2018-03-01

Mathematics learning in primary schools requires instructional media. According to Piaget's theory, students are still in the concrete operational stage. For this reason, the development of the primary level mathematics aids is needed to support the development of successful mathematics learning. The stages of this research are the stages of commercialization with preparatory, marketing, and measurement analysis procedures. Promotion as part of marketing is done by doing a demonstration to the teacher. Measurements were performed to explore the predictive factors of user feasibility in adopting the product. Measurements were conducted using the concept of Technology Acceptance Model (TAM). Measurement variables include external variables, perceived usefulness, perceived ease of use, attitude, intention to use, and actual use. The result of this research shows that the contribution of predictive factors of mathematics teachers on the teaching aids product as follows: the external variable and perceived ease of use at 74%, perceived usefulness at 72%, intention to use (behavioral) at 58%, attitude at 52%, and the consequence factor (actual use) at 42%.

Measurement of the cosmic ray spectrum and chemical composition in the 1015-1018 eV energy range

NASA Astrophysics Data System (ADS)

Chiavassa, Andrea

2018-01-01

Cosmic ray in the 1015-1018 eV energy range can only be detected with ground based experiments, sampling Extensive Air Showers (EAS) particles. The interest in this energetic interval is related to the search of the knee of the iron component of cosmic ray and to the study of the transition between galactic and extra-galactic primaries. The energy and mass calibration of these arrays can only be performed with complete EAS simulations as no sources are available for an absolute calibration. The systematic error on the energy assignment can be estimated around 30 ± 10%. The all particle spectrum measured in this energy range is more structured than previously thought, showing some faint features: a hardening slightly above 1016 eV and a steepening below 1017 eV. The studies of the primary chemical composition are quickly evolving towards the measurements of the primary spectra of different mass groups: up to now we are able to separate (on a event by event basis) light and heavy primaries. Above the knee a steepening of the heavy primary spectrum and a hardening of the light ones have been detected.

Benchmarking physician performance, part 2.

PubMed

Collier, David A; Collier, Cindy Eddins; Kelly, Thomas M

2006-01-01

Part 1 of this article (January-February 2006) reviewed ways of measuring the work of physicians through methods such as data envelopment analysis (DEA) and relative value units (RVUs). These techniques provide insights into: 1. Who are the best-performing physicians? 2. Who are the underperforming physicians? 3. How can underperforming physicians improve? 4. What are the underperformers' performance targets? 5. How do you deal with full- and part-time physicians in a university setting? Part 2 compares the performance of 16 primary care physicians in the same medical specialty using DEA efficiency scores. DEA is capable of modeling multiple criteria and automatically determines the relative weights of each performance measure. This research also provides a preliminary framework for how work measurement and DEA can be used as a basis for a medical team or physician compensation system.

A Performance Measurement and Implementation Methodology in a Department of Defense CIM (Computer Integrated Manufacturing) Environment

DTIC Science & Technology

1988-01-24

vanes.-The new facility is currently being called the Engine Blade/ Vape Facility (EB/VF). There are three primary goals in automating this proc..e...earlier, the search led primarily into the areas of CIM Justification, Automation Strategies , Performance Measurement, and Integration issues. Of...of living, has been steadily eroding. One dangerous trend that has developed in keenly competitive world markets , says Rohan [33], has been for U.S

40 CFR 142.11 - Initial determination of primary enforcement responsibility.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., certified or approved by the Administrator and capable of performing analytical measurements of all...'s program activity to assure that the design and construction of new or substantially modified...

40 CFR 142.11 - Initial determination of primary enforcement responsibility.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., certified or approved by the Administrator and capable of performing analytical measurements of all...'s program activity to assure that the design and construction of new or substantially modified...

Measuring business performance using indicators of ecologically sustainable organizations

NASA Astrophysics Data System (ADS)

Snow, Charles G., Jr.; Snow, Charles C.

2001-02-01

The purpose of this paper is to explore the use of ecology-based performance measures as a way of augmenting the Balanced Scorecard approach to organizational performance measurement. The Balanced Scorecard, as proposed by Kaplan and Norton, focuses on four primary dimensions; financial, internal-business-process, customer, and learning and growth perspectives. Recently, many 'green' organizational theorists have developed the concept of "Ecologically Sustainable Organizations" or ESOs, a concept rooted in open systems theory. The ESO is called upon to consider resource use and conservation as a strategy for long-term viability. This paper asserts that in order to achieve ESO status, an organization must not only measure but also reward resource conservation measures. Only by adding a fifth perspective for ecological dimensions will the entity be truly motivated toward ESO status.

Sources of primary and secondary organic aerosols in Chinese versus European Cities during winter time

NASA Astrophysics Data System (ADS)

Prevot, A. S.; Slowik, J.; El-Haddad, I.; Pieber, S. M.; Yuan, B.; Stefenelli, G.; Pospisilova, V.; Lopez-Hilfiker, F.; Qi, L.; Tong, Y.; Wang, L.; Daellenbach, K.; Klein, F.; Elser, M.; Junji, C.; Huang, R. J. J.; Baltensperger, U.

2017-12-01

In the recent years, aerosol mass spectrometric (AMS) measurements were performed in Beijing (China), Zurich (Switzerland) and other Chinese and European cities indicating the importance of not only primary sources but also secondary organic aerosol (SOA) sources despite low radiation levels for photooxidation. Among the primary sources, residential burning is especially important in winter including wood and coal burning. Also for secondary organic aerosols, VOC emissions of residential burning are likely an important source in winter. An interesting question is whether daytime photooxidation and/or night-time NO3 radical chemistry are important pathways for the SOA formation. Recently we developed a new measurement technique based on exctractive electrospray ionization (EESI) that allow for the study of the organic molecules in the particulate phase without fragmentation. Combined measurements with AMS and EESI will be discussed for smogchamber experiments (simulating both nighttime and daytime chemistry) SOA formation potential, the link between VOCs and SOA and the SOA composition. In-situ and off-line measurements in Europe and China are analyzed in the light of those experiments with a focus on the importance of residential burning to both primary and secondary organic aerosols in cities during winter.

Tobacco use disorder treatment in primary care

PubMed Central

Kunyk, Diane; Els, Charl; Papadakis, Sophia; Selby, Peter

2014-01-01

Abstract Objective To test a team-based, site-specific, multicomponent clinical system pathway designed for enhancing tobacco use disorder treatment by primary care physicians. Design A prospective cohort study. Setting Sixty primary care sites in Alberta. Participants A convenience sample of 198 primary care physicians from the population of 2857. Main outcome measures Data collection occurred between September 2010 and February 2012 on 3 distinct measures. Twenty-four weeks after the intervention, audits of the primary care practices assessed the adoption and sustainability of 10 tobacco clinical system pathway components, a survey measured changes in physicians’ treatment intentions, and patient chart reviews examined changes in physicians’ consistency with the treatment algorithm. Results The completion rate by physicians was 89.4%. An intention-to-treat approach was undertaken for statistical analysis. Intervention uptake was demonstrated by positive changes at 4 weeks in how many of the 10 clinical system measures were performed (mean [SD] = 4.22 [1.60] vs 8.57 [1.46]; P < .001). Physicians demonstrated significant favourable changes in 9 of the 12 measures of treatment intention (P < .05). The 18 282 chart reviews documented significant increases in 6 of the 8 algorithm components. Conclusion Our findings suggest that the provision of a tobacco clinical system pathway that incorporates other members of the health care team and builds on existing office infrastructures will support positive and sustainable changes in tobacco use disorder treatment by physicians in primary care. This study reaffirms the substantive and important role of supporting how treatment is delivered in physicians’ practices. PMID:25022640

Similar Superior Patient-Reported Outcome Measures for Anterior and Posterolateral Approaches After Total Hip Arthroplasty: Postoperative Patient-Reported Outcome Measure Improvement After 3 months in 12,774 Primary Total Hip Arthroplasties Using the Anterior, Anterolateral, Straight Lateral, or Posterolateral Approach.

PubMed

Peters, Rinne M; van Beers, Loes W A H; van Steenbergen, Liza N; Wolkenfelt, Julius; Ettema, Harmen B; Ten Have, Bas L E F; Rijk, Paul C; Stevens, Martin; Bulstra, Sjoerd K; Poolman, Rudolf W; Zijlstra, Wierd P

2018-06-01

Patient-reported outcome measures (PROMs) are used to evaluate the outcome of total hip arthroplasty (THA). We determined the effect of surgical approach on PROMs after primary THA. All primary THAs, with registered preoperative and 3 months postoperative PROMs were selected from the Dutch Arthroplasty Register. Based on surgical approach, 4 groups were discerned: (direct) anterior, anterolateral, direct lateral, and posterolateral approaches. The following PROMs were recorded: Hip disability and Osteoarthritis Outcome Score Physical function Short form (HOOS-PS); Oxford Hip Score; EQ-5D index score; EQ-5D thermometer; and Numeric Rating Scale measuring pain, both active and in rest. The difference between preoperative and postoperative scores was calculated (delta-PROM) and used as primary outcome measure. Multivariable linear regression analysis was performed for comparisons. Cohen's d was calculated as measure of effect size. All examined 4 approaches resulted in a significant increase of PROMs after primary THA in the Netherlands (n = 12,274). The anterior and posterolateral approaches were associated with significantly more improvement in HOOS-PS scores compared with the anterolateral and direct lateral approaches. Furthermore, the posterolateral and anterior approaches showed greater improvement on Numeric Rating Scale pain scores compared with the anterolateral approach. No relevant differences in delta-PROM were seen between the anterior and posterolateral surgical approaches. Anterior and posterolateral surgical approaches showed more improvement in self-reported physical functioning (HOOS-PS) compared with anterolateral and direct lateral approaches in patients receiving a primary THA. However, clinical differences were only small. Copyright © 2018 Elsevier Inc. All rights reserved.

A review of instruments to measure interprofessional team-based primary care.

PubMed

Shoemaker, Sarah J; Parchman, Michael L; Fuda, Kathleen Kerwin; Schaefer, Judith; Levin, Jessica; Hunt, Meaghan; Ricciardi, Richard

2016-07-01

Interprofessional team-based care is increasingly regarded as an important feature of delivery systems redesigned to provide more efficient and higher quality care, including primary care. Measurement of the functioning of such teams might enable improvement of team effectiveness and could facilitate research on team-based primary care. Our aims were to develop a conceptual framework of high-functioning primary care teams to identify and review instruments that measure the constructs identified in the framework, and to create a searchable, web-based atlas of such instruments (available at: http://primarycaremeasures.ahrq.gov/team-based-care/ ). Our conceptual framework was developed from existing frameworks, the teamwork literature, and expert input. The framework is based on an Input-Mediator-Output model and includes 12 constructs to which we mapped both instruments as a whole, and individual instrument items. Instruments were also reviewed for relevance to measuring team-based care, and characterized. Instruments were identified from peer-reviewed and grey literature, measure databases, and expert input. From nearly 200 instruments initially identified, we found 48 to be relevant to measuring team-based primary care. The majority of instruments were surveys (n = 44), and the remainder (n = 4) were observational checklists. Most instruments had been developed/tested in healthcare settings (n = 30) and addressed multiple constructs, most commonly communication (n = 42), heedful interrelating (n = 42), respectful interactions (n = 40), and shared explicit goals (n = 37). The majority of instruments had some reliability testing (n = 39) and over half included validity testing (n = 29). Currently available instruments offer promise to researchers and practitioners to assess teams' performance, but additional work is needed to adapt these instruments for primary care settings.

School Accountability: Mathematics Teachers Struggling with Change

ERIC Educational Resources Information Center

Obara, Samuel

2011-01-01

In this period of accountability advocated by the No Child Left Behind Act of 2001, testing has been selected as a primary means of measuring the performance of schools. The State of Georgia is in the process of replacing its old curriculum--Georgia's Quality Core Curriculum (QCC) with a new curriculum--Georgia Performance Standards (GPS) to…

External Stakeholders and Internal Practices in Departments of Teacher Education at European Universities

ERIC Educational Resources Information Center

Aarrevaara, Timo; Wikström, Janne; Maassen, Peter

2017-01-01

Research-intensive universities are operating in an environment of conflicting goals and priorities. Their status in research as well as education is dependent on their performance in various global arenas where performance can be measured with relatively clear indicators. However, success in operations outside the primary tasks of the academic…

Performance characteristics of lithium primary cells after controlled storage. [on-orbit for energy power supply

NASA Technical Reports Server (NTRS)

Deligiannis, F.; Shen, D. H.; Halpert, G.; Ang, V.; Donley, S.

1991-01-01

A program was initiated to investigate the effects of storage on the performance of lithium primary cells. Two types of liquid cathode cells were chosen to investigate these effects. The cell types included Li-SOCl2/BCX cells, Li-SO2 cells from two different manufacturers, and a small sample size of 8-year-old Li-SO2 cells. The following measurements are performed at each test interval: open circuit voltage, resistance and weight, microcalorimetry, ac impedance, capacity, and voltage delay. The authors examine the performance characteristics of these cells after one year of controlled storage at two temperatures (10 and 30 C). The Li-SO2 cells experienced little to no voltage and capacity degradation after one year storage. The Li-SOCl2/BCX cells exhibited significant voltage and capacity degradation after 30 C storage. Predischarging shortly prior to use appears to be an effective method of reducing the initial voltage drop. Studies are in progress to correlate ac impedance and microcalorimetry measurements with capacity losses and voltage delay.

Two-dimensional straightness measurement based on optical knife-edge sensing

NASA Astrophysics Data System (ADS)

Wang, Chen; Zhong, Fenghe; Ellis, Jonathan D.

2017-09-01

Straightness error is a parasitic translation along a perpendicular direction to the primary displacement axis of a linear stage. The parasitic translations could be coupled into other primary displacement directions of a multi-axis platform. Hence, its measurement and compensation are critical in precision multi-axis metrology, calibration, and manufacturing. This paper presents a two-dimensional (2D) straightness measurement configuration based on 2D optical knife-edge sensing, which is simple, light-weight, compact, and easy to align. It applies a 2D optical knife-edge to manipulate the diffraction pattern sensed by a quadrant photodetector, whose output voltages could derive 2D straightness errors after a calibration process. This paper analyzes the physical model of the configuration and performs simulations and experiments to study the system sensitivity, measurement nonlinearity, and error sources. The results demonstrate that the proposed configuration has higher sensitivity and insensitive to beam's vibration, compared with the conventional configurations without using the knife-edge, and could achieve ±0.25 μ m within a ±40 μ m measurement range along a 40 mm primary axial motion.

Primary productivity by phytoplankton in the tidal, fresh Potomac River, Maryland, May 1980 to August 1981

USGS Publications Warehouse

Cohen, R.R.; Pollock, S.O.

1983-01-01

Primary productivity by phytoplankton was measured on samples collected from the Potomac Tidal River, Maryland. The studies were performed monthly from May 1980 to September 1981. Additional studies were done once a week in August 1980, twice a week from August 4 to 8, 1980 and twice in September 1980. Depth-integrated samples were collected at five stations and incubated in boxes that were exposed to natural sunlight. The boxes were covered with neutral density filters transmitting 100 , 65, 32, 16, and 6 percent surface light. River water was pumped continuously over the samples. The extinction of light in the water column by phytoplankton was measured when samples were collected. Experiments were performed to select a method for routine productivity analysis. No difference was found between productivity: (1) determined in situ and in boxes; (2) measured in 300 ml and (4) calculated from short term (4 hours) and long term (10-24 hours) incubations. There were higher productivity differences in samples that were rotated among different light intensities every 15 minutes (simulating mixing) than those remaining stationary. Respiration was significantly less in samples pumped through a hose from those collected using a depth-integrating sampler. Depth-integrated primary productivity was determined from the productivity data using an equation modified from one reported in the literature. Depth-integrated gross primary productivity was highest in August 1980 and 1981 and lowest in January 1980. (USGS)

FHR Process Instruments

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

Holcomb, David Eugene

2015-01-01

Fluoride salt-cooled High temperature Reactors (FHRs) are entering into early phase engineering development. Initial candidate technologies have been identified to measure all of the required process variables. The purpose of this paper is to describe the proposed measurement techniques in sufficient detail to enable assessment of the proposed instrumentation suite and to support development of the component technologies. This paper builds upon the instrumentation chapter of the recently published FHR technology development roadmap. Locating instruments outside of the intense core radiation and high-temperature fluoride salt environment significantly decreases their environmental tolerance requirements. Under operating conditions, FHR primary coolant salt ismore » a transparent, low-vapor-pressure liquid. Consequently, FHRs can employ standoff optical measurements from above the salt pool to assess in-vessel conditions. For example, the core outlet temperature can be measured by observing the fuel s blackbody emission. Similarly, the intensity of the core s Cerenkov glow indicates the fission power level. Short-lived activation of the primary coolant provides another means for standoff measurements of process variables. The primary coolant flow and neutron flux can be measured using gamma spectroscopy along the primary coolant piping. FHR operation entails a number of process measurements. Reactor thermal power and core reactivity are the most significant variables for process control. Thermal power can be determined by measuring the primary coolant mass flow rate and temperature rise across the core. The leading candidate technologies for primary coolant temperature measurement are Au-Pt thermocouples and Johnson noise thermometry. Clamp-on ultrasonic flow measurement, that includes high-temperature tolerant standoffs, is a potential coolant flow measurement technique. Also, the salt redox condition will be monitored as an indicator of its corrosiveness. Both electrochemical techniques and optical spectroscopy are candidate fluoride salt redox measurement methods. Coolant level measurement can be performed using radar-level gauges located in standpipes above the reactor vessel. While substantial technical development remains for most of the instruments, industrially compatible instruments based upon proven technology can be reasonably extrapolated from the current state of the art.« less

The KASCADE-Grande experiment

NASA Astrophysics Data System (ADS)

Apel, W. D.; Arteaga, J. C.; Badea, A. F.; Bekk, K.; Bertaina, M.; Blümer, J.; Bozdog, H.; Brancus, I. M.; Buchholz, P.; Cantoni, E.; Chiavassa, A.; Cossavella, F.; Daumiller, K.; de Souza, V.; Di Pierro, F.; Doll, P.; Engel, R.; Engler, J.; Finger, M.; Fuhrmann, D.; Ghia, P. L.; Gils, H. J.; Glasstetter, R.; Grupen, C.; Haungs, A.; Heck, D.; Hörandel, J. R.; Huege, T.; Isar, P. G.; Kampert, K.-H.; Kang, D.; Kickelbick, D.; Klages, H. O.; Link, K.; łuczak, P.; Ludwig, M.; Mathes, H. J.; Mayer, H. J.; Melissas, M.; Milke, J.; Mitrica, B.; Morello, C.; Navarra, G.; Nehls, S.; Oehlschläger, J.; Ostapchenko, S.; Over, S.; Palmieri, N.; Petcu, M.; Pierog, T.; Rebel, H.; Roth, M.; Schieler, H.; Schröder, F.; Sima, O.; Stümpert, M.; Toma, G.; Trinchero, G. C.; Ulrich, H.; Weindl, A.; Wochele, J.; Wommer, M.; Zabierowski, J.

2010-08-01

KASCADE-Grande is the enlargement of the KASCADE extensive air shower detector, realized to expand the cosmic ray studies from the previous 10 14-10 17 eV primary energy range to 10 18 eV. This is performed by extending the area covered by the KASCADE electromagnetic array from 200×200 to 700×700 m 2 by means of 37 scintillator detector stations of 10 m 2 area each. This new array is named Grande and provides measurements of the all-charged particle component of extensive air showers ( Nch), while the original KASCADE array particularly provides information on the muon content (Nμ). Additional dense compact detector set-ups being sensitive to energetic hadrons and muons are used for data consistency checks and calibration purposes. The performance of the Grande array and its integration into the entire experimental complex is discussed. It is demonstrated that the overall observable resolutions are adequate to meet the physical requirements of the measurements, i.e. primary energy spectrum and elemental composition studies in the primary cosmic ray energy range of 10 16-10 18 eV.

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

Aaboud, M.; Aad, G.; Abbott, B.

This paper presents the method and performance of primary vertex reconstruction in proton–proton collision data recorded by the ATLAS experiment during Run 1 of the LHC. The studies presented focus on data taken during 2012 at a centre-of-mass energy of √s = 8 TeV. The performance has been measured as a function of the number of interactions per bunch crossing over a wide range, from one to seventy. The measurement of the position and size of the luminous region and its use as a constraint to improve the primary vertex resolution are discussed. A longitudinal vertex position resolution of aboutmore » 30 μm is achieved for events with high multiplicity of reconstructed tracks. The transverse position resolution is better than 20 μm and is dominated by the precision on the size of the luminous region. An analytical model is proposed to describe the primary vertex reconstruction efficiency as a function of the number of interactions per bunch crossing and of the longitudinal size of the luminous region. Agreement between the data and the predictions of this model is better than 3% up to seventy interactions per bunch crossing.« less

Does quality influence utilization of primary health care? Evidence from Haiti.

PubMed

Gage, Anna D; Leslie, Hannah H; Bitton, Asaf; Jerome, J Gregory; Joseph, Jean Paul; Thermidor, Roody; Kruk, Margaret E

2018-06-20

Expanding coverage of primary healthcare services such as antenatal care and vaccinations is a global health priority; however, many Haitians do not utilize these services. One reason may be that the population avoids low quality health facilities. We examined how facility infrastructure and the quality of primary health care service delivery were associated with community utilization of primary health care services in Haiti. We constructed two composite measures of quality for all Haitian facilities using the 2013 Service Provision Assessment survey. We geographically linked population clusters from the Demographic and Health Surveys to nearby facilities offering primary health care services. We assessed the cross-sectional association between quality and utilization of four primary care services: antenatal care, postnatal care, vaccinations and sick child care, as well as one more complex service: facility delivery. Facilities performed poorly on both measures of quality, scoring 0.55 and 0.58 out of 1 on infrastructure and service delivery quality respectively. In rural areas, utilization of several primary cares services (antenatal care, postnatal care, and vaccination) was associated with both infrastructure and quality of service delivery, with stronger associations for service delivery. Facility delivery was associated with infrastructure quality, and there was no association for sick child care. In urban areas, care utilization was not associated with either quality measure. Poor quality of care may deter utilization of beneficial primary health care services in rural areas of Haiti. Improving health service quality may offer an opportunity not only to improve health outcomes for patients, but also to expand coverage of key primary health care services.

Initial Validation of an Instrument Measuring Psychology-Specific Epistemological Beliefs

ERIC Educational Resources Information Center

Renken, Maggie D.; McMahan, Ethan A.; Nitkova, Martina

2015-01-01

Psychology-specific epistemological beliefs (EBs) are believed to influence students' approach to and performance in psychology courses. However, empirical research on this topic is limited due in part to a lack of well-validated instruments measuring this construct. The primary objective of this research was to develop and validate the…

Interaction between Cognitive and Non-Cognitive Factors: The Influences of Academic Goal Orientation and Working Memory on Mathematical Performance

ERIC Educational Resources Information Center

Lee, Kerry; Ning, Flora; Goh, Hui Chin

2014-01-01

Although the effects of achievement goals and working memory on academic performance are well established, it is not clear whether they jointly affect academic performance. Children from Primary 4 and 6 (N = 608) were administered (a) measures of working memory and updating from the automated working memory battery and a running span task, (b)…

Assessment of physical function and participation in chronic pain clinical trials: IMMPACT/OMERACT recommendations.

PubMed

Taylor, Ann M; Phillips, Kristine; Patel, Kushang V; Turk, Dennis C; Dworkin, Robert H; Beaton, Dorcas; Clauw, Daniel J; Gignac, Monique A M; Markman, John D; Williams, David A; Bujanover, Shay; Burke, Laurie B; Carr, Daniel B; Choy, Ernest H; Conaghan, Philip G; Cowan, Penney; Farrar, John T; Freeman, Roy; Gewandter, Jennifer; Gilron, Ian; Goli, Veeraindar; Gover, Tony D; Haddox, J David; Kerns, Robert D; Kopecky, Ernest A; Lee, David A; Malamut, Richard; Mease, Philip; Rappaport, Bob A; Simon, Lee S; Singh, Jasvinder A; Smith, Shannon M; Strand, Vibeke; Tugwell, Peter; Vanhove, Gertrude F; Veasley, Christin; Walco, Gary A; Wasan, Ajay D; Witter, James

2016-09-01

Although pain reduction is commonly the primary outcome in chronic pain clinical trials, physical functioning is also important. A challenge in designing chronic pain trials to determine efficacy and effectiveness of therapies is obtaining appropriate information about the impact of an intervention on physical function. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) and Outcome Measures in Rheumatology (OMERACT) convened a meeting to consider assessment of physical functioning and participation in research on chronic pain. The primary purpose of this article is to synthesize evidence on the scope of physical functioning to inform work on refining physical function outcome measurement. We address issues in assessing this broad construct and provide examples of frequently used measures of relevant concepts. Investigators can assess physical functioning using patient-reported outcome (PRO), performance-based, and objective measures of activity. This article aims to provide support for the use of these measures, covering broad aspects of functioning, including work participation, social participation, and caregiver burden, which researchers should consider when designing chronic pain clinical trials. Investigators should consider the inclusion of both PROs and performance-based measures as they provide different but also important complementary information. The development and use of reliable and valid PROs and performance-based measures of physical functioning may expedite development of treatments, and standardization of these measures has the potential to facilitate comparison across studies. We provide recommendations regarding important domains to stimulate research to develop tools that are more robust, address consistency and standardization, and engage patients early in tool development.

Performance of newly implemented Environmental Management Systems in primary schools in South Africa.

PubMed

Hens, Luc; Wiedemann, Torsten; Raath, Schalk; Stone, Riana; Renders, Paul; Craenhals, Eric

2010-01-01

Quantitative results from Environmental Management Systems (EMS) at primary schools have rarely been examined in literature. This paper presents the monitoring results of environmental care in 39 primary schools in Northern South Africa. During 2 years, after the EMS was implemented in the curriculum and in the school's management, the progress of environmental performances of the participating schools has been measured, by means of detailed questionnaires, related to four environmental aspects: water, waste, energy and greening. At the beginning of the project, 50% of the schools performed well on water-related environmental actions. Two years later it was 76%. For waste-related activities the improvement was even stronger: from 50% to 100%. The environmental performances of the schools improved also for greening-related actions, from 50% at the start of the project to 64% two years later. Only energy-related activities did not improve significantly with only 24% of all schools performing well at the end of the survey period. In general, the introduction of an EMS succeeded in an improvement of the overall environmental performances of the schools, but cost-intensive activities were less successful than others. Copyright 2009 Elsevier Ltd. All rights reserved.

[Depression and burden on primary caregivers of elderly persons with physical dependence of the UMF 171].

PubMed

Navarro-Sandoval, Cristina; Uriostegui-Espíritu, Lizbeth Carlota; Delgado-Quiñones, Edna Gabriela; Sahagún-Cuevas, Minerva Natalia

2017-01-01

According to the National Health and Nutrition Survey of 2012, more than a quarter of older adults (26.9%) have some degree of disability, requiring a primary caregiver to perform basic activities of daily living. The aim is to determine the prevalence of depression and burden on primary caregivers of elderly persons with physical dependence. A descriptive cross-sectional study with non-probability sampling that included the primary caregivers of elderly patients with physical dependence. Barthel scale was applied as a tool to measure the level of physical dependence in elderly patients; while the primary caregivers were applied to the Beck Depression and Zarit scale for assessing the level of caregiver burden. A sample of 76 primary caregivers was calculated and descriptive statistical analysis was performed. Of the 76 primary caregivers, 55.3% were without depression, 32.9% had mild depression, and 11.8% with moderate depression. According to the Zarit scale, 40.8% had no burden, 44.7% had burden light, and 14.5% intense burden. The role of primary caregiver is a stressful task which can interfere with their family health; so our role is to provide care not only to the geriatric dependent patients, but also to their caregiver.

Prospective, observational study comparing automated and visual point-of-care urinalysis in general practice

PubMed Central

van Delft, Sanne; Goedhart, Annelijn; Spigt, Mark; van Pinxteren, Bart; de Wit, Niek; Hopstaken, Rogier

2016-01-01

Objective Point-of-care testing (POCT) urinalysis might reduce errors in (subjective) reading, registration and communication of test results, and might also improve diagnostic outcome and optimise patient management. Evidence is lacking. In the present study, we have studied the analytical performance of automated urinalysis and visual urinalysis compared with a reference standard in routine general practice. Setting The study was performed in six general practitioner (GP) group practices in the Netherlands. Automated urinalysis was compared with visual urinalysis in these practices. Reference testing was performed in a primary care laboratory (Saltro, Utrecht, The Netherlands). Primary and secondary outcome measures Analytical performance of automated and visual urinalysis compared with the reference laboratory method was the primary outcome measure, analysed by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and Cohen's κ coefficient for agreement. Secondary outcome measure was the user-friendliness of the POCT analyser. Results Automated urinalysis by experienced and routinely trained practice assistants in general practice performs as good as visual urinalysis for nitrite, leucocytes and erythrocytes. Agreement for nitrite is high for automated and visual urinalysis. κ's are 0.824 and 0.803 (ranked as very good and good, respectively). Agreement with the central laboratory reference standard for automated and visual urinalysis for leucocytes is rather poor (0.256 for POCT and 0.197 for visual, respectively, ranked as fair and poor). κ's for erythrocytes are higher: 0.517 (automated) and 0.416 (visual), both ranked as moderate. The Urisys 1100 analyser was easy to use and considered to be not prone to flaws. Conclusions Automated urinalysis performed as good as traditional visual urinalysis on reading of nitrite, leucocytes and erythrocytes in routine general practice. Implementation of automated urinalysis in general practice is justified as automation is expected to reduce human errors in patient identification and transcribing of results. PMID:27503860

Investigations of a Coherently Driven Semiconductor Optical Cavity QED System

DTIC Science & Technology

2008-09-30

A. Fiber taper waveguide coupling Two of the primary difficulties in performing resonant optical measurements on the microcavity-QD system are ef...with the predomi- nantly radially polarized cavity mode. As a result, we esti- mate that spatial misalignment is the primary cause for the reduced...Mode splitting circles and peak reflection value diamonds as a fuction of Pd and ncav. Theoretical predic- tions are shown as dashed lines

Inability to Perform the Repeated Chair Stand Task Predicts Fall-Related Injury in Older Primary Care Patients.

PubMed

Shea, Cristina A; Ward, Rachel E; Welch, Sarah A; Kiely, Dan K; Goldstein, Richard; Bean, Jonathan F

2018-06-01

The aim of the study was to examine whether the chair stand component of the Short Physical Performance Battery predicts fall-related injury among older adult primary care patients. A 2-yr longitudinal cohort study of 430 Boston-area primary care patients aged ≥65 yrs screened to be at risk for mobility decline was conducted. The three components of the Short Physical Performance Battery (balance time, gait speed, and chair stand time) were measured at baseline. Participants reported incidence of fall-related injuries quarterly for 2 yrs. Complementary log-log discrete time hazard models were constructed to examine the hazard of fall-related injury across Short Physical Performance Battery scores, adjusting for age, sex, race, Digit Symbol Substitution Test score, and fall history. Participants were 68% female and 83% white, with a mean (SD) age of 76.6 (7.0). A total of 137 (32%) reported a fall-related injury during the follow-up period. Overall, inability to perform the chair stand task was a significant predictor of fall-related injury (hazard ratio = 2.11, 95% confidence interval = 1.23-3.62, P = 0.01). Total Short Physical Performance Battery score, gait component score, and balance component score were not predictive of fall-related injury. Inability to perform the repeated chair stand task was associated with increased hazard of an injurious fall for 2 yrs among a cohort of older adult primary care patients.

Investigations on optimization of accident management measures following a station blackout accident in a VVER-1000 pressurized water reactor

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

Tusheva, P.; Schaefer, F.; Kliem, S.

2012-07-01

The reactor safety issues are of primary importance for preserving the health of the population and ensuring no release of radioactivity and fission products into the environment. A part of the nuclear research focuses on improvement of the safety of existing nuclear power plants. Studies, research and efforts are a continuing process at improving the safety and reliability of existing and newly developed nuclear power plants at prevention of a core melt accident. Station blackout (loss of AC power supply) is one of the dominant accidents taken into consideration at performing accident analysis. In case of multiple failures of safetymore » systems it leads to a severe accident. To prevent an accident to turn into a severe one or to mitigate the consequences, accident management measures must be performed. The present paper outlines possibilities for application and optimization of accident management measures following a station blackout accident. Assessed is the behaviour of the nuclear power plant during a station blackout accident without accident management measures and with application of primary/secondary side oriented accident management measures. Discussed are the possibilities for operators ' intervention and the influence of the performed accident management measures on the course of the accident. Special attention has been paid to the effectiveness of the passive feeding and physical phenomena having an influence on the system behaviour. The performed simulations show that the effectiveness of the secondary side feeding procedure can be limited due to an early evaporation or flashing effects in the feed water system. The analyzed cases show that the effectiveness of the accident management measures strongly depends on the initiation criteria applied for depressurization of the reactor coolant system. (authors)« less

Agent Reasoning Transparency: The Influence of Information Level on Automation-Induced Complacency

DTIC Science & Technology

2017-06-30

Surveys and Tests 16 3.3.4 Experimental Design and Performance Measures 19 3.3.5 Procedure 21 3.4 Results 23 3.4.1 Complacent behavior, Primary Task...Method 57 4.3.1 Participants 57 4.3.2 Apparatus 57 4.3.3 Surveys and Tests 57 4.3.4 Experimental Design and Performance Measures 58 4.3.5...Discussion 115 5.5 Conclusion 119 6. References 120 Appendix A. Demographics Questionnaire 127 Appendix B. Attentional Control Survey 129

The Development and Validation of a Rapid Assessment Tool of Primary Care in China

PubMed Central

Mei, Jie; Liang, Yuan; Shi, LeiYu; Zhao, JingGe; Wang, YuTan; Kuang, Li

2016-01-01

Introduction. With Chinese health care reform increasingly emphasizing the importance of primary care, the need for a tool to evaluate primary care performance and service delivery is clear. This study presents a methodology for a rapid assessment of primary care organizations and service delivery in China. Methods. The study translated and adapted the Primary Care Assessment Tool-Adult Edition (PCAT-AE) into a Chinese version to measure core dimensions of primary care, namely, first contact, continuity, comprehensiveness, and coordination. A cross-sectional survey was conducted to assess the validity and reliability of the Chinese Rapid Primary Care Assessment Tool (CR-PCAT). Eight community health centers in Guangdong province have been selected to participate in the survey. Results. A total of 1465 effective samples were included for data analysis. Eight items were eliminated following principal component analysis and reliability testing. The principal component analysis extracted five multiple-item scales (first contact utilization, first contact accessibility, ongoing care, comprehensiveness, and coordination). The tests of scaling assumptions were basically met. Conclusion. The standard psychometric evaluation indicates that the scales have achieved relatively good reliability and validity. The CR-PCAT provides a rapid and reliable measure of four core dimensions of primary care, which could be applied in various scenarios. PMID:26885509

Evaluation of Low-Cost Mitigation Measures Implemented to Improve Air Quality in Nursery and Primary Schools

PubMed Central

Sá, Juliana P.; Branco, Pedro T. B. S.; Alvim-Ferraz, Maria C. M.; Martins, Fernando G.; Sousa, Sofia I. V.

2017-01-01

Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO2, CO, NO2, O3, CH2O, total volatile organic compounds (VOC), PM1, PM2.5, PM10, Total Suspended Particles (TSP) and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO) were found for PM2.5, PM10, CO2 and CH2O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO2. However, mitigation measures were not always sufficient to decrease the pollutants’ concentrations till values considered safe to protect human health. PMID:28561795

Improved reliability of pH measurements.

PubMed

Spitzer, Petra; Werner, Barbara

2002-11-01

Measurements of pH are performed on a large scale at laboratory level, and in industry. To meet the quality-control requirements and other technical specifications there is a need for traceability in measurement results. The prerequisite for the international acceptance of analytical data is reliability. To measure means to compare. Comparability entails use of recognised references to which the standard buffer solutions used for calibration of pH meter-electrode assemblies can be traced. The new recommendation on the measurement of pH recently published as a provisional document by the International Union on Pure and Applied Chemistry (IUPAC) enables traceability for measured pH values to a conventional reference frame which is recognised world-wide. The primary method for pH will be described. If analytical data are to be accepted internationally it is necessary to demonstrate the equivalence of the national traceability structures, including national measurement standards. For the first time key comparisons for pH have been performed by the Consultative Committee for Amount of Substance (CCQM, set up by the International Bureau of Weights and Measures, BIPM) to assess the equivalence of the national measurement procedures used to determine the pH of primary standard buffer solutions. The results of the first key comparison on pH CCQM-K9, and other international initiatives to improve the consistency of the results of measurement for pH, are reported.

Using quality experts from manufacturing to transform primary care.

PubMed

Steiner, Rose M; Walsworth, David T

2010-01-01

Improving Performance in Practice (IPIP) is an initiative convened by the American Board of Medical Specialties. It investigates the efficacy of coaches in helping primary-care practices improve the care of patients with diabetes and asthma. Most IPIP states use coaches who have a health care background, and are trained in quality and process improvement. Michigan uses quality experts from the manufacturing industry who are educated regarding the health care environment, which enables them to perform as quality-improvement coaches (QICs) in primary-care practices. In this case study, ninety-six quality experts were trained to coach primary-care practices, with 53 currently assigned to offices, and others assisting as needed. Practice teams and QICs identify gaps in care and office practices with the use of assorted quality-improvement tools. Reports are made monthly to describe clinical and process measures and methods used. Michigan has 33 practices engaged, involving 205 physicians and 40 midlevel providers. The teaming of quality experts from the manufacturing industry with primary-care office providers and staff resulted in office efficiency, improved care provided, and progress toward attainment of a patient-centered medical home (PCMH). Quality experts from manufacturing volunteered to coach for improvements in primary care. The efforts of QICs have been successful. Because the QICs are volunteers, sustainability of the Michigan Improving Performance in Practice program is a challenge.

Age differences in the performance of basketball dribbling by elementary school boys.

PubMed

Caterino, M C

1991-08-01

Age differences in hand contact time and ball-to-floor distance during the performance of a basketball dribbling task by 30 5- to 6-, 7- to 8-, and 9- to 10-yr.-old boys were studied. Each age group included 10 boys, five with high rhythm audiation skill and five with low rhythm audiation skill, as measured on Gordon's Primary or Intermediate Measures of Music Audiation. Performance during eight bounces was filmed with a 16-mm camera and analyzed with a stop-action projector. Analysis of variance indicated no statistically significant differences. Observed dribbling behaviors are discussed.

Identifying performance based measures for winter maintenance.

DOT National Transportation Integrated Search

2013-05-01

One of the Vermont Agency of : Transportations (VTrans) primary missions is to keep Vermont state highways open and safe : for the transportation network users, while managing the system in a cost : - : effective and environmentally sensitive mann...

Comparative study of the retinal nerve fibre layer thickness performed with optical coherence tomography and GDx scanning laser polarimetry in patients with primary open-angle glaucoma

PubMed Central

Wasyluk, Jaromir T.; Jankowska-Lech, Irmina; Terelak-Borys, Barbara; Grabska-Liberek, Iwona

2012-01-01

Summary Background We compared the parameters of retinal nerve fibre layer in patients with advanced glaucoma with the use of different OCT (Optical Coherence Tomograph) devices in relation to analogical measurements performed with GDx VCC (Nerve Fiber Analyzer with Variable Corneal Compensation) scanning laser polarimetry. Material/Methods Study subjects had advanced primary open-angle glaucoma, previously treated conservatively, diagnosed and confirmed by additional examinations (visual field, ophthalmoscopy of optic nerve, gonioscopy), A total of 10 patients were enrolled (9 women and 1 man), aged 18–70 years of age. Nineteen eyes with advanced glaucomatous neuropathy were examined. 1) Performing a threshold perimetry Octopus, G2 strategy and ophthalmoscopy of optic nerve to confirm the presence of advanced primary open-angle glaucoma; 2) performing a GDx VCC scanning laser polarimetry of retinal nerve fibre layer; 3) measuring the retinal nerve fibre layer thickness with 3 different optical coherence tomographs. Results The parameters of the retinal nerve fibre layer thickness are highly correlated between the GDx and OCT Stratus and 3D OCT-1000 devices in mean retinal nerve fibre layer thickness, retinal nerve fibre layer thickness in the upper sector, and correlation of NFI (GDx) with mean retinal nerve fibre layer thickness in OCT examinations. Absolute values of the retinal nerve fibre layer thickness (measured in μm) differ significantly between GDx and all OCT devices. Conclusions Examination with OCT devices is a sensitive diagnostic method of glaucoma, with good correlation with the results of GDx scanning laser polarimetry of the patients. PMID:22367131

Effect of part-time practice on patient outcomes.

PubMed

Parkerton, Patricia H; Wagner, Edward H; Smith, Dean G; Straley, Hugh L

2003-09-01

Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes. To determine whether patient outcomes vary with physicians' clinic hours. Cross-sectional retrospective design assessing primary care practices in 1998. All 25 outpatient-clinics of a single medical group in western Washington. One hundred ninety-four family practitioners and general internists, 80% of whom were part-time, who provided ambulatory primary care services to specified HMO patient panels. Physician appointment hours ranged from 10 to 35 per week (30% to 100% of full time). Twenty-three measures of individual primary care physician performance collected in an administrative database were aggregated into 4 outcome measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Multivariate regression on each of the 4 outcomes controlled for characteristics of physicians (administrative role, gender, seniority) and patient panels (size, case mix, age, gender). While the effects were small, part-time physicians had significantly higher rates for cancer screening (4% higher, P =.001), diabetic management (3% higher, P =.033), and for patient satisfaction (3% higher, P =.035). After controlling for potential confounders, there was no significant association with patient satisfaction (P =.212) or ambulatory costs (P =.323). Primary care physicians working fewer clinical hours were associated with higher quality performance than were physicians working longer hours, but with patient satisfaction and ambulatory costs similar to those of physicians working longer hours. The trend toward part-time clinical practice by primary care physicians may occur without harm to patient outcomes.

Research output on primary care in Australia, Canada, Germany, the Netherlands, the United Kingdom, and the United States: bibliometric analysis

PubMed Central

Glanville, Julie; Kendrick, Tony; McNally, Rosalind; Campbell, John

2011-01-01

Objective To compare the volume and quality of original research in primary care published by researchers from primary care in the United Kingdom against five countries with well established academic primary care. Design Bibliometric analysis. Setting United Kingdom, United States, Australia, Canada, Germany, and the Netherlands. Studies reviewed Research publications relevant to comprehensive primary care and authored by researchers from primary care, recorded in Medline and Embase, with publication dates 2001-7 inclusive. Main outcome measures Volume of published activity of generalist primary care researchers and the quality of the research output by those publishing the most using citation metrics: numbers of cited papers, proportion of cited papers, and mean citation scores. Results 82 169 papers published between 2001 and 2007 in the six countries were classified as research on primary care. In a 15% pragmatic random sample of these records, 40% of research on primary care from the United Kingdom and 46% from the Netherlands was authored by researchers employed in a primary care setting or employed in academic departments of primary care. The 141 researchers with the highest volume of publications reporting research findings published between 2001 and 2007 (inclusive) authored or part authored 8.3% of the total sample of papers. For authors with the highest proportion of publications cited at least five times, the best performers came from the United States (n=5), United Kingdom (n=4), and the Netherlands (n=2). In the top 10 of authors with the highest proportions of publications achieving 20 or more citations, six were from the United Kingdom and four from the United States. The mean Hirsch index (measure of a researcher’s productivity and impact of the published work) was 14 for the Netherlands, 13 for the United Kingdom, 12 for the United States, 7 for Canada, 4 for Australia, and 3 for Germany. Conclusion This international comparison of the volume and citation rates of papers by researchers from primary care consistently placed UK researchers among the best performers internationally. PMID:21385804

A smart rotary technique versus conventional pulpectomy for primary teeth: A randomized controlled clinical study

PubMed Central

Mokhtari, Negar; Shirazi, Alireza-Sarraf

2017-01-01

Background Techniques with adequate accuracy of working length determination along with shorter duration of treatment in pulpectomy procedure seems to be essential in pediatric dentistry. The aim of the present study was to evaluate the accuracy of root canal length measurement with Root ZX II apex locator and rotary system in pulpectomy of primary teeth. Material and Methods In this randomized control clinical trial complete pulpectomy was performed on 80 mandibular primary molars in 80, 4-6-year-old children. The study population was randomly divided into case and control groups. In control group conventional pulpectomy was performed and in the case group working length was determined by electronic apex locator Root ZXII and instrumented with Mtwo rotary files. Statistical evaluation was performed using Mann-Whitney and Chi-Square tests (P<0.05). Results There were no significant differences between electronic apex locator Root ZXII and conventional method in accuracy of root canal length determination. However significantly less time was needed for instrumenting with rotary files (P=0.000). Conclusions Considering the comparable results in accuracy of root canal length determination and the considerably shorter instrumentation time in Root ZXII apex locator and rotary system, it may be suggested for pulpectomy in primary molar teeth. Key words:Rotary technique, conventional technique, pulpectomy, primary teeth. PMID:29302280

A smart rotary technique versus conventional pulpectomy for primary teeth: A randomized controlled clinical study.

PubMed

Mokhtari, Negar; Shirazi, Alireza-Sarraf; Ebrahimi, Masoumeh

2017-11-01

Techniques with adequate accuracy of working length determination along with shorter duration of treatment in pulpectomy procedure seems to be essential in pediatric dentistry. The aim of the present study was to evaluate the accuracy of root canal length measurement with Root ZX II apex locator and rotary system in pulpectomy of primary teeth. In this randomized control clinical trial complete pulpectomy was performed on 80 mandibular primary molars in 80, 4-6-year-old children. The study population was randomly divided into case and control groups. In control group conventional pulpectomy was performed and in the case group working length was determined by electronic apex locator Root ZXII and instrumented with Mtwo rotary files. Statistical evaluation was performed using Mann-Whitney and Chi-Square tests ( P <0.05). There were no significant differences between electronic apex locator Root ZXII and conventional method in accuracy of root canal length determination. However significantly less time was needed for instrumenting with rotary files ( P =0.000). Considering the comparable results in accuracy of root canal length determination and the considerably shorter instrumentation time in Root ZXII apex locator and rotary system, it may be suggested for pulpectomy in primary molar teeth. Key words: Rotary technique, conventional technique, pulpectomy, primary teeth.

Preliminary dynamic tests of a flight-type ejector

NASA Technical Reports Server (NTRS)

Drummond, Colin K.

1992-01-01

A thrust augmenting ejector was tested to provide experimental data to assist in the assessment of theoretical models to predict duct and ejector fluid-dynamic characteristics. Eleven full-scale thrust augmenting ejector tests were conducted in which a rapid increase in the ejector nozzle pressure ratio was effected through a unique facility, bypass/burst-disk subsystem. The present work examines two cases representative of the test performance window. In the first case, the primary nozzle pressure ration (NPR) increased 36 percent from one unchoked (NPR = 1.29) primary flow condition to another (NPR = 1.75) over a 0.15 second interval. The second case involves choked primary flow conditions, where a 17 percent increase in primary nozzle flowrate (from NPR = 2.35 to NPR = 2.77) occurred over approximately 0.1 seconds. Although the real-time signal measurements support qualitative remarks on ejector performance, extracting quantitative ejector dynamic response was impeded by excessive aerodynamic noise and thrust stand dynamic (resonance) characteristics. It does appear, however, that a quasi-steady performance assumption is valid for this model with primary nozzle pressure increased on the order of 50 lb(sub f)/s. Transient signal treatment of the present dataset is discussed and initial interpretations of the results are compared with theoretical predictions for a similar Short Takeoff and Vertical Landing (STOVL) ejector model.

Geoscience Laser Ranging System design and performance predictions

NASA Technical Reports Server (NTRS)

Anderson, Kent L.

1991-01-01

The Geoscience Laser System (GLRS) will be a high-precision distance-measuring instrument planned for deployment on the EOS-B platform. Its primary objectives are to perform ranging measurements to ground targets to monitor crustal deformation and tectonic plate motions, and nadir-looking altimetry to determine ice sheet thicknesses, surface topography, and vertical profiles of clouds and aerosols. The system uses a mode-locked, 3-color Nd:YAG laser source, a Microchannel Plate-PMT for absolute time-of-flight (TOF) measurement (at 532 nm), a streak camera for TOF 2-color dispersion measurement (532 nm and 355 nm), and a Si avalanche photodiode for altimeter waveform detection (1064 nm). The performance goals are to make ranging measurements to ground targets with about 1 cm accuracy, and altimetry height measurements over ice with 10 cm accuracy. This paper presents an overview of the design concept developed during a phase B study. System engineering issues and trade studies are discussed, with particular attention to error budgets and performance predictions.

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

PubMed

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

2015-04-21

To examine the effectiveness of the quality management programme--European Practice Assessment--in primary care in Switzerland. Longitudinal study with three points of measurement. Primary care practices in Switzerland. In total, 45 of 91 primary care practices completed European Practice Assessment three times. The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: 'infrastructure', 'information', 'finance', and 'quality and safety' to examine changes over time. Significant improvements were found in three of four domains: 'quality and safety' (F=22.81, p<0.01), 'information' (F=27.901, p<0.01) and 'finance' (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effects of thermal aging on mechanical performance of paper

Treesearch

B.T. Hotle; J.M. Considine; M.J. Wald; R.E. Rowlands; K.T. Turner

2008-01-01

A missing element of paper aging research is a description of mechanical performance with aging. Tensile strength cannot be predicted directly from DP measurements, and existing models do not represent the effects of aging on strength and stiffness. The primary aim of the present work is to characterize changes of mechanical properties, such as tensile response and...

Motor Performance of Primary Age Handicapped and Nonhandicapped Children in the Mainstream: A Comparison.

ERIC Educational Resources Information Center

Sherrill, Claudine; Kelly, Luke

A comparative study was made of mentally retarded and nonhandicapped children in the first through third grades on motor performance as measured by running (50-yard dash), jumping (standing broad jump), and throwing (softball throw for distance). The subjects had received all of their physical education instruction in a mainstream setting since…

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

ERIC Educational Resources Information Center

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

2010-01-01

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

Development of a Criterion-Referenced, Performance-Based Assessment of Reading Comprehension in a Whole Literacy Program.

ERIC Educational Resources Information Center

Tibbetts, Katherine A.; And Others

This paper describes the development of a criterion-referenced, performance-based measure of third grade reading comprehension. The primary purpose of the assessment is to contribute unique and valid information for use in the formative evaluation of a whole literacy program. A secondary purpose is to supplement other program efforts to…

Improving Fifth Grade Students' Mathematics Self-Efficacy Calibration and Performance through Self-Regulation Training

ERIC Educational Resources Information Center

Ramdass, Darshanand H.

2009-01-01

This primary goal of this study was to investigate the effects of strategy training and self-reflection, two subprocesses of Zimmerman's cyclical model of self-regulation, on fifth grade students' mathematics performance, self-efficacy, self-evaluation, and calibration measures of self-efficacy bias, self-efficacy accuracy, self-evaluation bias,…

Development of a primary standard for absorbed dose from unsealed radionuclide solutions

NASA Astrophysics Data System (ADS)

Billas, I.; Shipley, D.; Galer, S.; Bass, G.; Sander, T.; Fenwick, A.; Smyth, V.

2016-12-01

Currently, the determination of the internal absorbed dose to tissue from an administered radionuclide solution relies on Monte Carlo (MC) calculations based on published nuclear decay data, such as emission probabilities and energies. In order to validate these methods with measurements, it is necessary to achieve the required traceability of the internal absorbed dose measurements of a radionuclide solution to a primary standard of absorbed dose. The purpose of this work was to develop a suitable primary standard. A comparison between measurements and calculations of absorbed dose allows the validation of the internal radiation dose assessment methods. The absorbed dose from an yttrium-90 chloride (90YCl) solution was measured with an extrapolation chamber. A phantom was developed at the National Physical Laboratory (NPL), the UK’s National Measurement Institute, to position the extrapolation chamber as closely as possible to the surface of the solution. The performance of the extrapolation chamber was characterised and a full uncertainty budget for the absorbed dose determination was obtained. Absorbed dose to air in the collecting volume of the chamber was converted to absorbed dose at the centre of the radionuclide solution by applying a MC calculated correction factor. This allowed a direct comparison of the analytically calculated and experimentally determined absorbed dose of an 90YCl solution. The relative standard uncertainty in the measurement of absorbed dose at the centre of an 90YCl solution with the extrapolation chamber was found to be 1.6% (k  =  1). The calculated 90Y absorbed doses from published medical internal radiation dose (MIRD) and radiation dose assessment resource (RADAR) data agreed with measurements to within 1.5% and 1.4%, respectively. This study has shown that it is feasible to use an extrapolation chamber for performing primary standard absorbed dose measurements of an unsealed radionuclide solution. Internal radiation dose assessment methods based on MIRD and RADAR data for 90Y have been validated with experimental absorbed dose determination and they agree within the stated expanded uncertainty (k  =  2).

Measuring Spanish Orthographic Development in Private, Public and Subsidised Schools in Chile

ERIC Educational Resources Information Center

Helman, Lori; Delbridge, Anne; Parker, David; Arnal, Martina; Jara Mödinger, Luz

2016-01-01

The current study has a twofold purpose: first, to determine the reliability of a tool for assessing orthographic development in Spanish; second, to assess differences in students' performance on the measure across multiple types of primary schools in a large city in Chile. A Spanish developmental spelling inventory that contained words of…

Examining the Validity of Self-Reports on Scales Measuring Students' Strategic Processing

ERIC Educational Resources Information Center

Samuelstuen, Marit S.; Braten, Ivar

2007-01-01

Background: Self-report inventories trying to measure strategic processing at a global level have been much used in both basic and applied research. However, the validity of global strategy scores is open to question because such inventories assess strategy perceptions outside the context of specific task performance. Aims: The primary aim was to…

Persistent Primary Aldosteronism Despite Iatrogenic Adrenal Hemorrhage After Adrenal Vein Sampling

PubMed Central

Okamura, Keisuke; Okuda, Tetsu; Shirai, Kazuyuki; Abe, Ichiro; Kobayashi, Kunihisa; Ishii, Tatsu; Haraoka, Seiji; Urata, Hidenori

2018-01-01

Before surgery for primary aldosteronism (PA), localization is evaluated with adrenal vein sampling (AVS). A 56-year-old Japanese woman had a right adrenal mass, hypokalemia, and a high aldosterone/renin ratio. Stress tests confirmed the diagnosis of PA. Subsequently, preoperative AVS was performed and right adrenal hemorrhage (AH) occurred unexpectedly. Because hypertension persisted, laparoscopic right adrenalectomy was performed. Postoperatively, the blood pressure was normalized. Pathological examination revealed an adrenal cortical adenoma largely unaffected by necrosis and hemorrhage. Previous reports have also indicated that AH may not ameliorate PA. We discussed the clinical progress of AH and the measures to prevent causing AH. PMID:29238437

Persistent Primary Aldosteronism Despite Iatrogenic Adrenal Hemorrhage After Adrenal Vein Sampling.

PubMed

Okamura, Keisuke; Okuda, Tetsu; Shirai, Kazuyuki; Abe, Ichiro; Kobayashi, Kunihisa; Ishii, Tatsu; Haraoka, Seiji; Urata, Hidenori

2018-01-01

Before surgery for primary aldosteronism (PA), localization is evaluated with adrenal vein sampling (AVS). A 56-year-old Japanese woman had a right adrenal mass, hypokalemia, and a high aldosterone/renin ratio. Stress tests confirmed the diagnosis of PA. Subsequently, preoperative AVS was performed and right adrenal hemorrhage (AH) occurred unexpectedly. Because hypertension persisted, laparoscopic right adrenalectomy was performed. Postoperatively, the blood pressure was normalized. Pathological examination revealed an adrenal cortical adenoma largely unaffected by necrosis and hemorrhage. Previous reports have also indicated that AH may not ameliorate PA. We discussed the clinical progress of AH and the measures to prevent causing AH.

Family physicians' ability to perform population management is associated with adoption of other aspects of the patient-centered medical home.

PubMed

Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto

2015-04-01

The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.

Diagnostic Capability of Peripapillary Retinal Volume Measurements in Glaucoma.

PubMed

Simavli, Huseyin; Poon, Linda Yi-Chieh; Que, Christian J; Liu, Yingna; Akduman, Mustafa; Tsikata, Edem; de Boer, Johannes F; Chen, Teresa C

2017-06-01

To determine the diagnostic capability of spectral domain optical coherence tomography peripapillary retinal volume (RV) measurements. A total of 156 patients, 89 primary open-angle glaucoma and 67 normal subjects, were recruited. Spectral domain optical coherence tomography peripapillary RV was calculated for 4 quadrants using 3 annuli of varying scan circle diameters: outer circumpapillary annuli of circular grids 1, 2, and 3 (OCA1, OCA2, OCA3). Area under the receiver operating characteristic curves and pairwise comparisons of receiver operating characteristic (ROC) curves were performed to determine which quadrants were best for diagnosing primary open-angle glaucoma. The pairwise comparisons of the best ROC curves for RV and retinal nerve fiber layer (RNFL) were performed. The artifact rates were analyzed. Pairwise comparisons showed that the smaller annuli OCA1 and OCA2 had better diagnostic performance than the largest annulus OCA3 (P<0.05 for all quadrants). OCA1 and OCA2 had similar diagnostic performance, except for the inferior quadrant which was better for OCA1 (P=0.0033). The pairwise comparisons of the best ROC curves for RV and RNFL were not statistically significant. RV measurements had lower rates of artifacts at 7.4% while RNFL measurements had higher rates at 42.9%. Peripapillary RV measurements have excellent ability for diagnosing not only glaucoma patients but also a subset of early glaucoma patients. The inferior quadrant of peripapillary annulus OCA1 demonstrated the best diagnostic capability for both glaucoma and early glaucoma. The diagnostic ability of RV is comparable with that of RNFL parameters in glaucoma but with lower artifact rates.

EER, COP, and the Second Law Efficiency for Air Conditioners

ERIC Educational Resources Information Center

Leff, Harvey S.; Teeters, William D.

1978-01-01

Describes the relationship existing between coefficient of performance (COP) and energy efficiency ratio (EER) in air conditioning units and introduces new efficiency parameters measured relative to the energy extracted from the primary energy source. (SL)

77 FR 36550 - Advisory Committee on Training in Primary Care Medicine and Dentistry; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

...-supported program is to train clinical educators on methods to teach and assess trainee competencies for...'s development of performance measures and methods of longitudinal evaluation for Public Health...

Prediction of Coronary Artery Disease Risk Based on Multiple Longitudinal Biomarkers

PubMed Central

Yang, Lili; Yu, Menggang; Gao, Sujuan

2016-01-01

In the last decade, few topics in the area of cardiovascular disease (CVD) research have received as much attention as risk prediction. One of the well documented risk factors for CVD is high blood pressure (BP). Traditional CVD risk prediction models consider BP levels measured at a single time and such models form the basis for current clinical guidelines for CVD prevention. However, in clinical practice, BP levels are often observed and recorded in a longitudinal fashion. Information on BP trajectories can be powerful predictors for CVD events. We consider joint modeling of time to coronary artery disease and individual longitudinal measures of systolic and diastolic BPs in a primary care cohort with up to 20 years of follow-up. We applied novel prediction metrics to assess the predictive performance of joint models. Predictive performances of proposed joint models and other models were assessed via simulations and illustrated using the primary care cohort. PMID:26439685

Toolkit for the Automated Characterization of Optical Trapping Forces on Microscopic Particles

NASA Astrophysics Data System (ADS)

Glaser, Joseph; Hoeprich, David; Resnick, Andrew

2014-03-01

Optical traps have been in use in microbiological studies for the past 40 years to obtain noninvasive control of microscopic particles. However, the magnitude of the applied forces is often unknown. Therefore, we have developed an automated data acquisition and processing system which characterizes trap properties for known particle geometries. Extensive experiments and measurements utilizing well-characterized objects were performed and compared to literature to confirm the system's performance. This system will enable the future analysis of a trapped primary cilium, a slender rod-shaped organelle with aspect ratio L/R >30, where `L' is the cilium length and `R' the cilium diameter. The trapping of cilia is of primary importance, as it will lead to the precise measurements of mechanical properties of the organelle and its significance to the epithelial cell. Support from the National Institutes of Health, 1R15DK092716 is gratefully acknowledged.

A novel implementation of homodyne time interval analysis method for primary vibration calibration

NASA Astrophysics Data System (ADS)

Sun, Qiao; Zhou, Ling; Cai, Chenguang; Hu, Hongbo

2011-12-01

In this paper, the shortcomings and their causes of the conventional homodyne time interval analysis (TIA) method is described with respect to its software algorithm and hardware implementation, based on which a simplified TIA method is proposed with the help of virtual instrument technology. Equipped with an ordinary Michelson interferometer and dual channel synchronous data acquisition card, the primary vibration calibration system using the simplified method can perform measurements of complex sensitivity of accelerometers accurately, meeting the uncertainty requirements laid down in pertaining ISO standard. The validity and accuracy of the simplified TIA method is verified by simulation and comparison experiments with its performance analyzed. This simplified method is recommended to apply in national metrology institute of developing countries and industrial primary vibration calibration labs for its simplified algorithm and low requirements on hardware.

Atrial electromechanical delay and diastolic dysfunction in primary Sjögren syndrome.

PubMed

Akyel, Ahmet; Tavil, Yusuf; Tufan, Abdurrahman; Yayla, Cagri; Kaya, Arif; Tezcan, Mehme Engin; Ozturk, Mehmet Akif; Boyaci, Bulent

2012-10-06

In this study we aimed to investigate myocardial function and atrial electromechanical properties by conventional and tissue doppler echocardiography in patients with primary Sjögren syndrome. Forty patients with Sjögren syndrome (SS) and 25 age- and sex-matched healthy volunteers were enrolled in the study. Using transthoracic echocardiography, myocardial performance index and atrial electromechanical properties were measured. Basal characteristics were similar between two groups. Myocardial performance index values were disturbed in patients with Sjögren syndrome (0.41 vs. 0.32, p < 0.01). There was significant intraatrial (16.4±6.4, 5.0±4.5, p < 0.01) and interatrial (30.6±10.1, 15.4±5.9, p < 0.01) electromechanical delay in this patient group. Myocardial function is disturbed and there is significant atrial electromechanical delay in patients with primary SS. This study is the first to show altered myocardial function and atrial electromechanical properties in primary SS.

Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)

PubMed Central

Sayed, Abdul-Rauf; le Grange, Cynthia; Bhagwan, Susheela; Manga, Nayna; Hellenberg, Derek

2016-01-01

Background Major health sector reform and the need for baseline measures of performance to determine impact. Aim Baseline audit of primary healthcare (PHC) performance. Setting Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa. Method The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study. Results Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers. Conclusion Gaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research. PMID:27247157

Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery.

PubMed

Akhavan, Sina; Ward, Lorrayne; Bozic, Kevin J

2016-01-01

Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery. The purposes of this study were to compare the costs associated with (1) primary total hip arthroplasty (THA); (2) primary total knee arthroplasty (TKA); and (3) three surgeons performing these total joint arthroplasties (TJAs) as measured using TDABC versus traditional hospital accounting (TA). Process maps were developed for each phase of care (preoperative, intraoperative, and postoperative) for patients undergoing primary TJA performed by one of three surgeons at a tertiary care medical center. Personnel costs for each phase of care were measured using TDABC based on fully loaded labor rates, including physician compensation. Costs associated with consumables (including implants) were calculated based on direct purchase price. Total costs for 677 primary TJAs were aggregated over 17 months (January 2012 to May 2013) and organized into cost categories (room and board, implant, operating room services, drugs, supplies, other services). Costs derived using TDABC, based on actual time and intensity of resources used, were compared with costs derived using TA techniques based on activity-based costing and indirect costs calculated as a percentage of direct costs from the hospital decision support system. Substantial differences between cost estimates using TDABC and TA were found for primary THA (USD 12,982 TDABC versus USD 23,915 TA), primary TKA (USD 13,661 TDABC versus USD 24,796 TA), and individually across all three surgeons for both (THA: TDABC = 49%-55% of TA total cost; TKA: TDABC = 53%-55% of TA total cost). Cost categories with the most variability between TA and TDABC estimates were operating room services and room and board. Traditional hospital cost accounting systems overestimate the costs associated with many surgical procedures, including primary TJA. TDABC provides a more accurate measure of true resource use associated with TJAs and can be used to identify high-cost/high-variability processes that can be targeted for process/quality improvement. Level III, therapeutic study.

Techniques used by United Kingdom consultant plastic surgeons to select implant size for primary breast augmentation.

PubMed

Holmes, W J M; Timmons, M J; Kauser, S

2015-10-01

Techniques used to estimate implant size for primary breast augmentation have evolved since the 1970s. Currently no consensus exists on the optimal method to select implant size for primary breast augmentation. In 2013 we asked United Kingdom consultant plastic surgeons who were full members of BAPRAS or BAAPS what was their technique for implant size selection for primary aesthetic breast augmentation. We also asked what was the range of implant sizes they commonly used. The answers to question one were grouped into four categories: experience, measurements, pre-operative external sizers and intra-operative sizers. The response rate was 46% (164/358). Overall, 95% (153/159) of all respondents performed some form of pre-operative assessment, the others relied on "experience" only. The most common technique for pre-operative assessment was by external sizers (74%). Measurements were used by 57% of respondents and 3% used intra-operative sizers only. A combination of measurements and sizers was used by 34% of respondents. The most common measurements were breast base (68%), breast tissue compliance (19%), breast height (15%), and chest diameter (9%). The median implant size commonly used in primary breast augmentation was 300cc. Pre-operative external sizers are the most common technique used by UK consultant plastic surgeons to select implant size for primary breast augmentation. We discuss the above findings in relation to the evolution of pre-operative planning techniques for breast augmentation. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

A neutron activation spectrometer and neutronic experimental platform for the National Ignition Facility (invited)

NASA Astrophysics Data System (ADS)

Yeamans, C. B.; Gharibyan, N.

2016-11-01

At the National Ignition Facility, the diagnostic instrument manipulator-based neutron activation spectrometer is used as a diagnostic of implosion performance for inertial confinement fusion experiments. Additionally, it serves as a platform for independent neutronic experiments and may be connected to fast recording systems for neutron effect tests on active electronics. As an implosion diagnostic, the neutron activation spectrometers are used to quantify fluence of primary DT neutrons, downscattered neutrons, and neutrons above the primary DT neutron energy created by reactions of upscattered D and T in flight. At a primary neutron yield of 1015 and a downscattered fraction of neutrons in the 10-12 MeV energy range of 0.04, the downscattered neutron fraction can be measured to a relative uncertainty of 8%. Significant asymmetries in downscattered neutrons have been observed. Spectrometers have been designed and fielded to measure the tritium-tritium and deuterium-tritium neutron outputs simultaneously in experiments using DT/TT fusion ratio as a direct measure of mix of ablator into the gas.

Effect of hydrogen addition on soot formation in an ethylene/air premixed flame

NASA Astrophysics Data System (ADS)

De Iuliis, S.; Maffi, S.; Migliorini, F.; Cignoli, F.; Zizak, G.

2012-03-01

The effect of hydrogen addition to fuel in soot formation and growth mechanisms is investigated in a rich ethylene/air premixed flame. To this purpose, three-angle scattering and extinction measurements are carried out in flames with different hydrogen contents. By applying the Rayleigh-Debye-Gans theory and the fractal-like description, soot concentration and morphology, with the evaluation of radius of gyration, volume-mean diameter and primary particle diameter are retrieved. To derive fractal parameters such as fractal dimension and fractal prefactor to be used for optical measurements, sampling technique and TEM analysis are performed. In addition, data concerning soot morphology obtained from TEM analysis are compared with the optical results. A good agreement in the value of the primary particle diameter between optical and ex-situ measurements is found. Significant effects of hydrogen addition are detected and presented in this work. In particular, hydrogen addition to fuel is responsible for a reduction in soot concentration, radius of gyration and primary particle diameter.

A neutron activation spectrometer and neutronic experimental platform for the National Ignition Facility (invited).

PubMed

Yeamans, C B; Gharibyan, N

2016-11-01

At the National Ignition Facility, the diagnostic instrument manipulator-based neutron activation spectrometer is used as a diagnostic of implosion performance for inertial confinement fusion experiments. Additionally, it serves as a platform for independent neutronic experiments and may be connected to fast recording systems for neutron effect tests on active electronics. As an implosion diagnostic, the neutron activation spectrometers are used to quantify fluence of primary DT neutrons, downscattered neutrons, and neutrons above the primary DT neutron energy created by reactions of upscattered D and T in flight. At a primary neutron yield of 10 15 and a downscattered fraction of neutrons in the 10-12 MeV energy range of 0.04, the downscattered neutron fraction can be measured to a relative uncertainty of 8%. Significant asymmetries in downscattered neutrons have been observed. Spectrometers have been designed and fielded to measure the tritium-tritium and deuterium-tritium neutron outputs simultaneously in experiments using DT/TT fusion ratio as a direct measure of mix of ablator into the gas.

Investigation of the quasi-simultaneous arrival (QSA) effect on a CAMECA IMS 7f-GEO.

PubMed

Jones, Clive; Fike, David A; Peres, Paula

2017-04-15

IMS 7f-GEO isotope ratio applications increasingly involve analyses (e.g., S - or O - isotopes, coupled with primary ion currents <30 pA) for which quasi-simultaneous arrival (QSA) could compromise precision and accuracy of data. QSA and associated correction have been widely investigated for the CAMECA NanoSIMS instruments, but not for the IMS series. Sulfur and oxygen isotopic ratio experiments were performed using an electron multiplier (EM) detector, employing Cs + primary ion currents of 1, 2, 5 and 11.5 pA (nominal) and a variety of secondary ion transmissions to vary QSA probability. An experiment to distinguish between QSA undercounting and purported aperture-related mass fractionation was performed using an EM for 16 O - and 18 O - plus an additional 16 O - measurement using a Faraday cup (FC) detector. An experiment to investigate the accuracy of the QSA correction was performed by comparing S isotopic ratios obtained using an EM with those obtained on the same sample using dual FCs. The QSA effect was observed on the IMS-7f-GEO, and QSA coefficients (β) of ~0.66 were determined, in agreement with reported NanoSIMS measurements, but different from the value (0.5) predicted using Poisson statistics. Aperture-related fractionation was not sufficient to explain the difference but uncertainties in primary ion flux measurement could play a role. When QSA corrected, the isotope ratio data obtained using the EM agreed with the dual FC data, within statistical error. QSA undercounting could compromise isotope ratio analyses requiring ~1 × 10 5 counts per second for the major isotope and primary currents <20 pA. The error could be >8‰ for a 1 pA primary current. However, correction can be accurately applied. For instrumental mass fractionation (IMF)-corrected data, the magnitude of the error resulting from not correcting for QSA is dependent on the difference in secondary ion count rate between the unknown and standard analyses. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Anthropometric evaluation and recommendation for primary schools classroom furniture design in Perlis

NASA Astrophysics Data System (ADS)

Shan, Lim Shaiu; Jing, Ewe Hui; Effendi, M. S. M.; Rosli, Muhamad Farizuan

2017-09-01

This study was carried out with the objective to obtain the anthropometric data of primary school children from Year 1 to Year 6 and evaluate the children's anthropometry with the current dimensions of classroom furniture (i.e. chair and table). In addition, this study also proposed the design dimensions for the improvement in classroom furniture design with the consideration of children's anthropometric data. A total of 390 children selected from 13 primary schools in Perlis, Malaysia were participated in this study. There were 11 anthropometric measurements of children have been measured in this study, which include stature (St), popliteal height (PH), knee height (KH), thigh thickness (TT), buttock popliteal length (BPL), hip breadth (HB), sitting shoulder height (SSH), sitting elbow height (SEH), forearm-hand length (FHL), height of lumbar point (HLP) and buttock clearance (BC). Besides that, 7 dimensions relating to current classroom chair have been measured, such as seat height (SH), seat depth (SD), seat width (SW), upper edge of backrest (UEB), lower edge of backrest (LEB), S point (SP), overall chair height (OCH). Another 5 dimensions of the existing classroom table have been measured too, which involve table height (TH), table depth (TD), table width (TW), under table height (UH) and seat to table clearance (STC). All the measurements were performed by using metal measuring tape. The anthropometric data of the children were analyzed with the help of Microsoft Excel 2013. Several equations with associated with the anthropometric data and furniture dimensions have been applied in this research. The new design dimensions for classroom furniture that proposed in this paper which based on the collected anthropometric data can be referred as a guideline for classroom furniture design. The implementation of these data may help to create comfortability, safety, suitability and improve performance of children in the classroom.

Dispersed Fringe Sensing Analysis - DFSA

NASA Technical Reports Server (NTRS)

Sigrist, Norbert; Shi, Fang; Redding, David C.; Basinger, Scott A.; Ohara, Catherine M.; Seo, Byoung-Joon; Bikkannavar, Siddarayappa A.; Spechler, Joshua A.

2012-01-01

Dispersed Fringe Sensing (DFS) is a technique for measuring and phasing segmented telescope mirrors using a dispersed broadband light image. DFS is capable of breaking the monochromatic light ambiguity, measuring absolute piston errors between segments of large segmented primary mirrors to tens of nanometers accuracy over a range of 100 micrometers or more. The DFSA software tool analyzes DFS images to extract DFS encoded segment piston errors, which can be used to measure piston distances between primary mirror segments of ground and space telescopes. This information is necessary to control mirror segments to establish a smooth, continuous primary figure needed to achieve high optical quality. The DFSA tool is versatile, allowing precise piston measurements from a variety of different optical configurations. DFSA technology may be used for measuring wavefront pistons from sub-apertures defined by adjacent segments (such as Keck Telescope), or from separated sub-apertures used for testing large optical systems (such as sub-aperture wavefront testing for large primary mirrors using auto-collimating flats). An experimental demonstration of the coarse-phasing technology with verification of DFSA was performed at the Keck Telescope. DFSA includes image processing, wavelength and source spectral calibration, fringe extraction line determination, dispersed fringe analysis, and wavefront piston sign determination. The code is robust against internal optical system aberrations and against spectral variations of the source. In addition to the DFSA tool, the software package contains a simple but sophisticated MATLAB model to generate dispersed fringe images of optical system configurations in order to quickly estimate the coarse phasing performance given the optical and operational design requirements. Combining MATLAB (a high-level language and interactive environment developed by MathWorks), MACOS (JPL s software package for Modeling and Analysis for Controlled Optical Systems), and DFSA provides a unique optical development, modeling and analysis package to study current and future approaches to coarse phasing controlled segmented optical systems.

Viscoelastic Properties Measurement of Human Lymphocytes by Atomic Force Microscopy Based on Magnetic Beads Cell Isolation.

PubMed

Mi Li; Lianqing Liu; Xiubin Xiao; Ning Xi; Yuechao Wang

2016-07-01

Cell mechanics has been proved to be an effective biomarker for indicating cellular states. The advent of atomic force microscopy (AFM) provides an exciting instrument for measuring the mechanical properties of single cells. However, current AFM single-cell mechanical measurements are commonly performed on cell lines cultured in vitro which are quite different from the primary cells in the human body. Investigating the mechanical properties of primary cells from clinical environments can help us to better understand cell behaviors. Here, by combining AFM with magnetic beads cell isolation, the viscoelastic properties of human primary B lymphocytes were quantitatively measured. B lymphocytes were isolated from the peripheral blood of healthy volunteers by density gradient centrifugation and CD19 magnetic beads cell isolation. The activity and specificity of the isolated cells were confirmed by fluorescence microscopy. AFM imaging revealed the surface topography and geometric parameters of B lymphocytes. The instantaneous modulus and relaxation time of living B lymphocytes were measured by AFM indenting technique, showing that the instantaneous modulus of human normal B lymphocytes was 2-3 kPa and the relaxation times were 0.03-0.06 s and 0.35-0.55 s. The differences in cellular visocoelastic properties between primary B lymphocytes and cell lines cultured in vitro were analyzed. The study proves the capability of AFM in quantifying the viscoelastic properties of individual specific primary cells from the blood sample of clinical patients, which will improve our understanding of the behaviors of cells in the human body.

Neurobehavioral effects of transportation noise in primary schoolchildren: a cross-sectional study

PubMed Central

2010-01-01

Background Due to shortcomings in the design, no source-specific exposure-effect relations are as yet available describing the effects of noise on children's cognitive performance. This paper reports on a study investigating the effects of aircraft and road traffic noise exposure on the cognitive performance of primary schoolchildren in both the home and the school setting. Methods Participants were 553 children (age 9-11 years) attending 24 primary schools around Schiphol Amsterdam Airport. Cognitive performance was measured by the Neurobehavioral Evaluation System (NES), and a set of paper-and-pencil tests. Multilevel regression analyses were applied to estimate the association between noise exposure and cognitive performance, accounting for demographic and school related confounders. Results Effects of school noise exposure were observed in the more difficult parts of the Switching Attention Test (SAT): children attending schools with higher road or aircraft noise levels made significantly more errors. The correlational pattern and factor structure of the data indicate that the coherence between the neurobehavioral tests and paper-and-pencil tests is high. Conclusions Based on this study and previous scientific literature it can be concluded that performance on simple tasks is less susceptible to the effects of noise than performance on more complex tasks. PMID:20515466

Development of Working Memory and Performance in Arithmetic: A Longitudinal Study with Children

ERIC Educational Resources Information Center

López, Magdalena

2014-01-01

Introduction: This study has aimed to investigate the relationship between the development of working memory and performance on arithmetic activities. Method: We conducted a 3-year longitudinal study of a sample of 90 children, that was followed during the first, second and third year of primary school. All children were tested on measures of WM…

A study of the effectiveness of the primary education improvement program (science) in selected schools of Northern Nigeria

NASA Astrophysics Data System (ADS)

Brown, Desmond P.; Reed, Jack A.

The Primary Education Improvement Program (Science) developed in Nigeria from 1970-1980 adopted a process approach to the teaching of science for children in Classes One and Two of primary school. In that insufficient formative data were available a study was organized to evaluate the attainment of the program's major objectives in terms of the children's ability to practice process skills. The study also attempted to measure children's interest, active participation and understanding of the lessons, as well as the availability of materials and ease of preparing and teaching the lessons for the teachers. Data were collected by means of teacher opinionnaires and a children's test to measure the attainment of process skills. The teachers who completed the opinionnaires rated the program as successful in terms of all the measured criteria. Children in the experimental and control groups were tested and their performances were compared. The results indicated that there were some significant differences in total test scores in favor of the experimental group after one year of primary school but none after two years. The program, though highly rated by teachers, did not produce the intended changes in children's behavior.

FPGA-based Fused Smart Sensor for Real-Time Plant-Transpiration Dynamic Estimation

PubMed Central

Millan-Almaraz, Jesus Roberto; de Jesus Romero-Troncoso, Rene; Guevara-Gonzalez, Ramon Gerardo; Contreras-Medina, Luis Miguel; Carrillo-Serrano, Roberto Valentin; Osornio-Rios, Roque Alfredo; Duarte-Galvan, Carlos; Rios-Alcaraz, Miguel Angel; Torres-Pacheco, Irineo

2010-01-01

Plant transpiration is considered one of the most important physiological functions because it constitutes the plants evolving adaptation to exchange moisture with a dry atmosphere which can dehydrate or eventually kill the plant. Due to the importance of transpiration, accurate measurement methods are required; therefore, a smart sensor that fuses five primary sensors is proposed which can measure air temperature, leaf temperature, air relative humidity, plant out relative humidity and ambient light. A field programmable gate array based unit is used to perform signal processing algorithms as average decimation and infinite impulse response filters to the primary sensor readings in order to reduce the signal noise and improve its quality. Once the primary sensor readings are filtered, transpiration dynamics such as: transpiration, stomatal conductance, leaf-air-temperature-difference and vapor pressure deficit are calculated in real time by the smart sensor. This permits the user to observe different primary and calculated measurements at the same time and the relationship between these which is very useful in precision agriculture in the detection of abnormal conditions. Finally, transpiration related stress conditions can be detected in real time because of the use of online processing and embedded communications capabilities. PMID:22163656

Role of Copper in the Performance of CdS/CdTe Solar Cells (Poster)

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

Demtsu, S.; Albin, D.; Sites, J.

2006-05-01

The performance of CdS/CdTe solar cells made with evaporated Cu as a primary back contact was studied through current-voltage (JV) at different intensities, quantum efficiency (QE) under light and voltage bias, capacitance-voltage (CV), and drive-level capacitance profiling (DLCP) measurements. The results show that while modest amounts of Cu enhance cell performance, excessive amounts degrade device quality and reduce performance. The analysis is supported with numerical simulations to reproduce and explain some of the experimental results.

Cognitive tunneling: use of visual information under stress.

PubMed

Dirkin, G R

1983-02-01

References to "tunnel vision" under stress are considered to describe a process of attentional, rather than visual, narrowing. The hypothesis of Easterbrook that the range of cue utilization is reduced under stress was tested with a primary task located in the visual periphery. High school volunteers performed a visual discrimination task with choice reaction time (RT) as the dependent variable. A 2 X 3 order of presentation by practice design, with repeated measures on the last factor, was employed. Two levels of stress, high and low, were operationalized by the subject's performing in the presence of an evaluative audience or alone. Pulse rate was employed as a manipulation check on arousal. The results partially supported the hypothesis that a peripherally visual primary task could be attended to under stress without decrement in performance.

Poorer Visual Acuity Is Associated with Declines in Cognitive Performance Across Multiple Cognitive Domains: The Maine-Syracuse Longitudinal Study.

PubMed

Dearborn, Peter J; Elias, Merrill F; Sullivan, Kevin J; Sullivan, Cara E; Robbins, Michael A

2018-06-21

Prior studies have found associations between visual acuity (VA) and cognitive function. However, these studies used a limited range of cognitive measures and did not control for cardiovascular disease risk factors (CVD-RFs) and baseline function. The primary objective of this study was to analyze the associations of VA and cognitive performance using a thorough neuropsychological test battery. This study used community-dwelling sample data across the sixth (2001-2006) and seventh (2006-2010) waves of the Maine-Syracuse Longitudinal Study (n=655). Wave 6 VA as measured by the Snellen Eye Test was the primary predictor of wave 6 and wave 7 Global cognitive performance, Visual-Spatial Organization and Memory, Verbal Episodic Memory, Working Memory, Scanning and Tracking, and Executive Function. Additionally, VA was used to predict longitudinal changes in wave 7 cognitive performance (wave 6 performance adjusted). We analyzed these relationships with multiple linear and logistic regression models adjusted for age, sex, education, ethnicity, depressive symptoms, physical function deficits in addition to CVD-RFs, chronic kidney disease, homocysteine, continuous systolic blood pressure, and hypertension status. Adjusted for demographic covariates and CVD-RFs, poorer VA was associated with concurrent and approximate 5-year declines in Global cognitive function, Visual-Spatial Organization and Memory, and Verbal Episodic Memory. VA may be used in combination with other screening measures to determine risk for cognitive decline. (JINS, 2018, 24, 1-9).

Screening and brief intervention for alcohol and other drug use in primary care: associations between organizational climate and practice.

PubMed

Cruvinel, Erica; Richter, Kimber P; Bastos, Ronaldo Rocha; Ronzani, Telmo Mota

2013-02-11

Numerous studies have demonstrated that positive organizational climates contribute to better work performance. Screening and brief intervention (SBI) for alcohol, tobacco, and other drug use has the potential to reach a broad population of hazardous drug users but has not yet been widely adopted in Brazil's health care system. We surveyed 149 primary health care professionals in 30 clinics in Brazil who were trained to conduct SBI among their patients. We prospectively measured how often they delivered SBI to evaluate the association between organizational climate and adoption/performance of SBI. Organizational climate was measured by the 2009 Organizational Climate Scale for Health Organizations, a scale validated in Brazil that assesses leadership, professional development, team spirit, relationship with the community, safety, strategy, and remuneration. Performance of SBI was measured prospectively by weekly assessments during the three months following training. We also assessed self-reported SBI and self-efficacy for performing SBI at three months post-training. We used inferential statistics to depict and test for the significance of associations. Teams with better organizational climates implemented SBI more frequently. Organizational climate factors most closely associated with SBI implementation included professional development and relationship with the community. The dimensions of leadership and remuneration were also significantly associated with SBI. Organizational climate may influence implementation of SBI and ultimately may affect the ability of organizations to identify and address drug use.

The impact of a medical procedure service on patient safety, procedure quality and resident training opportunities.

PubMed

Tukey, Melissa H; Wiener, Renda Soylemez

2014-03-01

At some academic hospitals, medical procedure services are being developed to provide supervision for residents performing bedside procedures in hopes of improving patient safety and resident education. There is limited knowledge of the impact of such services on procedural complication rates and resident procedural training opportunities. To determine the impact of a medical procedure service (MPS) on patient safety and resident procedural training opportunities. Retrospective cohort analysis comparing characteristics and outcomes of procedures performed by the MPS versus the primary medical service. Consecutive adults admitted to internal medicine services at a large academic hospital who underwent a bedside medical procedure (central venous catheterization, thoracentesis, paracentesis, lumbar puncture) between 1 July 2010 and 31 December 2011. The primary outcome was a composite rate of major complications. Secondary outcomes included resident participation in bedside procedures and use of "best practice" safety process measures. We evaluated 1,707 bedside procedures (548 by the MPS, 1,159 by the primary services). There were no differences in the composite rate of major complications (1.6 % vs. 1.9 %, p = 0.71) or resident participation in bedside procedures (57.0 % vs. 54.3 %, p = 0.31) between the MPS and the primary services. Procedures performed by the MPS were more likely to be successfully completed (95.8 % vs. 92.8 %, p = 0.02) and to use best practice safety process measures, including use of ultrasound guidance when appropriate (96.8 % vs. 90.0 %, p = 0.0004), avoidance of femoral venous catheterization (89.5 vs. 82.7 %, p = 0.02) and involvement of attending physicians (99.3 % vs. 57.0 %, p < 0.0001). Although use of a MPS did not significantly affect the rate of major complications or resident opportunities for training in bedside procedures, it was associated with increased use of best practice safety process measures.

Improved Gout Outcomes in Primary Care Using a Novel Disease Management Program: A Pilot Study.

PubMed

Bulbin, David; Denio, Alfred E; Berger, Andrea; Brown, Jason; Maynard, Carson; Sharma, Tarun; Kirchner, H Lester; Ayoub, William T

2018-02-13

To pilot a primary care gout management improvement intervention. Two large primary care sites were selected: one underwent the intervention, the other, a control, underwent no intervention. The intervention consisted of: engagement of intervention site staff, surveys of provider performance improvement preferences, and onsite live and enduring online education. Electronic Health Record reminders were constructed. Both the intervention and control sites had 3 quality measures assessed monthly: percent of gout patients treated with urate lowering therapy, percent of treated patients monitored with serum urate, and percent of treated patients at target serum urate ≤ 6.0 mg/dl. The intervention site providers received monthly reports comparing their measures against their peers. By 6 months, the intervention site significantly improved all 3 gout performance measures. Percentage treated increased from 54.4 to 61.1%, OR 1.19 (95% CI 1.08, 1.31 and p-value <0.001); percentage monitored increased from 56.1 to 79.2% OR 1.52 (95% CI 1.24, 1.87 and P-value <0.001); and percentage at goal increased from 26.8 to 43.3% OR 1.43 (95% CI 1.16, 1.77 and p-value <0.001. At 6 months after intervention, gout patients at the intervention site were more likely to be monitored (79.2% vs. 53.4%, OR 3.54 (95% CI: 2.30, 5.45 and p-value < 0.001)) and at goal (43.3% vs. 28.3%; OR 1.99 (95% CI: 1.33, 2.96 and p-value <0.001) than control site patients. Numbers treated did not significantly improve over the control site. A pilot multifaceted gout management program can significantly improve primary care gout management performance. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Expected Navigation Flight Performance for the Magnetospheric Multiscale (MMS) Mission

NASA Technical Reports Server (NTRS)

Olson, Corwin; Wright, Cinnamon; Long, Anne

2012-01-01

The Magnetospheric Multiscale (MMS) mission consists of four formation-flying spacecraft placed in highly eccentric elliptical orbits about the Earth. The primary scientific mission objective is to study magnetic reconnection within the Earth s magnetosphere. The baseline navigation concept is the independent estimation of each spacecraft state using GPS pseudorange measurements (referenced to an onboard Ultra Stable Oscillator) and accelerometer measurements during maneuvers. State estimation for the MMS spacecraft is performed onboard each vehicle using the Goddard Enhanced Onboard Navigation System, which is embedded in the Navigator GPS receiver. This paper describes the latest efforts to characterize expected navigation flight performance using upgraded simulation models derived from recent analyses.

The Association between Working Memory and Educational Attainment as Measured in Different Mathematical Subtopics in the Swedish National Assessment: Primary Education

ERIC Educational Resources Information Center

Nyroos, Mikaela; Wiklund-Hornqvist, Carola

2012-01-01

The aim of this study was to examine the relationship between working memory capacity and mathematical performance measured by the national curriculum assessment in third-grade children (n = 40). The national tests concerned six subareas within mathematics. One-way ANOVA, two-tailed Pearson correlation and multiple regression analyses were…

Effects of Cognitive Training with and without Aerobic Exercise on Cognitively-Demanding Everyday Activities

PubMed Central

McDaniel, Mark A.; Binder, Ellen F.; Bugg, Julie M.; Waldum, Emily R.; Dufault, Carolyn; Meyer, Amanda; Johanning, Jennifer; Zheng, Jie; Schechtman, Kenneth B.; Kudelka, Chris

2015-01-01

We investigated the potential benefits of a novel cognitive training protocol and an aerobic exercise intervention, both individually and in concert, on older adults’ performances in laboratory simulations of select real-world tasks. The cognitive training focused on a range of cognitive processes, including attentional coordination, prospective memory, and retrospective-memory retrieval, processes that are likely involved in many everyday tasks, and that decline with age. Primary outcome measures were three laboratory tasks that simulated everyday activities: Cooking Breakfast, Virtual Week, and Memory for Health Information. Two months of cognitive training improved older adults’ performance on prospective memory tasks embedded in Virtual Week. Cognitive training, either alone or in combination with six months of aerobic exercise, did not significantly improve Cooking Breakfast or Memory for Health Information. Although gains in aerobic power were comparable to previous reports, aerobic exercise did not produce improvements for the primary outcome measures. Discussion focuses on the possibility that cognitive training programs that include explicit strategy instruction and varied practice contexts may confer gains to older adults for performance on cognitively challenging everyday tasks. PMID:25244489

Physiological and Performance Measures for Baseline Concussion Assessment.

PubMed

Dobney, Danielle M; Thomas, Scott G; Taha, Tim; Keightley, Michelle

2017-05-17

Baseline testing is a common strategy for concussion assessment and management. Research continues to evaluate novel measures for potential to improve baseline testing methods. The primary objective was to; 1) determine the feasibility of including physiological, neuromuscular and mood measures as part of baseline concussion testing protocol, 2) describe typical values in a varsity athlete sample, and 3) estimate the influence of concussion history on these baseline measures. Prospective observational study. University Athletic Therapy Clinic. 100 varsity athletes. Frequency and domain measures of heart rate variability (HRV), blood pressure (BP), grip strength, Profile of Mood States and the Sport Concussion Assessment Tool-2. Physiological, neuromuscular performance and mood measures were feasible at baseline. Participants with a history of two or more previous concussions displayed significantly higher diastolic blood pressure. Females reported higher total mood disturbance compared to males. Physiological and neuromuscular performance measures are safe and feasible as baseline concussion assessment outcomes. History of concussion may have an influence on diastolic blood pressure.

EUV multilayer coatings for the Atmospheric Imaging Assembly instrument aboard the Solar Dynamics Observatory

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

Soufli, R; Windt, D L; Robinson, J C

2006-02-09

Multilayer coatings for the 7 EUV channels of the AIA have been developed and completed successfully on all AIA flight mirrors. Mo/Si coatings (131, 171, 193.5, 211 {angstrom}) were deposited at Lawrence Livermore National Laboratory (LLNL). Mg/SiC (304, 335 {angstrom}) and Mo/Y (94 {angstrom}) coatings were deposited at Columbia University. EUV reflectance of the 131/335 {angstrom}, 171 {angstrom}, 193.5/211 {angstrom} primary and secondary flight mirrors and the 94/304 {angstrom} secondary flight mirror was measured at beamline 6.3.2. of the Advanced Light Source (ALS) at LBNL. EUV reflectance of the 94/304 {angstrom} primary and secondary flight mirrors was measured at beamlinemore » X24C of the National Synchrotron Light Source (NSLS) at Brookhaven National Lab. Preliminary EUV reflectance measurements of the 94, 304 and 335 {angstrom} coatings were performed with a laser plasma source reflectometer located at Columbia University. Prior to multilayer coating, Atomic Force Microscopy (AFM) characterization and cleaning of all flight substrates was performed at LLNL.« less

Does exercise habit strength moderate the relationship between emotional distress and short-term memory in Malaysian primary school children?

PubMed

Zainol, Nurul Ain; Hashim, Hairul Anuar

2015-01-01

We examined the moderating effects of exercise habit strength on the relationship between emotional distress and short-term memory in primary school children. The sample consisted of 165 primary school students (10-12 years old). Participants completed measures of emotional distress, exercise habit strength, and the Digit Span Test. Mid-year exam results were used as an indicator of academic performance. Structural equation modelling (SEM) was used to analyse the data. The results of SEM revealed an acceptable fit for the hypothesised model. Exercise habit was positively associated with short-term memory, and better short-term memory was associated with better academic performance. However, although an inverse relationship was found between emotional distress and short-term memory, a positive association was found between exercise habit strength and emotional distress. The findings indicate that exercise habit is positively associated with cognitive ability and mediates the negative effect of distress.

Cognition in older patients with multiple sclerosis compared to patients with amnestic mild cognitive impairment and healthy older adults.

PubMed

Roth, Alexandra K; Denney, Douglas R; Burns, Jeffrey M; Lynch, Sharon G

2018-06-25

Progress in the treatment of multiple sclerosis (MS) has resulted in larger numbers of patients living to an advanced age, but little is known about the cognitive status of these individuals. The primary purpose of this study was to identify differences in the cognitive performance between elderly individuals with MS and those with amnestic mild cognitive impairment (aMCI). Three groups ranging in age from 60 to 80 were compared: patients with MS (n = 64), patients with aMCI (n = 58), and healthy adults (n = 70). All participants completed a standard neuropsychological test battery that evaluated domains of attention, processing speed, executive function, memory, language, and visual spatial function. Compared to age- and gender-matched healthy controls, elderly MS patients exhibited a pattern of cognitive impairment centering on information processing speed and memory that was consistent with the deficits observed in other studies of MS patients regardless of age. Compared to aMCI patients, the MS patients exhibited worse performance on measures of processing speed, but better performance on a measure of memory under cued conditions (Selective Reminding Test), a nonspeeded measure of language (Boston Naming Test), and measures of executive function with processing speed statistically controlled (Trail Making Test, Stroop Test). Differences on neuropsychological measures can serve to distinguish aMCI from MS-related cognitive impairment in older patients, but it is essential that these measures control for the deficit in processing speed that is such a primary feature of MS. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Symbolic magnitude processing in elementary school children: A group administered paper-and-pencil measure (SYMP Test).

PubMed

Brankaer, Carmen; Ghesquière, Pol; De Smedt, Bert

2017-08-01

The ability to compare symbolic numerical magnitudes correlates with children's concurrent and future mathematics achievement. We developed and evaluated a quick timed paper-and-pencil measure that can easily be used, for example in large-scale research, in which children have to cross out the numerically larger of two Arabic one- and two-digit numbers (SYMP Test). We investigated performance on this test in 1,588 primary school children (Grades 1-6) and examined in each grade its associations with mathematics achievement. The SYMP Test had satisfactory test-retest reliability. The SYMP Test showed significant and stable correlations with mathematics achievement for both one-digit and two-digit comparison, across all grades. This replicates the previously observed association between symbolic numerical magnitude processing and mathematics achievement, but extends it by showing that the association is observed in all grades in primary education and occurs for single- as well as multi-digit processing. Children with mathematical learning difficulties performed significantly lower on one-digit comparison and two-digit comparison in all grades. This all suggests satisfactory construct and criterion-related validity of the SYMP Test, which can be used in research, when performing large-scale (intervention) studies, and by practitioners, as screening measure to identify children at risk for mathematical difficulties or dyscalculia.

A protocol of rope skipping exercise for primary school children: A pilot test

NASA Astrophysics Data System (ADS)

Radzi, A. N. M.; Rambely, A. S.; Chellapan, K.

2014-06-01

This paper aims to investigate the methods and sample used in rope skipping as an exercise approach. A systematic literature review was approached in identifying skipping performance in the related researches. The methods were compared to determine the best methodological approach for the targeted skipping based research measure. A pilot test was performed among seven students below 12 years old. As the outcome of the review, a skipping protocol design has been proposed for 10 years old primary school students. The proposed protocol design is to be submitted to PPUKM Ethical Committee for approval prior to its implementation in investigation memory enhancement in relation to designed skipping activities.

The increase in fatigue crack growth rates observed for Zircaloy-4 in a PWR environment

NASA Astrophysics Data System (ADS)

Cockeram, B. V.; Kammenzind, B. F.

2018-02-01

Cyclic stresses produced during the operation of nuclear reactors can result in the extension of cracks by processes of fatigue. Although fatigue crack growth rate (FCGR) data for Zircaloy-4 in air are available, little testing has been performed in a PWR primary water environment. Test programs have been performed by Gee et al., in 1989 and Picker and Pickles in 1984 by the UK Atomic Energy Authority, and by Wisner et al., in 1994, that have shown an enhancement in FCGR for Zircaloy-2 and Zircaloy-4 in high-temperature water. In this work, FCGR testing is performed on Zircaloy-4 in a PWR environment in the hydrided and non-hydrided condition over a range of stress-intensity. Measurements of crack extension are performed using a direct current potential drop (DCPD) method. The cyclic rate in the PWR primary water environment is varied between 1 cycle per minute to 0.1 cycle per minute. Faster FCGR rates are observed in water in comparison to FCGR testing performed in air for the hydrided material. Hydrided and non-hydrided materials had similar FCGR values in air, but the non-hydrided material exhibited much lower rates of FCGR in a PWR primary water environment than for hydrided material. Hydrides are shown to exhibit an increased tendency for cracking or decohesion in a PWR primary water environment that results in an enhancement in FCGR values. The FCGR in the PWR primary water only increased slightly with decreasing cycle frequency in the range of 1 cycle per minute to 0.1 cycle per minute. Comparisons between the FCGR in water and air show the enhancement from the PWR environment is affected by the applied stress intensity.

New insights into bile acid malabsorption.

PubMed

Johnston, Ian; Nolan, Jonathan; Pattni, Sanjeev S; Walters, Julian R F

2011-10-01

Bile acid malabsorption occurs when there is impaired absorption of bile acids in the terminal ileum, so interrupting the normal enterohepatic circulation. The excess bile acids in the colon cause diarrhea, and treatment with bile acid sequestrants is beneficial. The condition can be diagnosed with difficulty by measuring fecal bile acids, or more easily by retention of selenohomocholyltaurine (SeHCAT), where this is available. Chronic diarrhea caused by primary bile acid diarrhea appears to be common, but is under-recognized where SeHCAT testing is not performed. Measuring excessive bile acid synthesis with 7α-hydroxy-4-cholesten-3-one may be an alternative means of diagnosis. It appears that there is no absorption defect in primary bile acid diarrhea but, instead, an overproduction of bile acids. Fibroblast growth factor 19 (FGF19) inhibits hepatic bile acid synthesis. Defective production of FGF19 from the ileum may be the cause of primary bile acid diarrhea.

[Correlation between the width of lingual vein and the changes of hemodynamics of portal system in patients with primary liver cancer].

PubMed

Yue, Xiao-Qiang; Gao, Jing-Dong; Zhai, Xiao-Feng; Liu, Qing; Jiang, Dong; Ling, Chang-Quan

2006-09-01

To explore the correlation between the width of lingual varix and changes of hemodynamics of portal system in patients with primary liver cancer so as to supply the data for the forecast of portal hypertension by observing lingual varix. The diameter of lingual vein (Dlv) was measured by vernier caliper as dependent variable, and the diameters and indexes of hemodynamics of portal vessels were measured by Doppler as independent variables, then a multipe stepwise analysis was performed. The diameters of portal vein (Dpv) and splenic vein (Dsv) entered the formula Dlv (mm) = 0.185 + 0.311 Dsv (mm) + 0.236 Dpv (mm) when the entry and removal values were alpha(in)=0.10 and alpha(out)=0.15, respectively. The width of lingual vein is closely correlated with the diameters of portal vein and splenic vein in patients with primary liver cancer.

Crew workload strategies in advanced cockpits

NASA Technical Reports Server (NTRS)

Hart, Sandra G.

1990-01-01

Many methods of measuring and predicting operator workload have been developed that provide useful information in the design, evaluation, and operation of complex systems and which aid in developing models of human attention and performance. However, the relationships between such measures, imposed task demands, and measures of performance remain complex and even contradictory. It appears that we have ignored an important factor: people do not passively translate task demands into performance. Rather, they actively manage their time, resources, and effort to achieve an acceptable level of performance while maintaining a comfortable level of workload. While such adaptive, creative, and strategic behaviors are the primary reason that human operators remain an essential component of all advanced man-machine systems, they also result in individual differences in the way people respond to the same task demands and inconsistent relationships among measures. Finally, we are able to measure workload and performance, but interpreting such measures remains difficult; it is still not clear how much workload is too much or too little nor the consequences of suboptimal workload on system performance and the mental, physical, and emotional well-being of the human operators. The rationale and philosophy of a program of research developed to address these issues will be reviewed and contrasted to traditional methods of defining, measuring, and predicting human operator workload. Viewgraphs are given.

Does Armodafinil Improve Driving Task Performance and Weight Loss in Sleep Apnea? A Randomized Trial.

PubMed

Chapman, Julia Louise; Cayanan, Elizabeth Anne; Hoyos, Camilla Miranda; Serinel, Yasmina; Comas, Maria; Yee, Brendon John; Wong, Keith Keat Huat; Grunstein, Ronald Robert; Marshall, Nathaniel Stuart

2018-05-18

RATIONALE Obstructive sleep apnea (OSA) patients unable to tolerate standard treatments have few alternatives. They may benefit from weight loss, but the major symptom of daytime performance impairment may remain during weight loss programs. OBJECTIVES We hypothesized that wakefulness-promoter armodafinil would improve driving task performance over placebo in patients undergoing weight loss. METHODS Placebo-controlled, double-blind, randomized trial of Armodafinil vs Placebo daily for 6 months in patients who were also randomized to one of two diets for six months with follow-up at one year in overweight, adult, OSA patients who had rejected standard treatment and suffered daytime sleepiness. MEASUREMENTS Primary outcome: change in steering deviation in the final 30 minutes of a 90 minute afternoon driving task (AusED) at six months. Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, fat mass measured by dual-emission X-ray absorptiometry (DXA). MAIN RESULTS Armodafinil improved driving task performance over placebo at three months (12.9cm, 95%CI 4.1 to 21.7, p=0.004), but not the primary timepoint of six months (5.5cm, 95%CI -3.3 to 14.3, p=0.223). Patients on armodafinil lost 2.4kg more fat than those on placebo at six months (95%CI 0.9 to 4.0, p=0.002). Other secondary outcomes were not significantly improved. CONCLUSIONS Armodafinil did not improve driving task performance at the primary endpoint of six months. Armodafinil might be a useful adjunctive to weight loss in OSA patients rejecting conventional treatments but this needs to be directly tested in a specifically designed, properly powered clinical trial. Clinical trial registration available at www.anzctr.org.au, ID ACTRN12611000847910.

Model-Based Wavefront Control for CCAT

NASA Technical Reports Server (NTRS)

Redding, David; Lou, John Z.; Kissil, Andy; Bradford, Matt; Padin, Steve; Woody, David

2011-01-01

The 25-m aperture CCAT submillimeter-wave telescope will have a primary mirror that is divided into 162 individual segments, each of which is provided with 3 positioning actuators. CCAT will be equipped with innovative Imaging Displacement Sensors (IDS) inexpensive optical edge sensors capable of accurately measuring all segment relative motions. These measurements are used in a Kalman-filter-based Optical State Estimator to estimate wavefront errors, permitting use of a minimum-wavefront controller without direct wavefront measurement. This controller corrects the optical impact of errors in 6 degrees of freedom per segment, including lateral translations of the segments, using only the 3 actuated degrees of freedom per segment. The global motions of the Primary and Secondary Mirrors are not measured by the edge sensors. These are controlled using a gravity-sag look-up table. Predicted performance is illustrated by simulated response to errors such as gravity sag.

Hypoxia and flight performance of military instructor pilots in a flight simulator.

PubMed

Temme, Leonard A; Still, David L; Acromite, Michael T

2010-07-01

Military aircrew and other operational personnel frequently perform their duties at altitudes posing a significant hypoxia risk, often with limited access to supplemental oxygen. Despite the significant risk hypoxia poses, there are few studies relating it to primary flight performance, which is the purpose of the present study. Objective, quantitative measures of aircraft control were collected from 14 experienced, active duty instructor pilot volunteers as they breathed an air/nitrogen mix that provided an oxygen partial pressure equivalent to the atmosphere at 18,000 ft (5486.4 m) above mean sea level. The flight task required holding a constant airspeed, altitude, and heading at an airspeed significantly slower than the aircraft's minimum drag speed. The simulated aircraft's inherent instability at the target speed challenged the pilot to maintain constant control of the aircraft in order to minimize deviations from the assigned flight parameters. Each pilot's flight performance was evaluated by measuring all deviations from assigned target values. Hypoxia degraded the pilot's precision of altitude and airspeed control by 53%, a statistically significant decrease in flight performance. The effect on heading control effects was not statistically significant. There was no evidence of performance differences when breathing room air pre- and post-hypoxia. Moderate levels of hypoxia degraded the ability of military instructor pilots to perform a precision slow flight task. This is one of a small number of studies to quantify an effect of hypoxia on primary flight performance.

Time estimation as a secondary task to measure workload. [attention sharing effect on operator performance

NASA Technical Reports Server (NTRS)

Hart, S. G.

1975-01-01

Variation in the length of time productions and verbal estimates of duration was investigated to determine the influence of concurrent activity on operator time perception. The length of 10-, 20-, and 30-sec intervals produced while performing six different compensatory tracking tasks was significantly longer, 23% on the average, than those produced while performing no other task. Verbal estimates of session duration, taken at the end of each of 27 experimental sessions, reflected a parallel increase in subjective underestimation of the passage of time as the difficulty of the task performed increased. These data suggest that estimates of duration made while performing a manual control task provide stable and sensitive measures of the workload imposed by the primary task, with minimal interference.

Individual Differences in Dual Task Performance.

DTIC Science & Technology

1981-06-10

SJCURITY CLASSIFICATION OF THIS PAGE("en Data Entered) second experimental series, we compared ability to detect visual and audi- tory targets in single...used performance on a simple secondary task executed during an easy primary task to predict performance on a more diffi- cult’version of the same...process concepts developed b’j cognitive ps:choloqists°’ In this laborators, we adapted a number of experimental tasks to 4ield individual measures of the

The insertion torque-depth curve integral as a measure of implant primary stability: An in vitro study on polyurethane foam blocks.

PubMed

Di Stefano, Danilo Alessio; Arosio, Paolo; Gastaldi, Giorgio; Gherlone, Enrico

2017-07-08

Recent research has shown that dynamic parameters correlate with insertion energy-that is, the total work needed to place an implant into its site-might convey more reliable information concerning immediate implant primary stability at insertion than the commonly used insertion torque (IT), the reverse torque (RT), or the implant stability quotient (ISQ). Yet knowledge on these dynamic parameters is still limited. The purpose of this in vitro study was to evaluate whether an energy-related parameter, the torque-depth curve integral (I), could be a reliable measure of primary stability. This was done by assessing if (I) measurement was operator-independent, by investigating its correlation with other known primary stability parameters (IT, RT, or ISQ) by quantifying the (I) average error and correlating (I), IT, RT, and ISQ variations with bone density. Five operators placed 200 implants in polyurethane foam blocks of different densities using a micromotor that calculated the (I) during implant placement. Primary implant stability was assessed by measuring the ISQ, IT, and RT. ANOVA tests were used to evaluate whether measurements were operator independent (P>.05 in all cases). A correlation analysis was performed between (I) and IT, ISQ, and RT. The (I) average error was calculated and compared with that of the other parameters by ANOVA. (I)-density, IT-density, ISQ-density, and RT-density plots were drawn, and their slopes were compared by ANCOVA. The (I) measurements were operator independent and correlated with IT, ISQ, and RT. The average error of these parameters was not significantly different (P>.05 in all cases). The (I)-density, IT-density, ISQ-density, and RT-density curves were linear in the 0.16 to 0.49 g/cm³ range, with the (I)-density curves having a significantly greater slope than those regarding the other parameters (P≤.001 in all cases). The torque-depth curve integral (I) provides a reliable assessment of primary stability and shows a greater sensitivity to density variations than other known primary stability parameters. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

A Review of NIST Primary Activity Standards for (18)F: 1982 to 2013.

PubMed

Bergeron, Denis E; Cessna, Jeffrey T; Coursey, Bert M; Fitzgerald, Ryan; Zimmerman, Brian E

2014-01-01

The new NIST activity standardization for (18)F, described in 2014 in Applied Radiation and Isotopes (v. 85, p. 77), differs from results obtained between 1998 and 2008 by 4 %. The new results are considered to be very reliable; they are based on a battery of robust primary measurement techniques and bring the NIST standard into accord with other national metrology institutes. This paper reviews all ten (18)F activity standardizations performed at NIST from 1982 to 2013, with a focus on experimental variables that might account for discrepancies. We have identified many possible sources of measurement bias and eliminated most of them, but we have not adequately accounted for the 1998-2008 results.

Measuring coherence of computer-assisted likelihood ratio methods.

PubMed

Haraksim, Rudolf; Ramos, Daniel; Meuwly, Didier; Berger, Charles E H

2015-04-01

Measuring the performance of forensic evaluation methods that compute likelihood ratios (LRs) is relevant for both the development and the validation of such methods. A framework of performance characteristics categorized as primary and secondary is introduced in this study to help achieve such development and validation. Ground-truth labelled fingerprint data is used to assess the performance of an example likelihood ratio method in terms of those performance characteristics. Discrimination, calibration, and especially the coherence of this LR method are assessed as a function of the quantity and quality of the trace fingerprint specimen. Assessment of the coherence revealed a weakness of the comparison algorithm in the computer-assisted likelihood ratio method used. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care.

PubMed

Parker, Dianne; Wensing, Michel; Esmail, Aneez; Valderas, Jose M

2015-09-01

There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care. The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events. Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care.

Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

PubMed Central

Parker, Dianne; Wensing, Michel; Esmail, Aneez; Valderas, Jose M

2015-01-01

ABSTRACT Background: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture. Objective: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care. Methods: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care. Results: The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events. Conclusion: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care. PMID:26339832

Improving the provision of language services at an academic medical center: ensuring high-quality health communication for limited-English-proficient patients.

PubMed

Standiford, Connie J; Nolan, Elizabeth; Harris, Michelle; Bernstein, Steven J

2009-12-01

To evaluate and improve the provision of language services at an academic medicine center caring for a diverse population including many limited-English-proficient (LEP) patients. The authors performed a prospective observational study between November 2006 and December 2008 evaluating the provision of language services at the University of Michigan Health System. The primary performance measures were (1) screening patients for their preferred language for health care, (2) assessing the proportion of LEP patients receiving language services from a qualified language services provider, and (3) assessing whether there were any disparities in diabetes care for LEP patients compared with English-speaking patients. The proportion of patients screened for preferred language increased from 59% to 96% with targeted inventions, such as training staff to capture preferred language for health care and correcting prior inaccurate primary language data entry. The proportion of LEP outpatients with a qualified language services provider increased from 19% to 83% through the use of staff and contract interpreters, over-the-phone interpreting and bilingual providers. There were no systematic differences in diabetes quality performance measures between LEP and English-proficient patients. Academic medical centers should measure their provision of language services and compare quality and safety data (e.g., performance measures and adverse events) between LEP and English-speaking patients to identify disparities in care. Leadership support and ongoing training are needed to ensure language-specific services are embedded into clinical care to meet the needs of our diverse patient populations.

Performance indicators used to assess the quality of primary dental care.

PubMed

González, Grisel Zacca; Klazinga, Niek; ten Asbroek, Guus; Delnoij, Diana M

2006-12-01

An appropriate quality of medical care including dental care should be an objective of every government that aims to improve the oral health of its population. To determine performance indicators that could be used to assess the quality of primary dental care at different levels of a health care system, the sources for data collection and finally, the dimensions of quality measured by these indicators. An explorative study of the international literature was conducted using medical databases, journals and books, and official websites of organisations and associations. This resulted in a set of 57 indicators, which were classified into the following dimensions for each intended user group: For patients: health outcomes and subjective indicators; for professionals: their performance and the rates of success, failure and complications; for health care system managers and policymakers: their resources, finances and health care utilisation. A set of 57 performance indicators were identified to assess the quality of primary dental care at the levels of patients, professionals and the health care system. These indicators could be used by managers and decision-makers at any level of the health care system according to the characteristics of the services.

Exploring the relationships among performance-based functional ability, self-rated disability, perceived instrumental support, and depression: a structural equation model analysis.

PubMed

Weil, Joyce; Hutchinson, Susan R; Traxler, Karen

2014-11-01

Data from the Women's Health and Aging Study were used to test a model of factors explaining depressive symptomology. The primary purpose of the study was to explore the association between performance-based measures of functional ability and depression and to examine the role of self-rated physical difficulties and perceived instrumental support in mediating the relationship between performance-based functioning and depression. The inclusion of performance-based measures allows for the testing of functional ability as a clinical precursor to disability and depression: a critical, but rarely examined, association in the disablement process. Structural equation modeling supported the overall fit of the model and found an indirect relationship between performance-based functioning and depression, with perceived physical difficulties serving as a significant mediator. Our results highlight the complementary nature of performance-based and self-rated measures and the importance of including perception of self-rated physical difficulties when examining depression in older persons. © The Author(s) 2014.

Performing international outreach: PhUn Week in an Australian primary school.

PubMed

Halpin, Patricia A

2017-03-01

Physiology Understanding (PhUn) Week is an annual science outreach program sponsored by the American Physiological Society in which K-12 students learn about physiology through meeting a physiologist and performing an experiment. Performing PhUn Week at an Australian private primary school during a family vacation in 2014 enabled me to receive a fellowship to return the following year for further implementation. To set up the outreach, I contacted the assistant principal of a public primary school, and she connected me with the physical education (PE) teacher. Together, the PE teacher and I planned the event. Over the course of 2 days, I taught eight classes, a total of 176 K-12 students. I started each lesson by explaining the role of a physiologist. The scientific method was described and explained. A hypothesis, "Exercise increases heart rate," was designed and tested. The students measured their heart rates, exercised, and measured their heart rates again. After data collection, results were reported, and the students all agreed that their hypothesis was supported. We then discussed heart function and why heart rate increases with exercise. The students then performed a pedometer challenge, where they estimated the number of steps during walking, running, and kangaroo hopping. They enjoyed testing their predictions and repeated these experiments several times. The students then made suggestions of ways they could continue this lesson outside of school. This first report of an international PhUn week confirmed that these events form partnerships among educators and inspire K-12 students to think about becoming scientists. Copyright © 2017 the American Physiological Society.

Measuring workload for tuberculosis service provision at primary care level: a methodology

PubMed Central

2012-01-01

We developed and piloted a methodology to establish TB related work load at primary care level for clinical and laboratory staff. Workload is influenced by activities to be implemented, time to perform them, their frequency and patient load. Of particular importance is the patient pathway for diagnosis and treatment and the frequency of clinic visits. Using observation with checklists, clocking, interviews and review of registers, allows assessing the contribution of different factors on the workload. PMID:22640406

Use of AUDIT-based measures to identify unhealthy alcohol use and alcohol dependence in primary care: a validation study.

PubMed

Johnson, J Aaron; Lee, Anna; Vinson, Daniel; Seale, J Paul

2013-01-01

As programs for screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use disseminate, evidence-based approaches for identifying patients with unhealthy alcohol use and alcohol dependence (AD) are needed. While the National Institute on Alcohol Abuse and Alcoholism Clinician Guide suggests use of a single alcohol screening question (SASQ) for screening and Diagnostic and Statistical Manual checklists for assessment, many SBIRT programs use alcohol use disorders identification test (AUDIT) "zones" for screening and assessment. Validation data for these zones are limited. This study used primary care data from a bi-ethnic southern U.S. population to examine the ability of the AUDIT zones and other AUDIT-based approaches to identify unhealthy alcohol use and dependence. Existing data were analyzed from interviews with 625 female and male adult drinkers presenting to 5 southeastern primary care practices. Timeline follow-back was used to identify at-risk drinking, and diagnostic interview schedule was used to identify alcohol abuse and dependence. Validity measures compared performance of AUDIT, AUDIT-C, and AUDIT dependence domains scores, with and without a 30-day binge drinking measure, for detecting unhealthy alcohol use and dependence. Optimal AUDIT scores for detecting unhealthy alcohol use were lower than current commonly used cutoffs (5 for men, 3 for women). Improved performance was obtained by combining AUDIT cutoffs of 6 for men and 4 for women with a 30-day binge drinking measure. AUDIT scores of 15 for men and 13 for women detected AD with 100% specificity but low sensitivity (20 and 18%, respectively). AUDIT dependence subscale scores of 2 or more showed similar specificity (99%) and slightly higher sensitivity (31% for men, 24% for women). Combining lower AUDIT cutoff scores and binge drinking measures may increase the detection of unhealthy alcohol use in primary care. Use of lower cutoff scores and dependence subscale scores may increase diagnosis of AD; however, better measures for detecting dependence are needed. Copyright © 2012 by the Research Society on Alcoholism.

Performance measures for freight & general traffic : investigating similarities and differences using alternate data sources.

DOT National Transportation Integrated Search

2015-06-01

Recent advances in probe vehicle data collection systems have enabled monitoring traffic : conditions at finer temporal and spatial resolution. The primary objective of the current study is : to leverage these probe data sources to understand if ther...

Evaluating a Pay-for-Performance Program for Medicaid Children in an Accountable Care Organization.

PubMed

Gleeson, Sean; Kelleher, Kelly; Gardner, William

2016-03-01

Pay for performance (P4P) is a mechanism by which purchasers of health care offer greater financial rewards to physicians for improving processes or outcomes of care. To our knowledge, P4P has not been studied within the context of a pediatric accountable care organization (ACO). To determine whether P4P promotes pediatric performance improvement in primary care physicians. This retrospective cohort study was conducted from January 1, 2010, to December 31, 2013. A differences-in-differences design was used to test whether P4P improved physician performance in an ACO serving Medicaid children. Data were obtained from 2966 physicians and 323,812 patients. Three groups of physicians were identified: (1) community physicians who received the P4P incentives, (2) nonincentivized community physicians, and (3) nonincentivized physicians employed at a hospital. Pay for performance. Healthcare Effectiveness Data Information Set measure rates for preventive care, chronic care, and acute care primary care services. We examined 21 quality measures, 14 of which were subject to P4P incentives. There were 203 incentivized physicians, 2590 nonincentivized physicians, and 173 nonincentivized hospital physicians. Among them, the incentivized community physicians had greater improvements in performance than the nonincentivized community physicians on 2 of 2 well visits (largest difference was for adolescent well care: odds ratio, 1.05; 99.88% CI, 1.02-1.08), 3 of 10 immunization-incentivized measures (largest difference was for inactivated polio vaccine: odds ratio, 1.14; 99.88% CI, 1.07-1.21), and 2 nonincentivized measures (largest difference was for rotavirus: odds ratio, 1.11; 99.88% CI, 1.04-1.18). The employed physician group at the hospital had greater improvements in performance than the incentivized community physicians on 8 of 14 incentivized measures and 1 of 7 nonincentivized measures (largest difference was for hepatitis A vaccine: odds ratio, 0.34; 99.88% CI, 0.31-0.37). Pay for performance resulted in modest changes in physician performance in a pediatric ACO, but other interventions at the disposal of the ACO may have been even more effective. Further research is required to find methods to enhance quality improvements across large distributed pediatric health systems.

Water-drinking test in primary angle-closure suspect before and after laser peripheral iridotomy.

PubMed

Waisbourd, Michael; Savant, Shravan V; Sun, Yi; Martinez, Patricia; Myers, Jonathan S

2016-03-01

This study aimed to investigate whether performing a laser peripheral iridotomy in primary angle-closure suspects had an effect on the intraocular pressure response during the water-drinking test. Prospective study in a hospital setting. Primary angle-closure suspects scheduled for a laser peripheral iridotomy. Primary angle-closure suspects were evaluated before the laser peripheral iridotomy and 2 weeks after. On each visit, subjects underwent the water-drinking test. Intraocular pressure was measured every 15 min within a 1-h period. Intraocular pressure fluctuations during the water drinking test. Twenty patients were enrolled. The mean age was 58.1 years (±10.2 SD), predominantly female (n = 14, 70%). Average intraocular pressure range (maximum-minimum) during the water-drinking test increased significantly from 2.6 ± 1.1 mmHg before the laser peripheral iridotomy to 3.5 ± 1.5 mmHg after (P = 0.04). The mean difference between peak and last intraocular pressure measurements increased after the laser peripheral iridotomy was performed, from 2.5 mmHg (±1.27 SD) to 3.3 mmHg (±1.66 SD), (P = 0.057). There was no change in mean peak intraocular pressure (maximum-baseline) before and after the laser peripheral iridotomy (P = 0.87). Primary angle-closure suspects who underwent the water-drinking test had a slightly more pronounced recovery of intraocular pressure after the laser peripheral iridotomy was performed, which may be attributed to increase in the area of exposed trabecular meshwork following treatment. Differences in intraocular pressure curves before and after laser peripheral iridotomy were minimal, and therefore, the water-drinking test had limited value as a provocative test in this patient population. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Performance of a new hand-held device for exhaled nitric oxide measurement in adults and children.

PubMed

Alving, K; Janson, C; Nordvall, L

2006-04-20

Exhaled nitric oxide (NO) measurement has been shown to be a valuable tool in the management of patients with asthma. Up to now, most measurements have been done with stationary, chemiluminescence-based NO analysers, which are not suitable for the primary health care setting. A hand-held NO analyser which simplifies the measurement would be of value both in specialized and primary health care. In this study, the performance of a new electrochemical hand-held device for exhaled NO measurements (NIOX MINO) was compared with a standard stationary chemiluminescence unit (NIOX). A total of 71 subjects (6-60 years; 36 males), both healthy controls and atopic patients with and without asthma were included. The mean of three approved exhalations (50 ml/s) in each device, and the first approved measurement in the hand-held device, were compared with regard to NO readings (Bland-Altman plots), measurement feasibility (success rate with 6 attempts) and repeatability (intrasubject SD). Success rate was high (> or = 84%) in both devices for both adults and children. The subjects represented a FENO range of 8-147 parts per billion (ppb). When comparing the mean of three measurements (n = 61), the median of the intrasubject difference in exhaled NO for the two devices was -1.2 ppb; thus generally the hand-held device gave slightly higher readings. The Bland-Altman plot shows that the 95% limits of agreement were -9.8 and 8.0 ppb. The intrasubject median difference between the NIOX and the first approved measurement in the NIOX MINO was -2.0 ppb, and limits of agreement were -13.2 and 10.2 ppb. The median repeatability for NIOX and NIOX MINO were 1.1 and 1.2 ppb, respectively. The hand-held device (NIOX MINO) and the stationary system (NIOX) are in clinically acceptable agreement both when the mean of three measurements and the first approved measurement (NIOX MINO) is used. The hand-held device shows good repeatability, and it can be used successfully on adults and most children. The new hand-held device will enable the introduction of exhaled NO measurements into the primary health care.

Symptomatic pain and fibromyalgia treatment through multidisciplinary approach for primary care.

PubMed

Gonzalez Gonzalez, Jaime; del Teso Rubio, Maria del Mar; Waliño Paniagua, Carmen Nelida; Criado-Alvarez, Juan Jose; Sanchez Holgado, Javier

2015-01-01

Fibromyalgia is a chronic disease of unknown etiology characterized by widespread muscle pain, with occupational, familial, social, physical and psychological performance involvement. The multidisciplinary approach to the disease leads to improvement in quality of life and symptomatology. To evaluate the improvement of activities of daily living (ADL) and quality of life following a multidisciplinary intervention (Health Primary Care and Occupational Therapy). Pretest-posttest study performed with a simple random sample of 21 patients with fibromyalgia (range 16-55 years). The measurement was performed with the Barthel scale (ADL), the scale of Lawton and Brody (IADL), the FIQ questionnaire, and no standardized surveys to assess the pre and post intervention situation. An intervention on motor skills (basic motor skills, pool exercise, outdoor exercise, restructuring, occupational performance and graded activity and intervention in ADL) was performed, combining pharmacological control of their symptoms and treatment. Fibromyalgia patients are not fully satisfied with their treatment; Primary Care receives a score of 6.89, and Hospital Care 5.79, improving the Barthel, Lawton and Brody and FIQ indexes, being statistically significant (p<.05). After the combined procedure the number of independent women in ADL and IADL increases. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Application of the diagnostic radiological index of protection to protective garments

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

Pasciak, Alexander S.; Jones, A. Kyle, E-mail: kyle.jones@mdanderson.org; Wagner, Louis K.

2015-02-15

Purpose: Previously, the diagnostic radiological index of protection (DRIP) was proposed as a metric for quantifying the protective value of radioprotective garments. The DRIP is a weighted sum of the percent transmissions of different radiation beams through a garment. Ideally, the beams would represent the anticipated stray radiation encountered during clinical use. However, it is impractical to expect a medical physicist to possess the equipment necessary to accurately measure transmission of scattered radiation. Therefore, as a proof of concept, the authors tested a method that applied the DRIP to clinical practice. Methods: Primary beam qualities used in interventional cardiology andmore » radiology were observed and catalogued. Based on the observed range of beam qualities, five representative clinical primary beam qualities, specified by kV and added filtration, were selected for this evaluation. Monte Carlo simulations were performed using these primary beams as source definitions to generate scattered spectra from the clinical primary beams. Using numerical optimization, ideal scatter mimicking primary beams, specified by kV and added aluminum filtration, were matched to the scattered spectra according to half- and quarter-value layers and spectral shape. To within reasonable approximation, these theoretical scatter-mimicking primary beams were reproduced experimentally in laboratory x ray beams and used to measure transmission through pure lead and protective garments. For this proof of concept, the DRIP for pure lead and the garments was calculated by assigning equal weighting to percent transmission measurements for each of the five beams. Finally, the areal density of lead and garments was measured for consideration alongside the DRIP to assess the protective value of each material for a given weight. Results: The authors identified ideal scatter mimicking primary beams that matched scattered spectra to within 0.01 mm for half- and quarter-value layers in copper and within 5% for the shape function. The corresponding experimental scatter-mimicking primary beams matched the Monte Carlo generated scattered spectra with maximum deviations of 6.8% and 6.6% for half- and quarter-value layers. The measured DRIP for 0.50 mm lead sheet was 2.0, indicating that it transmitted, on average, 2% of incident radiation. The measured DRIP for a lead garment and one lead-alternative garment closely matched that for pure lead of 0.50 mm thickness. The DRIP for other garments was substantially higher than 0.50 mm lead (3.9–5.4), indicating they transmitted about twice as much radiation. When the DRIP was plotted versus areal density, it was clear that, of the garments tested, none were better than lead on a weight-by-weight basis. Conclusions: A method for measuring the DRIP for protective garments using scatter-mimicking primary beams was developed. There was little discernable advantage in protective value per unit weight for lead-alternative versus lead-only garments. Careful consideration must be given to the balance of protection and weight when choosing a lead-alternative protective garment with a lower specified “lead equivalence,” e.g., 0.35 mm. The DRIP has the potential to resolve this dilemma. Reporting the DRIP relative to areal density is an ideal metric for objective comparisons of protective garment performance, considering both protective value in terms of transmission of radiation and garment weight.« less

Blood-Brain Barrier Disruption Is Initiated During Primary HIV Infection and Not Rapidly Altered by Antiretroviral Therapy.

PubMed

Rahimy, Elham; Li, Fang-Yong; Hagberg, Lars; Fuchs, Dietmar; Robertson, Kevin; Meyerhoff, Dieter J; Zetterberg, Henrik; Price, Richard W; Gisslén, Magnus; Spudich, Serena

2017-04-01

We explored the establishment of abnormal blood-brain barrier (BBB) permeability and its relationship to neuropathogenesis during primary human immunodeficiency virus (HIV) infection by evaluating the cerebrospinal fluid (CSF) to serum albumin quotient (QAlb) in patients with primary HIV infection. We also analyzed effects of initiating combination antiretroviral therapy (cART). The QAlb was measured in longitudinal observational studies of primary HIV infection. We analyzed trajectories of the QAlb before and after cART initiation, using mixed-effects models, and associations between the QAlb and the CSF level of neurofilament light chain (NFL), the ratio of N-acetylaspartate to creatinine levels (a magnetic resonance spectroscopy neuronal integrity biomarker), and neuropsychological performance. The baseline age-adjusted QAlb was elevated in 106 patients with primary HIV infection (median time of measurement, 91 days after infection), compared with that in 64 controls (P = .02). Before cART initiation, the QAlb increased over time in 84 participants with a normal baseline QAlb (P = .006) and decreased in 22 with a high baseline QAlb (P = .011). The QAlb did not change after a median cART duration of 398 days, initiated at a median interval of 225 days after infection (P = .174). The QAlb correlated with the NFL level at baseline (r = 0.497 and P < .001) and longitudinally (r = 0.555 and P < .001) and with the ratio of N-acetylaspartate to creatinine levels in parietal gray matter (r = -0.352 and P < .001 at baseline and r = -0.387 and P = .008 longitudinally) but not with neuropsychological performance. The QAlb rises during primary HIV infection, associates with neuronal injury, and does not significantly improve over a year of treatment. BBB-associated neuropathogenesis in HIV-infected patients may initiate during primary infection. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Blood-Brain Barrier Disruption Is Initiated During Primary HIV Infection and Not Rapidly Altered by Antiretroviral Therapy

PubMed Central

Rahimy, Elham; Li, Fang-Yong; Hagberg, Lars; Fuchs, Dietmar; Robertson, Kevin; Meyerhoff, Dieter J.; Zetterberg, Henrik; Price, Richard W.; Gisslén, Magnus

2017-01-01

Abstract Background. We explored the establishment of abnormal blood-brain barrier (BBB) permeability and its relationship to neuropathogenesis during primary human immunodeficiency virus (HIV) infection by evaluating the cerebrospinal fluid (CSF) to serum albumin quotient (QAlb) in patients with primary HIV infection. We also analyzed effects of initiating combination antiretroviral therapy (cART). Methods. The QAlb was measured in longitudinal observational studies of primary HIV infection. We analyzed trajectories of the QAlb before and after cART initiation, using mixed-effects models, and associations between the QAlb and the CSF level of neurofilament light chain (NFL), the ratio of N-acetylaspartate to creatinine levels (a magnetic resonance spectroscopy neuronal integrity biomarker), and neuropsychological performance. Results. The baseline age-adjusted QAlb was elevated in 106 patients with primary HIV infection (median time of measurement, 91 days after infection), compared with that in 64 controls (P = .02). Before cART initiation, the QAlb increased over time in 84 participants with a normal baseline QAlb (P = .006) and decreased in 22 with a high baseline QAlb (P = .011). The QAlb did not change after a median cART duration of 398 days, initiated at a median interval of 225 days after infection (P = .174). The QAlb correlated with the NFL level at baseline (r = 0.497 and P < .001) and longitudinally (r = 0.555 and P < .001) and with the ratio of N-acetylaspartate to creatinine levels in parietal gray matter (r = −0.352 and P < .001 at baseline and r = −0.387 and P = .008 longitudinally) but not with neuropsychological performance. Conclusion. The QAlb rises during primary HIV infection, associates with neuronal injury, and does not significantly improve over a year of treatment. BBB-associated neuropathogenesis in HIV-infected patients may initiate during primary infection. PMID:28368497

Solar Probe Cup: Laboratory Performance

NASA Astrophysics Data System (ADS)

Case, A. W.; Kasper, J. C.; Korreck, K. E.; Stevens, M. L.; Larson, D. E.; Wright, K. H., Jr.; Gallagher, D. L.; Whittlesey, P. L.

2017-12-01

The Solar Probe Cup (SPC) is a Faraday Cup instrument that will fly on the Paker Solar Probe (PSP) spacecraft, orbiting the Sun at as close as 9.86 solar radii. The SPC instrument is designed to measure the thermal solar wind plasma (protons, alphas, and electrons) that will be encountered throughout its close encounter with the Sun. Due to the solar wind flow being primarily radial, the SPC instrument is pointed directly at the Sun, resulting in an extreme thermal environment that must be tolerated throughout the primary data collection phase. Laboratory testing has been performed over the past 6 months to demonstrate the instrument's performance relative to its requirements, and to characterize the measurements over the expected thermal range. This presentation will demonstrate the performance of the instrument as measured in the lab, describe the operational configurations planned for flight, and discuss the data products that will be created.

Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

PubMed

Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

2015-12-01

Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may be significant inter-observer variability.

Igniter adapter-to-igniter chamber deflection test

NASA Technical Reports Server (NTRS)

Cook, M.

1990-01-01

Testing was performed to determine the maximum RSRM igniter adapter-to-igniter chamber joint deflection at the crown of the inner joint primary seal. The deflection data was gathered to support igniter inner joint gasket resiliency predictions which led to launch commit criteria temperature determinations. The proximity (deflection) gage holes for the first test (Test No. 1) were incorrectly located; therefore, the test was declared a non-test. Prior to Test No. 2, test article configuration was modified with the correct proximity gage locations. Deflection data were successfully acquired during Test No. 2. However, the proximity gage deflection measurements were adversely affected by temperature increases. Deflections measured after the temperature rise at the proximity gages were considered unreliable. An analysis was performed to predict the maximum deflections based on the reliable data measured before the detectable temperature rise. Deflections to the primary seal crown location were adjusted to correspond to the time of maximum expected operating pressure (2,159 psi) to account for proximity gage bias, and to account for maximum attach and special bolt relaxation. The maximum joint deflection for the igniter inner joint at the crown of the primary seal, accounting for all significant correction factors, was 0.0031 in. (3.1 mil). Since the predicted (0.003 in.) and tested maximum deflection values were sufficiently close, the launch commit criteria was not changed as a result of this test. Data from this test should be used to determine if the igniter inner joint gasket seals are capable of maintaining sealing capability at a joint displacement of (1.4) x (0.0031 in.) = 0.00434 inches. Additional testing should be performed to increase the database on igniter deflections and address launch commit criteria temperatures.

Real-time measurement of mental workload: A feasibility study

NASA Technical Reports Server (NTRS)

Kramer, Arthur; Humphrey, Darryl; Sirevaag, Erik; Mecklinger, Axel

1990-01-01

The primary goal of the study was to explore the utility of event-related brain potentials (ERP) as real-time measures of workload. To this end, subjects performed two different tasks both separately and together. One task required that subjects monitor a bank of constantly changing gauges and detect critical deviations. Difficulty was varied by changing the predictability of the gauges. The second task was mental arithmetic. Difficulty was varied by requiring subjects to perform operations on either two or three columns of numbers. Two conditions that could easily be distinguished on the basis of performance measures were selected for the real-time evaluation of ERPs. A bootstrapping approach was adopted in which one thousand samples of n trials (n = 1, 3, 5 ...65) were classified using several measures of P300 and Slow Wave amplitude. Classification accuracies of 85 percent were achieved with 25 trials. Results are discussed in terms of potential enhancements for real-time recording.

Progress in the Fabrication and Testing of Telescope Mirrors for The James Webb Space Telescope

NASA Astrophysics Data System (ADS)

Bowers, Charles W.; Clampin, M.; Feinberg, L.; Keski-Kuha, R.; McKay, A.; Chaney, D.; Gallagher, B.; Ha, K.

2012-01-01

The telescope of the James Webb Space Telescope (JWST) is an f/20, three mirror anastigmat design, passively cooled (40K) in an L2 orbit. The design provides diffraction limited performance (Strehl ≥ 0.8) at λ=2μm. To fit within the launch vehicle envelope (Arianne V), the 6.6 meter primary mirror and the secondary mirror support structure are folded for launch, then deployed and aligned in space. The primary mirror is composed of 18 individual, 1.3 meter (flat:flat) hexagonal segments, each adjustable in seven degrees of freedom (six rigid body + radius of curvature) provided by a set of high precision actuators. The actuated secondary mirror ( 0.74m) is similarly positioned in six degrees of rigid body motion. The .70x.51m, fixed tertiary and 0.17m, flat fine steering mirror complete the telescope mirror complement. The telescope is supported by a composite structure optimized for performance at cryogenic temperatures. All telescope mirrors are made of Be with substantial lightweighting (21kg for each 1.3M primary segment). Additional Be mounting and supporting structure for the high precision ( 10nm steps) actuators are attached to the primary segments and secondary mirror. All mirrors undergo a process of thermal stabilization to reduce stress. An extensive series of interferometric measurements guide each step of the polishing process. Final polishing must account for any deformation between the ambient temperature of polishing and the cryogenic, operational temperature. This is accomplished by producing highly precise, cryo deformation target maps of each surface which are incorporated into the final polishing cycle. All flight mirrors have now completed polishing, coating with protected Au and final cryo testing, and the telescope is on track to meet all system requirements. We here review the measured performance of the component mirrors and the predicted performance of the flight telescope.

[Validity of adjusted morbidity groups with respect to clinical risk groups in the field of primary care].

PubMed

Monterde, David; Vela, Emili; Clèries, Montse; García Eroles, Luis; Pérez Sust, Pol

2018-02-09

To compare the performance in terms of goodness of fit and explanatory power of 2morbidity groupers in primary care (PC): adjusted morbidity groups (AMG) and clinical risk groups (CRG). Cross-sectional study. PC in the Catalan Institute for the Health (CIH), Catalonia, Spain. Population allocated in primary care centers of the CIH for the year 2014. Three indicators of interest are analyzed such as urgent hospitalization, number of visits and spending in pharmacy. A stratified analysis by centers is applied adjusting generalized lineal models from the variables age, sex and morbidity grouping to explain each one of the 3variables of interest. The statistical measures to analyze the performance of the different models applied are the Akaike index, the Bayes index and the pseudo-variability explained by deviance change. The results show that in the area of the primary care the explanatory power of the AMGs is higher to that offered by the CRGs, especially for the case of the visits and the pharmacy. The performance of GMAs in the area of the CIH PC is higher than that shown by the CRGs. Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.

Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: a randomized placebo-controlled pilot study.

PubMed

Zick, Suzanna M; Wright, Benjamin D; Sen, Ananda; Arnedt, J Todd

2011-09-22

Despite being the most commonly used herbal for sleep disorders, chamomile's (Matricaria recutita) efficacy and safety for treating chronic primary insomnia is unknown. We examined the preliminary efficacy and safety of chamomile for improving subjective sleep and daytime symptoms in patients with chronic insomnia. We performed a randomized, double-blind, placebo-controlled pilot trial in 34 patients aged 18-65 years with DSM-IV primary insomnia for ≥ 6-months. Patients were randomized to 270 mg of chamomile twice daily or placebo for 28-days. The primary outcomes were sleep diary measures. Secondary outcomes included daytime symptoms, safety assessments, and effect size of these measures. There were no significant differences between groups in changes in sleep diary measures, including total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), sleep quality, and number of awakenings. Chamomile did show modest advantage on daytime functioning, although these did not reach statistical significance. Effect sizes were generally small to moderate (Cohen's d ≤ 0.20 to < 0.60) with sleep latency, night time awakenings, and Fatigue Severity Scale (FSS), having moderate effect sizes in favor of chamomile. However, TST demonstrated a moderate effect size in favor of placebo. There were no differences in adverse events reported by the chamomile group compared to placebo. Chamomile could provide modest benefits of daytime functioning and mixed benefits on sleep diary measures relative to placebo in adults with chronic primary insomnia. However, further studies in select insomnia patients would be needed to investigate these conclusions.

Recall initiation strategies must be controlled in training studies that use immediate free recall tasks to measure the components of working memory capacity across time.

PubMed

Gibson, Bradley S; Gondoli, Dawn M; Johnson, Ann C; Robison, Matthew K

2014-01-01

There has been great interest in using working memory (WM) training regimens as an alternative treatment for ADHD, but it has recently been concluded that existing training regimens may not be optimally designed because they target the primary memory component but not the secondary component of WM capacity. This conclusion requires the ability to accurately measure changes in primary and secondary memory abilities over time. The immediate free recall task has been used in previous studies to measure these changes; however, one concern with these tasks is that the recall order required on training exercises may influence the recall strategy used during free recall, which may in turn influence the relative number of items recalled from primary and secondary memory. To address this issue, previous training studies have explicitly controlled recall strategy before and after training. However, the necessity of controlling for recall strategies has not been explicitly tested. The present study investigated the effects of forward-serial-order training on free recall performance under conditions in which recall strategy was not controlled using a sample of adolescents with ADHD. Unlike when recall order was controlled, the main findings showed selective improvement of the secondary memory component (as opposed to the primary memory component) when recall order was uncontrolled. This finding advances our understanding of WM training by highlighting the importance of controlling for recall strategies when free recall tasks are used to measure changes in the primary and secondary components of WM across time.

Effect of National Partnerships on NAPLAN

ERIC Educational Resources Information Center

Chua, Hui Ping; Khan, R. Nazim; Humphry, Stephen; Hassell, Robert

2017-01-01

The annual National Assessment Program--Literacy and Numeracy (NAPLAN) measures the literacy and numeracy skills of primary and secondary students in Australia. Under the three Smarter Schools National Partnership, additional funding is provided to the independent schools with the expectation of improving student performance. Using multilevel…

40 CFR 57.405 - Formulation, approval, and implementation of requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... completion of the measures specified in the approved plan evaluating the performance and adequacy of the SCS.... The reliability study shall include a comprehensive analysis of the system's operation during one or... (CONTINUED) AIR PROGRAMS (CONTINUED) PRIMARY NONFERROUS SMELTER ORDERS Supplementary Control System...

40 CFR 57.405 - Formulation, approval, and implementation of requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... completion of the measures specified in the approved plan evaluating the performance and adequacy of the SCS.... The reliability study shall include a comprehensive analysis of the system's operation during one or... (CONTINUED) AIR PROGRAMS (CONTINUED) PRIMARY NONFERROUS SMELTER ORDERS Supplementary Control System...

40 CFR 57.405 - Formulation, approval, and implementation of requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... completion of the measures specified in the approved plan evaluating the performance and adequacy of the SCS.... The reliability study shall include a comprehensive analysis of the system's operation during one or... (CONTINUED) AIR PROGRAMS (CONTINUED) PRIMARY NONFERROUS SMELTER ORDERS Supplementary Control System...

40 CFR 57.405 - Formulation, approval, and implementation of requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... completion of the measures specified in the approved plan evaluating the performance and adequacy of the SCS.... The reliability study shall include a comprehensive analysis of the system's operation during one or... (CONTINUED) AIR PROGRAMS (CONTINUED) PRIMARY NONFERROUS SMELTER ORDERS Supplementary Control System...

NEW APPROACH AND METHODOLOGIES FOR CHARACTERIZING THE HYDROGEOLOGIC PROPERTIES OF AQUIFERS

EPA Science Inventory

In the authors' opinion, the ability of hydrologists to perform field measurements of aquifer hydraulic properties must be enhanced if we are to improve significantly our capacity to solve ground water contamination problems at Superfund and other sites. herefore, the primary pur...

Design of the POINT study: Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT).

PubMed

Hazen, Ankie C M; Sloeserwij, Vivianne M; Zwart, Dorien L M; de Bont, Antoinette A; Bouvy, Marcel L; de Gier, Johan J; de Wit, Niek J; Leendertse, Anne J

2015-07-02

In the Netherlands, 5.6 % of acute hospital admissions are medication-related. Almost half of these admissions are potentially preventable. Reviewing medication in patients at risk in primary care might prevent these hospital admissions. At present, implementation of medication reviews in primary care is suboptimal: pharmacists lack access to patient information, pharmacists are short of clinical knowledge and skills, and working processes of pharmacists (focus on dispensing) and general practitioners (focus on clinical practice) match poorly. Integration of the pharmacist in the primary health care team might improve pharmaceutical care outcomes. The aim of this study is to evaluate the effect of integration of a non-dispensing pharmacist in general practice on the safety of pharmacotherapy in the Netherlands. The POINT study is a non-randomised controlled intervention study with pre-post comparison in an integrated primary care setting. We compare three different models of pharmaceutical care provision in primary care: 1) a non-dispensing pharmacist as an integral member of a primary care team, 2) a pharmacist in a community pharmacy with a predefined training in performing medication reviews and 3) a pharmacist in a community pharmacy (care as usual). In all models, GPs remain accountable for individual medication prescription. In the first model, ten non-dispensing clinical pharmacists are posted in ten primary care practices (including 5 - 10 000 patients each) for a period of 15 months. These non-dispensing pharmacists perform patient consultations, including medication reviews, and share responsibility for the pharmaceutical care provided in the practice. The two other groups consist of ten primary care practices with collaborating pharmacists. The main outcome measurement is the number of medication-related hospital admissions during follow-up. Secondary outcome measurements are potential medication errors, drug burden index and costs. Parallel to this study, a qualitative study is conducted to evaluate the feasibility of introducing a NDP in general practice. As the POINT study is a large-scale intervention study, it should provide evidence as to whether integration of a non-dispensing clinical pharmacist in primary care will result in safer pharmacotherapy. The qualitative study also generates knowledge on the optimal implementation of this model in primary care. Results are expected in 2016. NTR4389 , The Netherlands National Trial Register, 07-01-2014.

The measured performance of a grazing incidence relay optics telescope for solar X-ray astronomy

NASA Technical Reports Server (NTRS)

Moses, Dan; Krieger, Allen S.; Davis, John M.

1986-01-01

The design, fabrication, and test performance of a grazing-incidence diverging magnifier (GIDM) for use in high-resolution X-ray imaging of the solar corona are described. The GIDM, designed to be mounted in front of the focus of a 30.48-cm Wolter-Schwarzschild primary, is an Ni-coated Be hyperboloid-hyperboloid structure of principal diameter 3.15 cm; the two components are mounted on a central steel plate which acts as a support and spacer. The combined instrument has overall length 1.9 m, effective focal length 5.4 m, and plate scale 26.0 micron/arcsec. In point- and line-source measurements in an 89.5-m vacuum test facility, the on-axis resolution is shown to be equal to that of the primary alone. The field of view for 1-arcsec resolution is limited to 1.25 arcmin in radius, but the effective-area limitation is less significant when CCD detectors of high quantum efficiency are used instead of film.

Impact of audit and feedback and pay-for-performance interventions on pediatric hospitalist discharge communication with primary care providers.

PubMed

Tejedor-Sojo, Javier; Creek, Tracy; Leong, Traci

2015-01-01

The study team sought to improve hospitalist communication with primary care providers (PCPs) at discharge through interventions consisting of (a) audit and feedback and (b) inclusion of a discharge communication measure in the incentive compensation for pediatric hospitalists. The setting was a 16-physician pediatric hospitalist group within a tertiary pediatric hospital. Discharge summaries were selected randomly for documentation of communication with PCPs. At baseline, 57% of charts had documented communication with PCPs, increasing to 84% during the audit and feedback period. Following the addition of a financial incentive, documentation of communication with PCPs increased to 93% and was sustained during the combined intervention period. The number of physicians meeting the study's performance goal increased from 1 to 14 by the end of the study period. A financial incentive coupled with an audit and feedback tool was effective at modifying physician behavior, achieving focused, measurable quality improvement gains. © 2014 by the American College of Medical Quality.

Effects of a 15-week accumulated brisk walking programme on the body composition of primary school children.

PubMed

Ford, Paul A; Perkins, Gill; Swaine, Ian

2013-01-01

The purpose of this study was to establish whether an accumulated brisk walking programme, performed during the school day, is effective in changing body composition in primary school children aged 5-11 years. Altogether, 152 participants (79 boys and 73 girls) took part in this repeated-measures intervention study, divided into groups of walkers and controls. The walkers took part in the intervention during school time, which involved brisk walking around the school grounds for 15 min in the morning and afternoon, at least three times a week for 15 weeks. This represented an additional 90 min of moderate physical activity per week. The controls undertook their usual school day activities. Pre- and post-intervention anthropometric and body composition measures were taken. Body fat (-1.95 ± 2.6%) and fat mass (-0.49 ± 1.0 kg) were significantly reduced in the walkers after the intervention, whereas the controls showed no significant changes in these measures. Our results show that regular accumulated bouts of brisk walking during the school day can positively affect body composition in primary school children.

Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.

PubMed

Claassens, Mareli M; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J; Enarson, Donald A; Beyers, Nulda; Borgdorff, Martien W

2013-01-01

Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

PubMed Central

Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

2013-01-01

Background Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. Methods One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. Results The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). Conclusion The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB. PMID:24098461

Integrated Approach to Reduce Perinatal Adverse Events: Standardized Processes, Interdisciplinary Teamwork Training, and Performance Feedback.

PubMed

Riley, William; Begun, James W; Meredith, Les; Miller, Kristi K; Connolly, Kathy; Price, Rebecca; Muri, Janet H; McCullough, Mac; Davis, Stanley

2016-12-01

To improve safety practices and reduce adverse events in perinatal units of acute care hospitals. Primary data collected from perinatal units of 14 hospitals participating in the intervention between 2008 and 2012. Baseline secondary data collected from the same hospitals between 2006 and 2007. A prospective study involving 342,754 deliveries was conducted using a quality improvement collaborative that supported three primary interventions. Primary measures include adoption of three standardized care processes and four measures of outcomes. Chart audits were conducted to measure the implementation of standardized care processes. Outcome measures were collected and validated by the National Perinatal Information Center. The hospital perinatal units increased use of all three care processes, raising consolidated overall use from 38 to 81 percent between 2008 and 2012. The harms measured by the Adverse Outcome Index decreased 14 percent, and a run chart analysis revealed two special causes associated with the interventions. This study demonstrates the ability of hospital perinatal staff to implement efforts to reduce perinatal harm using a quality improvement collaborative. Findings help inform the relationship between the use of standardized care processes, teamwork training, and improved perinatal outcomes, and suggest that a multiplicity of integrated strategies, rather than a single intervention, may be essential to achieve high reliability. © Health Research and Educational Trust.

Functional near infrared spectroscopy for awake monkey to accelerate neurorehabilitation study

NASA Astrophysics Data System (ADS)

Kawaguchi, Hiroshi; Higo, Noriyuki; Kato, Junpei; Matsuda, Keiji; Yamada, Toru

2017-02-01

Functional near-infrared spectroscopy (fNIRS) is suitable for measuring brain functions during neurorehabilitation because of its portability and less motion restriction. However, it is not known whether neural reconstruction can be observed through changes in cerebral hemodynamics. In this study, we modified an fNIRS system for measuring the motor function of awake monkeys to study cerebral hemodynamics during neurorehabilitation. Computer simulation was performed to determine the optimal fNIRS source-detector interval for monkey motor cortex. Accurate digital phantoms were constructed based on anatomical magnetic resonance images. Light propagation based on the diffusion equation was numerically calculated using the finite element method. The source-detector pair was placed on the scalp above the primary motor cortex. Four different interval values (10, 15, 20, 25 mm) were examined. The results showed that the detected intensity decreased and the partial optical path length in gray matter increased with an increase in the source-detector interval. We found that 15 mm is the optimal interval for the fNIRS measurement of monkey motor cortex. The preliminary measurement was performed on a healthy female macaque monkey using fNIRS equipment and custom-made optodes and optode holder. The optodes were attached above bilateral primary motor cortices. Under the awaking condition, 10 to 20 trials of alternated single-sided hand movements for several seconds with intervals of 10 to 30 s were performed. Increases and decreases in oxy- and deoxyhemoglobin concentration were observed in a localized area in the hemisphere contralateral to the moved forelimb.

New developments in EPID-based 3D dosimetry in The Netherlands Cancer Institute

NASA Astrophysics Data System (ADS)

Mijnheer, B.; Rozendaal, R.; Olaciregui-Ruiz, I.; González, P.; van Oers, R.; Mans, A.

2017-05-01

EPID-based offline 3D in vivo dosimetry is performed routinely in The Netherlands Cancer Institute for almost all RT treatments. The 3D dose distribution is reconstructed using the EPID primary dose in combination with a back-projection algorithm and compared with the planned dose distribution. Recently the method was adapted for real-time dose verification, performing 3D dose verification in less than 300 ms, which is faster than the current portal frame acquisition rate. In this way a possibility is created for halting the linac in case of large delivery errors. Furthermore, a new method for pre-treatment QA was developed in which the EPID primary dose behind a phantom or patient is predicted using the CT data of that phantom or patient in combination with in-air EPID measurements. This virtual EPID primary transit dose is then used to reconstruct the 3D dose distribution within the phantom or patient geometry using the same dose engine as applied offline. In order to assess the relevance of our clinically applied alert criteria, we investigated the sensitivity of our EPID-based 3D dose verification system to detect delivery errors in VMAT treatments. This was done through simulation by modifying patient treatment plans, as well as experimentally by performing EPID measurements during the irradiation of an Alderson phantom, both after deliberately introducing errors during VMAT delivery. In this presentation these new developments will be elucidated.

Performance of the primary mirror center-of-curvature optical metrology system during cryogenic testing of the JWST Pathfinder telescope

NASA Astrophysics Data System (ADS)

Hadaway, James B.; Wells, Conrad; Olczak, Gene; Waldman, Mark; Whitman, Tony; Cosentino, Joseph; Connolly, Mark; Chaney, David; Telfer, Randal

2016-07-01

The James Webb Space Telescope (JWST) primary mirror (PM) is 6.6 m in diameter and consists of 18 hexagonal segments, each 1.5 m point-to-point. Each segment has a six degree-of-freedom hexapod actuation system and a radius of-curvature (RoC) actuation system. The full telescope will be tested at its cryogenic operating temperature at Johnson Space Center. This testing will include center-of-curvature measurements of the PM, using the Center-of-Curvature Optical Assembly (COCOA) and the Absolute Distance Meter Assembly (ADMA). The COCOA includes an interferometer, a reflective null, an interferometer-null calibration system, coarse and fine alignment systems, and two displacement measuring interferometer systems. A multiple-wavelength interferometer (MWIF) is used for alignment and phasing of the PM segments. The ADMA is used to measure, and set, the spacing between the PM and the focus of the COCOA null (i.e. the PM center-of-curvature) for determination of the ROC. The performance of these metrology systems was assessed during two cryogenic tests at JSC. This testing was performed using the JWST Pathfinder telescope, consisting mostly of engineering development and spare hardware. The Pathfinder PM consists of two spare segments. These tests provided the opportunity to assess how well the center-of-curvature optical metrology hardware, along with the software and procedures, performed using real JWST telescope hardware. This paper will describe the test setup, the testing performed, and the resulting metrology system performance. The knowledge gained and the lessons learned during this testing will be of great benefit to the accurate and efficient cryogenic testing of the JWST flight telescope.

Performance of the Primary Mirror Center-of-curvature Optical Metrology System During Cryogenic Testing of the JWST Pathfinder Telescope

NASA Technical Reports Server (NTRS)

Hadaway, James B.; Wells, Conrad; Olczak, Gene; Waldman, Mark; Whitman, Tony; Cosentino, Joseph; Connolly, Mark; Chaney, David; Telfer, Randal

2016-01-01

The James Webb Space Telescope (JWST) primary mirror (PM) is 6.6 m in diameter and consists of 18 hexagonal segments, each 1.5 m point-to-point. Each segment has a six degree-of-freedom hexapod actuation system and a radius-of-curvature (RoC) actuation system. The full telescope will be tested at its cryogenic operating temperature at Johnson Space Center. This testing will include center-of-curvature measurements of the PM, using the Center-of-Curvature Optical Assembly (COCOA) and the Absolute Distance Meter Assembly (ADMA). The COCOA includes an interferometer, a reflective null, an interferometer-null calibration system, coarse & fine alignment systems, and two displacement measuring interferometer systems. A multiple-wavelength interferometer (MWIF) is used for alignment & phasing of the PM segments. The ADMA is used to measure, and set, the spacing between the PM and the focus of the COCOA null (i.e. the PM center-of-curvature) for determination of the ROC. The performance of these metrology systems was assessed during two cryogenic tests at JSC. This testing was performed using the JWST Pathfinder telescope, consisting mostly of engineering development & spare hardware. The Pathfinder PM consists of two spare segments. These tests provided the opportunity to assess how well the center-of-curvature optical metrology hardware, along with the software & procedures, performed using real JWST telescope hardware. This paper will describe the test setup, the testing performed, and the resulting metrology system performance. The knowledge gained and the lessons learned during this testing will be of great benefit to the accurate & efficient cryogenic testing of the JWST flight telescope.

Kaolin

USGS Publications Warehouse

Virta, Robert L.

2014-01-01

The article reports on the market performance of kaolin in the U.S. in 2009 and presents an outlook for its 2010 performance. There was a decline in the domestic sales of kaolin from 6.74 measurement ton (Mt) to 5.2 Mt. Companies in the country engaged in kaolin production include Advanced Primary Minerals Corp., Applied Minerals Inc., and Daleco Resources Corp. The decline in world production of kaolin from 2008 to 2009 is also noted.

Team composition and chronic disease management within primary healthcare practices in eastern Ontario: an application of the Measuring Organizational Attributes of Primary Health Care Survey.

PubMed

Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan

2018-04-15

Various organizational-level attributes are being implemented in primary healthcare to improve healthcare delivery. There is a need to describe the distribution and nature of these attributes and explore differences across practices.AimThe aim of this study was to better understand organizational attributes of primary care teams, focusing specifically on team composition, nursing roles, and strategies that support chronic disease management. We employed a cross-sectional survey design. Team composition, nursing roles, availability of health services, and chronic disease management activities were described using the 'Measuring Organizational Attributes of Primary Health Care Survey.'FindingsA total of 76% (n=26 out of 34) of practice locations completed the survey, including family health teams (FHT; n=21) and community health centers (CHC; n=4). Nurse practitioners (NPs) and registered nurses (RNs) were the most common non-physician providers, and CHCs had a greater proportion of non-physician providers than FHTs. There was overlap in roles performed by NPs and RNs, and registered practical nurses engaged in fewer roles compared with NPs and RNs. A greater proportion of FHTs had systematic chronic disease management services for hypertension, depression and Alzheimer's disease compared with CHC practices. The 'Measuring Organizational Attributes of Primary Health Care Survey' was a useful tool to highlight variability in organizational attributes across PHC practices. Nurses are prominent within PHC practices, engaging in a wide range of roles related to chronic disease management, suggesting a need to better understand their contributions to patient care to optimize their roles.

Identification, summary and comparison of tools used to measure organizational attributes associated with chronic disease management within primary care settings

PubMed Central

Lukewich, Julia; Corbin, Renée; VanDenKerkhof, Elizabeth G; Edge, Dana S; Williamson, Tyler; Tranmer, Joan E

2014-01-01

Rationale, aims and objectives Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Methods Systematic search and review methodology consisting of a comprehensive and exhaustive search that is based on a broad question to identify the best available evidence was employed. Results A total of 30 organizational attribute data collection tools that have been used within the primary care setting were identified. The tools varied with respect to overall focus and level of organizational detail captured, theoretical foundations, administration and completion methods, types of questions asked, and the extent to which psychometric property testing had been performed. The tools utilized within the Quality and Costs of Primary Care in Europe study and the Canadian Primary Health Care Practice-Based Surveys were the most recently developed tools. Furthermore, of the 30 tools reviewed, the Canadian Primary Health Care Practice-Based Surveys collected the most information on organizational attributes. Conclusions There is a need to collect primary care organizational attribute information at a national level to better understand factors affecting the quality of chronic disease prevention and management across a given country. The data collection tools identified in this review can be used to establish data collection strategies to collect this important information. PMID:24840066

The Monkey game: A computerized verbal working memory task for self-reliant administration in primary school children.

PubMed

Van de Weijer-Bergsma, Eva; Kroesbergen, Evelyn H; Jolani, Shahab; Van Luit, Johannes E H

2016-06-01

In two studies, the psychometric properties of an online self-reliant verbal working memory task (the Monkey game) for primary school children (6-12 years of age) were examined. In Study 1, children (n = 5,203) from 31 primary schools participated. The participants completed computerized verbal and visual-spatial working memory tasks (i.e., the Monkey game and the Lion game) and a paper-and-pencil version of Raven's Standard Progressive Matrices. Reading comprehension and math achievement test scores were obtained from the schools. First, the internal consistency of the Monkey game was examined. Second, multilevel modeling was used to examine the effects of classroom membership. Multilevel multivariate regression analysis was used to examine the Monkey game's concurrent relationship with the Lion game and its predictive relationships with reading comprehension and math achievement. Also, age-related differences in performance were examined. In Study 2, the concurrent relationships between the Monkey game and two tester-led computerized working memory tasks were further examined (n = 140). Also, the 1- and 2-year stability of the Monkey game was investigated. The Monkey game showed excellent internal consistency, good concurrent relationships with the other working memory measures, and significant age differences in performance. Performance on the Monkey game was also predictive of subsequent reading comprehension and mathematics performance, even after controlling for individual differences in intelligence. Performance on the Monkey game was influenced by classroom membership. The Monkey game is a reliable and suitable instrument for the online computerized and self-reliant assessment of verbal working memory in primary school children.

Measurement of pion, kaon and proton production in proton–proton collisions at $$\\sqrt{s} = 7$$ TeV

DOE PAGES

Adam, J.; Adamová, D.; Aggarwal, M. M.; ...

2015-05-27

The measurement of primary π ±, K ±, p and p¯ production at mid-rapidity (|y|< 0.5) in proton–proton collisions at √s = 7 TeV performed with a large ion collider experiment at the large hadron collider (LHC) is reported. Particle identification is performed using the specific ionisation energy-loss and time-of-flight information, the ring-imaging Cherenkov technique and the kink-topology identification of weak decays of charged kaons. Transverse momentum spectra are measured from 0.1 up to 3 GeV/c for pions, from 0.2 up to 6 GeV/c for kaons and from 0.3 up to 6 GeV/c for protons. The measured spectra and particlemore » ratios are compared with quantum chromodynamics-inspired models, tuned to reproduce also the earlier measurements performed at the LHC. Lastly, the integrated particle yields and ratios as well as the average transverse momenta are compared with results at lower collision energies.« less

Constrained optimization via simulation models for new product innovation

NASA Astrophysics Data System (ADS)

Pujowidianto, Nugroho A.

2017-11-01

We consider the problem of constrained optimization where the decision makers aim to optimize the primary performance measure while constraining the secondary performance measures. This paper provides a brief overview of stochastically constrained optimization via discrete event simulation. Most review papers tend to be methodology-based. This review attempts to be problem-based as decision makers may have already decided on the problem formulation. We consider constrained optimization models as there are usually constraints on secondary performance measures as trade-off in new product development. It starts by laying out different possible methods and the reasons using constrained optimization via simulation models. It is then followed by the review of different simulation optimization approach to address constrained optimization depending on the number of decision variables, the type of constraints, and the risk preferences of the decision makers in handling uncertainties.

True Measures

ERIC Educational Resources Information Center

Cox, Ron

2010-01-01

Air filters perform an important function in commercial and institutional facilities. Because indoor air typically is two to five times more polluted than outdoor air, air filters are needed to remove respirable particles such as microorganisms, dust and allergens from the breathing air. In fact, air filters provide the primary defense for…

A NEW APPROACH AND METHODOLOGIES FOR CHARACTERIZING THE HYDROGEOLOGIC PROPERTIES OF AQUIFERS

EPA Science Inventory

In the authors' opinion, the ability of hydrologists to perform field measurements of aquifer hydraulic properties must be enhanced if we are to improve significantly our capacity to solve ground water contamination problems at Superfund and other sites. Therefore, the primary pu...

Simulation-based Assessment of the Management of Critical Events by Board-certified Anesthesiologists.

PubMed

Weinger, Matthew B; Banerjee, Arna; Burden, Amanda R; McIvor, William R; Boulet, John; Cooper, Jeffrey B; Steadman, Randolph; Shotwell, Matthew S; Slagle, Jason M; DeMaria, Samuel; Torsher, Laurence; Sinz, Elizabeth; Levine, Adam I; Rask, John; Davis, Fred; Park, Christine; Gaba, David M

2017-09-01

We sought to determine whether mannequin-based simulation can reliably characterize how board-certified anesthesiologists manage simulated medical emergencies. Our primary focus was to identify gaps in performance and to establish psychometric properties of the assessment methods. A total of 263 consenting board-certified anesthesiologists participating in existing simulation-based maintenance of certification courses at one of eight simulation centers were video recorded performing simulated emergency scenarios. Each participated in two 20-min, standardized, high-fidelity simulated medical crisis scenarios, once each as primary anesthesiologist and first responder. Via a Delphi technique, an independent panel of expert anesthesiologists identified critical performance elements for each scenario. Trained, blinded anesthesiologists rated video recordings using standardized rating tools. Measures included the percentage of critical performance elements observed and holistic (one to nine ordinal scale) ratings of participant's technical and nontechnical performance. Raters also judged whether the performance was at a level expected of a board-certified anesthesiologist. Rater reliability for most measures was good. In 284 simulated emergencies, participants were rated as successfully completing 81% (interquartile range, 75 to 90%) of the critical performance elements. The median rating of both technical and nontechnical holistic performance was five, distributed across the nine-point scale. Approximately one-quarter of participants received low holistic ratings (i.e., three or less). Higher-rated performances were associated with younger age but not with previous simulation experience or other individual characteristics. Calling for help was associated with better individual and team performance. Standardized simulation-based assessment identified performance gaps informing opportunities for improvement. If a substantial proportion of experienced anesthesiologists struggle with managing medical emergencies, continuing medical education activities should be reevaluated.

LIDAR and acoustics applications to ocean productivity

NASA Technical Reports Server (NTRS)

Collins, D. J.

1982-01-01

The requirements for the submersible, the instrumentation necessary to perform these measurements, and the optical and acoustical technology required to develop the ocean color scanner instrumentation are described. The development of a second generation ocean color scanner produced the need for coincident in situ scientific measurements which examine the primary productivity of the upper ocean on time and space scales which are large compared to the environmental scales. The vertical and horizontal variability of the biota, including the relationship between chlorophyll and primary productivity, the productivity of zooplankton, and the dynamic interaction between phytoplankton and zooplankton, and between these populations and the physical environment are investigated. A towed submersible will be constructed which accommodates both an underwater LIDAR instrument and a multifrequency sonar.

A Review of NIST Primary Activity Standards for 18F: 1982 to 2013

PubMed Central

Bergeron, Denis E; Cessna, Jeffrey T; Coursey, Bert M; Fitzgerald, Ryan; Zimmerman, Brian E

2014-01-01

The new NIST activity standardization for 18F, described in 2014 in Applied Radiation and Isotopes (v. 85, p. 77), differs from results obtained between 1998 and 2008 by 4 %. The new results are considered to be very reliable; they are based on a battery of robust primary measurement techniques and bring the NIST standard into accord with other national metrology institutes. This paper reviews all ten 18F activity standardizations performed at NIST from 1982 to 2013, with a focus on experimental variables that might account for discrepancies. We have identified many possible sources of measurement bias and eliminated most of them, but we have not adequately accounted for the 1998–2008 results. PMID:26601035

Mars Pathfinder Wheel Abrasion Experiment Ground Test

NASA Technical Reports Server (NTRS)

Keith, Theo G., Jr.; Siebert, Mark W.

1998-01-01

The National Aeronautics and Space Administration (NASA) sent a mission to the martian surface, called Mars Pathfinder. The mission payload consisted of a lander and a rover. The primary purpose of the mission was demonstrating a novel entry, descent, and landing method that included a heat shield, a parachute, rockets, and a cocoon of giant air bags. Once on the surface, the spacecraft returned temperature measurements near the Martian surface, atmosphere pressure, wind speed measurements, and images from the lander and rover. The rover obtained 16 elemental measurements of rocks and soils, performed soil-mechanics, atmospheric sedimentation measurements, and soil abrasiveness measurements.

Direct measurements of fluorine atom concentration, gain length and small signal gain in an hydrogen fluoride overtone laser

NASA Astrophysics Data System (ADS)

Wisniewski, Charles F.; Hewett, Kevin B.; Manke, Gerald C., II; Randall Truman, C.; Hager, Gordon D.

2003-03-01

Experimental techniques have been developed to directly measure the concentration of fluorine atoms, the gain length and the small signal gain in a hydrogen fluoride 5 cm slit nozzle laser. A gas phase titration technique was utilized to measure the fluorine atom concentration using HCl as the titrant. The gain length was measured using a pitot probe to locate the interface of the primary flow with the high Mach number shroud flows. A tunable diode laser was utilized to perform small signal gain measurements on HF overtone ( ν=2→0) transitions.

Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review

PubMed Central

Berkowitz, Seth A; Aragon, Katherine; Hines, Jonas; Seligman, Hilary; Lee, Sei; Sarkar, Urmimala

2013-01-01

Objective To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. Data Sources MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources. Study Design Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations. Data Collection/Extraction Methods Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form. Principal Findings We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome. Conclusions Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations. PMID:23445498

Integration of altitude and airspeed information into a primary flight display via moving-tape formats: Evaluation during random tracking task

NASA Technical Reports Server (NTRS)

Abbott, Terence S.; Nataupsky, Mark; Steinmetz, George G.

1987-01-01

A ground-based aircraft simulation study was conducted to determine the effects on pilot preference and performance of integrating airspeed and altitude information into an advanced electronic primary flight display via moving-tape (linear moving scale) formats. Several key issues relating to the implementation of moving-tape formats were examined in this study: tape centering, tape orientation, and trend information. The factor of centering refers to whether the tape was centered about the actual airspeed or altitude or about some other defined reference value. Tape orientation refers to whether the represented values are arranged in descending or ascending order. Two pilots participated in this study, with each performing 32 runs along seemingly random, previously unknown flight profiles. The data taken, analyzed, and presented consisted of path performance parameters, pilot-control inputs, and electrical brain response measurements.

Evaluating the interior thermal performance of mosques in the tropical environment

NASA Astrophysics Data System (ADS)

Nordin, N. I.; Misni, A.

2018-02-01

This study introduces the methodology applied in conducting data collection and data analysis. Data collection is the process of gathering and measuring information on targeted variables in an established systematic method. Qualitative and quantitative methods are combined in collecting data from government departments, site experiments and observation. Furthermore, analysing the indoor thermal performance data in the heritage and new mosques were used thermal monitoring tests, while validation will be made by meteorology data. Origin 8 version of the software is used to analyse all the data. Comparison techniques were applied to analyse several factors that influence the indoor thermal performance of mosques, namely building envelope include floor area, opening, and material used. Building orientation, location, surrounding vegetation and water elements are also recorded as supported building primary data. The comparison of primary data using these variables for four mosques include heritage and new buildings were revealed.

Do clinical standards for diabetes care address excess risk for hypoglycemia in vulnerable patients? A systematic review.

PubMed

Berkowitz, Seth A; Aragon, Katherine; Hines, Jonas; Seligman, Hilary; Lee, Sei; Sarkar, Urmimala

2013-08-01

To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources. Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations. Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form. We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome. Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations. © Health Research and Educational Trust.

[Quality of health care for diabetic and hypertensive patients in primary care settings servicing Mexican Seguro Popular].

PubMed

Ortiz-Domínguez, Maki E; Garrido-Latorre, Francisco; Orozco, Ricardo; Pineda-Pérez, Dayana; Rodríguez-Salgado, Marlenne

2011-01-01

To assess health care quality provided to type-2 diabetic and hypertensive patients in primary care settings from the Mexican Ministry of Health and to evaluate whether accredited clinics providing services to the Mexican Seguro Popular performed better in terms of metabolic control of those patients compared to the non-accredited. Cross-sectional study performed on 2008. Previous year clinical measures were obtained from 5 444 diabetic and 5 827 hypertensive patient's clinical records. Adequate metabolic control (glucose <110 mg/dl for diabetes and blood pressure <140/90 mmHg for hypertension) associated factors were assessed by multiple-multilevel logistic regression methods. Patients attending accredited clinics were more likely to be controlled, however, metabolic control was not constant over time of accreditation. Additional efforts are required to monitor accredited clinics' performance in order to maintain both metabolic control and clinical assessment of patients.

Performance indicators and indices of sludge management in urban wastewater treatment plants.

PubMed

Silva, C; Saldanha Matos, J; Rosa, M J

2016-12-15

Sludge (or biosolids) management is highly complex and has a significant cost associated with the biosolids disposal, as well as with the energy and flocculant consumption in the sludge processing units. The sludge management performance indicators (PIs) and indices (PXs) are thus core measures of the performance assessment system developed for urban wastewater treatment plants (WWTPs). The key PIs proposed cover the sludge unit production and dry solids concentration (DS), disposal/beneficial use, quality compliance for agricultural use and costs, whereas the complementary PIs assess the plant reliability and the chemical reagents' use. A key PI was also developed for assessing the phosphorus reclamation, namely through the beneficial use of the biosolids and the reclaimed water in agriculture. The results of a field study with 17 Portuguese urban WWTPs in a 5-year period were used to derive the PI reference values which are neither inherent to the PI formulation nor literature-based. Clusters by sludge type (primary, activated, trickling filter and mixed sludge) and by digestion and dewatering processes were analysed and the reference values for sludge production and dry solids were proposed for two clusters: activated sludge or biofilter WWTPs with primary sedimentation, sludge anaerobic digestion and centrifuge dewatering; activated sludge WWTPs without primary sedimentation and anaerobic digestion and with centrifuge dewatering. The key PXs are computed for the DS after each processing unit and the complementary PXs for the energy consumption and the operating conditions DS-determining. The PX reference values are treatment specific and literature based. The PI and PX system was applied to a WWTP and the results demonstrate that it diagnosis the situation and indicates opportunities and measures for improving the WWTP performance in sludge management. Copyright © 2016 Elsevier Ltd. All rights reserved.

Use of quality indicators in physical therapist practice: an observational study.

PubMed

Jette, Diane U; Jewell, Dianne V

2012-04-01

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 contain provisions specific to health care quality that apply to physical therapists. Published evidence examining gaps in the quality of physical therapy services is limited. The primary purpose of this study was to determine the use of quality indicators in physical therapist practice. This was an observational study. All members of the Orthopaedic and Private Practice sections of the American Physical Therapy Association were invited to participate by completing an electronic survey. The survey included 22 brief patient descriptions, each followed by questions regarding the use of examinations and interventions based on the 2009 list of Medicare-approved quality measures. Separate multivariate logistic regression models were used to determine the odds ratios related to the performance of each examination and intervention on more than 90% of patients, given perceptions of its importance to care, the burden of performing it, and the level of evidence supporting its use. Participants (n=2,544) reported a relatively low frequency of performing examinations and interventions supporting primary and secondary prevention (3.6%-51.3%) and use of standardized measures (5.5%-35.8%). Perceptions of high importance and low burden were associated with greater odds of performing an examination or intervention. Importance and burden were more influential factors than the perceived availability of evidence to support use of identified techniques. The survey was not assessed for test-retest reliability. A low response rate was a source of potential bias. The study findings suggest that physical therapists may not see themselves as providers of primary or secondary prevention services. Patient management strategies associated with these types of services also may be perceived as relatively unimportant or burdensome.

Quantitative Primary Tumor Indocyanine Green Measurements Predict Osteosarcoma Metastatic Lung Burden in a Mouse Model.

PubMed

Fourman, Mitchell S; Mahjoub, Adel; Mandell, Jon B; Yu, Shibing; Tebbets, Jessica C; Crasto, Jared A; Alexander, Peter E; Weiss, Kurt R

2018-03-01

Current preclinical osteosarcoma (OS) models largely focus on quantifying primary tumor burden. However, most fatalities from OS are caused by metastatic disease. The quantification of metastatic OS currently relies on CT, which is limited by motion artifact, requires intravenous contrast, and can be technically demanding in the preclinical setting. We describe the ability for indocyanine green (ICG) fluorescence angiography to quantify primary and metastatic OS in a previously validated orthotopic, immunocompetent mouse model. (1) Can near-infrared ICG fluorescence be used to attach a comparable, quantitative value to the primary OS tumor in our experimental mouse model? (2) Will primary tumor fluorescence differ in mice that go on to develop metastatic lung disease? (3) Does primary tumor fluorescence correlate with tumor volume measured with CT? Six groups of 4- to 6-week-old immunocompetent Balb/c mice (n = 6 per group) received paraphyseal injections into their left hindlimb proximal tibia consisting of variable numbers of K7M2 mouse OS cells. A hindlimb transfemoral amputation was performed 4 weeks after injection with euthanasia and lung extraction performed 10 weeks after injection. Histologic examination of lung and primary tumor specimens confirmed ICG localization only within the tumor bed. Mice with visible or palpable tumor growth had greater hindlimb fluorescence (3.5 ± 2.3 arbitrary perfusion units [APU], defined as the fluorescence pixel return normalized by the detector) compared with those with a negative examination (0.71 ± 0.38 APU, -2.7 ± 0.5 mean difference, 95% confidence interval -3.7 to -1.8, p < 0.001). A strong linear trend (r = 0.81, p < 0.01) was observed between primary tumor and lung fluorescence, suggesting that quantitative ICG tumor fluorescence is directly related to eventual metastatic burden. We did not find a correlation (r = 0.04, p = 0.45) between normalized primary tumor fluorescence and CT volumetric measurements. We demonstrate a novel methodology for quantifying primary and metastatic OS in a previously validated, immunocompetent, orthotopic mouse model. Quantitative fluorescence of the primary tumor with ICG angiography is linearly related to metastatic burden, a relationship that does not exist with respect to clinical tumor size. This highlights the potential utility of ICG near-infrared fluorescence imaging as a valuable preclinical proof-of-concept modality. Future experimental work will use this model to evaluate the efficacy of novel OS small molecule inhibitors. Given the histologic localization of ICG to only the tumor bed, we envision the clinical use of ICG angiography as an intraoperative margin and tumor detector. Such a tool may be used as an alternative to intraoperative histology to confirm negative primary tumor margins or as a valuable tool for debulking surgeries in vulnerable anatomic locations. Because we have demonstrated the successful preservation of ICG in frozen tumor samples, future work will focus on blinded validation of this modality in observational human trials, comparing the ICG fluorescence of harvested tissue samples with fresh frozen pathology.

Primary versus secondary tracheoesophageal puncture for voice rehabilitation in laryngectomy patients: A systematic review.

PubMed

Luu, K; Chang, B A; Valenzuela, D; Anderson, D

2018-05-16

Among voice restoration options following laryngectomy, tracheoesophageal puncture (TEP) appears to be the most common. Currently, there is no consensus that exists with regard to the timing of performing TEP and the decision to perform a primary or secondary TEP has mostly been based on physician preference and expert opinion rather than data. The objective of this study was to compare primary and secondary tracheoesophageal puncture (TEP) for voice rehabilitation in laryngectomy patients in terms of success and complication rates. A systematic review of studies in the English literature was conducted for studies that directly compared primary and secondary TEP. A comprehensive search of MEDLINE (January 1948-15 July 2016), EMBASE (January 1974-15 July 2016) and Web of Science (January 1970-15 July 2016) was performed. Two authors (KL/BAC) independently reviewed titles and abstracts, read full-text papers, extracted data and assessed quality. Disagreements were resolved via consensus. A third author (DV) resolved disagreements between reviewers when consensus was not possible. Eleven retrospective clinical cohort studies were included. No randomised controlled trials were identified. Newcastle-Ottawa score for assessment of quality ranged from 5 to 7. Success rate was defined differently across most studies. Two studies found higher success with primary TEP compared to secondary TEP; nine studies found no difference. Voice outcomes were inconsistently measured; no difference between groups was found in 4 studies. Complication rates were divided into TEP site related, infectious and stenosis. No difference between primary and secondary TEP was found in all but one study which showed a higher rate of pharyngocutaneous fistula in the primary TEP group in salvage laryngectomy patients. There is no robust evidence to suggest that primary TEP is associated with poorer outcomes compared to secondary TEP. A well-designed randomised controlled trial is required to appropriately answer this question. © 2018 John Wiley & Sons Ltd.

Do case-generic measures of queue performance for bypass surgery accurately reflect the waiting-list experiences of those most urgent?

PubMed

Burstein, Jason; Lee, Douglas S; Alter, David A

2006-02-01

Queue performance is typically assessed using generic measures, which capture the queue in aggregate. The objective of this study was to examine whether case-generic measures of queue performance appropriately reflected the waiting-list experiences of those patients with greatest disease severity. We examined the queue for isolated coronary artery bypass grafting (CABG) in Ontario between April 1993 and March 2000 using data obtained from the Cardiac Care Network. Our primary measure of queue performance was the proportion of patients who received their bypass surgery within their recommended maximum waiting times (%RMWTs) in any given month. We compared case-generic measures of queue performance to case-specific measures of queue performance stratified by urgency level. The queue was largely comprised of elective cases ranging from 73% (1993) to 57%(1999). Urgent patients comprised the minority of the queue ranging from 14% (1993) to 20% (1999). Case-generic month-to-month variations in the percentage of cases completed within RMWTs (an aggregated waiting list measure encompassing the characteristics of all patients in the queue) closely resembled the experiences of elective patients (R2 = 0.81), but conversely, bore little relationship to the waiting-list experiences of those most urgent (R2 = 0.15). Case-generic measures of queue performance for bypass surgery in Ontario were not reflective of the waiting-list experiences of those most urgent. Our results reinforce the concept that urgency-specific waiting list monitoring systems are required to best evaluate and appropriately respond to fluctuations in queue performance.

Stable estimate of primary OC/EC ratios in the EC tracer method

NASA Astrophysics Data System (ADS)

Chu, Shao-Hang

In fine particulate matter studies, the primary OC/EC ratio plays an important role in estimating the secondary organic aerosol contribution to PM2.5 concentrations using the EC tracer method. In this study, numerical experiments are carried out to test and compare various statistical techniques in the estimation of primary OC/EC ratios. The influence of random measurement errors in both primary OC and EC measurements on the estimation of the expected primary OC/EC ratios is examined. It is found that random measurement errors in EC generally create an underestimation of the slope and an overestimation of the intercept of the ordinary least-squares regression line. The Deming regression analysis performs much better than the ordinary regression, but it tends to overcorrect the problem by slightly overestimating the slope and underestimating the intercept. Averaging the ratios directly is usually undesirable because the average is strongly influenced by unrealistically high values of OC/EC ratios resulting from random measurement errors at low EC concentrations. The errors generally result in a skewed distribution of the OC/EC ratios even if the parent distributions of OC and EC are close to normal. When measured OC contains a significant amount of non-combustion OC Deming regression is a much better tool and should be used to estimate both the primary OC/EC ratio and the non-combustion OC. However, if the non-combustion OC is negligibly small the best and most robust estimator of the OC/EC ratio turns out to be the simple ratio of the OC and EC averages. It not only reduces random errors by averaging individual variables separately but also acts as a weighted average of ratios to minimize the influence of unrealistically high OC/EC ratios created by measurement errors at low EC concentrations. The median of OC/EC ratios ranks a close second, and the geometric mean of ratios ranks third. This is because their estimations are insensitive to questionable extreme values. A real world example is given using the ambient data collected from an Atlanta STN site during the winter of 2001-2002.

Edge Stabilized Ribbon (ESR); Stress, Dislocation Density and Electronic Performance

NASA Technical Reports Server (NTRS)

Sachs, E. M.

1984-01-01

The edge stabilized ribbon (ESR) silicon ribbon was grown in widths of 1, 2.2 and 4.0 inches at speeds ranging from .6 to 7 in/min, which result in ribbon thicknesses of 5 to 400 microns. One of the primary problems remaining in ESR growth is that of thermally induced mechanical stresses. This problem is manifested as ribbon with a high degree of residual stress or as ribbon with buckled ribbon. Thermal stresses result in a high dislocation density in the grown material, resulting in compromised electronic performance. Improvements in ribbon flatness were accomplished by modification of the ribbon cooling profile. Ribbon flatness and other experimental observations of ESR ribbon are discussed. Laser scanner measurements show a good correlation between diffusion length and dislocation density which indicates that the high dislocation densities are the primary cause of the poor current performance of ESR materials. Dislocation densities were reduced and improved electronic performance resulted. Laser scanner data on new and old material are presented.

Patient-reported outcome measures versus inertial performance-based outcome measures: A prospective study in patients undergoing primary total knee arthroplasty.

PubMed

Bolink, S A A N; Grimm, B; Heyligers, I C

2015-12-01

Outcome assessment of total knee arthroplasty (TKA) by subjective patient reported outcome measures (PROMs) may not fully capture the functional (dis-)abilities of relevance. Objective performance-based outcome measures could provide distinct information. An ambulant inertial measurement unit (IMU) allows kinematic assessment of physical performance and could potentially be used for routine follow-up. To investigate the responsiveness of IMU measures in patients following TKA and compare outcomes with conventional PROMs. Patients with end stage knee OA (n=20, m/f=7/13; age=67.4 standard deviation 7.7 years) were measured preoperatively and one year postoperatively. IMU measures were derived during gait, sit-stand transfers and block step-up transfers. PROMs were assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS). Responsiveness was calculated by the effect size, correlations were calculated with Spearman's rho correlation coefficient. One year after TKA, patients performed significantly better at gait, sit-to-stand transfers and block step-up transfers. Measures of time and kinematic IMU measures demonstrated significant improvements postoperatively for each performance-based test. The largest improvement was found in block step-up transfers (effect size=0.56-1.20). WOMAC function score and KSS function score demonstrated moderate correlations (Spearman's rho=0.45-0.74) with some of the physical performance-based measures pre- and postoperatively. To characterize the changes in physical function after TKA, PROMs could be supplemented by performance-based measures, assessing function during different activities and allowing kinematic characterization with an ambulant IMU. Copyright © 2015 Elsevier B.V. All rights reserved.

Monogamy versus Consensual Non-Monogamy: Alternative Approaches to Pursuing a Strategically Pluralistic Mating Strategy.

PubMed

Mogilski, Justin K; Memering, Stacy L; Welling, Lisa L M; Shackelford, Todd K

2017-02-01

This study examined the frequency of partner-directed mate retention behaviors and several self- and partner-rated romantic relationship evaluations (i.e., sociosexuality, relationship satisfaction, mate value, and partner ideal measures) within monogamous and consensually non-monogamous (CNM) relationships. Measures were compared (1) between monogamous and CNM participants and (2) between two concurrent partners within each CNM relationship (i.e., primary and secondary partners). We found that individuals in currently monogamous relationships (n = 123) performed more mate retention behaviors compared to those currently in CNM relationships (n = 76). Within CNM relationships, participants reported engaging in more mate retention behaviors with primary partners compared to secondary partners. Likewise, CNM participants reported talking about their extra-dyadic sexual experiences and downplaying these sexual experiences more often with their primary partner compared to their secondary partner. There were no significant differences between ratings of monogamous and primary partners in participants' overall relationship satisfaction. However, monogamous participants reported less satisfaction with the amount of communication and openness they had with their partner compared to CNM participants' reports of their primary partner, but not secondary partner. By comparison, CNM participants reported higher overall relationship satisfaction with primary compared to secondary partners and considered their primary partner to be more desirable as a long-term mate than their secondary partner. We interpret these results within the context of previous research on monogamous and CNM relationships and hypothesize that these relationship configurations are alternative strategies for pursuing a strategically pluralistic mating strategy.

Optimal Control Allocation with Load Sensor Feedback for Active Load Suppression

NASA Technical Reports Server (NTRS)

Miller, Christopher

2017-01-01

These slide sets describe the OCLA formulation and associated algorithms as a set of new technologies in the first practical application of load limiting flight control utilizing load feedback as a primary control measurement. Slide set one describes Experiment Development and slide set two describes Flight-Test Performance.

Validation of SMAP surface soil moisture products with core validation sites

USDA-ARS?s Scientific Manuscript database

The NASA Soil Moisture Active Passive (SMAP) mission has utilized a set of core validation sites as the primary methodology in assessing the soil moisture retrieval algorithm performance. Those sites provide well-calibrated in situ soil moisture measurements within SMAP product grid pixels for diver...

Copper Indium Gallium Diselenide Solar Cells | Photovoltaic Research | NREL

Science.gov Websites

primary research areas that are currently our focus are the following: Understanding effects of material . Such metastable effects frustrate the repeatable and accurate measurement of a module's performance in by perturbing the voltage bias or temperature. Another associated challenge is that elevated

A Curriculum without Foundation

ERIC Educational Resources Information Center

Boyle, Bill; Bragg, Joanna

2006-01-01

Peter Tymms has written recently ("BERJ", August 2004) on the subject of measuring whether standards are rising in English and mathematics in primary schools based on pupil outcomes from national end of key stage tests. This article takes the position that the performance data debate is an interesting one but peripheral to a far bigger…

Collaboration in Pennsylvania: Rapidly Spreading Improved Chronic Care for Patients to Practices

ERIC Educational Resources Information Center

Bricker, Patricia L.; Baron, Richard J.; Scheirer, Jorge J.; DeWalt, Darren A.; Derrickson, John; Yunghans, Suzanne; Gabbay, Robert A.

2010-01-01

Introduction: Pennsylvania's Improving Performance in Practice (IPIP) program is administered by the Pennsylvania (PA) chapters of the American Academy of Family Physicians, American College of Physicians, and American Academy of Pediatrics. The project has provided coaching, monthly measurement, and patient registry support for 155 primary-care…

(PRESENTED NAQC SAN FRANCISCO, CA) COARSE PM METHODS STUDY: STUDY DESIGN AND RESULTS

EPA Science Inventory

Comprehensive field studies were conducted to evaluate the performance of sampling methods for measuring the coarse fraction of PM10 in ambient air. Five separate sampling approaches were evaluated at each of three sampling sites. As the primary basis of comparison, a discrete ...

MULTI-SITE EVALUATIONS OF CANDIDATE METHODOLOGIES FOR DETERMINING COARSE PARTICULATE MATTER (PMC) CONCENTRATIONS

EPA Science Inventory

Comprehensive field studies were conducted to evaluate the performance of sampling methods for measuring the coarse fraction of PM10 in ambient air. Five separate sampling approaches were evaluated at each of three sampling sites. As the primary basis of comparison, a discret...

MULTI-SITE EVALUATIONS OF CANDIDATE METHODOLOGIES FOR DETERMINING COARSE PARTICULATE MATTER (PMC) CONCENTRATIONS

EPA Science Inventory

Comprehensive field studies were conducted to evaluate the performance of sampling methods for measuring the coarse fraction of PM10 in ambient air. Five separate sampling approaches were evaluated at each of three sampling sites. As the primary basis of comparison, a discrete ...

Realization of the medium and high vacuum primary standard in CENAM, Mexico

NASA Astrophysics Data System (ADS)

Torres-Guzman, J. C.; Santander, L. A.; Jousten, K.

2005-12-01

A medium and high vacuum primary standard, based on the static expansion method, has been set up at Centro Nacional de Metrología (CENAM), Mexico. This system has four volumes and covers a measuring range of 1 × 10-5 Pa to 1 × 103 Pa of absolute pressure. As part of its realization, a characterization was performed, which included volume calibrations, several tests and a bilateral key comparison. To determine the expansion ratios, two methods were applied: the gravimetric method and the method with a linearized spinning rotor gauge. The outgassing ratios for the whole system were also determined. A comparison was performed with Physikalisch-Technische Bundesanstalt (comparison SIM-Euromet.M.P-BK3). By means of this comparison, a link has been achieved with the Euromet comparison (Euromet.M.P-K1.b). As a result, it is concluded that the value obtained at CENAM is equivalent to the Euromet reference value, and therefore the design, construction and operation of CENAM's SEE-1 vacuum primary standard were successful.

Dynamic Analysis of the Abnormal Isometric Strength Movement Pattern between Shoulder and Elbow Joint in Patients with Hemiplegia.

PubMed

Liu, Yali; Hong, Yuezhen; Ji, Linhong

2018-01-01

Patients with hemiplegia usually have weak muscle selectivity and usually perform strength at a secondary joint (secondary strength) during performing a strength at one joint (primary strength). The abnormal strength pattern between shoulder and elbow joint has been analyzed by the maximum value while the performing process with strength changing from 0 to maximum then to 0 was a dynamic process. The objective of this study was to develop a method to dynamically analyze the strength changing process. Ten patients were asked to perform four group asks (maximum and 50% maximum voluntary strength in shoulder abduction, shoulder adduction, elbow flexion, and elbow extension). Strength and activities from seven muscles were measured. The changes of secondary strength had significant correlation with those of primary strength in all tasks ( R > 0.76, p < 0.01). The antagonistic muscles were moderately influenced by the primary strength ( R > 0.4, p < 0.01). Deltoid muscles, biceps brachii, triceps brachii, and brachioradialis had significant influences on the abnormal strength pattern (all p < 0.01). The dynamic method was proved to be efficient to analyze the different influences of muscles on the abnormal strength pattern. The muscles, deltoid muscles, biceps brachii, triceps brachii, and brachioradialis, much influenced the stereotyped movement pattern between shoulder and elbow joint.

Dynamic Analysis of the Abnormal Isometric Strength Movement Pattern between Shoulder and Elbow Joint in Patients with Hemiplegia

PubMed Central

2018-01-01

Patients with hemiplegia usually have weak muscle selectivity and usually perform strength at a secondary joint (secondary strength) during performing a strength at one joint (primary strength). The abnormal strength pattern between shoulder and elbow joint has been analyzed by the maximum value while the performing process with strength changing from 0 to maximum then to 0 was a dynamic process. The objective of this study was to develop a method to dynamically analyze the strength changing process. Ten patients were asked to perform four group asks (maximum and 50% maximum voluntary strength in shoulder abduction, shoulder adduction, elbow flexion, and elbow extension). Strength and activities from seven muscles were measured. The changes of secondary strength had significant correlation with those of primary strength in all tasks (R > 0.76, p < 0.01). The antagonistic muscles were moderately influenced by the primary strength (R > 0.4, p < 0.01). Deltoid muscles, biceps brachii, triceps brachii, and brachioradialis had significant influences on the abnormal strength pattern (all p < 0.01). The dynamic method was proved to be efficient to analyze the different influences of muscles on the abnormal strength pattern. The muscles, deltoid muscles, biceps brachii, triceps brachii, and brachioradialis, much influenced the stereotyped movement pattern between shoulder and elbow joint. PMID:29610654

Exploring the state of health and safety management system performance measurement in mining organizations.

PubMed

Haas, Emily Joy; Yorio, Patrick

2016-03-01

Complex arguments continue to be articulated regarding the theoretical foundation of health and safety management system (HSMS) performance measurement. The culmination of these efforts has begun to enhance a collective understanding. Despite this enhanced theoretical understanding, however, there are still continuing debates and little consensus. The goal of the current research effort was to empirically explore common methods to HSMS performance measurement in mining organizations. The purpose was to determine if value and insight could be added into the ongoing approaches of the best ways to engage in health and safety performance measurement. Nine site-level health and safety management professionals were provided with 133 practices corresponding to 20 HSMS elements, each fitting into the plan, do, check, act phases common to most HSMS. Participants were asked to supply detailed information as to how they (1) assess the performance of each practice in their organization, or (2) would assess each practice if it were an identified strategic imperative. Qualitative content analysis indicated that the approximately 1200 responses provided could be described and categorized into interventions , organizational performance , and worker performance . A discussion of how these categories relate to existing indicator frameworks is provided. The analysis also revealed divergence in two important measurement issues; (1) quantitative vs qualitative measurement and reporting; and (2) the primary use of objective or subjective metrics. In lieu of these findings we ultimately recommend a balanced measurement and reporting approach within the three metric categories and conclude with suggestions for future research.

Exploring the state of health and safety management system performance measurement in mining organizations

PubMed Central

Haas, Emily Joy; Yorio, Patrick

2016-01-01

Complex arguments continue to be articulated regarding the theoretical foundation of health and safety management system (HSMS) performance measurement. The culmination of these efforts has begun to enhance a collective understanding. Despite this enhanced theoretical understanding, however, there are still continuing debates and little consensus. The goal of the current research effort was to empirically explore common methods to HSMS performance measurement in mining organizations. The purpose was to determine if value and insight could be added into the ongoing approaches of the best ways to engage in health and safety performance measurement. Nine site-level health and safety management professionals were provided with 133 practices corresponding to 20 HSMS elements, each fitting into the plan, do, check, act phases common to most HSMS. Participants were asked to supply detailed information as to how they (1) assess the performance of each practice in their organization, or (2) would assess each practice if it were an identified strategic imperative. Qualitative content analysis indicated that the approximately 1200 responses provided could be described and categorized into interventions, organizational performance, and worker performance. A discussion of how these categories relate to existing indicator frameworks is provided. The analysis also revealed divergence in two important measurement issues; (1) quantitative vs qualitative measurement and reporting; and (2) the primary use of objective or subjective metrics. In lieu of these findings we ultimately recommend a balanced measurement and reporting approach within the three metric categories and conclude with suggestions for future research. PMID:26823642

Impact of the pay-for-performance contract and the management of hypertension in Scottish primary care: a 6-year population-based repeated cross-sectional study.

PubMed

Simpson, Colin R; Hannaford, Philip C; Ritchie, Lewis D; Sheikh, Aziz; Williams, David

2011-07-01

The 2004 introduction of the pay-for-performance contract has increased the proportion of income that GPs are able to earn by targeting quality care to patients with chronic diseases such as hypertension. To investigate the impact of pay for performance on the management of patients with hypertension in Scottish primary care. A population-based repeated cross-sectional study in Scottish primary care practices (n = 315) contributing to the Primary Care Clinical Informatics Unit database. A dataset was extracted on 826 973 patients aged ≥40 years including, age, sex, socioeconomic deprivation status, hypertension diagnosis, recorded blood pressure measurement, attainment of target blood pressure levels, and provision of hypertension-related prescribing for each year from 2001 until 2006. Increasing treatment for hypertension (absolute difference [AD] 9.2%; 95% confidence interval [CI] = 9.0 to 9.5) occurred throughout the study period. The majority of increases found in blood pressure measurement (AD 46.8%; 95% CI = 46.5 to 47.1) and recorded hypertension (AD 5.9%; 95% CI = 5.7 to 6.0) occurred prior to 2004. Blood pressure control increased throughout the study period (absolute increase ≤140/90 mmHg; 18.9%; 95% CI = 18.5 to 19.4). After 2004, the oldest female, as well as the male and female patients with the greatest socioeconomic deprivation status, became less likely than their youngest (<40 years) and most affluent counterparts to have a blood pressure measurement recorded (P<0.05). Patients not prescribed therapy were younger and had higher blood pressure levels (P<0.001). It is likely that the continued efforts of general practice to improve hypertension diagnosis, monitoring, and treatment will reduce future cardiovascular events and mortality in those with hypertension. However, there is a need to follow up patients who are older and more socioeconomically deprived once they are diagnosed, as well as prescribing antihypertensive therapy to younger patients, who are likely to benefit from early intervention.

Time to antibiotics for septic shock: evaluating a proposed performance measure.

PubMed

Venkatesh, Arjun K; Avula, Umakanth; Bartimus, Holly; Reif, Justin; Schmidt, Michael J; Powell, Emilie S

2013-04-01

International guidelines recommend antibiotics within 1 hour of septic shock recognition; however, a recently proposed performance measure is focused on measuring antibiotic administration within 3 hours of emergency department (ED) arrival. Our objective was to describe the time course of septic shock and subsequent implications for performance measurement. Cross-sectional study of consecutive ED patients ultimately diagnosed with septic shock. All patients were evaluated at an urban, academic ED in 2006 to 2008. Primary outcomes included time to definition of septic shock and performance on 2 measures: antibiotics within 3 hours of ED arrival vs antibiotics within 1 hour of septic shock definition. Of 267 patients with septic shock, the median time to definition was 88 minutes (interquartile range, 37-156), and 217 patients (81.9%) met the definition within 3 hours of arrival. Of 221 (83.4%) of patients who received antibiotics within 3 hours of arrival, 38 (17.2%) did not receive antibiotics within 1 hour of definition. Of 207 patients who received antibiotics within 1 hour of definition, 11.6% (n = 24) did not receive antibiotics within 3 hours of arrival. The arrival measure did not accurately classify performance in 23.4% of patients. Nearly 1 of 5 patients cannot be captured for performance measurement within 3 hours of ED arrival due to the variable progression of septic shock. Use of this measure would misclassify performance in 23% of patients. Measuring antibiotic administration based on the clinical course of septic shock rather than from ED arrival would be more appropriate. Copyright © 2013 Elsevier Inc. All rights reserved.

Peer Victimization and Academic Performance in Primary School Children.

PubMed

Mundy, Lisa K; Canterford, Louise; Kosola, Silja; Degenhardt, Louisa; Allen, Nicholas B; Patton, George C

Peer victimization is a common antecedent of poor social and emotional adjustment. Its relationship with objectively measured academic performance is unclear. In this study we aimed to quantify the cross-sectional associations between peer victimization and academic performance in a large population sample of children. Eight- to 9-year-old children were recruited from a stratified random sample of primary schools in Australia. Academic performance was measured on a national achievement test (1 year of learning equals 40 points). Physical and verbal victimization were measured according to child self-report. Multilevel mixed-effects linear regression analyses were conducted. For female children, verbal victimization was associated with poorer academic performance on writing (β = 17.2; 95% confidence interval [CI], -28.2 to -6.2) and grammar/punctuation (β = -20.8; 95% CI, -40.1 to -1.6). Physical victimization was associated with poorer performance on numeracy (male children: β = -29.0; 95% CI, -53.8 to -4.1; female children: β = -30.1; 95% CI, -56.6 to -3.5), and writing (female children: β = -21.5; 95% CI, -40.4 to -2.7). Verbal and physical victimization were associated with poorer performance on reading (male children: β = -31.5; 95% CI, -59.9 to -3.1; female children: β = -30.2; 95% CI, -58.6 to -1.8), writing (female children: β = -25.5; 95% CI, -42.8 to -8.2), spelling (female children: β = -32.3; 95% CI, -59.6 to -4.9), and grammar/punctuation (female children: β = -32.2; 95% CI, -62.4 to -2.0). Children who were physically victimized were 6 to 9 months behind their non-victimized peers on measures of academic performance. There are growing reasons for education systems to invest in the prevention of bullying and promotion of positive peer relationships from the earliest years of school. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Development of the TARGET Training Effectiveness Tool and Underlying Algorithms Specifying Training Method - Performance Outcome Relationships

DTIC Science & Technology

2014-05-01

hand and right hand on the piano, or strumming and chording on the guitar . Perceptual This skill category involves detecting and interpreting sensory...measured as the percent correct, # correct, accumulated points, task/test scoring correct action/timing/performance. This also includes quality rating by...competition and scoring , as well as constraints, privileges and penalties. Simulation-Based The primary delivery environment is an interactive synthetic

Using a heterodyne vibrometer in combination with pulse excitation for primary calibration of ultrasonic hydrophones in amplitude and phase

NASA Astrophysics Data System (ADS)

Weber, Martin; Wilkens, Volker

2017-08-01

A high-frequency vibrometer was used with ultrasonic pulse excitation in order to perform a primary hydrophone calibration. This approach enables the simultaneous characterization of the amplitude and phase transfer characteristic of ultrasonic hydrophones. The method allows a high frequency resolution in a considerably short time for the measurement. Furthermore, the uncertainty contributions of this approach were investigated and quantified. A membrane hydrophone was calibrated and the uncertainty budget for this measurement was determined. The calibration results are presented up to 70~\\text{MHz} . The measurement results show good agreement with the results obtained by sinusoidal burst excitation through the use of the vibrometer and by a homodyne laser interferometer, with RMS deviation of approximately 3% -4% in the frequency range from 1 to 60~\\text{MHz} . Further hydrophones were characterized up to 100~\\text{MHz} with this procedure to demonstrate the suitability for very high frequency calibration.

Theoretical and experimental analyses of the performance of two-color laser ranging systems

NASA Technical Reports Server (NTRS)

Im, K. E.; Gardner, C. S.

1985-01-01

The statistical properties of the signals reflected from the retroreflector equipped satellites were studied. It is found that coherence interference between pulse reflections from retroreflectors of different ranges on the array platform is the primary cause of signal fluctuations. The performance of a cross-correlation technique to estimate the differential propagation time is analyzed by considering both shot noise and speckle. For the retroreflector arrays, timing performance is dominated by interference induced speckle, and the differential propagation time cannot be resolved to better than the pulse widths of the received signals. The differential timing measurements obtained over a horizontal path are analyzed. The ocean-reflected pulse measurements obtained from the airborne two-color laser altimeter experiment are presented.

20 years of cosmic muons research performed in IFIN-HH

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

Mitrica, Bogdan

2012-11-20

During the last two decades a modern direction in particle physics research has been developed in IFIN-HH Bucharest, Romania. The history started with the WILLI detector built in IFIN-HH Bucharest in collaboration with KIT Karlsruhe (formerly Forschungszentrum Karlsruhe). The detector was designed for measurements of the low energy muon charge ratio (< 1GeV) based on a delayed coincidence method, measuring the decay time of the muons stopped in the detector: the positive muons decay freely, but the negative muons are captured in the atom thus creating muonic atoms and decay depending on the nature of the host atom. In amore » first configuration, the WILLI detector was placed in a fixed position for measuring vertical muons. Further WILLI has been transformed in a rotatable device which allows directional measurements of muon charge ratio and muon flux. The results exhibit a pronounced azimuthal asymmetry (East-West effect) due to the different in fluence of the geomagnetic field on the trajectories of positive and negative muons in air. In parallel, flux measurement, taking into account muon events with nergies > 0.4GeV, show a diurnal modulation of the muon flux. The analysis of the muon events for energies < 0.6GeV reveals an aperiodic variation of the muon flux. A new detection system performing coincidence measurements between the WILLI calorimeter and a small array of 12 scintillators plates has been installed in IFIN-HH starting from the autumn of 2010. The aim of the system is to investigate muon charge ratio from individual EAS by using the mini-array as trigger for the WILLI calorimeter. Such experimental studies could provide detailed information on hadronic interaction models and primary cosmic ray composition at energies around 10{sup 15}eV. Simulation studies and preliminary experimental tests, regarding the performances of the mini-array, have been performed using H and Fe primaries, with energies in a range 10{sup 13}eV - 10{sup 15}eV. The results show detailed effects of the direction of EAS incidence relative to the geomagnetic field, depending, in particular, of the primary mass. Based on the results, we can say that WILLI-EAS experiment could be used for testing the hadronic interaction models. Measurements of the high energy muon flux in underground of the salt mine from Slanic Prahova, Romania was performed using a new mobile detector developed in IFIN-HH, Bucharest. Consisting of 2 scintillator plates measuring in coincidence, the detector is installed on a van which facilitates measurements on different positions at surface or in underground. The detector was used to measure muon fluxes in different locations at surface or in underground. The detector was used to measure muon fluxes at different sites of Romania and in the underground of the salt mines from Slanic Prahova, Romania where IFIN-HH has a modern underground laboratory. New methods for the detection of cosmic ray muons are investigated in our institute based on scintillator techniques using optical fiber and MPPC photodyodes.« less

Use of manometric temperature measurement (MTM) and SMART freeze dryer technology for development of an optimized freeze-drying cycle.

PubMed

Gieseler, Henning; Kramer, Tony; Pikal, Michael J

2007-12-01

This report provides, for the first time, a summary of experiments using SMART Freeze Dryer technology during a 9 month testing period. A minimum ice sublimation area of about 300 cm(2) for the laboratory freeze dryer, with a chamber volume 107.5 L, was found consistent with data obtained during previous experiments with a smaller freeze dryer (52 L). Good reproducibility was found for cycle design with different type of excipients, formulations, and vials used. SMART primary drying end point estimates were accurate in the majority of the experiments, but showed an over prediction of primary cycle time when the product did not fully achieve steady state conditions before the first MTM measurement was performed. Product resistance data for 5% sucrose mixtures at varying fill depths were very reproducible. Product temperature determined by SMART was typically in good agreement with thermocouple data through about 50% of primary drying time, with significant deviations occurring near the end of primary drying, as expected, but showing a bias much earlier in primary drying for high solid content formulations (16.6% Pfizer product) and polyvinylpyrrolidone (40 kDa) likely due to water "re-adsorption" by the amorphous product during the MTM test. (c) 2007 Wiley-Liss, Inc.

[Reducing stress levels and anxiety in primary-care physicians through training and practice of a mindfulness meditation technique].

PubMed

Franco Justo, Clemente

2010-11-01

To check the effectiveness of a mindfulness development meditation technique on stress and anxiety in a group of primary-care physicians. Quasi-experimental with pretest/posttest/follow-up measurements in a control group and an experimental group. SITE: University of Almeria. 38 primary-care physicians enrolled in a Teaching Aptitude Course (CAP). An experimental group and a control group were formed with 19 participants in each. The experimental group took a psycho-educational meditation program for training and practice in mindfulness. The Perceived Stress Scale (PSS), the Strain Questionnaire and the State-Trait Anxiety Questionnaire were used to measure stress and anxiety levels. A comparative statistical analysis was performed using the Mann-Whitney non-parametric U test, finding a significant reduction in all the primary-care physician stress and anxiety variables in the experimental group compared to the control group in pretest-posttest and follow-up tests. The results of this study support the effectiveness of mindfulness development meditation techniques in decreasing stress and anxiety in primary-care physicians. Nevertheless, the study shows various limitations that would have to be corrected in successive studies to bring more validity to the results. Copyright © 2009 Elsevier España, S.L. All rights reserved.

Measurement of thyroxine and its glucuronide in municipal wastewater and solids using weak anion exchange solid phase extraction and ultrahigh performance liquid chromatography-tandem mass spectrometry.

PubMed

Brown, Alistair K; Wong, Charles S

2017-11-24

A solids extraction method, using sonication in combination with weak anion exchange solid phase extraction, was created to extract thyroxine (T4) and thyroxine-O-β-d-glucuronide (T4-Glc) simultaneously from wastewaters and sludges, and to quantify these compounds via reversed-phase ultra-high performance liquid chromatography-tandem mass spectrometry. The method limits of quantification were all in the low ng/g (dry weight solids) range for both T4 and T4-Glc: 2.13 and 2.63ng/g respectively in primary wastewater, 4.3 and 28.3ng/g for primary suspended solids, for 1.1 and 3.7ng/g for return activated sludge. Precision for measurements of T4 and T4-Glc were 2.6 and 6.5% (intraday) and 9.6 and 5.7% (interday) respectively, while linearity was 0.9967 and 0.9943 respectively. Overall recoveries for T4 and T4-Glc in primary suspended solids were 94% and 95%, and 86 and 101% in primary wastewater, respectively. Extraction efficiency tests using primary sludge determined that one methanol aliquot was sufficient during the extraction process as opposed to 2 or 3 aliquots. Mass loadings at the North Main Wastewater Treatment Plant in Winnipeg, Canada showed 316%, 714%, and 714% greater T4-Glc than T4 associated with the suspended solids of the primary, secondary, and final effluent respectively, yet 765% more T4 than T4-Glc associated with the solids of the mixed liquor. Moreover, 26% of T4 and 49% of T4-Glc were associated with the suspended solids during the treatment process. This method demonstrates the need to assess accurately both metabolite conjugates of contaminants of emerging concern, as well as the sorbed levels of particle-reactive analytes such as T4 in the aquatic environment. Copyright © 2017 Elsevier B.V. All rights reserved.

Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: A randomized placebo-controlled pilot study

PubMed Central

2011-01-01

Background Despite being the most commonly used herbal for sleep disorders, chamomile's (Matricaria recutita) efficacy and safety for treating chronic primary insomnia is unknown. We examined the preliminary efficacy and safety of chamomile for improving subjective sleep and daytime symptoms in patients with chronic insomnia. Methods We performed a randomized, double-blind, placebo-controlled pilot trial in 34 patients aged 18-65 years with DSM-IV primary insomnia for ≥ 6-months. Patients were randomized to 270 mg of chamomile twice daily or placebo for 28-days. The primary outcomes were sleep diary measures. Secondary outcomes included daytime symptoms, safety assessments, and effect size of these measures. Results There were no significant differences between groups in changes in sleep diary measures, including total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), sleep quality, and number of awakenings. Chamomile did show modest advantage on daytime functioning, although these did not reach statistical significance. Effect sizes were generally small to moderate (Cohen's d ≤ 0.20 to < 0.60) with sleep latency, night time awakenings, and Fatigue Severity Scale (FSS), having moderate effect sizes in favor of chamomile. However, TST demonstrated a moderate effect size in favor of placebo. There were no differences in adverse events reported by the chamomile group compared to placebo. Conclusion Chamomile could provide modest benefits of daytime functioning and mixed benefits on sleep diary measures relative to placebo in adults with chronic primary insomnia. However, further studies in select insomnia patients would be needed to investigate these conclusions. Trial Registration ClinicalTrials.gov Identifier NCT01286324 PMID:21939549

Factors Contributing to the Current Academic Performance of Both Private Primary Schools and Public Primary Schools: A Case of Kitale Municipality, Kenya

ERIC Educational Resources Information Center

Catherine, Ochenje

2015-01-01

There have been current controversial discussions concerning the performance of private primary schools versus public primary schools in the Kenya Certificate of Primary Examination (K.C.P.E.). Lately, the private primary schools appear to be performing better than public primary schools. For example; in the 2003 K.C.P.E. results, more than 31% of…

Panel management, team culture, and worklife experience.

PubMed

Willard-Grace, Rachel; Dubé, Kate; Hessler, Danielle; O'Brien, Bridget; Earnest, Gillian; Gupta, Reena; Shunk, Rebecca; Grumbach, Kevin

2015-09-01

Burnout and professional dissatisfaction are threats to the primary care workforce. We investigated the relationship between panel management capability, team culture, cynicism, and perceived "do-ability" of primary care among primary care providers (PCPs) and staff in primary care practices. We surveyed 326 PCPs and 142 staff members in 10 county-administered, 6 university-run, and 3 Veterans Affairs primary care clinics in a large urban area in 2013. Predictor variables included capability for performing panel management and perception of team culture. Outcome variables included 2 work experience measures--the Maslach Burnout Inventory cynicism scale and a 1-item measure of the "do-ability" of primary care this year compared with last year. Generalized Estimation Equation (GEE) models were used to account for clustering at the clinic level. Greater panel management capability and higher team culture were associated with lower cynicism among PCPs and staff and higher reported "do-ability" of primary care among PCPs. Panel management capability and team culture interacted to predict the 2 work experience outcomes. Among PCPs and staff reporting high team culture, there was little association between panel management capability and the outcomes, which were uniformly positive. However, there was a strong relationship between greater panel management capability and improved work experience outcomes for PCPs and staff reporting low team culture. Team-based processes of care such as panel management may be an important strategy to protect against cynicism and dissatisfaction in primary care, particularly in settings that are still working to improve their team culture. (c) 2015 APA, all rights reserved).

Effects of a Velocity-Vector Based Command Augmentation System and Synthetic Vision System Terrain Portrayal and Guidance Symbology Concepts on Single-Pilot Performance

NASA Technical Reports Server (NTRS)

Liu, Dahai; Goodrich, Kenneth H.; Peak, Bob

2010-01-01

This study investigated the effects of synthetic vision system (SVS) concepts and advanced flight controls on the performance of pilots flying a light, single-engine general aviation airplane. We evaluated the effects and interactions of two levels of terrain portrayal, guidance symbology, and flight control response type on pilot performance during the conduct of a relatively complex instrument approach procedure. The terrain and guidance presentations were evaluated as elements of an integrated primary flight display system. The approach procedure used in the study included a steeply descending, curved segment as might be encountered in emerging, required navigation performance (RNP) based procedures. Pilot performance measures consisted of flight technical performance, perceived workload, perceived situational awareness and subjective preference. The results revealed that an elevation based generic terrain portrayal significantly improved perceived situation awareness without adversely affecting flight technical performance or workload. Other factors (pilot instrument rating, control response type, and guidance symbology) were not found to significantly affect the performance measures.

Long-term observations of tropospheric ozone: GAW Measurement Guidelines

NASA Astrophysics Data System (ADS)

Tarasova, Oksana; Galbally, Ian E.; Schultz, Martin G.

2013-04-01

The Global Atmosphere Watch (GAW) Programme of the World Meteorological Organization (WMO) coordinates long-term observations of the chemical composition and physical properties of the atmosphere which are relevant for understanding of atmospheric chemistry and climate change. Atmospheric observations of reactive gases (tropospheric ozone, carbon monoxide, volatile organic compounds and nitrogen oxides) coordinated by the GAW Programme complement local and regional scale air quality monitoring efforts. As part of the GAW quality assurance (QA) system detailed measurement guidelines for atmospheric trace species are developed by international expert teams at irregular intervals. The most recent report focuses on continuous in-situ measurements of ozone in the troposphere, performed in particular at continental or island sites with altitudes ranging from sea level to mountain tops. Data Quality Objectives (DQOs) are defined for different applications of the data (e.g. trend analysis and verification of global model forecasts). These DQOs include a thorough discussion of the tolerable level of measurement uncertainty and data completeness. The guidelines present the best practices and practical arrangements adopted by the GAW Programme in order to enable the GAW station network to approach or achieve the defined tropospheric ozone DQOs. The document includes information on the selection of station and measurement locations, required skills and training of staff, recommendations on the measurement technique and the necessary equipment to perform highest quality measurements, rules for conducting the measurements, preparing the data and archiving them, and more. Much emphasis is given to discussions about how to ensure the quality of the data through tracing calibrations back to primary standards, proper calibration and data analysis, etc. In the GAW Programme the QA system is implemented through Central Facilities (Central Calibration Laboratories, World and Regional Calibration Centers and World Data Centers), Scientific Advisory Groups and GAW Training and Education Center. These bodies support primary standards, provide calibration and data archiving facilities, coordinate comparison campaigns, perform stations audit, provide documentation and training of personnel.

Evaluation of diabetic foot screening in Primary Care.

PubMed

Alonso-Fernández, Margarita; Mediavilla-Bravo, José Javier; López-Simarro, Flora; Comas-Samper, José Manuel; Carramiñana-Barrera, Francisco; Mancera-Romero, José; de Santiago Nocito, Ana

2014-01-01

To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening. A multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded. In the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P<.001), history of neuropathy (P=.005), and history of peripheral artery disease (P<.05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P<.001) and economic incentives for goal attainment (P<.001). Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

Dosimetric characterization of a new directional low-dose rate brachytherapy source.

PubMed

Aima, Manik; DeWerd, Larry A; Mitch, Michael G; Hammer, Clifford G; Culberson, Wesley S

2018-05-24

CivaTech Oncology Inc. (Durham, NC) has developed a novel low-dose rate (LDR) brachytherapy source called the CivaSheet. TM The source is a planar array of discrete elements ("CivaDots") which are directional in nature. The CivaDot geometry and design are considerably different than conventional LDR cylindrically symmetric sources. Thus, a thorough investigation is required to ascertain the dosimetric characteristics of the source. This work investigates the repeatability and reproducibility of a primary source strength standard for the CivaDot and characterizes the CivaDot dose distribution by performing in-phantom measurements and Monte Carlo (MC) simulations. Existing dosimetric formalisms were adapted to accommodate a directional source, and other distinguishing characteristics including the presence of gold shield x-ray fluorescence were addressed in this investigation. Primary air-kerma strength (S K ) measurements of the CivaDots were performed using two free-air chambers namely, the Variable-Aperture Free-Air Chamber (VAFAC) at the University of Wisconsin Medical Radiation Research Center (UWMRRC) and the National Institute of Standards and Technology (NIST) Wide-Angle Free-Air Chamber (WAFAC). An intercomparison of the two free-air chamber measurements was performed along with a comparison of the different assumed CivaDot energy spectra and associated correction factors. Dose distribution measurements of the source were performed in a custom polymethylmethacrylate (PMMA) phantom using Gafchromic TM EBT3 film and thermoluminescent dosimeter (TLD) microcubes. Monte Carlo simulations of the source and the measurement setup were performed using MCNP6 radiation transport code. The CivaDot S K was determined using the two free-air chambers for eight sources with an agreement of better than 1.1% for all sources. The NIST measured CivaDot energy spectrum intensity peaks were within 1.8% of the MC-predicted spectrum intensity peaks. The difference in the net source-specific correction factor determined for the CivaDot free-air chamber measurements for the NIST WAFAC and UW VAFAC was 0.7%. The dose-rate constant analog was determined to be 0.555 cGy h -1 U -1 . The average difference observed in the estimated CivaDot dose-rate constant analog using measurements and MCNP6-predicted value (0.558 cGy h -1 U -1 ) was 0.6% ± 2.3% for eight CivaDot sources using EBT3 film, and -2.6% ± 1.7% using TLD microcube measurements. The CivaDot two-dimensional dose-to-water distribution measured in phantom was compared to the corresponding MC predictions at six depths. The observed difference using a pixel-by-pixel subtraction map of the measured and the predicted dose-to-water distribution was generally within 2-3%, with maximum differences up to 5% of the dose prescribed at the depth of 1 cm. Primary S K measurements of the CivaDot demonstrated good repeatability and reproducibility of the free-air chamber measurements. Measurements of the CivaDot dose distribution using the EBT3 film stack phantom and its subsequent comparison to Monte Carlo-predicted dose distributions were encouraging, given the overall uncertainties. This work will aid in the eventual realization of a clinically viable dosimetric framework for the CivaSheet based on the CivaDot dose distribution. © 2018 American Association of Physicists in Medicine.

Sensitivity of Magnetospheric Multi-Scale (MMS) Mission Navigation Accuracy to Major Error Sources

NASA Technical Reports Server (NTRS)

Olson, Corwin; Long, Anne; Car[emter. Russell

2011-01-01

The Magnetospheric Multiscale (MMS) mission consists of four satellites flying in formation in highly elliptical orbits about the Earth, with a primary objective of studying magnetic reconnection. The baseline navigation concept is independent estimation of each spacecraft state using GPS pseudorange measurements referenced to an Ultra Stable Oscillator (USO) with accelerometer measurements included during maneuvers. MMS state estimation is performed onboard each spacecraft using the Goddard Enhanced Onboard Navigation System (GEONS), which is embedded in the Navigator GPS receiver. This paper describes the sensitivity of MMS navigation performance to two major error sources: USO clock errors and thrust acceleration knowledge errors.

Sensitivity of Magnetospheric Multi-Scale (MMS) Mission Naviation Accuracy to Major Error Sources

NASA Technical Reports Server (NTRS)

Olson, Corwin; Long, Anne; Carpenter, J. Russell

2011-01-01

The Magnetospheric Multiscale (MMS) mission consists of four satellites flying in formation in highly elliptical orbits about the Earth, with a primary objective of studying magnetic reconnection. The baseline navigation concept is independent estimation of each spacecraft state using GPS pseudorange measurements referenced to an Ultra Stable Oscillator (USO) with accelerometer measurements included during maneuvers. MMS state estimation is performed onboard each spacecraft using the Goddard Enhanced Onboard Navigation System (GEONS), which is embedded in the Navigator GPS receiver. This paper describes the sensitivity of MMS navigation performance to two major error sources: USO clock errors and thrust acceleration knowledge errors.

Primary care quality in the Medicare Program: comparing the performance of Medicare health maintenance organizations and traditional fee-for-service medicare.

PubMed

Safran, Dana Gelb; Wilson, Ira B; Rogers, William H; Montgomery, Jana E; Chang, Hong

2002-04-08

Since 1972, Medicare beneficiaries have had the option of enrolling in a Medicare-qualified health maintenance organization (HMO). Little information exists to inform beneficiaries' choices between the traditional fee-for-service (FFS) Medicare program and an HMO. To compare the primary care received by seniors in Medicare HMOs with that of seniors in the traditional FFS Medicare program, and among HMOs, and to examine performance differences associated with HMO model-type and profit status. Data were derived from a cross-sectional observational survey of Medicare beneficiaries 65 years or older in the 13 states with mature, substantial Medicare HMO markets. Only beneficiaries continuously enrolled for 12 months or more in traditional FFS Medicare or a qualified Medicare HMO were eligible. Data were obtained using a 5-stage protocol involving mail and telephone (64% response rate). Analyses included respondents who identified a primary physician and had all required data elements (N = 8828). We compared FFS and HMO performance on 11 summary scales measuring 7 defining characteristics of primary care: (1) access, (2) continuity, (3) integration, (4) comprehensiveness, (5) "whole-person" orientation, (6) clinical interaction, and (7) sustained clinician-patient partnership. For 9 of 11 indicators, performance favored traditional FFS Medicare over HMOs (P<.001). Financial access favored HMOs (P<.001). Preventive counseling did not differ by system. Network-model HMOs performed more favorably than staff/group-model HMOs on 9 of 11 indicators (P<.001). Few differences were associated with HMO profit status. The findings are consistent with previous comparisons of indemnity insurance and network-model and staff/group-model HMOs in elderly and nonelderly populations. The stability of results across time, geography, and populations suggests that the relative strengths and weaknesses of each system are enduring attributes of their care. Medicare enrollees seem to face the perennial cost-quality trade-off: that is, deciding whether the advantages of primary care under traditional FFS Medicare are worth the higher out-of-pocket costs.

Identification, summary and comparison of tools used to measure organizational attributes associated with chronic disease management within primary care settings.

PubMed

Lukewich, Julia; Corbin, Renée; VanDenKerkhof, Elizabeth G; Edge, Dana S; Williamson, Tyler; Tranmer, Joan E

2014-12-01

Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Systematic search and review methodology consisting of a comprehensive and exhaustive search that is based on a broad question to identify the best available evidence was employed. A total of 30 organizational attribute data collection tools that have been used within the primary care setting were identified. The tools varied with respect to overall focus and level of organizational detail captured, theoretical foundations, administration and completion methods, types of questions asked, and the extent to which psychometric property testing had been performed. The tools utilized within the Quality and Costs of Primary Care in Europe study and the Canadian Primary Health Care Practice-Based Surveys were the most recently developed tools. Furthermore, of the 30 tools reviewed, the Canadian Primary Health Care Practice-Based Surveys collected the most information on organizational attributes. There is a need to collect primary care organizational attribute information at a national level to better understand factors affecting the quality of chronic disease prevention and management across a given country. The data collection tools identified in this review can be used to establish data collection strategies to collect this important information. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Performance Evaluation of Five Turbidity Sensors in Three Primary Standards

USGS Publications Warehouse

Snazelle, Teri T.

2015-10-28

Open-File Report 2015-1172 is temporarily unavailable.Five commercially available turbidity sensors were evaluated by the U.S. Geological Survey, Hydrologic Instrumentation Facility (HIF) for accuracy and precision in three types of turbidity standards; formazin, StablCal, and AMCO Clear (AMCO–AEPA). The U.S. Environmental Protection Agency (EPA) recognizes all three turbidity standards as primary standards, meaning they are acceptable for reporting purposes. The Forrest Technology Systems (FTS) DTS-12, the Hach SOLITAX sc, the Xylem EXO turbidity sensor, the Yellow Springs Instrument (YSI) 6136 turbidity sensor, and the Hydrolab Series 5 self-cleaning turbidity sensor were evaluated to determine if turbidity measurements in the three primary standards are comparable to each other, and to ascertain if the primary standards are truly interchangeable. A formazin 4000 nephelometric turbidity unit (NTU) stock was purchased and dilutions of 40, 100, 400, 800, and 1000 NTU were made fresh the day of testing. StablCal and AMCO Clear (for Hach 2100N) standards with corresponding concentrations were also purchased for the evaluation. Sensor performance was not evaluated in turbidity levels less than 40 NTU due to the unavailability of polymer-bead turbidity standards rated for general use. The percent error was calculated as the true (not absolute) difference between the measured turbidity and the standard value, divided by the standard value.The sensors that demonstrated the best overall performance in the evaluation were the Hach SOLITAX and the Hydrolab Series 5 turbidity sensor when the operating range (0.001–4000 NTU for the SOLITAX and 0.1–3000 NTU for the Hydrolab) was considered in addition to sensor accuracy and precision. The average percent error in the three standards was 3.80 percent for the SOLITAX and -4.46 percent for the Hydrolab. The DTS-12 also demonstrated good accuracy with an average percent error of 2.02 percent and a maximum relative standard deviation of 0.51 percent for the operating range, which was limited to 0.01–1600 NTU at the time of this report. Test results indicated an average percent error of 19.81 percent in the three standards for the EXO turbidity sensor and 9.66 percent for the YSI 6136. The significant variability in sensor performance in the three primary standards suggests that although all three types are accepted as primary calibration standards, they are not interchangeable, and sensor results in the three types of standards are not directly comparable.

Profiling Speech and Pausing in Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Dementia (FTD)

PubMed Central

Yunusova, Yana; Graham, Naida L.; Shellikeri, Sanjana; Phuong, Kent; Kulkarni, Madhura; Rochon, Elizabeth; Tang-Wai, David F.; Chow, Tiffany W.; Black, Sandra E.; Zinman, Lorne H.; Green, Jordan R.

2016-01-01

Objective This study examines reading aloud in patients with amyotrophic lateral sclerosis (ALS) and those with frontotemporal dementia (FTD) in order to determine whether differences in patterns of speaking and pausing exist between patients with primary motor vs. primary cognitive-linguistic deficits, and in contrast to healthy controls. Design 136 participants were included in the study: 33 controls, 85 patients with ALS, and 18 patients with either the behavioural variant of FTD (FTD-BV) or progressive nonfluent aphasia (FTD-PNFA). Participants with ALS were further divided into 4 non-overlapping subgroups—mild, respiratory, bulbar (with oral-motor deficit) and bulbar-respiratory—based on the presence and severity of motor bulbar or respiratory signs. All participants read a passage aloud. Custom-made software was used to perform speech and pause analyses, and this provided measures of speaking and articulatory rates, duration of speech, and number and duration of pauses. These measures were statistically compared in different subgroups of patients. Results The results revealed clear differences between patient groups and healthy controls on the passage reading task. A speech-based motor function measure (i.e., articulatory rate) was able to distinguish patients with bulbar ALS or FTD-PNFA from those with respiratory ALS or FTD-BV. Distinguishing the disordered groups proved challenging based on the pausing measures. Conclusions and Relevance This study demonstrated the use of speech measures in the identification of those with an oral-motor deficit, and showed the usefulness of performing a relatively simple reading test to assess speech versus pause behaviors across the ALS—FTD disease continuum. The findings also suggest that motor speech assessment should be performed as part of the diagnostic workup for patients with FTD. PMID:26789001

The 32-GHz performance of the DSS-14 70-meter antenna: 1989 configuration

NASA Technical Reports Server (NTRS)

Gatti, M. S.; Klein, M. J.; Kuiper, T. B. H.

1989-01-01

The results of preliminary 32 GHz calibrations of the 70 meter antenna at Goldstone are presented. Measurements were done between March and July 1989 using Virgo A and Venus as the primary efficiency calibrators. The flux densites of theses radio sources at 32 GHz are not known with high accuracy, but were extrapolated from calibrated data at lower frequencies. The measured value of efficiency (0.35) agreed closely with the predicted value (0.32), and the results are very repeatable. Flux densities of secondary sources used in the observations were subsequently derived. These measurements were performed using a beamswitching radiometer that employed an uncooled high-electron mobility transistor (HEMT) low-noise amplifier. This system was installed primarily to determine the performance of the antenna in its 1989 configuration, but the experience will also aid in successful future calibration of the Deep Space Network (DSN) at this frequency.

Sparse aperture differential piston measurements using the pyramid wave-front sensor

NASA Astrophysics Data System (ADS)

Arcidiacono, Carmelo; Chen, Xinyang; Yan, Zhaojun; Zheng, Lixin; Agapito, Guido; Wang, Chaoyan; Zhu, Nenghong; Zhu, Liyun; Cai, Jianqing; Tang, Zhenghong

2016-07-01

In this paper we report on the laboratory experiment we settled in the Shanghai Astronomical Observatory (SHAO) to investigate the pyramid wave-front sensor (WFS) ability to measure the differential piston on a sparse aperture. The ultimate goal is to verify the ability of the pyramid WFS work in close loop to perform the phasing of the primary mirrors of a sparse Fizeau imaging telescope. In the experiment we installed on the optical bench we performed various test checking the ability to flat the wave-front using a deformable mirror and to measure the signal of the differential piston on a two pupils setup. These steps represent the background from which we start to perform full close loop operation on multiple apertures. These steps were also useful to characterize the achromatic double pyramids (double prisms) manufactured in the SHAO optical workshop.

Performance analysis for the cryogenic etalon spectrometer on the Upper Atmospheric Research Satellite

NASA Technical Reports Server (NTRS)

Roche, A. E.; Forney, P. B.; Kumer, J. B.; Naes, L. G.; Nast, T. C.

1983-01-01

The Upper Atmospheric Research Satellite (UARS) program has the objective of providing an 18-month to 2-year platform for observations of the upper atmosphere, giving particular attention to the stratosphere, mesosphere, and lower thermosphere. The primary aims of the mission are related to the measurement of the solar energy input between 120 and 500 km, the acquisition of global maps of the vertical and horizontal distribution of a series of critical trace and minor species, and the investigation of the dynamics of the upper atmosphere. One of several instruments designed to perform neutral species measurements on board the satellite is the Cryogenic Limb Array Etalon Spectrometer (CLAES). The CLAES experiment is concerned with measurements of concentrations of species of interest to the ozone layer balance. Attention is given to the performance requirements of the instrument and the effects of these requirements on the cryogenic design.

Importance-satisfaction analysis for primary care physicians' perspective on EHRs in Taiwan.

PubMed

Ho, Cheng-Hsun; Wene, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

2014-06-06

The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians' perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians.

Studies of parvovirus vaccination in the dog: the performance of live attenuated feline parvovirus vaccines.

PubMed

Thompson, H; McCandlish, I A; Cornwell, H J; Macartney, L; Maxwell, N S; Weipers, A F; Wills, I R; Black, J A; Mackenzie, A C

1988-04-16

The performance of three live attenuated feline parvovirus vaccines licensed for use in the dog was studied. At the end of the primary vaccination course 67 per cent of dogs had inadequate antibody levels (less than or equal to 32) as measured by a haemagglutination inhibition test. Interference by maternal antibody accounted for some of the failures but the fact that there was no significant difference in performance between dogs vaccinated at 12 weeks or 16 weeks of age indicated that maternal antibody was not the only factor.

NTD-GE Based Microcalorimeter Performance

NASA Technical Reports Server (NTRS)

Bandler, Simon; Silver, Eric; Schnopper, Herbert; Murray, Stephen; Barbera, Marco; Madden, Norm; Landis, Don; Beeman, Jeff; Haller, Eugene; Tucker, Greg

2000-01-01

Our group has been developing x-ray microcalorimeters consisting of neutron transmutation doped (NTD) germanium thermistors attached to superconducting tin absorbers. We discuss the performance of single pixel x-ray detectors, and describe an array technology. In this paper we describe the read-out circuit that allows us to measure fast signals in our detectors as this will be important in understanding the primary cause of resolution broadening. We describe briefly a multiplexing scheme that allows a number of different calorimeters to be read out using a single JFET. We list the possible causes of broadening and give a description of the experiment which best demonstrates the cause of the primary broadening source. We mention our strategy for finding a suitable solution to this problem and describe briefly a technology for building arrays of these calorimeters.

Plasma properties in electron-bombardment ion thrusters

NASA Technical Reports Server (NTRS)

Matossian, J. N.; Beattie, J. R.

1987-01-01

The paper describes a technique for computing volume-averaged plasma properties within electron-bombardment ion thrusters, using spatially varying Langmuir-probe measurements. Average values of the electron densities are defined by integrating the spatially varying Maxwellian and primary electron densities over the ionization volume, and then dividing by the volume. Plasma properties obtained in the 30-cm-diameter J-series and ring-cusp thrusters are analyzed by the volume-averaging technique. The superior performance exhibited by the ring-cusp thruster is correlated with a higher average Maxwellian electron temperature. The ring-cusp thruster maintains the same fraction of primary electrons as does the J-series thruster, but at a much lower ion production cost. The volume-averaged predictions for both thrusters are compared with those of a detailed thruster performance model.

Portraying the Contribution of Individual Behaviors to Team Cohesion and Performance

NASA Technical Reports Server (NTRS)

Parke, Bonny; Orasanu, Judith

2012-01-01

Behaviors of individuals in teams both contribute to and are molded by team dynamics. How they do so has been the subject of much research. A method of portraying individuals' behaviors in teams, the Team Diagramming Method (TDM) is presented. Behaviors are rated by other team members on three important dimensions: positivity/negativity, dominant/submissive, and task-orientedness/expressiveness. A study of 5-person teams engaging in a 3-day moon simulation task demonstrated that measures of these perceived behaviors as well as the variances of these behaviors correlated with cohesion measures and performance. The method shows strengths and weaknesses of particular teams and, by comparison with high-performing teams, suggests interventions based on individual as well as team behaviors. The primary goal of this study was to determine the extent to which these team level variables, derived from all team members' rated behaviors, were associated with previous methods of measuring cohesion and with performance. A secondary goal was to determine the stability of TDM measures over time by comparing team level variables based on ratings early and later in the team s work together.

The National Football League Scouting Combine from 1999 to 2014: normative reference values and an examination of body mass normalization techniques.

PubMed

Nuzzo, James L

2015-02-01

The primary purpose of this study was to identify the most appropriate method for normalizing physical performance measures to body mass in American football players. Data were obtained from the population of players (n = 4,603) that completed the vertical jump, broad jump, 40-yd sprint, 20-yd shuttle, 3-cone drill, and bench press at the National Football League Scouting Combine from 1999 to 2014. Correlation coefficients were used to assess relationships between body mass and physical performance measures. For the entire group and each playing position, absolute (i.e., non-normalized) performance measures were significantly (p ≤ 0.05) correlated with body mass, indicating that normalization is warranted. Ratio scaling, however, was not appropriate for normalizing most performance measures because it merely reversed (and increased in magnitude) the significant correlations between body mass and performance. Allometric scaling with derived allometric parameters was appropriate for normalizing all performance measures because correlations between body mass and performance were near to zero and no longer statistically significant. However, the derived allometric parameters differed by playing position. Thus, when normalizing physical performance measures to body mass, strength and conditioning professionals should use allometric scaling with test- and position-specific allometric parameters. Additionally, in the current study, percentile rankings were generated to provide test- and position-specific normative reference values for the absolute measures. Until body mass normalization techniques are adopted more broadly, strength and conditioning professionals can use these normative references values to compare current players with those who have already participated in the Scouting Combine.

Flowfield characterization and model development in detonation tubes

NASA Astrophysics Data System (ADS)

Owens, Zachary Clark

A series of experiments and numerical simulations are performed to advance the understanding of flowfield phenomena and impulse generation in detonation tubes. Experiments employing laser-based velocimetry, high-speed schlieren imaging and pressure measurements are used to construct a dataset against which numerical models can be validated. The numerical modeling culminates in the development of a two-dimensional, multi-species, finite-rate-chemistry, parallel, Navier-Stokes solver. The resulting model is specifically designed to assess unsteady, compressible, reacting flowfields, and its utility for studying multidimensional detonation structure is demonstrated. A reduced, quasi-one-dimensional model with source terms accounting for wall losses is also developed for rapid parametric assessment. Using these experimental and numerical tools, two primary objectives are pursued. The first objective is to gain an understanding of how nozzles affect unsteady, detonation flowfields and how they can be designed to maximize impulse in a detonation based propulsion system called a pulse detonation engine. It is shown that unlike conventional, steady-flow propulsion systems where converging-diverging nozzles generate optimal performance, unsteady detonation tube performance during a single-cycle is maximized using purely diverging nozzles. The second objective is to identify the primary underlying mechanisms that cause velocity and pressure measurements to deviate from idealized theory. An investigation of the influence of non-ideal losses including wall heat transfer, friction and condensation leads to the development of improved models that reconcile long-standing discrepancies between predicted and measured detonation tube performance. It is demonstrated for the first time that wall condensation of water vapor in the combustion products can cause significant deviations from ideal theory.

Variability in the performance of preventive services and in the degree of control of identified health problems: A primary care study protocol

PubMed Central

Bolíbar, Bonaventura; Pareja, Clara; Astier-Peña, M Pilar; Morán, Julio; Rodríguez-Blanco, Teresa; Rosell-Murphy, Magdalena; Iglesias, Manuel; Juncosa, Sebastián; Mascort, Juanjo; Violan, Concepció; Magallón, Rosa; Apezteguia, Javier

2008-01-01

Background Preventive activities carried out in primary care have important variability that makes necessary to know which factors have an impact in order to establish future strategies for improvement. The present study has three objectives: 1) To describe the variability in the implementation of 7 preventive services (screening for smoking status, alcohol abuse, hypertension, hypercholesterolemia, obesity, influenza and tetanus immunization) and to determine their related factors; 2) To describe the degree of control of 5 identified health problems (smoking, alcohol abuse, hypertension, hypercholesterolemia and obesity); 3) To calculate intraclass correlation coefficients. Design Multi-centered cross-sectional study of a randomised sample of primary health care teams from 3 regions of Spain designed to analyse variability and related factors of 7 selected preventive services in years 2006 and 2007. At the end of 2008, we will perform a cross-sectional study of a cohort of patients attended in 2006 or 2007 to asses the degree of control of 5 identified health problems. All subjects older than16 years assigned to a randomised sample of 22 computerized primary health care teams and attended during the study period are included in each region providing a sample with more than 850.000 subjects. The main outcome measures will be implementation of 7 preventive services and control of 5 identified health problems. Furthermore, there will be 3 levels of data collection: 1) Patient level (age, gender, morbidity, preventive services, attendance); 2) Health-care professional level (professional characteristics, years working at the team, workload); 3) Team level (characteristics, electronic clinical record system). Data will be transferred from electronic clinical records to a central database with prior encryption and dissociation of subject, professional and team identity. Global and regional analysis will be performed including standard analysis for primary health care teams and health-care professional level. Linear and logistic regression multilevel analysis adjusted for individual and cluster variables will also be performed. Variability in the number of preventive services implemented will be calculated with Poisson multilevel models. Team and health-care professional will be considered random effects. Intraclass correlation coefficients, standard error and variance components for the different outcome measures will be calculated. PMID:18691407

A randomized trial on the acute and steady-state effects of a new antidepressant, vortioxetine (Lu AA21004), on actual driving and cognition.

PubMed

Theunissen, E L; Street, D; Højer, A-M; Vermeeren, A; van Oers, A; Ramaekers, J G

2013-06-01

The aim of this study was to assess the effects of a novel antidepressant, vortioxetine 10 mg, on driving, cognitive, and psychomotor performance in 24 healthy subjects in a double-blind, placebo-controlled, three-way crossover design. Mirtazapine 30 mg was included as an active comparator. Drugs were administered in the evening of 15 consecutive days. Performance was measured in the morning of days 2 and 16, using standardized tests measuring on-the-road driving, memory, tracking, divided attention, and vigilance. The statistical analysis on the primary measure of driving, i.e., SD of lateral position showed noninferiority of vortioxetine on days 2 and 16, and inferiority for mirtazapine on day 2. Vortioxetine did not cause cognitive or psychomotor impairment. Mirtazapine, however, impaired cognitive and psychomotor performance on day 2. Most of these effects disappeared after multiple doses of mirtazapine. To conclude, vortioxetine did not impair driving, cognitive, or psychomotor performance after single or multiple doses.

Performance of a new hand-held device for exhaled nitric oxide measurement in adults and children

PubMed Central

Alving, K; Janson, C; Nordvall, L

2006-01-01

Background Exhaled nitric oxide (NO) measurement has been shown to be a valuable tool in the management of patients with asthma. Up to now, most measurements have been done with stationary, chemiluminescence-based NO analysers, which are not suitable for the primary health care setting. A hand-held NO analyser which simplifies the measurement would be of value both in specialized and primary health care. In this study, the performance of a new electrochemical hand-held device for exhaled NO measurements (NIOX MINO) was compared with a standard stationary chemiluminescence unit (NIOX). Methods A total of 71 subjects (6–60 years; 36 males), both healthy controls and atopic patients with and without asthma were included. The mean of three approved exhalations (50 ml/s) in each device, and the first approved measurement in the hand-held device, were compared with regard to NO readings (Bland-Altman plots), measurement feasibility (success rate with 6 attempts) and repeatability (intrasubject SD). Results Success rate was high (≥ 84%) in both devices for both adults and children. The subjects represented a FENO range of 8–147 parts per billion (ppb). When comparing the mean of three measurements (n = 61), the median of the intrasubject difference in exhaled NO for the two devices was -1.2 ppb; thus generally the hand-held device gave slightly higher readings. The Bland-Altman plot shows that the 95% limits of agreement were -9.8 and 8.0 ppb. The intrasubject median difference between the NIOX and the first approved measurement in the NIOX MINO was -2.0 ppb, and limits of agreement were -13.2 and 10.2 ppb. The median repeatability for NIOX and NIOX MINO were 1.1 and 1.2 ppb, respectively. Conclusion The hand-held device (NIOX MINO) and the stationary system (NIOX) are in clinically acceptable agreement both when the mean of three measurements and the first approved measurement (NIOX MINO) is used. The hand-held device shows good repeatability, and it can be used successfully on adults and most children. The new hand-held device will enable the introduction of exhaled NO measurements into the primary health care. PMID:16626491

Incentive-Based Primary Care: Cost and Utilization Analysis

PubMed Central

Hollander, Marcus J; Kadlec, Helena

2015-01-01

Context: In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. Objective: To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. Design: The study used Ministry of Health administrative data for Fiscal Year 2010–2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Main Outcome Measures: Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). Results: After controlling for patients’ age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Conclusion: Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization. PMID:26263389

Medical yoga for patients with stress-related symptoms and diagnoses in primary health care: a randomized controlled trial.

PubMed

Köhn, Monica; Persson Lundholm, Ulla; Bryngelsson, Ing-Liss; Anderzén-Carlsson, Agneta; Westerdahl, Elisabeth

2013-01-01

An increasing number of patients are suffering from stress-related symptoms and diagnoses. The purpose of this study was to evaluate the medical yoga treatment in patients with stress-related symptoms and diagnoses in primary health care. A randomized controlled study was performed at a primary health care centre in Sweden from March to June, 2011. Patients were randomly allocated to a control group receiving standard care or a yoga group treated with medical yoga for 1 hour, once a week, over a 12-week period in addition to the standard care. A total of 37 men and women, mean age of 53 ± 12 years were included. General stress level (measured using Perceived Stress Scale (PSS)), burnout (Shirom-Melamed Burnout Questionnaire (SMBQ)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), insomnia severity (Insomnia Severity Index (ISI)), pain (visual analogue scale (VAS)), and overall health status (Euro Quality of Life VAS (EQ-VAS)) were measured before and after 12 weeks. Patients assigned to the Yoga group showed significantly greater improvements on measures of general stress level (P < 0.000), anxiety (P < 0.019), and overall health status (P < 0.018) compared to controls. Treatment with medical yoga is effective in reducing levels of stress and anxiety in patients with stress-related symptoms in primary health care.

Medical Yoga for Patients with Stress-Related Symptoms and Diagnoses in Primary Health Care: A Randomized Controlled Trial

PubMed Central

Köhn, Monica; Persson Lundholm, Ulla; Bryngelsson, Ing-Liss; Anderzén-Carlsson, Agneta; Westerdahl, Elisabeth

2013-01-01

An increasing number of patients are suffering from stress-related symptoms and diagnoses. The purpose of this study was to evaluate the medical yoga treatment in patients with stress-related symptoms and diagnoses in primary health care. A randomized controlled study was performed at a primary health care centre in Sweden from March to June, 2011. Patients were randomly allocated to a control group receiving standard care or a yoga group treated with medical yoga for 1 hour, once a week, over a 12-week period in addition to the standard care. A total of 37 men and women, mean age of 53 ± 12 years were included. General stress level (measured using Perceived Stress Scale (PSS)), burnout (Shirom-Melamed Burnout Questionnaire (SMBQ)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), insomnia severity (Insomnia Severity Index (ISI)), pain (visual analogue scale (VAS)), and overall health status (Euro Quality of Life VAS (EQ-VAS)) were measured before and after 12 weeks. Patients assigned to the Yoga group showed significantly greater improvements on measures of general stress level (P < 0.000), anxiety (P < 0.019), and overall health status (P < 0.018) compared to controls. Treatment with medical yoga is effective in reducing levels of stress and anxiety in patients with stress-related symptoms in primary health care. PMID:23533465

Fγ: A new observable for photon-hadron discrimination in hybrid air shower events

NASA Astrophysics Data System (ADS)

Niechciol, M.; Risse, M.; Ruehl, P.; Settimo, M.; Younk, P. W.; Yushkov, A.

2018-01-01

To search for ultra-high-energy photons in primary cosmic rays, air shower observables are needed that allow a good separation between primary photons and primary hadrons. We present a new observable, Fγ, which can be extracted from ground-array data in hybrid events, where simultaneous measurements of the longitudinal and the lateral shower profile are performed. The observable is based on a template fit to the lateral distribution measured by the ground array with the template taking into account the complementary information from the measurement of the longitudinal profile, i.e. the primary energy and the geometry of the shower. Fγ shows a very good photon-hadron separation, which is even superior to the separation given by the well-known Xmax observable (the atmospheric depth of the shower maximum). At energies around 1 EeV (10 EeV), Fγ provides a background rejection better than 97.8 % (99.9 %) at a signal efficiency of 50 %. Advantages of the observable Fγ are its technical stability with respect to irregularities in the ground array (i.e. missing or temporarily non-operating stations) and that it can be applied over the full energy range accessible to the air shower detector, down to its threshold energy. Furthermore, Fγ complements nicely to Xmax such that both observables can well be combined to achieve an even better discrimination power, exploiting the rich information available in hybrid events.

The productivity and cost-efficiency of models for involving nurse practitioners in primary care: a perspective from queueing analysis.

PubMed

Liu, Nan; D'Aunno, Thomas

2012-04-01

To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how. The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings. Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery. The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model. © Health Research and Educational Trust.

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

Cojocaru, Claudiu; Mui, Bryan; McEwen, Malcolm

Purpose: To investigate the stability of a water calorimetry system as a primary standard for absorbed dose to water using measurements performed in cobalt-60 and high-energy linac photon beams over a span of more than a decade. Methods: Calorimetry measures adsorbed dose directly by recording the amount of heat created when ionizing radiation passes through matter. The radiation-induced temperature rise was measured using two thermistors calibrated against the NRC temperature primary standard, using an AC bridge with lock-in amplifier for precise measurement. The calorimeter system was operated under thermal equilibrium at 4 °C (to eliminate convection) with drifts in watermore » temperature less than 0.1 mK/min. Seven water vessels of various designs were used to make repeated measurements over the course of 17 years. Results: The standard uncertainty achieved for a set of ten calorimeter measurements (4 Gy delivered) was generally well below 0.15 % while the variation between multiple sets for a given vessel was consistent with this value. The long-term stability of the system combined with inter-vessel variations indicated that there was good control of the radiochemistry (chemical heat defect). Conclusions: The measurements performed over a period of several years showed that the combined water calorimeters showed stability at +/− 0.25 % level. Thus, rather than relying on a particular vessel as an artifact one can realize the Gray through the more generalized method of combining a glass vessel, high-purity water and thermistor probes. This provides increased robustness in the dissemination of absorbed dose to Canadian users.« less

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

Johnson, Gary E.; Diefenderfer, Heida L.

The purpose of this document is to describe research, monitoring, and evaluation (RME) for the Federal Columbia River Estuary Program, hereafter called 'the Estuary Program'. The intent of this RME effort is to provide data and information to evaluate progress toward meeting program goals and objectives and support decision making in the Estuary Program. The goal of the Estuary Program is to understand, conserve, and restore the estuary ecosystem to improve the performance of listed salmonid populations. The Estuary Program has five general objectives, designed to fulfill the program goal, as follows: (1) Understand the primary stressors affecting ecosystem controllingmore » factors, such as ocean conditions and invasive species. (2) Conserve and restore factors controlling ecosystem structures and processes, such as hydrodynamics and water quality. (3) Increase the quantity and quality of ecosystem structures, i.e., habitats, juvenile salmonids use during migration through the estuary. (4) Maintain the food web to benefit salmonid performance. (5) Improve salmonid performance in terms of life history diversity, foraging success, growth, and survival. The goal of estuary RME is to provide pertinent and timely research and monitoring information to planners, implementers, and managers of the Estuary Program. The goal leads to three primary management questions pertaining to the main focus of the Estuary Program: estuary habitat conservation and restoration. (1) Are the estuary habitat actions achieving the expected biological and environmental performance targets? (2) Are the offsite habitat actions in the estuary improving juvenile salmonid performance and which actions are most effective at addressing the limiting factors preventing achievement of habitat, fish, or wildlife performance objectives? (3) What are the limiting factors or threats in the estuary/ocean preventing the achievement of desired habitat or fish performance objectives? Performance measures for the estuary are monitored indicators that reflect the status of habitat conditions and fish performance, e.g., habitat connectivity, survival, and life history diversity. Performance measures also pertain to implementation and compliance. Such measures are part of the monitoring, research, and action plans in this estuary RME document. Performance targets specific to the estuary were not included in the 2007 draft Biological Opinion.« less

Experiment of low resistance joints for the ITER correction coil.

PubMed

Liu, Huajun; Wu, Yu; Wu, Weiyue; Liu, Bo; Shi, Yi; Guo, Shuai

2013-01-01

A test method was designed and performed to measure joint resistance of the ITER correction coil (CC) in liquid helium (LHe) temperature. A 10 kA superconducting transformer was manufactured to provide the joints current. The transformer consisted of two concentric layer-wound superconducting solenoids. NbTi superconducting wire was wound in the primary coil and the ITER CC conductor was wound in the secondary coil. The primary and the secondary coils were both immersed in liquid helium of a 300 mm useful bore diameter cryostat. Two ITER CC joints were assembled in the secondary loop and tested. The current of the secondary loop was ramped to 9 kA in several steps. The two joint resistances were measured to be 1.2 nΩ and 1.65 nΩ, respectively.

Precision pointing compensation for DSN antennas with optical distance measuring sensors

NASA Technical Reports Server (NTRS)

Scheid, R. E.

1989-01-01

The pointing control loops of Deep Space Network (DSN) antennas do not account for unmodeled deflections of the primary and secondary reflectors. As a result, structural distortions due to unpredictable environmental loads can result in uncompensated boresight shifts which degrade pointing accuracy. The design proposed here can provide real-time bias commands to the pointing control system to compensate for environmental effects on pointing performance. The bias commands can be computed in real time from optically measured deflections at a number of points on the primary and secondary reflectors. Computer simulations with a reduced-order finite-element model of a DSN antenna validate the concept and lead to a proposed design by which a ten-to-one reduction in pointing uncertainty can be achieved under nominal uncertainty conditions.

Association between urine aldosterone and diastolic function in patients with primary aldosteronism and essential hypertension.

PubMed

Chang, Yi-Yao; Lee, Hsiu-Hao; Hung, Chi-Sheng; Wu, Xue-Ming; Lee, Jen-Kuang; Wang, Shuo-Meng; Liao, Min-Tsun; Chen, Ying-Hsien; Wu, Vin-Cent; Wu, Kwan-Dun; Lin, Yen-Hung

2014-09-01

To investigate the association between aldosterone and cardiac diastolic dysfunction. We prospectively enrolled 20 patients with primary aldosteronism (PA) and 22 patients with essential hypertension (EH). Plasma aldosterone concentration, plasma renin activity, and 24-h urine aldosterone level were measured. Echocardiography, including tissue Doppler image recordings, was performed. PA patients had a significantly higher left ventricular (LV) mass index and worse LV diastolic function than those in EH patients. Among various measures of aldosterone, log-transformed 24-h urine aldosterone level had the most consistent correlation with diastolic function. Aldosterone is strongly associated with LV diastolic dysfunction. Twenty-four hour urine aldosterone is a good indicator to evaluate the impact of aldosterone on LV diastolic function. Copyright © 2014. Published by Elsevier Inc.

Traceable Dynamic Calibration of Force Transducers by Primary Means

PubMed Central

Vlajic, Nicholas; Chijioke, Ako

2018-01-01

We describe an apparatus for traceable, dynamic calibration of force transducers using harmonic excitation, and report calibration measurements of force transducers using this apparatus. In this system, the force applied to the transducer is produced by the acceleration of an attached mass, and is determined according to Newton’s second law, F = ma. The acceleration is measured by primary means, using laser interferometry. The capabilities of this system are demonstrated by performing dynamic calibrations of two shear-web-type force transducers up to a frequency of 2 kHz, with an expanded uncertainty below 1.2 %. We give an accounting of all significant sources of uncertainty, including a detailed consideration of the effects of dynamic tilting (rocking), which is a leading source of uncertainty in such harmonic force calibration systems. PMID:29887643

Implementation of a Wavefront-Sensing Algorithm

NASA Technical Reports Server (NTRS)

Smith, Jeffrey S.; Dean, Bruce; Aronstein, David

2013-01-01

A computer program has been written as a unique implementation of an image-based wavefront-sensing algorithm reported in "Iterative-Transform Phase Retrieval Using Adaptive Diversity" (GSC-14879-1), NASA Tech Briefs, Vol. 31, No. 4 (April 2007), page 32. This software was originally intended for application to the James Webb Space Telescope, but is also applicable to other segmented-mirror telescopes. The software is capable of determining optical-wavefront information using, as input, a variable number of irradiance measurements collected in defocus planes about the best focal position. The software also uses input of the geometrical definition of the telescope exit pupil (otherwise denoted the pupil mask) to identify the locations of the segments of the primary telescope mirror. From the irradiance data and mask information, the software calculates an estimate of the optical wavefront (a measure of performance) of the telescope generally and across each primary mirror segment specifically. The software is capable of generating irradiance data, wavefront estimates, and basis functions for the full telescope and for each primary-mirror segment. Optionally, each of these pieces of information can be measured or computed outside of the software and incorporated during execution of the software.

Primary school children are able to perform basic life-saving first aid measures.

PubMed

Bollig, Georg; Wahl, Hans Alvin; Svendsen, Martin Veel

2009-06-01

First aid measures can be life-saving. Starting first aid education early may strengthen interest, motivation and ability to provide first aid. To determine if a first aid teaching program including 5 lessons (45 min each) of theoretical and practical training for 6-7-year-old children can influence their performance in a first aid scenario. 228 primary school children at the age of 6-7 years were included in the study, 102 girls and 126 boys. One child was 5 years old. 117 children were taught basic first aid measures and 111 without training served as control group. In the test scenario the children had to provide first aid to an unconscious victim after a cycle accident. The course participants were retested after 6 months. Statistically significant differences between course participants compared to those without training could be shown for all tested subjects, including correct assessment of consciousness (p<0.001), correct assessment of breathing (p<0.001), knowledge of the correct emergency telephone number (p<0.001), giving correct emergency call information (p<0.001), knowledge of correct recovery position (p<0.001), correct airway management (p<0.001). Retesting after 6 months showed statistically significant differences for 5 of 6 tested items. 6-7-Year-old children can give basic first aid to an unconscious patient. A course with 5 lessons leads to a significant increase in first aid knowledge and skills. Knowledge retention is good after 6 months. All primary school children should receive first aid training starting in first grade.

Does Acid Challenge Affect the Properties and Bond Stability of Restorative Materials on Primary Teeth?

PubMed

Tedesco, Tamara K; Calvo, Ana F B; Yoshioka, Laysa; Fukushima, Karen A; Cesar, Paulo F; Raggio, Daniela P

2018-05-31

To evaluate the effect of acidic challenge (AC) on the properties and bond stability of restorative materials to primary enamel and dentin. One hundred twenty primary molars were assigned to 12 groups according to substrate (enamel or dentin), restorative material (composite, high-viscosity glass ionomer cement [HV-GIC] or resin-modified glass-ionomer cement [RM-GIC]), and immersion after restoration (control [saline solution/7 days] or AC [cola-based drink/5 min/3x per day/7 days]). Twenty-four hours after the restorative procedure, specimens were submitted to one of the proposed challenges. Half of the specimens were immediately subjected to the microshear bond strength test, and the other half after 12 months. To determine flexural strength flexural strength and superficial roughness (SR), 30 specimens were built up. After 24 h, the first measurement of SR from 10 specimens was performed. Specimens were then immersed in one of proposed challenges and SR was measured again. Subsequently, flexural strength testing was performed. Bond strength, surface roughness, and flexural strength data were subjected to ANOVA and Tukey's test. Composite showed the highest bond strengths compared to the others materials on both substrates. The storage period negatively influenced the bond strength only for composite groups in dentin. AC after restoration negatively influenced bond strength when the materials were evaluated in eroded dentin. AC affected the second SR measurement, showing increased SR for all restorative materials. AC did not affect flexural strength. The acidic challenge jeopardizes the surface roughness and bond strength of restorations to eroded dentin.

Measure for measure: curriculum requirements and children's achievement in music education.

PubMed

Bond, Trevor; Bond, Marie

2010-01-01

Children in all public primary schools in Queensland, Australia have weekly music lessons designed to develop key musical concepts such as reading, writing, singing and playing simple music notation. Their understanding of basic musical concepts is developed through a blend of kinaesthetic, visual and auditory experiences. In keeping with the pedagogical principles outlined by the Hungarian composer, Zoltan Kodaly, early musical experiences are based in singing well-known children's chants - usually restricted to notes of the pentatonic scale. In order to determine the extent to which primary school children's musical understandings developed in response to these carefully structured developmental learning experiences, the Queensland Primary Music Curriculum was examined to yield a set of over 70 indicators of musical understanding in the areas of rhythm, melody and part-work,the essential skills for choral singing. Data were collected from more than 400 children's attempts at elicited musical performances. Quantitative data analysis procedures derived from the Rasch model for measurement were used to establish the sequence of children's mastery of key musical concepts. Results suggested that while the music curriculum did reflect the general development of musical concepts, the grade allocation for a few concepts needed to be revised. Subsequently, children's performances over several years were also analysed to track the musical achievements of students over time. The empirical evidence confirmed that children's musical development was enhanced by school learning and that indicators can be used to identify both outstanding and atypical development of musical understanding. It was concluded that modest adjustments to the music curriculum might enhance children's learning opportunities in music.

Linking clinician interaction and coordination to clinical performance in Patient-Aligned Care Teams.

PubMed

Hysong, Sylvia J; Thomas, Candice L; Spitzmüller, Christiane; Amspoker, Amber B; Woodard, LeChauncy; Modi, Varsha; Naik, Aanand D

2016-01-15

Team coordination within clinical care settings is a critical component of effective patient care. Less is known about the extent, effectiveness, and impact of coordination activities among professionals within VA Patient-Aligned Care Teams (PACTs). This study will address these gaps by describing the specific, fundamental tasks and practices involved in PACT coordination, their impact on performance measures, and the role of coordination task complexity. First, we will use a web-based survey of coordination practices among 1600 PACTs in the national VHA. Survey findings will characterize PACT coordination practices and assess their association with clinical performance measures. Functional job analysis, using 6-8 subject matter experts who are 3rd and 4th year residents in VA Primary Care rotations, will be utilized to identify the tasks involved in completing clinical performance measures to standard. From this, expert ratings of coordination complexity will be used to determine the level of coordinative complexity required for each of the clinical performance measures drawn from the VA External Peer Review Program (EPRP). For objective 3, data collected from the first two methods will evaluate the effect of clinical complexity on the relationships between measures of PACT coordination and their ratings on the clinical performance measures. Results from this study will support successful implementation of coordinated team-based work in clinical settings by providing knowledge regarding which aspects of care require the most complex levels of coordination and how specific coordination practices impact clinical performance.

Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. An observational study based on quality indicators.

PubMed

van Lieshout, Jan; Grol, Richard; Campbell, Stephen; Falcoff, Hector; Capell, Eva Frigola; Glehr, Mathias; Goldfracht, Margalit; Kumpusalo, Esko; Künzi, Beat; Ludt, Sabine; Petek, Davorina; Vanderstighelen, Veerle; Wensing, Michel

2012-10-05

Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size. In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanisation; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex. We included 181 practices (63% of the number targeted). Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (sd 32%) to 94% (sd 10%) for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (sd 21%), 86% (sd 12%) and 48% (sd 22%) respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between practices than between countries. CVRM measured by quality indicators showed wide variation within and between countries and possibly leaves room for improvement in all countries involved. Few associations of performance scores with practice size were found.

Relationship between the Fluorescence Lifetime of Chlorophyll 'a' and Primary Productivity within the Mississippi River Plume and Adjacent Shelf Region

NASA Technical Reports Server (NTRS)

Hall, Callie; Miller, Richard L.; Fernandez, Salvador M.; McKee, Brent A.

2000-01-01

In situ measurements of chlorophyll fluorescence intensity have been widely used to estimate phytoplankton biomass. However, because the fluorescence quantum yield of chlorophyll a in vivo can be highly variable, measurements of chlorophyll fluorescence intensity cannot be directly correlated with phytoplankton biomass and do not provide information on the physiological state of the phytoplankton under study. Conversely, lifetime-based measurements of chlorophyll fluorescence provide a framework in which photosynthetic rates of phytoplankton can be analyzed according to phytoplankton physiology. Along with the measurement of primary production and ambient nutrient concentrations within the Mississippi River plume in the northern Gulf of Mexico, phytoplankton fluorescence lifetimes were measured using a Fluorescence Lifetime Phytoplankton Analyzer (developed under a NASA Small Business Innovative Research contract to Ciencia, Inc.). Variability of fluorescence lifetimes within the plume can be used as a background from which to interpret variations in the maximum quantum yield of photochemistry. The extent to which nutrient and effluent loading in this dynamic coastal area affect the photosynthetic performance of phytoplankton will be presented as a function of phytoplankton fluorescence lifetimes.

Age-Related Differences in Listening Effort During Degraded Speech Recognition.

PubMed

Ward, Kristina M; Shen, Jing; Souza, Pamela E; Grieco-Calub, Tina M

The purpose of the present study was to quantify age-related differences in executive control as it relates to dual-task performance, which is thought to represent listening effort, during degraded speech recognition. Twenty-five younger adults (YA; 18-24 years) and 21 older adults (OA; 56-82 years) completed a dual-task paradigm that consisted of a primary speech recognition task and a secondary visual monitoring task. Sentence material in the primary task was either unprocessed or spectrally degraded into 8, 6, or 4 spectral channels using noise-band vocoding. Performance on the visual monitoring task was assessed by the accuracy and reaction time of participants' responses. Performance on the primary and secondary task was quantified in isolation (i.e., single task) and during the dual-task paradigm. Participants also completed a standardized psychometric measure of executive control, including attention and inhibition. Statistical analyses were implemented to evaluate changes in listeners' performance on the primary and secondary tasks (1) per condition (unprocessed vs. vocoded conditions); (2) per task (single task vs. dual task); and (3) per group (YA vs. OA). Speech recognition declined with increasing spectral degradation for both YA and OA when they performed the task in isolation or concurrently with the visual monitoring task. OA were slower and less accurate than YA on the visual monitoring task when performed in isolation, which paralleled age-related differences in standardized scores of executive control. When compared with single-task performance, OA experienced greater declines in secondary-task accuracy, but not reaction time, than YA. Furthermore, results revealed that age-related differences in executive control significantly contributed to age-related differences on the visual monitoring task during the dual-task paradigm. OA experienced significantly greater declines in secondary-task accuracy during degraded speech recognition than YA. These findings are interpreted as suggesting that OA expended greater listening effort than YA, which may be partially attributed to age-related differences in executive control.

Impact of a Pay-for-Performance Program on Care for Black Patients with Hypertension: Important Answers in the Era of the Affordable Care Act.

PubMed

Petersen, Laura A; Ramos, Kate Simpson; Pietz, Kenneth; Woodard, LeChauncy D

2017-06-01

Evaluate the effect of a pay-for-performance intervention on the quality of hypertension care provided to black patients and determine whether it produced risk selection. Primary data collected between 2007 and 2009 from Veterans Affairs physicians and their primary care panels. Nested study within a cluster randomized controlled trial of three types of financial incentives and no incentives (control). We compared the proportion of physicians' black patients meeting hypertension performance measures for baseline and final performance periods. We measured risk selection by comparing the proportion of patients who switched providers, patient visit frequency, and panel turnover. Due to limited power, we prespecified in the analysis plan combining the three incentive groups and oversampling black patients. Data collected electronically and by chart review. The proportion of black patients who achieved blood pressure control or received an appropriate response to uncontrolled blood pressure in the final period was 6.3 percent (95 percent confidence interval, 0.8-11.7 percent) greater for physicians who received an incentive than for controls. There was no difference between intervention and controls in the proportion of patients who switched providers, visit frequency, or panel turnover. A pay-for-performance intervention improved blood pressure control or appropriate response to uncontrolled blood pressure in black patients and did not produce risk selection. © Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Feeding biomechanics of the cownose ray, Rhinoptera bonasus, over ontogeny

PubMed Central

Kolmann, Matthew A; Huber, Daniel R; Motta, Philip J; Grubbs, R Dean

2015-01-01

Growth affects the performance of structure, so the pattern of growth must influence the role of a structure and an organism. Because animal performance is linked to morphological specialization, ontogenetic change in size may influence an organism's biological role. High bite force generation is presumably selected for in durophagous taxa. Therefore, these animals provide an excellent study system for investigating biomechanical consequences of growth on performance. An ontogenetic series of 27 cownose rays (Rhinoptera bonasus) were dissected in order to develop a biomechanical model of the feeding mechanism, which was then compared with bite forces measured from live rays. Mechanical advantage of the feeding apparatus was generally conserved throughout ontogeny, while an increase in the mass and cross-sectional area of the jaw adductors resulted in allometric gains in bite force generation. Of primary importance to forceful biting in this taxon is the use of a fibrocartilaginous tendon associated with the insertion of the primary jaw adductor division. This tendon may serve to redirect muscle forces anteriorly, transmitting them within the plane of biting. Measured bite forces obtained through electrostimulation of the jaw adductors in live rays were higher than predicted, possibly due to differences in specific tension of actual batoid muscle and that used in the model. Mass-specific bite forces in these rays are the highest recorded for elasmobranchs. Cownose rays exemplify a species that, through allometric growth of bite performance and morphological novelties, have expanded their ecological performance over ontogeny. PMID:26183820

The effects of pay for performance on disparities in stroke, hypertension, and coronary heart disease management: interrupted time series study.

PubMed

Lee, John Tayu; Netuveli, Gopalakrishnan; Majeed, Azeem; Millett, Christopher

2011-01-01

The Quality and Outcomes Framework (QOF), a major pay-for-performance programme, was introduced into United Kingdom primary care in April 2004. The impact of this programme on disparities in health care remains unclear. This study examines the following questions: has this pay for performance programme improved the quality of care for coronary heart disease, stroke and hypertension in white, black and south Asian patients? Has this programme reduced disparities in the quality of care between these ethnic groups? Did general practices with different baseline performance respond differently to this programme? Retrospective cohort study of patients registered with family practices in Wandsworth, London during 2007. Segmented regression analysis of interrupted time series was used to take into account the previous time trend. Primary outcome measures were mean systolic and diastolic blood pressure, and cholesterol levels. Our findings suggest that the implementation of QOF resulted in significant short term improvements in blood pressure control. The magnitude of benefit varied between ethnic groups with a statistically significant short term reduction in systolic BP in white and black but not in south Asian patients with hypertension. Disparities in risk factor control were attenuated only on few measures and largely remained intact at the end of the study period. Pay for performance programmes such as the QOF in the UK should set challenging but achievable targets. Specific targets aimed at reducing ethnic disparities in health care may also be needed.

WE-DE-207B-09: Scatter Radiation Measurement From a Digital Breast Tomosynthesis System and Its Impact On Shielding Consideration

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

Yang, K; Li, X; Liu, B

2016-06-15

Purpose: To accurately measure the scatter radiation from a Hologic digital breast tomosynthesis (DBT) system and to provide updated scatter distribution to guide radiation shielding calculation for DBT rooms. Methods: A high sensitivity GOS-based linear detector was used to measure the angular distribution of scatter radiation from a Hologic Selenia Dimensions DBT system. The linear detector was calibrated for its energy response of typical DBT spectra. Following the NCRP147 approach, the measured scatter intensity was normalized by the primary beam area and primary air kerma at 1m from the scatter phantom center and presented as the scatter fraction. Direct comparisonmore » was made against Simpkin’s initial measurement. Key parameters including the phantom size, primary beam area, and kV/anode/target combination were also studied. Results: The measured scatter-to-primary-ratio and scatter fraction data closely matched with previous data from Simpkin. The measured data demonstrated the unique nonisotropic distribution of the scattered radiation around a Hologic DBT system, with two strong peaks around 25° and 160°. The majority scatter radiation (>70%) originated from the imaging detector assembly, instead of the phantom. With a workload from a previous local survey, the scatter air kerma at 1m from the phantom center for wall/door is 0.018mGy/patient, for floor is 0.164mGy/patient, and for ceiling is 0.037mGy/patient. Conclusion: Comparing to Simpkin’s previous data, the scatter air kerma from Holgoic DBT is at least two times higher. The main reasons include the harder primary beam with higher workload, added tomosynthesis acquisition, and strong small angle forward scattering. Due to the highly conservative initial assumptions, the shielding recommendation from NCRP147 is still sufficient for the Hologic DBT system given the workload from a previous local survey. With the data provided from this study, accurate shielding calculation can be performed for Hologic DBT systems with specific workload and barrier distance.« less

A framework to measure the value of public health services.

PubMed

Jacobson, Peter D; Neumann, Peter J

2009-10-01

To develop a framework that public health practitioners could use to measure the value of public health services. Primary data were collected from August 2006 through March 2007. We interviewed (n=46) public health practitioners in four states, leaders of national public health organizations, and academic researchers. Using a semi-structured interview protocol, we conducted a series of qualitative interviews to define the component parts of value for public health services and identify methodologies used to measure value and data collected. The primary form of analysis is descriptive, synthesizing information across respondents as to how they measure the value of their services. Our interviews did not reveal a consensus on how to measure value or a specific framework for doing so. Nonetheless, the interviews identified some potential strategies, such as cost accounting and performance-based contracting mechanisms. The interviews noted implementation barriers, including limits to staff capacity and data availability. We developed a framework that considers four component elements to measure value: external factors that must be taken into account (i.e., mandates); key internal actions that a local health department must take (i.e., staff assessment); using appropriate quantitative measures; and communicating value to elected officials and the public.

(Cost)-effectiveness of family meetings on indicated prevention of anxiety and depressive symptoms and disorders of primary family caregivers of patients with dementia: design of a randomized controlled trial.

PubMed

Joling, Karlijn J; van Hout, Hein P J; Scheltens, Philip; Vernooij-Dassen, Myrra; van den Berg, Bernard; Bosmans, Judith; Gillissen, Freek; Mittelman, Mary; van Marwijk, Harm W J

2008-01-21

Dementia is a major public health problem with enormous costs to society and major consequences for both patients and their relatives. Family members of persons with dementia provide much of the care for older adults with dementia in the community. Caring for a demented relative is not easy and fraught with emotional strain, distress, and physical exhaustion. Family caregivers of dementia patients have an extremely high risk developing affective disorders such as major depression and anxiety disorder. Family meetings appear to be among the most powerful psychosocial interventions to reduce depression in caregivers. An American landmark study reported substantial beneficial effects of a multifaceted intervention where family meetings had a central place on depression in family caregivers as well as on delay of institutionalization of patients. These effects were not replicated in other countries yet. We perform the first trial comparing only structured family meetings with significant others versus usual care among primary family caregivers of community dwelling demented patients and measure the effectiveness on both depression and anxiety in the primary caregiver, both on disorder and symptom levels. In this randomized controlled trial effectiveness as well as cost-effectiveness of family meetings is evaluated. The intervention group receives four family meetings with family and close friends of the primary family caregiver of a community dwelling patient with a clinical diagnosis of dementia. Dyads of patients and their primary caregiver are followed up to one year after baseline assessment. The main outcome measures are the incidence of anxiety and depressive disorders assessed with the Mini-International Neuropsychiatric Interview (MINI) and the severity of anxiety and depressive symptoms in caregivers is measured by validated self report instruments: the Centre for Epidemiologic Studies Depression Scale (CES-D) for depression and the anxiety scales of the Hospital Anxiety and Depression scales (HADS) for anxiety. The economic evaluation is performed from a societal perspective. By evaluating the effectiveness of only structured family meetings organized in the Netherlands, this study will contribute to the existing literature about the value of psychosocial interventions for dementia caregivers. Dutch Trial Registry ISRCTN90163486.

Effectiveness evaluation of a health promotion programme in primary schools: a cluster randomised controlled trial.

PubMed

Grillich, Ludwig; Kien, Christina; Takuya, Yanagida; Weber, Michael; Gartlehner, Gerald

2016-07-30

Programmes based on the World Health Organization's Health Promoting Schools framework (HPS) have been implemented in several countries but for evidence-based policy-making more research is required to determine the effectiveness of the HPS approach. We conducted a cluster randomised controlled trial. The units of randomisation were primary school classes recruited in May 2010. Eligible participants were Year 3 primary school classes in Lower Austria that had not participated in a similar programme during the last two years. After baseline assessment in September 2010, 53 classes from 45 primary schools in Lower Austria were randomly assigned to an intervention (n = 26 classes, 432 children) or waiting control arm (n = 27 classes, 493 children aged 8.7 years +/- 4 months). Over the course of 1.5 academic years, participating teachers received on-the-job training (20 h) and two workshops (8 h) to promote health related behaviour in students such as physical activity during the school day and to improve the quality of regular physical education classes. We assessed 15 outcomes grouped into five categories: Emotional and Social Experience in School, Physical Activity, Well-being, and Attention Performance measured by validated and standardised questionnaire and Motor Skills measured by validated and standardised motoric and coordination tests in the school gym. The primary outcome was Classroom Climate and part of the outcomecategory Emotional and Social Experience in School. The final assessment took place in April 2012. All assessors were blinded to the allocation of classes. Multilevel growth modelling was used to investigate programme effectiveness. We could not detect any statistically significant differences between groups for the outcomecategories Emotional and Social Experience in school (p = 0.22 to 0.78), Physical Activity, Well-being, and Attention Performance. Significant differences between groups were limited to the outcomecategory Motor Skills (Complex Reaction Ability, Spatial Orientation Skills, Coordination with Precision) which were higher in the intervention group (P < .05). Despite small statistically significant differences in Motor Skills, our study could not detect any clinically relevant improvements in the Emotional and Social Experience at School (including the primary outcome ClassroomClimate), Physical Activity, Well-being, Motor Skills and Attention Performance of students. German register of clinical studies: DRKS00000622 . Retrospectively registered: 03.12.2010. Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107-2010).

Variations and relationship of quality and NIR spectral characteristics of cotton fibers collected from multi-location field performance trials

USDA-ARS?s Scientific Manuscript database

High volume instrumentation (HVITM) and advanced fiber information system (AFIS) measurements are increasingly being utilized as primary and routine means of acquiring fiber quality data by cotton breeders and fiber processors. There is amount of information regarding fiber and yarn qualities, but l...

Examining Secondary Writing: Curriculum-Based Measures and Six Traits

ERIC Educational Resources Information Center

Havlin, Patricia J.

2013-01-01

Writing assessments have taken two primary forms in the past two decades: direct and indirect. Irrespective of type, either form needs to be anchored to making decisions in the classroom and predicting performance on high-stakes tests, particularly in a high-stakes environment with serious consequences. In this study, 11th-grade students were…

Designing Intervention Studies: Selected Populations, Range Restrictions, and Statistical Power

ERIC Educational Resources Information Center

Miciak, Jeremy; Taylor, W. Pat; Stuebing, Karla K.; Fletcher, Jack M.; Vaughn, Sharon

2016-01-01

An appropriate estimate of statistical power is critical for the design of intervention studies. Although the inclusion of a pretest covariate in the test of the primary outcome can increase statistical power, samples selected on the basis of pretest performance may demonstrate range restriction on the selection measure and other correlated…

Occupational Therapy Home Program for Children with Intellectual Disabilities: A Randomized, Controlled Trial

ERIC Educational Resources Information Center

Wuang, Yee-Pay; Ho, Guang-Sheng; Su, Chwen-Yng

2013-01-01

This study aimed to investigate the effectiveness of a proposed occupational therapy home program (OTHP) for children with intellectual disabilities (ID). Children with ID were randomly and equally assigned to OTHP or to no OTHP groups. The primary outcome measures were Canadian Occupational Performance, Bruininks-Oseretsky Test of Motor…

The Relationship between Executive Functioning, Central Coherence, and Repetitive Behaviors in the High-Functioning Autism Spectrum

ERIC Educational Resources Information Center

South, Mikle; Ozonoff, Sally; McMahon, William M.

2007-01-01

This study examined the relationship between everyday repetitive behavior (primary symptoms of autism) and performance on neuropsychological tests of executive function and central coherence (secondary symptoms). It was hypothesized that the frequency and intensity of repetitive behavior would be positively correlated with laboratory measures of…

High-Performance Computing Data Center | Computational Science | NREL

Science.gov Websites

liquid cooling to achieve its very low PUE, then captures and reuses waste heat as the primary heating dry cooler that uses refrigerant in a passive cycle to dissipate heat-is reducing onsite water Measuring efficiency through PUE Warm-water liquid cooling Re-using waste heat from computing components

Panel Recommends State-Level NAEP for 12th Graders

ERIC Educational Resources Information Center

Olson, Lynn

2004-01-01

A national commission formed to review the future of the 12th grade National Assessment of Educational Progress (NAEP) has recommended that the nation's primary barometer of student performance should expand dramatically to provide mandatory state results on the achievement of 12th graders and to measure their readiness for college, employment,…

Reliability and Factor Structure of the Attitude toward Tutoring Agent Scale (ATTAS)

ERIC Educational Resources Information Center

Adcock, Amy B.; Van Eck, Richard N.

2005-01-01

Pedagogical agents are gaining acceptance as effective learning tools (Baylor & Ryu, 2003; Moreno, Mayer, Spires & Lester 2001; Moreno, 2004). The increase in the use of agents highlights the need for standardized measurements for evaluating user performance in these environments. While learning gains are a primary variable of interest in such…

Managing Marginal School Employees: Applying Standards-Based Performance Measures

ERIC Educational Resources Information Center

Fields, Lynette; Reck, Brianne; Egley, Robert

2006-01-01

This book contains a collection of case studies that provide a variety of situations in managing or working with marginal employees in a school system. Managing Marginal School Employees will serve as a primary or companion text for administrator candidates or current administrators that include dilemmas for the student to think about, discuss,…

Designing and Implementing Human Capital Management Systems in Educator Evaluation

ERIC Educational Resources Information Center

Kraemer, Sara; Milanowski, Anthony; Scott, Jenna; Adrien, Richard; Fairbairn, Shane; Bourn, Ronda; Hill, Marsha

2015-01-01

The Department of Education's Teacher Incentive Fund (TIF) 4 program represents a programmatic shift away from educator compensation reform as the primary lever of change for teacher performance and student learning. The TIF 4 program is designed to encourage the use of educator effectiveness measures to support the strategic instructional vision…

Executive Functions: Formative versus Reflective Measurement

ERIC Educational Resources Information Center

Willoughby, Michael; Holochwost, Steven J.; Blanton, Zane E.; Blair, Clancy B.

2014-01-01

The primary objective of this article was to critically evaluate the routine use of confirmatory factor analysis (CFA) for representing an individual's performance across a battery of executive function tasks. A conceptual review and statistical reanalysis of N = 10 studies that used CFA methods of EF tasks was undertaken. Despite evidence of…

Principals' Group Seeks Influence on Incentive Pay

ERIC Educational Resources Information Center

Samuels, Christina A.

2008-01-01

School districts that want to start pay-for-performance programs for school leaders should look beyond high-stakes student tests as the primary measure for awarding bonuses, a position paper released last week by the National Association of Secondary School Principals says. Gerald N. Tirozzi, the executive director of the Reston, Virginia-based…

Wisconsin Card Sorting Test Performance in Children with Developmental Coordination Disorder

ERIC Educational Resources Information Center

Wuang, Yee-Pay; Su, Chwen-Yng; Su, Jui-Hsing

2011-01-01

The primary purpose of this study was to investigate and compare the executive functions measured by the Wisconsin Card Sorting Test (WCST) between children with developmental coordination disorder (DCD) and age-matched normal controls. A second purpose was to examine the relations between executive functions and school functions in DCD children.…

40 CFR 125.87 - As an owner or operator of a new facility, must I perform monitoring?

Code of Federal Regulations, 2010 CFR

2010-07-01

... biweekly during the primary period of reproduction, larval recruitment, and peak abundance identified... screen systems, you must monitor head loss across the screens and correlate the measured value with the... source water surface elevation (best professional judgment based on available hydrological data). The...

A comparison of time taken to return to baseline erectile function following focal and whole gland ablative therapies for localized prostate cancer: A systematic review.

PubMed

Faure Walker, Nicholas A; Norris, Joseph M; Shah, Taimur T; Yap, Tet; Cathcart, Paul; Moore, Caroline M; Ahmed, Hashim U; Emberton, Mark; Minhas, Suks

2018-02-01

To systematically review erectile function (EF) outcomes following primary whole gland (WG) and focal ablative therapies for localized prostate cancer to ascertain whether the treatment modality or intended treatment volume affects the time taken to recover baseline EF. A systematic review was performed according to the preferred reporting items for systematic review and meta-analysis statement. Inclusion criteria were men with localized prostate cancer treated with primary, ablative therapy. Primary outcome was the return to baseline EF measured with objective, validated symptoms scores. Secondary outcome was use of phosphodiesterase inhibitors or erectile aids. Meta-analysis was not performed owing to heterogenous outcome measures. Of 222 articles identified in February 2017, 55 studies which reported EF after ablative therapy were identified but only 17 used validated outcome measures and met inclusion criteria. WG cryotherapy was used in 2 studies, WG high-intensity focused ultrasound (HIFU) in 5, focal cryotherapy in 2, focal HIFU in 3, focal phototherapy or laser therapy in 4, vascular-targeted photodynamic therapy in 3, and irreversible electroporation in 2. WG cryotherapy was associated with a significant decline in EF at 6 months with minimal improvement at 36 months. Baseline IIEF-15 of patients undergoing focal HIFU fell 30 points at 1 month but returned to baseline by 6 months. The remaining focal therapies demonstrated minimal or no effect on EF, but the men in these studies had small foci of disease. The review is limited by lack of randomized studies and heterogenous outcome measures. Most studies assessing the outcomes of focal therapy on sexual function were not of high quality, used heterogenous outcomes, and had relatively short follow up, highlighting the need for more robustly designed studies using validated patient reported outcome measures  for comparison. However, FT in general resulted in less effect on EF than WG ablation. Copyright © 2018 Elsevier Inc. All rights reserved.

Abnormal externally guided movement preparation in recent-onset schizophrenia is associated with impaired selective attention to external input.

PubMed

Smid, Henderikus G O M; Westenbroek, Joanna M; Bruggeman, Richard; Knegtering, Henderikus; Van den Bosch, Robert J

2009-11-30

Several theories propose that the primary cognitive impairment in schizophrenia concerns a deficit in the processing of external input information. There is also evidence, however, for impaired motor preparation in schizophrenia. This provokes the question whether the impaired motor preparation in schizophrenia is a secondary consequence of disturbed (selective) processing of the input needed for that preparation, or an independent primary deficit. The aim of the present study was to discriminate between these hypotheses, by investigating externally guided movement preparation in relation to selective stimulus processing. The sample comprised 16 recent-onset schizophrenia patients and 16 controls who performed a movement-precuing task. In this task, a precue delivered information about one, two or no parameters of a movement summoned by a subsequent stimulus. Performance measures and measures derived from the electroencephalogram showed that patients yielded smaller benefits from the precues and showed less cue-based preparatory activity in advance of the imperative stimulus than the controls, suggesting a response preparation deficit. However, patients also showed less activity reflecting selective attention to the precue. We therefore conclude that the existing evidence for an impairment of externally guided motor preparation in schizophrenia is most likely due to a deficit in selective attention to the external input, which lends support to theories proposing that the primary cognitive deficit in schizophrenia concerns the processing of input information.

Clinical Guideline for Female Lower Urinary Tract Symptoms.

PubMed

Takahashi, Satoru; Takei, Mineo; Nishizawa, Osamu; Yamaguchi, Osamu; Kato, Kumiko; Gotoh, Momokazu; Yoshimura, Yasukuni; Takeyama, Masami; Ozawa, Hideo; Shimada, Makoto; Yamanishi, Tomonori; Yoshida, Masaki; Tomoe, Hikaru; Yokoyama, Osamu; Koyama, Masayasu

2016-01-01

The "Japanese Clinical Guideline for Female Lower Urinary Tract Symptoms," published in Japan in November 2013, contains two algorithms (a primary and a specialized treatment algorithm) that are novel worldwide as they cover female lower urinary tract symptoms other than urinary incontinence. For primary treatment, necessary types of evaluation include querying the patient regarding symptoms and medical history, examining physical findings, and performing urinalysis. The types of evaluations that should be performed for select cases include evaluation with symptom/quality of life (QOL) questionnaires, urination records, residual urine measurement, urine cytology, urine culture, serum creatinine measurement, and ultrasonography. If the main symptoms are voiding/post-voiding, specialized treatment should be considered because multiple conditions may be involved. When storage difficulties are the main symptoms, the patient should be assessed using the primary algorithm. When conditions such as overactive bladder or stress incontinence are diagnosed and treatment is administered, but sufficient improvement is not achieved, the specialized algorithm should be considered. In case of specialized treatment, physiological re-evaluation, urinary tract/pelvic imaging evaluation, and urodynamic testing are conducted for conditions such as refractory overactive bladder and stress incontinence. There are two causes of voiding/post-voiding symptoms: lower urinary tract obstruction and detrusor underactivity. Lower urinary tract obstruction caused by pelvic organ prolapse may be improved by surgery. © 2015 Wiley Publishing Asia Pty Ltd.

Association of practice size and pay-for-performance incentives with the quality of diabetes management in primary care.

PubMed

Vamos, Eszter P; Pape, Utz J; Bottle, Alex; Hamilton, Fiona Louise; Curcin, Vasa; Ng, Anthea; Molokhia, Mariam; Car, Josip; Majeed, Azeem; Millett, Christopher

2011-09-06

Not enough is known about the association between practice size and clinical outcomes in primary care. We examined this association between 1997 and 2005, in addition to the impact of the Quality and Outcomes Framework, a pay-for-performance incentive scheme introduced in the United Kingdom in 2004, on diabetes management. We conducted a retrospective open-cohort study using data from the General Practice Research Database. We enrolled 422 general practices providing care for 154,945 patients with diabetes. Our primary outcome measures were the achievement of national treatment targets for blood pressure, glycated hemoglobin (HbA(1c)) levels and total cholesterol. We saw improvements in the recording of process of care measures, prescribing and achieving intermediate outcomes in all practice sizes during the study period. We saw improvement in reaching national targets after the introduction of the Quality and Outcomes Framework. These improvements significantly exceeded the underlying trends in all practice sizes for achieving targets for cholesterol level and blood pressure, but not for HbA(1c) level. In 1997 and 2005, there were no significant differences between the smallest and largest practices in achieving targets for blood pressure (1997 odds ratio [OR] 0.98, 95% confidence interval [CI] 0.82 to 1.16; 2005 OR 0.92, 95% CI 0.80 to 1.06 in 2005), cholesterol level (1997 OR 0.94, 95% CI 0.76 to 1.16; 2005 OR 1.1, 95% CI 0.97 to 1.40) and glycated hemoglobin level (1997 OR 0.79, 95% CI 0.55 to 1.14; 2005 OR 1.05, 95% CI 0.93 to 1.19). We found no evidence that size of practice is associated with the quality of diabetes management in primary care. Pay-for-performance programs appear to benefit both large and small practices to a similar extent.

Reasoning in the Capacity to Make Medical Decisions: The Consideration of Values

PubMed Central

Karel, Michele J.; Gurrera, Ronald J.; Hicken, Bret; Moye, Jennifer

2010-01-01

Purpose To examine the contribution of “values-based reasoning” in evaluating older adults’ capacity to make medical decisions. Design and Methods Older men with schizophrenia (n=20) or dementia (n=20), and a primary care comparison group (n=19), completed cognitive and psychiatric screening and an interview to determine their capacity to make medical decisions, which included a component on values. All of the participants were receiving treatment at Veterans Administration (VA) outpatient clinics. Results Participants varied widely in the activities and relationships they most valued, the extent to which religious beliefs would influence healthcare decisions, and in ratings of the importance of preserving quality versus length of life. Most participants preferred shared decision making with doctor, family, or both. Individuals with schizophrenia or dementia performed worse than a primary care comparison group in reasoning measured by the ability to list risks and benefits and compare choices. Individuals with dementia performed comparably to the primary care group in reasoning measured by the ability to justify choices in terms of valued abilities or activities, whereas individuals with schizophrenia performed relatively worse compared to the other two groups. Compared to primary care patients, participants with schizophrenia and with dementia were impaired on the ability to explain treatment choices in terms of valued relationships. Conclusion Medical decision making may be influenced by strongly held values and beliefs, emotions, and long life experience. To date, these issues have not been explicitly included in structured evaluations of medical decision-making capacity. This study demonstrated that it is possible to inquire of and elicit a range of healthcare related values and preferences from older adults with dementia or schizophrenia, and individuals with mild to moderate dementia may be able to discuss healthcare options in relation to their values. However, how best to incorporate a values assessment into a structured capacity evaluation deserves further research attention. PMID:20465077

Detecting recurrent major depressive disorder within primary care rapidly and reliably using short questionnaire measures.

PubMed

Thapar, Ajay; Hammerton, Gemma; Collishaw, Stephan; Potter, Robert; Rice, Frances; Harold, Gordon; Craddock, Nicholas; Thapar, Anita; Smith, Daniel J

2014-01-01

Major depressive disorder (MDD) is often a chronic disorder with relapses usually detected and managed in primary care using a validated depression symptom questionnaire. However, for individuals with recurrent depression the choice of which questionnaire to use and whether a shorter measure could suffice is not established. To compare the nine-item Patient Health Questionnaire (PHQ-9), the Beck Depression Inventory, and the Hospital Anxiety and Depression Scale against shorter PHQ-derived measures for detecting episodes of DSM-IV major depression in primary care patients with recurrent MDD. Diagnostic accuracy study of adults with recurrent depression in primary care predominantly from Wales Scores on each of the depression questionnaire measures were compared with the results of a semi-structured clinical diagnostic interview using Receiver Operating Characteristic curve analysis for 337 adults with recurrent MDD. Concurrent questionnaire and interview data were available for 272 participants. The one-month prevalence rate of depression was 22.2%. The area under the curve (AUC) and positive predictive value (PPV) at the derived optimal cut-off value for the three longer questionnaires were comparable (AUC = 0.86-0.90, PPV = 49.4-58.4%) but the AUC for the PHQ-9 was significantly greater than for the PHQ-2. However, by supplementing the PHQ-2 score with items on problems concentrating and feeling slowed down or restless, the AUC (0.91) and the PPV (55.3%) were comparable with those for the PHQ-9. A novel four-item PHQ-based questionnaire measure of depression performs equivalently to three longer depression questionnaires in identifying depression relapse in patients with recurrent MDD.

A mobile system for a comprehensive online-characterization of nanoparticle aggregates based on wide-angle light scattering and laser-induced incandescence

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

Huber, Franz J. T.; Will, Stefan, E-mail: stefan.will@fau.de; Erlangen Graduate School in Advanced Optical Technologies

A mobile demonstrator for the comprehensive online-characterization of gas-borne nanoparticle aggregates is presented. Two optical measurement techniques are combined, both utilizing a pulsed Nd:YAG laser as light source. Aggregate size and fractal dimension are measured by Wide-Angle Light Scattering (WALS). An ellipsoidal mirror images elastically scattered light from scattering angles between 10° and 165° onto a CCD-camera chip resulting in an almost complete scattering diagram with high angular resolution. Primary particle size and volume fraction are measured by time-resolved Laser-Induced Incandescence (TiRe-LII). Here, particles are heated up to about 3000 K by the short laser pulse, the enhanced thermal radiationmore » signal is detected with gated photomultiplier tubes. Analysis of the signal decay time and maximum LII-signal allows for the determination of primary particle diameter and volume fraction. The performance of the system is demonstrated by combined measurements on soot nanoparticle aggregates from a soot aerosol generator. Particle and aggregate sizes are varied by using different equivalence ratios of the combustion in the generator. Soot volume fraction can be adjusted by different levels of dilution with air. Online-measurements were carried out demonstrating the favorable performance of the system and the potential for industrial applications such as process control and product development. The particle properties obtained are confirmed through transmission electron microscopy analysis on representative samples.« less

A mobile system for a comprehensive online-characterization of nanoparticle aggregates based on wide-angle light scattering and laser-induced incandescence.

PubMed

Huber, Franz J T; Altenhoff, Michael; Will, Stefan

2016-05-01

A mobile demonstrator for the comprehensive online-characterization of gas-borne nanoparticle aggregates is presented. Two optical measurement techniques are combined, both utilizing a pulsed Nd:YAG laser as light source. Aggregate size and fractal dimension are measured by Wide-Angle Light Scattering (WALS). An ellipsoidal mirror images elastically scattered light from scattering angles between 10° and 165° onto a CCD-camera chip resulting in an almost complete scattering diagram with high angular resolution. Primary particle size and volume fraction are measured by time-resolved Laser-Induced Incandescence (TiRe-LII). Here, particles are heated up to about 3000 K by the short laser pulse, the enhanced thermal radiation signal is detected with gated photomultiplier tubes. Analysis of the signal decay time and maximum LII-signal allows for the determination of primary particle diameter and volume fraction. The performance of the system is demonstrated by combined measurements on soot nanoparticle aggregates from a soot aerosol generator. Particle and aggregate sizes are varied by using different equivalence ratios of the combustion in the generator. Soot volume fraction can be adjusted by different levels of dilution with air. Online-measurements were carried out demonstrating the favorable performance of the system and the potential for industrial applications such as process control and product development. The particle properties obtained are confirmed through transmission electron microscopy analysis on representative samples.

A mobile system for a comprehensive online-characterization of nanoparticle aggregates based on wide-angle light scattering and laser-induced incandescence

NASA Astrophysics Data System (ADS)

Huber, Franz J. T.; Altenhoff, Michael; Will, Stefan

2016-05-01

A mobile demonstrator for the comprehensive online-characterization of gas-borne nanoparticle aggregates is presented. Two optical measurement techniques are combined, both utilizing a pulsed Nd:YAG laser as light source. Aggregate size and fractal dimension are measured by Wide-Angle Light Scattering (WALS). An ellipsoidal mirror images elastically scattered light from scattering angles between 10° and 165° onto a CCD-camera chip resulting in an almost complete scattering diagram with high angular resolution. Primary particle size and volume fraction are measured by time-resolved Laser-Induced Incandescence (TiRe-LII). Here, particles are heated up to about 3000 K by the short laser pulse, the enhanced thermal radiation signal is detected with gated photomultiplier tubes. Analysis of the signal decay time and maximum LII-signal allows for the determination of primary particle diameter and volume fraction. The performance of the system is demonstrated by combined measurements on soot nanoparticle aggregates from a soot aerosol generator. Particle and aggregate sizes are varied by using different equivalence ratios of the combustion in the generator. Soot volume fraction can be adjusted by different levels of dilution with air. Online-measurements were carried out demonstrating the favorable performance of the system and the potential for industrial applications such as process control and product development. The particle properties obtained are confirmed through transmission electron microscopy analysis on representative samples.

Motivational deficits and cognitive test performance in schizophrenia.

PubMed

Fervaha, Gagan; Zakzanis, Konstantine K; Foussias, George; Graff-Guerrero, Ariel; Agid, Ofer; Remington, Gary

2014-09-01

Motivational and cognitive deficits are core features of schizophrenia, both closely linked with functional outcomes. Although poor effort and decreased motivation are known to affect performance on cognitive tests, the extent of this relationship is unclear in patients with schizophrenia. To evaluate the association between intrinsic motivation and cognitive test performance in patients with schizophrenia. Cross-sectional and 6-month prospective follow-up study performed at 57 sites in the United States, including academic and community medical treatment centers, participating in the Clinical Antipsychotic Trials of Intervention Effectiveness study. The primary sample included 431 stable patients with a DSM-IV diagnosis of schizophrenia currently receiving a stable medication regimen. Cognitive performance and intrinsic motivation were evaluated using a comprehensive neuropsychological test battery and a derived measure from the Heinrichs-Carpenter Quality of Life Scale, respectively. Symptom severity and functional status were also assessed. The primary outcome variable was global neurocognition. Individual domains of cognition were also evaluated for their association with motivation. Level of intrinsic motivation was significantly and positively correlated with global cognitive test performance, a relationship that held for each domain of cognition evaluated (correlation range, 0.20-0.34; P < .001). This association was found to be reliable after statistically accounting for positive, negative, depressive, and overall symptom severity (P < .05) and after accounting for community functioning (P < .001). The relationship between motivation and cognitive performance also remained significant after controlling for antipsychotic dose (P < .05). Prospective increase in motivation during the 6-month follow-up was also found to be significantly related to improvement in global cognitive performance (P < .05). The present findings provide strong support for a robust and reliable relationship between motivation and cognitive performance and suggest that test performance is not purely a measure of ability. Future studies assessing cognition in patients with schizophrenia should consider potential moderating variables such as effort and motivation. Implications for the assessment and interpretation of cognitive impairment based on neuropsychological test measures in schizophrenia are discussed, especially in the case of clinical trials for cognition-enhancing treatments. clinicaltrials.gov Identifier: NCT00014001.

Active wavefront control challenges of the NASA Large Deployable Reflector (LDR)

NASA Technical Reports Server (NTRS)

Meinel, Aden B.; Meinel, Marjorie P.; Manhart, Paul K.; Hochberg, Eric B.

1989-01-01

The 20-m Large Deployable Reflector will have a segmented primary mirror. Achieving diffraction-limited performance at 50 microns requires correction for the errors of tilt and piston of the primary mirror. This correction can be obtained in two ways, the use of an active primary or a correction at a demagnified pupil of the primary. A critical requirement is the means for measurement of the wavefront error and maintaining phasing during the observation of objects that may be too faint for determining the error. Absolute phasing can only be determined using a cooperative source. Maintenance of phasing can be done with an on-board source. A number of options are being explored as discussed below. The many issues concerning the assessment and control of an active segmented mirror will be addressed with an early construction of the Precision Segmented Reflector testbed.

Active wavefront control challenges of the NASA Large Deployable Reflector (LDR)

NASA Astrophysics Data System (ADS)

Meinel, Aden B.; Meinel, Marjorie P.; Manhart, Paul K.; Hochberg, Eric B.

1989-09-01

The 20-m Large Deployable Reflector will have a segmented primary mirror. Achieving diffraction-limited performance at 50 microns requires correction for the errors of tilt and piston of the primary mirror. This correction can be obtained in two ways, the use of an active primary or a correction at a demagnified pupil of the primary. A critical requirement is the means for measurement of the wavefront error and maintaining phasing during the observation of objects that may be too faint for determining the error. Absolute phasing can only be determined using a cooperative source. Maintenance of phasing can be done with an on-board source. A number of options are being explored as discussed below. The many issues concerning the assessment and control of an active segmented mirror will be addressed with an early construction of the Precision Segmented Reflector testbed.

A new bio-optical model to estimate phytoplankton primary production: An application in the eastern Mediterranean Sea

NASA Astrophysics Data System (ADS)

Stefanì, Chiara; Bonamano, Simone; Melchiorri, Cristiano; Piermattei, Viviana; Fani, Fabiola; Lazzara, Luigi; Marcelli, Marco

2015-04-01

The estimation of phytoplankton primary production provides basic input for the quantification of carbon flux in the ocean because of the strong relationship between available photosynthetic energy at the ocean surface and energy storage by algal photosynthesis. We used a new version of PhytoVFP (Variable Fluorescence Phytoplankton Production) bio-optical model to calculate phytoplankton primary production (PP) in the euphotic zone. PhytoVFP is classified as a Wavelength- and Depth-resolved (WRDR) model and is based on the implementation of photosynthetic efficiency (Fv / Fmax), measured in-situ by the PrimProd probe. An innovation of the model is the reproduction of the daily photoacclimation process by varying photosynthetic parameters (Ek, alfa and Pbmax ) along the water column as a function of stratification. The PhytoVFP model is structured into three main modules: (1) "PAR estimation ";- (2) "Photo-acclimation of marine phytoplankton"; - (3) "Phytoplankton primary production estimation". The performance of the PhytoVFP model was evaluated using PAR and 14C primary production measures collected during the SAMCA3 and SAMCA4 oceanographic cruises. The comparison between the measured and calculated radiation showed a good correlation, both in the surface and along the water column (R2 = 0.8992 in the presence, and R2 = 0.8747 in the absence, of clouds) Sensitivity tests, carried out on phie (photosynthetic quantum yield) and beta (photoinhibition parameter), allowed us to identify the best model parametrization which minimized the MAE (Mean Absolute Error). The values assigned to these parameters allowed to have a good correlation between the measured and estimated primary production values (R² = 0.808923). The results of PhytoVFP model have been also compared with its older version and the Morel (1991) model showing that the MAE of the new version is lower than the other models. The PhytoVFP model was applied on Primprod data collected during MedGOOS12 cruise in order to analyse the vertical distribution of phytoplankton primary production in the eastern Mediterranean sea.

Ten-Year Results of the Press Fit Condylar Sigma Cobalt-Chrome Total Knee Replacement.

PubMed

Keenan, Oisin; Brenkel, Ivan; Walmsley, Phil

2018-04-10

Total knee arthroplasty (TKA) is reliant on safe and effective implants. The Press Fit Condylar Sigma Cobalt-Chrome (PFCSCC) was introduced in 2006, but no reports have examined long-term failure rates and patient-reported outcome measures (PROMs). The primary aim of this study was to assess survival outcomes of the PFCSCC at 10 years after implantation. Prospective data collection was performed on all patients undergoing primary TKA in one orthopaedic department using this prosthesis exclusively from February 1, 2006, to January 31, 2007. Follow-up was at 10 years. Survival analysis was performed using two primary outcome measures: (1) all-cause joint revision and (2) aseptic revision. Secondary outcomes measures included the American Knee Society Score (AKSS) and Oxford Knee Score (OKS). In total, 249 knees of 233 patients underwent primary TKA. Mean patient age was 66.7 years (range 34-80), and mean body mass index (BMI) was 30 kg/m 2 (20.7-40.1). Reviewing all causes of revisions, 14 joints (5.6%) of 14 patients required reoperation. Of these, nine were for deep infection, including six in the first year. Four (1.6%) underwent aseptic revision. Mean AKSS changed from 47.6 to 90.4 ( n  = 140; p  < 0.001) at 10 years, and mean OKS changed from 38.3 to 23.2 ( n  = 149; p  < 0.001). Prospective analysis of consecutive TKA cases using this design of prosthesis demonstrated high survival rates of 94.4% (all-cause revision) and 98.4% (aseptic revision) at 10 years. Postoperative gains in PROMs were sustained at 10 years. These real-world data represent a substantial extension to previous reports for the PFCSCC and suggest that it is not prone to late mechanical failure. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Measurement of pion, kaon and proton production in proton-proton collisions at [Formula: see text] TeV.

PubMed

Adam, J; Adamová, D; Aggarwal, M M; Rinella, G Aglieri; Agnello, M; Agrawal, N; Ahammed, Z; Ahmed, I; Ahn, S U; Aimo, I; Aiola, S; Ajaz, M; Akindinov, A; Alam, S N; Aleksandrov, D; Alessandro, B; Alexandre, D; Molina, R Alfaro; Alici, A; Alkin, A; Alme, J; Alt, T; Altinpinar, S; Altsybeev, I; Prado, C Alves Garcia; Andrei, C; Andronic, A; Anguelov, V; Anielski, J; Antičić, T; Antinori, F; Antonioli, P; Aphecetche, L; Appelshäuser, H; Arcelli, S; Armesto, N; Arnaldi, R; Aronsson, T; Arsene, I C; Arslandok, M; Augustinus, A; Averbeck, R; Azmi, M D; Bach, M; Badalà, A; Baek, Y W; Bagnasco, S; Bailhache, R; Bala, R; Baldisseri, A; Ball, M; Pedrosa, F Baltasar Dos Santos; Baral, R C; Barbano, A M; Barbera, R; Barile, F; Barnaföldi, G G; Barnby, L S; Barret, V; Bartalini, P; Bartke, J; Bartsch, E; Basile, M; Bastid, N; Basu, S; Bathen, B; Batigne, G; Camejo, A Batista; Batyunya, B; Batzing, P C; Bearden, I G; Beck, H; Bedda, C; Behera, N K; Belikov, I; Bellini, F; Martinez, H Bello; Bellwied, R; Belmont, R; Belmont-Moreno, E; Belyaev, V; Bencedi, G; Beole, S; Berceanu, I; Bercuci, A; Berdnikov, Y; Berenyi, D; Bertens, R A; Berzano, D; Betev, L; Bhasin, A; Bhat, I R; Bhati, A K; Bhattacharjee, B; Bhom, J; Bianchi, L; Bianchi, N; Bianchin, C; Bielčík, J; Bielčíková, J; Bilandzic, A; Biswas, S; Bjelogrlic, S; Blanco, F; Blau, D; Blume, C; Bock, F; Bogdanov, A; Bøggild, H; Boldizsár, L; Bombara, M; Book, J; Borel, H; Borissov, A; Borri, M; Bossú, F; Botje, M; Botta, E; Böttger, S; Braun-Munzinger, P; Bregant, M; Breitner, T; Broker, T A; Browning, T A; Broz, M; Brucken, E J; Bruna, E; Bruno, G E; Budnikov, D; Buesching, H; Bufalino, S; Buncic, P; Busch, O; Buthelezi, Z; Buxton, J T; Caffarri, D; Cai, X; Caines, H; Diaz, L Calero; Caliva, A; Villar, E Calvo; Camerini, P; Carena, F; Carena, W; Castellanos, J Castillo; Castro, A J; Casula, E A R; Cavicchioli, C; Sanchez, C Ceballos; Cepila, J; Cerello, P; Chang, B; Chapeland, S; Chartier, M; Charvet, J L; Chattopadhyay, S; Chattopadhyay, S; Chelnokov, V; Cherney, M; Cheshkov, C; Cheynis, B; Barroso, V Chibante; Chinellato, D D; Chochula, P; Choi, K; Chojnacki, M; Choudhury, S; Christakoglou, P; Christensen, C H; Christiansen, P; Chujo, T; Chung, S U; Cicalo, C; Cifarelli, L; Cindolo, F; Cleymans, J; Colamaria, F; Colella, D; Collu, A; Colocci, M; Balbastre, G Conesa; Valle, Z Conesa Del; Connors, M E; Contreras, J G; Cormier, T M; Morales, Y Corrales; Maldonado, I Cortés; Cortese, P; Cosentino, M R; Costa, F; Crochet, P; Albino, R Cruz; Cuautle, E; Cunqueiro, L; Dahms, T; Dainese, A; Danu, A; Das, D; Das, I; Das, S; Dash, A; Dash, S; De, S; Caro, A De; Cataldo, G de; Cuveland, J de; Falco, A De; Gruttola, D De; Marco, N De; Pasquale, S De; Deisting, A; Deloff, A; Dénes, E; D'Erasmo, G; Bari, D Di; Mauro, A Di; Nezza, P Di; Corchero, M A Diaz; Dietel, T; Dillenseger, P; Divià, R; Djuvsland, Ø; Dobrin, A; Dobrowolski, T; Gimenez, D Domenicis; Dönigus, B; Dordic, O; Dubey, A K; Dubla, A; Ducroux, L; Dupieux, P; Ehlers, R J; Elia, D; Engel, H; Erazmus, B; Erhardt, F; Eschweiler, D; Espagnon, B; Estienne, M; Esumi, S; Eum, J; Evans, D; Evdokimov, S; Eyyubova, G; Fabbietti, L; Fabris, D; Faivre, J; Fantoni, A; Fasel, M; Feldkamp, L; Felea, D; Feliciello, A; Feofilov, G; Ferencei, J; Téllez, A Fernández; Ferreiro, E G; Ferretti, A; Festanti, A; Figiel, J; Figueredo, M A S; Filchagin, S; Finogeev, D; Fionda, F M; Fiore, E M; Fleck, M G; Floris, M; Foertsch, S; Foka, P; Fokin, S; Fragiacomo, E; Francescon, A; Frankenfeld, U; Fuchs, U; Furget, C; Furs, A; Girard, M Fusco; Gaardhøje, J J; Gagliardi, M; Gago, A M; Gallio, M; Gangadharan, D R; Ganoti, P; Gao, C; Garabatos, C; Garcia-Solis, E; Gargiulo, C; Gasik, P; Germain, M; Gheata, A; Gheata, M; Ghosh, P; Ghosh, S K; Gianotti, P; Giubellino, P; Giubilato, P; Dziadus, E Gladysz; Glässel, P; Ramirez, A Gomez; Zamora, P González; Gorbunov, S; Görlich, L; Gotovac, S; Grabski, V; Graczykowski, L K; Grelli, A; Grigoras, A; Grigoras, C; Grigoriev, V; Grigoryan, A; Grigoryan, S; Grinyov, B; Grion, N; Grosse-Oetringhaus, J F; Grossiord, J-Y; Grosso, R; Guber, F; Guernane, R; Guerzoni, B; Gulbrandsen, K; Gulkanyan, H; Gunji, T; Gupta, A; Gupta, R; Haake, R; Haaland, Ø; Hadjidakis, C; Haiduc, M; Hamagaki, H; Hamar, G; Hanratty, L D; Hansen, A; Harris, J W; Hartmann, H; Harton, A; Hatzifotiadou, D; Hayashi, S; Heckel, S T; Heide, M; Helstrup, H; Herghelegiu, A; Corral, G Herrera; Hess, B A; Hetland, K F; Hilden, T E; Hillemanns, H; Hippolyte, B; Hristov, P; Huang, M; Humanic, T J; Hussain, N; Hussain, T; Hutter, D; Hwang, D S; Ilkaev, R; Ilkiv, I; Inaba, M; Ionita, C; Ippolitov, M; Irfan, M; Ivanov, M; Ivanov, V; Izucheev, V; Jacobs, P M; Jahnke, C; Jang, H J; Janik, M A; Jayarathna, P H S Y; Jena, C; Jena, S; Bustamante, R T Jimenez; Jones, P G; Jung, H; Jusko, A; Kalinak, P; Kalweit, A; Kamin, J; Kang, J H; Kaplin, V; Kar, S; Uysal, A Karasu; Karavichev, O; Karavicheva, T; Karpechev, E; Kebschull, U; Keidel, R; Keijdener, D L D; Keil, M; Khan, K H; Khan, M M; Khan, P; Khan, S A; Khanzadeev, A; Kharlov, Y; Kileng, B; Kim, B; Kim, D W; Kim, D J; Kim, H; Kim, J S; Kim, M; Kim, M; Kim, S; Kim, T; Kirsch, S; Kisel, I; Kiselev, S; Kisiel, A; Kiss, G; Klay, J L; Klein, C; Klein, J; Klein-Bösing, C; Kluge, A; Knichel, M L; Knospe, A G; Kobayashi, T; Kobdaj, C; Kofarago, M; Köhler, M K; Kollegger, T; Kolojvari, A; Kondratiev, V; Kondratyeva, N; Kondratyuk, E; Konevskikh, A; Kouzinopoulos, C; Kovalenko, O; Kovalenko, V; Kowalski, M; Kox, S; Meethaleveedu, G Koyithatta; Kral, J; Králik, I; Kravčáková, A; Krelina, M; Kretz, M; Krivda, M; Krizek, F; Kryshen, E; Krzewicki, M; Kubera, A M; Kučera, V; Kucheriaev, Y; Kugathasan, T; Kuhn, C; Kuijer, P G; Kulakov, I; Kumar, J; Kumar, L; Kurashvili, P; Kurepin, A; Kurepin, A B; Kuryakin, A; Kushpil, S; Kweon, M J; Kwon, Y; Pointe, S L La; Rocca, P La; Fernandes, C Lagana; Lakomov, I; Langoy, R; Lara, C; Lardeux, A; Lattuca, A; Laudi, E; Lea, R; Leardini, L; Lee, G R; Lee, S; Legrand, I; Lehnert, J; Lemmon, R C; Lenti, V; Leogrande, E; Monzón, I León; Leoncino, M; Lévai, P; Li, S; Li, X; Lien, J; Lietava, R; Lindal, S; Lindenstruth, V; Lippmann, C; Lisa, M A; Ljunggren, H M; Lodato, D F; Loenne, P I; Loggins, V R; Loginov, V; Loizides, C; Lopez, X; Torres, E López; Lowe, A; Lu, X-G; Luettig, P; Lunardon, M; Luparello, G; Maevskaya, A; Mager, M; Mahajan, S; Mahmood, S M; Maire, A; Majka, R D; Malaev, M; Cervantes, I Maldonado; Malinina, L; Mal'Kevich, D; Malzacher, P; Mamonov, A; Manceau, L; Manko, V; Manso, F; Manzari, V; Marchisone, M; Mareš, J; Margagliotti, G V; Margotti, A; Margutti, J; Marín, A; Markert, C; Marquard, M; Martin, N A; Blanco, J Martin; Martinengo, P; Martínez, M I; Martínez García, G; Pedreira, M Martinez; Martynov, Y; Mas, A; Masciocchi, S; Masera, M; Masoni, A; Massacrier, L; Mastroserio, A; Masui, H; Matyja, A; Mayer, C; Mazer, J; Mazzoni, M A; Mcdonald, D; Meddi, F; Menchaca-Rocha, A; Meninno, E; Pérez, J Mercado; Meres, M; Miake, Y; Mieskolainen, M M; Mikhaylov, K; Milano, L; Milosevic, J; Minervini, L M; Mischke, A; Mishra, A N; Miśkowiec, D; Mitra, J; Mitu, C M; Mohammadi, N; Mohanty, B; Molnar, L; Zetina, L Montaño; Montes, E; Morando, M; Godoy, D A Moreira De; Moretto, S; Morreale, A; Morsch, A; Muccifora, V; Mudnic, E; Mühlheim, D; Muhuri, S; Mukherjee, M; Müller, H; Mulligan, J D; Munhoz, M G; Murray, S; Musa, L; Musinsky, J; Nandi, B K; Nania, R; Nappi, E; Naru, M U; Nattrass, C; Nayak, K; Nayak, T K; Nazarenko, S; Nedosekin, A; Nellen, L; Ng, F; Nicassio, M; Niculescu, M; Niedziela, J; Nielsen, B S; Nikolaev, S; Nikulin, S; Nikulin, V; Noferini, F; Nomokonov, P; Nooren, G; Norman, J; Nyanin, A; Nystrand, J; Oeschler, H; Oh, S; Oh, S K; Ohlson, A; Okatan, A; Okubo, T; Olah, L; Oleniacz, J; Silva, A C Oliveira Da; Oliver, M H; Onderwaater, J; Oppedisano, C; Velasquez, A Ortiz; Oskarsson, A; Otwinowski, J; Oyama, K; Ozdemir, M; Pachmayer, Y; Pagano, P; Paić, G; Pajares, C; Pal, S K; Pan, J; Pandey, A K; Pant, D; Papikyan, V; Pappalardo, G S; Pareek, P; Park, W J; Parmar, S; Passfeld, A; Paticchio, V; Paul, B; Pawlak, T; Peitzmann, T; Costa, H Pereira Da; Filho, E Pereira De Oliveira; Peresunko, D; Lara, C E Pérez; Peskov, V; Pestov, Y; Petráček, V; Petrov, V; Petrovici, M; Petta, C; Piano, S; Pikna, M; Pillot, P; Pinazza, O; Pinsky, L; Piyarathna, D B; Płoskoń, M; Planinic, M; Pluta, J; Pochybova, S; Podesta-Lerma, P L M; Poghosyan, M G; Polichtchouk, B; Poljak, N; Poonsawat, W; Pop, A; Porteboeuf-Houssais, S; Porter, J; Pospisil, J; Prasad, S K; Preghenella, R; Prino, F; Pruneau, C A; Pshenichnov, I; Puccio, M; Puddu, G; Pujahari, P; Punin, V; Putschke, J; Qvigstad, H; Rachevski, A; Raha, S; Rajput, S; Rak, J; Rakotozafindrabe, A; Ramello, L; Raniwala, R; Raniwala, S; Räsänen, S S; Rascanu, B T; Rathee, D; Razazi, V; Read, K F; Real, J S; Redlich, K; Reed, R J; Rehman, A; Reichelt, P; Reicher, M; Reidt, F; Ren, X; Renfordt, R; Reolon, A R; Reshetin, A; Rettig, F; Revol, J-P; Reygers, K; Riabov, V; Ricci, R A; Richert, T; Richter, M; Riedler, P; Riegler, W; Riggi, F; Ristea, C; Rivetti, A; Rocco, E; Cahuantzi, M Rodríguez; Manso, A Rodriguez; Røed, K; Rogochaya, E; Rohr, D; Röhrich, D; Romita, R; Ronchetti, F; Ronflette, L; Rosnet, P; Rossi, A; Roukoutakis, F; Roy, A; Roy, C; Roy, P; Montero, A J Rubio; Rui, R; Russo, R; Ryabinkin, E; Ryabov, Y; Rybicki, A; Sadovsky, S; Šafařík, K; Sahlmuller, B; Sahoo, P; Sahoo, R; Sahoo, S; Sahu, P K; Saini, J; Sakai, S; Saleh, M A; Salgado, C A; Salzwedel, J; Sambyal, S; Samsonov, V; Castro, X Sanchez; Šándor, L; Sandoval, A; Sano, M; Santagati, G; Sarkar, D; Scapparone, E; Scarlassara, F; Scharenberg, R P; Schiaua, C; Schicker, R; Schmidt, C; Schmidt, H R; Schuchmann, S; Schukraft, J; Schulc, M; Schuster, T; Schutz, Y; Schwarz, K; Schweda, K; Scioli, G; Scomparin, E; Scott, R; Seeder, K S; Seger, J E; Sekiguchi, Y; Selyuzhenkov, I; Senosi, K; Seo, J; Serradilla, E; Sevcenco, A; Shabanov, A; Shabetai, A; Shadura, O; Shahoyan, R; Shangaraev, A; Sharma, A; Sharma, N; Shigaki, K; Shtejer, K; Sibiriak, Y; 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Tveter, T S; Ullaland, K; Uras, A; Usai, G L; Utrobicic, A; Vajzer, M; Vala, M; Palomo, L Valencia; Vallero, S; Maarel, J Van Der; Hoorne, J W Van; Leeuwen, M van; Vanat, T; Vyvre, P Vande; Varga, D; Vargas, A; Vargyas, M; Varma, R; Vasileiou, M; Vasiliev, A; Vauthier, A; Vechernin, V; Veen, A M; Veldhoen, M; Velure, A; Venaruzzo, M; Vercellin, E; Limón, S Vergara; Vernet, R; Verweij, M; Vickovic, L; Viesti, G; Viinikainen, J; Vilakazi, Z; Baillie, O Villalobos; Vinogradov, A; Vinogradov, L; Vinogradov, Y; Virgili, T; Vislavicius, V; Viyogi, Y P; Vodopyanov, A; Völkl, M A; Voloshin, K; Voloshin, S A; Volpe, G; Haller, B von; Vorobyev, I; Vranic, D; Vrláková, J; Vulpescu, B; Vyushin, A; Wagner, B; Wagner, J; Wang, H; Wang, M; Wang, Y; Watanabe, D; Weber, M; Weber, S G; Wessels, J P; Westerhoff, U; Wiechula, J; Wikne, J; Wilde, M; Wilk, G; Wilkinson, J; Williams, M C S; Windelband, B; Winn, M; Yaldo, C G; Yamaguchi, Y; Yang, H; Yang, P; Yano, S; Yasnopolskiy, S; Yin, Z; Yokoyama, H; Yoo, I-K; Yurchenko, V; Yushmanov, I; Zaborowska, A; Zaccolo, V; Zaman, A; Zampolli, C; Zanoli, H J C; Zaporozhets, S; Zarochentsev, A; Závada, P; Zaviyalov, N; Zbroszczyk, H; Zgura, I S; Zhalov, M; Zhang, H; Zhang, X; Zhang, Y; Zhao, C; Zhigareva, N; Zhou, D; Zhou, Y; Zhou, Z; Zhu, H; Zhu, J; Zhu, X; Zichichi, A; Zimmermann, A; Zimmermann, M B; Zinovjev, G; Zyzak, M

The measurement of primary [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] production at mid-rapidity ([Formula: see text] 0.5) in proton-proton collisions at [Formula: see text][Formula: see text] 7 TeV performed with a large ion collider experiment at the large hadron collider (LHC) is reported. Particle identification is performed using the specific ionisation energy-loss and time-of-flight information, the ring-imaging Cherenkov technique and the kink-topology identification of weak decays of charged kaons. Transverse momentum spectra are measured from 0.1 up to 3 GeV/[Formula: see text] for pions, from 0.2 up to 6 GeV/[Formula: see text] for kaons and from 0.3 up to 6 GeV/[Formula: see text] for protons. The measured spectra and particle ratios are compared with quantum chromodynamics-inspired models, tuned to reproduce also the earlier measurements performed at the LHC. Furthermore, the integrated particle yields and ratios as well as the average transverse momenta are compared with results at lower collision energies.

Multichamber Multipotentiostat System for Cellular Microphysiometry.

PubMed

Lima, Eduardo A; Snider, Rachel M; Reiserer, Ronald S; McKenzie, Jennifer R; Kimmel, Danielle W; Eklund, Sven E; Wikswo, John P; Cliffel, David E

2014-12-01

Multianalyte microphysiometry is a powerful technique for studying cellular metabolic flux in real time. Monitoring several analytes concurrently in a number of individual chambers, however, requires specific instrumentation that is not available commercially in a single, compact, benchtop form at an affordable cost. We developed a multipotentiostat system capable of performing simultaneous amperometric and potentiometric measurements in up to eight individual chambers. The modular design and custom LabVIEW™ control software provide flexibility and allow for expansion and modification to suit different experimental conditions. Superior accuracy is achieved when operating the instrument in a standalone configuration; however, measurements performed in conjunction with a previously developed multianalyte microphysiometer have shown low levels of crosstalk as well. Calibrations and experiments with primary and immortalized cell cultures demonstrate the performance of the instrument and its capabilities.

A Novel Method for Assessing Task Complexity in Outpatient Clinical-Performance Measures.

PubMed

Hysong, Sylvia J; Amspoker, Amber B; Petersen, Laura A

2016-04-01

Clinical-performance measurement has helped improve the quality of health-care; yet success in attaining high levels of quality across multiple domains simultaneously still varies considerably. Although many sources of variability in care quality have been studied, the difficulty required to complete the clinical work itself has received little attention. We present a task-based methodology for evaluating the difficulty of clinical-performance measures (CPMs) by assessing the complexity of their component requisite tasks. Using Functional Job Analysis (FJA), subject-matter experts (SMEs) generated task lists for 17 CPMs; task lists were rated on ten dimensions of complexity, and then aggregated into difficulty composites. Eleven outpatient work SMEs; 133 VA Medical Centers nationwide. Clinical Performance: 17 outpatient CPMs (2000-2008) at 133 VA Medical Centers nationwide. Measure Difficulty: for each CPM, the number of component requisite tasks and the average rating across ten FJA complexity scales for the set of tasks comprising the measure. Measures varied considerably in the number of component tasks (M = 10.56, SD = 6.25, min = 5, max = 25). Measures of chronic care following acute myocardial infarction exhibited significantly higher measure difficulty ratings compared to diabetes or screening measures, but not to immunization measures ([Formula: see text] = 0.45, -0.04, -0.05, and -0.06 respectively; F (3, 186) = 3.57, p = 0.015). Measure difficulty ratings were not significantly correlated with the number of component tasks (r = -0.30, p = 0.23). Evaluating the difficulty of achieving recommended CPM performance levels requires more than simply counting the tasks involved; using FJA to assess the complexity of CPMs' component tasks presents an alternate means of assessing the difficulty of primary-care CPMs and accounting for performance variation among measures and performers. This in turn could be used in designing performance reward programs, or to match workflow to clinician time and effort.

FAST INdiCATE Trial protocol. Clinical efficacy of functional strength training for upper limb motor recovery early after stroke: neural correlates and prognostic indicators.

PubMed

Pomeroy, Valerie M; Ward, Nick S; Johansen-Berg, Heidi; van Vliet, Paulette; Burridge, Jane; Hunter, Susan M; Lemon, Roger N; Rothwell, John; Weir, Christopher J; Wing, Alan; Walker, Andrew A; Kennedy, Niamh; Barton, Garry; Greenwood, Richard J; McConnachie, Alex

2014-02-01

Functional strength training in addition to conventional physical therapy could enhance upper limb recovery early after stroke more than movement performance therapy plus conventional physical therapy. To determine (a) the relative clinical efficacy of conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy for upper limb recovery; (b) the neural correlates of response to conventional physical therapy combined with functional strength training and conventional physical therapy combined with movement performance therapy; (c) whether any one or combination of baseline measures predict motor improvement in response to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy. Randomized, controlled, observer-blind trial. The sample will consist of 288 participants with upper limb paresis resulting from a stroke that occurred within the previous 60 days. All will be allocated to conventional physical therapy combined with functional strength training or conventional physical therapy combined with movement performance therapy. Functional strength training and movement performance therapy will be undertaken for up to 1·5 h/day, five-days/week for six-weeks. Measurements will be undertaken before randomization, six-weeks thereafter, and six-months after stroke. Primary efficacy outcome will be the Action Research Arm Test. Explanatory measurements will include voxel-wise estimates of brain activity during hand movement, brain white matter integrity (fractional anisotropy), and brain-muscle connectivity (e.g. latency of motor evoked potentials). The primary clinical efficacy analysis will compare treatment groups using a multilevel normal linear model adjusting for stratification variables and for which therapist administered the treatment. Effect of conventional physical therapy combined with functional strength training versus conventional physical therapy combined with movement performance therapy will be summarized using the adjusted mean difference and 95% confidence interval. To identify the neural correlates of improvement in both groups, we will investigate associations between change from baseline in clinical outcomes and each explanatory measure. To identify baseline measurements that independently predict motor improvement, we will develop a multiple regression model. © 2013 The Authors. International Journal of Stroke published by John Wiley & Sons Ltd on behalf of World Stroke Organization.

Botulinum toxin A injections and occupational therapy in children with unilateral spastic cerebral palsy: a randomized controlled trial.

PubMed

Lidman, Git; Nachemson, Ann; Peny-Dahlstrand, Marie; Himmelmann, Kate

2015-08-01

To investigate the effects of repeated botulinum toxin A (BoNT-A) injections combined with occupational therapy, including a splint, compared with occupational therapy alone on hand function in children with unilateral spastic cerebral palsy (USCP), in all International Classification of Functioning, Disability and Health (ICF) domains. This was a randomized controlled study, population-based and evaluator-blinded for primary outcome (October 2004 to September 2010). Twenty children (14 males; median age 3y 1mo) with USCP, recruited at a rehabilitation centre in Sweden, were assigned to one of two parallel groups using concealed allocation. In the course of one year, 10 children received occupational therapy, while 10 received repeated BoNT-A plus occupational therapy (BoNT-A/OT). Primary outcome (Assisting Hand Assessment [AHA]), and secondary outcome measures (range of movement [ROM], and Canadian Occupational Performance Measure), were measured at baseline, 3, 6, 9, and 12 months. AHA revealed a superior effect in the BoNT-A/OT group at 12 months: 6 out of 10 improved compared with 1 out of 10 in the occupational therapy group (p<0.03). A 95% Peskun exact confidence interval for the difference in proportions is given as 0.01 to 0.81. Secondary outcomes improved in both groups. Repeated BoNT-A/OT appeared superior to occupational therapy alone for bimanual performance in young children with USCP. Active ROM and goal performance improved in both groups. © 2015 Mac Keith Press.

Non-Verbal Episodic Memory Deficits in Primary Progressive Aphasias are Highly Predictive of Underlying Amyloid Pathology.

PubMed

Ramanan, Siddharth; Flanagan, Emma; Leyton, Cristian E; Villemagne, Victor L; Rowe, Christopher C; Hodges, John R; Hornberger, Michael

2016-01-01

Diagnostic distinction of primary progressive aphasias (PPA) remains challenging, in particular for the logopenic (lvPPA) and nonfluent/agrammatic (naPPA) variants. Recent findings highlight that episodic memory deficits appear to discriminate these PPA variants from each other, as only lvPPA perform poorly on these tasks while having underlying amyloid pathology similar to that seen in amnestic dementias like Alzheimer's disease (AD). Most memory tests are, however, language based and thus potentially confounded by the prevalent language deficits in PPA. The current study investigated this issue across PPA variants by contrasting verbal and non-verbal episodic memory measures while controlling for their performance on a language subtest of a general cognitive screen. A total of 203 participants were included (25 lvPPA; 29 naPPA; 59 AD; 90 controls) and underwent extensive verbal and non-verbal episodic memory testing, with a subset of patients (n = 45) with confirmed amyloid profiles as assessed by Pittsburgh Compound B and PET. The most powerful discriminator between naPPA and lvPPA patients was a non-verbal recall measure (Rey Complex Figure delayed recall), with 81% of PPA patients classified correctly at presentation. Importantly, AD and lvPPA patients performed comparably on this measure, further highlighting the importance of underlying amyloid pathology in episodic memory profiles. The findings demonstrate that non-verbal recall emerges as the best discriminator of lvPPA and naPPA when controlling for language deficits in high load amyloid PPA cases.

SU-F-I-36: In-Utero Dose Measurements Within Postmortem Subjects for Estimating Fetal Doses in Pregnant Patients Examined with Pulmonary Embolism, Trauma, and Appendicitis CT

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

Lipnharski, I; Quails, N; Carranza, C

Purpose: The imaging of pregnant patients is medically necessary in certain clinical situations. The purpose of this work was to directly measure uterine doses in a cadaver scanned with CT protocols commonly performed on pregnant patients in order to estimate fetal dose and assess potential risk. Method: One postmortem subject was scanned on a 320-slice CT scanner with standard pulmonary embolism, trauma, and appendicitis protocols. All protocols were performed with the scan parameters and ranges currently used in clinical practice. Exams were performed both with and without iterative reconstruction to highlight the dose savings potential. Optically stimulated luminescent dosimeters (OSLDs)more » were inserted into the uterus in order to approximate fetal doses. Results: In the pulmonary embolism CT protocol, the uterus is outside of the primary beam, and the dose to the uterus was under 1 mGy. In the trauma and appendicitis protocols, the uterus is in the primary beam, the fetal dose estimates were 30.5 mGy for the trauma protocol, and 20.6 mGy for the appendicitis protocol. Iterative reconstruction reduced fetal doses by 30%, with uterine doses at 21.3 for the trauma and 14.3 mGy for the appendicitis protocol. Conclusion: Fetal doses were under 1 mGy when exposed to scatter radiation, and under 50 mGy when exposed to primary radiation with the trauma and appendicitis protocols. Consistent with the National Council on Radiation Protection & Measurements (NCRP) and the International Commission on Radiological Protection (ICRP), these doses exhibit a negligible risk to the fetus, with only a small increased risk of cancer. Still, CT scans are not recommended during pregnancy unless the benefits of the exam clearly outweigh the potential risk. Furthermore, when possible, pregnant patients should be examined on CT scanners equipped with iterative reconstruction in order to keep patient doses as low as reasonable achievable.« less

The effects on the plankton community of filter-feeding Sacramento blackfish, Orthodon microlepidotus.

PubMed

Byers, Stephanie; Vinyard, Gary L

1990-06-01

A series of mesocosm experiments was performed to assess the effects on the plankton community of filter-feeding Sacramento blackfish (Cyprinidae; Orthodon microlepidotus). Phytoplankton size-frequency distribution, zooplankton abundance, primary production, potential secondary production, and nutrient concentrations were measured. Blackfish reduce numbers of both evasive and nonevasive zooplankton and large phytoplankton while enhancing nanoplankton densities. Blackfish also significantly increase primary production and potential secondary community production. Levels of dissolved inorganic phosphorus and ammonia-nitrogen also increase. The effects of blackfish are generally similar to those reported for other filter-feeding fish.

Variation in nuclear size and PD-L2 positivity correlate with aggressive chromophobe renal cell carcinoma.

PubMed

Mostafa, Mohamed E; Abdelkader, Amrou; Kuroda, Naoto; Pérez-Montiel, Delia; Banerjee, Anjishnu; Hes, Ondrej; Iczkowski, Kenneth A

2018-06-01

Chromophobe renal cell carcinoma (CRCC) is not amenable to International Society for Urologic Pathology-endorsed nucleolar grading. Novel grading approaches were proposed, but the rarity of adverse pathology hampers their discriminatory value. We investigate simple linear micrometer measurements and a proposed immunostain in CRCCs. 32 patients' CRCCs were studied: 12 adverse cases (stage pT3, recurrence, or metastasis), 15 controls (stage ≤pT2, no recurrence or metastasis after >3 years), and 8 metastases (3 were paired with primary adverse cases). The ratio of greatest dimensions of largest and smallest nuclei, in each of 5 "worst" high-power fields, excluding those with degenerative features, was designated variation in nuclear size (VNS). Percent multinucleate cells (PMC) were also counted. Mouse anti PD-L2 monoclonal antibody immunostaining was performed. Mean VNS measured in adverse primary and control primary tumors were 3.7 ± 0.5 and 2.4 ± 0.4 respectively (P < .001), and 3.4 ± 0.4 for metastases (P < .001). Optimal VNS cut-off was 2.5, with sensitivity and specificity 0.85 and 0.81, respectively. PMCs were 6.0 ± 3.0 for adverse group, 5.7 ± 2.7 for controls, and 4.1 ± 1.6 for metastases (P = NS). PD-L2 could not discriminate adverse versus good primary tumors (χ 2 1.6, P = .2), but was higher in metastases (χ 2 6.9, P < .01), or metastases plus adverse primary tumors (χ 2 4.8, P = .03), compared to good-pathology primary tumors. In conclusion, VNS is an easily obtained measurement that can predict adverse behavior of chromophobe RCC, and may impart value for needle biopsy reporting and the choice of active surveillance. PD-L2 was elevated in metastases but was less useful for primary tumors. Copyright © 2018 Elsevier Inc. All rights reserved.

Demystifying the Mysteries: Sexual Dimorphism in Primary Teeth.

PubMed

Singh, Akshara; Bhatia, Hind Pal; Sood, Shveta; Sharma, Naresh

2017-04-01

One of the critical steps in the process of identification is the sex determination of an unknown individual. Many studies have shown that sex can be determined using the human skeleton, especially by examining the pelvis and skull. Odontometric analysis of the human sexual variation has been less investigated, especially of primary dentition. To verify the presence of sexual dimorphism in primary teeth of local population of Faridabad, Haryana, India. The research was performed on dental casts of 500 children (250 boys and 250 girls, age range 3-5 years). Mesiodistal and buccolingual crown dimensions of maxillary and mandibular primary teeth were measured with a digital Vernier's caliper and were analysed for sexual dimorphism. Mann-Whitney-U test was used to check the statistical significance of difference in tooth dimensions among boys and girls. Differences were found in the mean values of mesiodistal and buccolingual diameters of primary teeth, in which boys generally had larger crown diameters than girls. Primary teeth may be used as an additional tool for sex identification of juvenile skeletons where other dimorphic features are not much developed.

Effectiveness of a virtual intervention for primary healthcare professionals aimed at improving attitudes towards the empowerment of patients with chronic diseases: study protocol for a cluster randomized controlled trial (e-MPODERA project).

PubMed

González-González, Ana Isabel; Orrego, Carola; Perestelo-Perez, Lilisbeth; Bermejo-Caja, Carlos Jesús; Mora, Nuria; Koatz, Débora; Ballester, Marta; Del Pino, Tasmania; Pérez-Ramos, Jeannet; Toledo-Chavarri, Ana; Robles, Noemí; Pérez-Rivas, Francisco Javier; Ramírez-Puerta, Ana Belén; Canellas-Criado, Yolanda; Del Rey-Granado, Yolanda; Muñoz-Balsa, Marcos José; Becerril-Rojas, Beatriz; Rodríguez-Morales, David; Sánchez-Perruca, Luis; Vázquez, José Ramón; Aguirre, Armando

2017-10-30

Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases. This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice. This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases. ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016.

Prevalence of primary hyperaldosteronism in a systemic arterial hypertension league.

PubMed

Ribeiro, Maria Jacqueline Silva; Figueiredo Neto, José Albuquerque de; Memória, Edson Viriato; Lopes, Maíra de Castro; Faria, Manuel dos Santos; Salgado Filho, Natalino; Oliveira, Thiara Castro de

2009-01-01

Until recently, primary hyperaldosteronism was considered a rare cause of secondary hypertension. However, in recent years, many studies have suggested that this disease can affect up to 20% of hypertensive individuals. To determine the prevalence of primary hyperaldosteronism in hypertensive patients treated at the hypertension league of a university hospital. Serum aldosterone and plasma renin activity levels were measured in 105 patients while they were undergoing standard antihypertensive treatment, with the exception of those using betablockers and spironolactone, in fasting condition and after rest in the supine position for 20 minutes. Those with an aldosterone/plasma renin activity ratio > 25 were submitted to the saline suppression test and, after the confirmation of the autonomy of aldosterone secretion, a computed tomography of the adrenals was performed. The results are presented as percentages and means and standard deviations. Of the 105 patients, 6.54% presented refractory hypertension. Nine presented an aldosterone/plasma renin activity ratio > 25 (8.5% of the total). Of these, 08 were submitted to the saline suppression test and 01 (with refractory hypertension) had the diagnosis of primary hyperaldosteronism confirmed (0.96% of the total). A computed tomography of the adrenals was performed, which showed normal results. The prevalence of primary hyperaldosteronism in the studied sample was 0.96% of the total. However, when only the patients with refractory hypertension were evaluated, the prevalence was 14.3%.

Knowledge, attitude, willingness and readiness of primary health care providers to provide oral health services to children in Niagara, Ontario: a cross-sectional survey.

PubMed

Singhal, Sonica; Figueiredo, Rafael; Dupuis, Sandy; Skellet, Rachel; Wincott, Tara; Dyer, Carolyn; Feller, Andrea; Quiñonez, Carlos

2017-01-01

Most children are exposed to medical, but not dental, care at an early age, making primary health care providers an important player in the reduction of tooth decay. The goal of this research was to understand the feasibility of using primary health care providers in promoting oral health by assessing their knowledge, attitude, willingness and readiness in this regard. Using the Dillman method, a mail-in cross-sectional survey was conducted among all family physicians and pediatricians in the Niagara region of Ontario who have primary contact with children. A descriptive analysis was performed. Close to 70% (181/265) of providers responded. More than 90% know that untreated tooth decay could affect the general health of a child. More than 80% examine the oral cavity for more than 50% of their child patients. However, more than 50% are not aware that white spots or lines on the tooth surface are the first signs of tooth decay. Lack of clinical time was the top reason for not performing oral disease prevention measures. Overall, survey responses show a positive attitude and willingness to engage in the oral health of children. To capitalize on this, there is a need to identify mechanisms of providing preventive oral health care services by primary health care providers; including improving their knowledge of oral health and addressing other potential barriers.

Pharmacodynamics of temazepam in primary insomnia: assessment of the value of quantitative electroencephalography and saccadic eye movements in predicting improvement of sleep.

PubMed

Tuk, B; Oberyé, J J; Pieters, M S; Schoemaker, R C; Kemp, B; van Gerven, J; Danhof, M; Kamphuisen, H A; Cohen, A F; Breimer, D D; Peck, C C

1997-10-01

Quantitative electroencephalographic parameters and saccadic eye movements are frequently used as pharmacodynamic measures of benzodiazepine effect. We investigated the relationship between these measures and the hypnotic effect. The correlation between the pharmacodynamic measures and sleep quality was determined in 21 patients with primary insomnia. The pharmacokinetic-pharmacodynamic relationships were characterized after administration of 20 mg oral temazepam. The hypnotic effect was determined on the basis of polysomnographic sleep recordings and a subjective sleep evaluation questionnaire. Correlations between pharmacodynamic measures and the improvement of sleep were investigated. The pharmacokinetic-pharmacodynamic relationships for the parameters derived from electroencephalography and saccadic eye movements showed considerable interindividual variability. Administration of temazepam led to a significant improvement in the objective parameters sleep period efficiency, wake time after sleep onset, and sleep efficiency and in the subjective assessment of sleep quality. No significant correlations were observed between the pharmacokinetic-pharmacodynamic-derived parameters and the improvement in objective or subjective sleep parameters. In subjects with primary insomnia the administration of 20 mg oral temazepam results in changes in both the pharmacodynamic measures and in quality of sleep. No individual correlations between the pharmacodynamic measures and quality of sleep were observed. We concluded that the investigated pharmacodynamic measures are of value in the first assessment of clinical efficacy and for the selection of the dose(s) to be investigated in subsequent trials that aim at showing clinical efficacy. However, the conclusive quantification of clinical efficacy should be performed only on the basis of the clinical end point itself.

Nuclear Diagnostics at the National Ignition Facility, 2013-2015

NASA Astrophysics Data System (ADS)

Yeamans, C. B.; Cassata, W. S.; Church, J. A.; Fittinghoff, D. N.; Gatu Johnson, M.; Gharibyan, N.; Határik, R.; Sayre, D. B.; Sio, H. W.; Bionta, R. M.; Bleuel, D. L.; Caggiano, J. A.; Cerjan, C. J.; Cooper, G. W.; Eckart, M. J.; Edwards, E. R.; Faye, S. A.; Forrest, C. J.; Frenje, J. A.; Glebov, V. Yu; Grant, P. M.; Grim, G. P.; Hartouni, E. P.; Herrmann, H. W.; Kilkenny, J. D.; Knauer, J. P.; Mackinnon, A. J.; Merrill, F. E.; Moody, K. J.; Moran, M. J.; Petrasso, R. D.; Phillips, T. W.; Rinderknecht, H. G.; Schneider, D. H. G.; Sepke, S. M.; Shaughnessy, D. A.; Stoeffl, W.; Velsko, C. A.; Volegov, P.

2016-05-01

The National Ignition Facility (NIF) relies on a suite of nuclear diagnostics to measure the neutronic output of experiments. Neutron time-of-flight (NTOF) and neutron activation diagnostics (NAD) provide performance metrics of absolute neutron yield and neutron spectral content: spectral width and non-thermal content, from which implosion physical quantities of temperature and scattering mass are inferred. Spatially-distributed flange- mounted NADs (FNAD) measure, with nearly identical systematic uncertainties, primary DT neutron emission to infer a whole-sky neutron field. An automated FNAD system is being developed. A magnetic recoil spectrometer (MRS) shares few systematics with comparable NTOF and NAD devices, and as such is deployed for independent measurement of the primary neutronic quantities. The gas-Cherenkov Gamma Reaction History (GRH) instrument records four energy channels of time-resolved gamma emission to measure nuclear bang time and burn width, as well as to infer carbon areal density in experiments utilizing plastic or diamond capsules. A neutron imaging system (NIS) takes two images of the neutron source, typically gated to create coregistered 13-15 MeV primary and 6-12 MeV downscattered images. The radiochemical analysis of gaseous samples (RAGS) instrument pumps target chamber gas to a chemical reaction and fractionation system configured with gamma counters, allowing measurement of radionuclides with half-lives as short as 8 seconds. Solid radiochemistry collectors (SRC) with backing NAD foils collect target debris, where activated materials from the target assembly are used as indicators of neutron spectrum content, and also serve as the primary diagnostic for nuclear forensic science experiments. Particle time-of-flight (PTOF) measures compression-bang time using DT- or DD-neutrons, as well as shock bang-time using D3He-protons for implosions with lower x-ray background. In concert, these diagnostics serve to measure the basic and advanced quantities required to understand NIF experimental results.

Core outcome measures for opioid abuse liability laboratory assessment studies in humans: IMMPACT recommendations

PubMed Central

Comer, Sandra D.; Zacny, James P.; Dworkin, Robert H.; Turk, Dennis C.; Bigelow, George E.; Foltin, Richard W.; Jasinski, Donald R.; Sellers, Edward M.; Adams, Edgar H.; Balster, Robert; Burke, Laurie B.; Cerny, Igor; Colucci, Robert D.; Cone, Edward; Cowan, Penney; Farrar, John T.; Haddox, J. David; Haythornthwaite, Jennifer A.; Hertz, Sharon; Jay, Gary W.; Johanson, Chris-Ellyn; Junor, Roderick; Katz, Nathaniel P.; Klein, Michael; Kopecky, Ernest A.; Leiderman, Deborah B.; McDermott, Michael P.; O’Brien, Charles; O’Connor, Alec B.; Palmer, Pamela P.; Raja, Srinivasa N.; Rappaport, Bob A.; Rauschkolb, Christine; Rowbotham, Michael C.; Sampaio, Cristina; Setnik, Beatrice; Sokolowska, Marta; Stauffer, Joseph W.; Walsh, Sharon L.

2012-01-01

A critical component in development of opioid analgesics is assessment of their abuse liability (AL). Standardization of approaches and measures used in assessing AL has the potential to facilitate comparisons across studies, research laboratories, and drugs. The goal of this report is to provide consensus recommendations regarding core outcome measures for assessing abuse potential of opioid medications in humans in a controlled laboratory setting. Although many of the recommended measures are appropriate for assessing the AL of medications from other drug classes, the focus here is on opioid medications because they present unique risks from both physiological (e.g., respiratory depression, physical dependence) and public health (e.g., individuals in pain) perspectives. A brief historical perspective on AL testing is provided and then those measures that can be considered primary and secondary outcomes and possible additional outcomes in AL assessment are discussed. These outcome measures include: (1) subjective effects (some of which comprise the primary outcome measures, including drug liking); (2) physiological responses; (3) drug self-administration behavior; and (4) cognitive and psychomotor performance. Prior to presenting recommendations for standardized approaches and measures to be used in AL assessments, the appropriateness of using these measures in clinical trials with patients in pain is discussed. PMID:22998781

Event-related potentials and secondary task performance during simulated driving.

PubMed

Wester, A E; Böcker, K B E; Volkerts, E R; Verster, J C; Kenemans, J L

2008-01-01

Inattention and distraction account for a substantial number of traffic accidents. Therefore, we examined the impact of secondary task performance (an auditory oddball task) on a primary driving task (lane keeping). Twenty healthy participants performed two 20-min tests in the Divided Attention Steering Simulator (DASS). The visual secondary task of the DASS was replaced by an auditory oddball task to allow recording of brain activity. The driving task and the secondary (distracting) oddball task were presented in isolation and simultaneously, to assess their mutual interference. In addition to performance measures (lane keeping in the primary driving task and reaction speed in the secondary oddball task), brain activity, i.e. event-related potentials (ERPs), was recorded. Performance parameters on the driving test and the secondary oddball task did not differ between performance in isolation and simultaneous performance. However, when both tasks were performed simultaneously, reaction time variability increased in the secondary oddball task. Analysis of brain activity indicated that ERP amplitude (P3a amplitude) related to the secondary task, was significantly reduced when the task was performed simultaneously with the driving test. This study shows that when performing a simple secondary task during driving, performance of the driving task and this secondary task are both unaffected. However, analysis of brain activity shows reduced cortical processing of irrelevant, potentially distracting stimuli from the secondary task during driving.

Prevalence of upper gastrointestinal symptoms and their influence on nutritional state and performance status in patients with different primary tumors receiving palliative care.

PubMed

Bovio, Giacomo; Fonte, Maria Luisa; Baiardi, Paola

2014-02-01

The aim of this study was to investigate the relationship between gastrointestinal symptoms, nutritional balance, and performance status in patients receiving palliative care for advanced cancers originating in different sites. We studied a total of 105 patients. Upper gastrointestinal symptoms, Eastern Cooperative Oncology Group Performance Status score (ECOG-PS), dietary intakes, anthropometric measures, and some serum proteins were determined. Unintentional weight loss, alterations in anthropometric measures, and highest number of symptoms were greater in patients with lung and stomach cancer. No differences were found in ECOG-PS according to cancer site. Patients with gastric or lung cancer have most evidence of protein-calorie malnutrition and a higher prevalence of upper gastrointestinal symptoms. The performance status is not affected by tumor site. Early nutritional support should be planned for all patients with cancer, especially for patients with gastric or lung cancer.

Derated ion thruster design issues

NASA Technical Reports Server (NTRS)

Patterson, Michael J.; Rawlin, Vincent K.

1991-01-01

Preliminary activities to develop and refine a lightweight 30 cm engineering model ion thruster are discussed. The approach is to develop a 'derated' ion thruster capable of performing both auxiliary and primary propulsion roles over an input power range of at least 0.5 to 5.0 kilo-W. Design modifications to a baseline thruster to reduce mass and volume are discussed. Performance data over an order of magnitude input power range are presented, with emphasis on the performance impact of engine throttling. Thruster design modifications to optimize performance over specific power envelopes are discussed. Additionally, lifetime estimates based on wear test measurements are made for the operation envelope of the engine.

Kaumalapau Harbor, Hawaii, Breakwater Repair

DTIC Science & Technology

2012-05-01

agricultural economy to an economy based on tourism . Primary use of the harbor changed from the export of pineapple to the import of fuel and goods to...unit. The pulse-velocity measurement apparatus consists of a transmitter and receiver connected to electronic circuitry that generates a pulse sent...performance indices include a ME of -0.43 ft, RMSE of 0.66 ft and SI ERDC/CHL TR-12-7 86 of 0.24. In other words , the Maui SWAN model will perform as good

Characteristics of ring-cusp discharge chambers

NASA Technical Reports Server (NTRS)

Matossian, J. N.; Beattie, J. R.

1991-01-01

Measurements have been obtained for the operating characteristics of a 30 cm diameter ring-cusp ion thruster (RCIT), quantitatively comparing its performance parameters to those of a divergent-field J-series cluster of the same size. The high level of performance established for the RCIT is due to its maintenance of both a higher primary-electron population and Maxwellian-electron temperature, as the beam-ion production cost is reduced to its baseline value. Ion losses to the discharge-chamber walls can be reduced by an applied electrostatic field.

Site planning and integration fiscal year 1999 multi-year work plan (MYWP) update for WBS 1.8.2.1

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

SCHULTZ, E.A.

The primary mission of the Site Planning and Integration (SP and I) project is to assist Fluor Daniel Project Direction to ensure that all work performed under the Project Hanford Management Contract (PHMC) is adequately planned, executed, controlled, and that performance is measured and reported in an integrated fashion. Furthermore, SP and I is responsible for the development, implementation, and management of systems and processes that integrate technical, schedule, and cost baselines for PHMC work.

Transport of Neutrons and Photons Through Iron and Water Layers

NASA Astrophysics Data System (ADS)

Košťál, Michal; Cvachovec, František; Ošmera, Bohumil; Hansen, Wolfgang; Noack, Klaus

2009-08-01

The neutron and photon spectra were measured after iron and water plates placed at the horizontal channel of the Dresden University reactor AK-2. The measurements have been performed with the multiparameter spectrometer [1] with a stilbene cylindrical crystal, 10 × 10 mm or 45 × 45 mm; the neutron and photon spectra have been measured simultaneously. The calculations were performed with the MCNP code and nuclear data libraries ENDF/B VI.2, ENDF/BVII.0, JENDL 3.3 and JEFF 3.1. The measured channel leakage spectrum was used as the input spectrum for the transport calculation. Photons, the primary photons from the reactor - as well as the ones induced by neutron interaction - were calculated. The comparison of the measurements and calculations through 10 cm of iron and 20 cm thickness of water are presented. Besides that, the attenuation of the radiation mixed field by iron layers from 5 to 30 cm is presented; the measured and calculated data are compared.

Benchmark calculation for radioactivity inventory using MAXS library based on JENDL-4.0 and JEFF-3.0/A for decommissioning BWR plants

NASA Astrophysics Data System (ADS)

Tanaka, Ken-ichi

2016-06-01

We performed benchmark calculation for radioactivity activated in a Primary Containment Vessel (PCV) of a Boiling Water Reactor (BWR) by using MAXS library, which was developed by collapsing with neutron energy spectra in the PCV of the BWR. Radioactivities due to neutron irradiation were measured by using activation foil detector of Gold (Au) and Nickel (Ni) at thirty locations in the PCV. We performed activation calculations of the foils with SCALE5.1/ORIGEN-S code with irradiation conditions of each foil location as the benchmark calculation. We compared calculations and measurements to estimate an effectiveness of MAXS library.

Rates of Cerebral Protein Synthesis in Primary Visual Cortex during Sleep-Dependent Memory Consolidation, a Study in Human Subjects.

PubMed

Picchioni, Dante; Schmidt, Kathleen C; McWhirter, Kelly K; Loutaev, Inna; Pavletic, Adriana J; Speer, Andrew M; Zametkin, Alan J; Miao, Ning; Bishu, Shrinivas; Turetsky, Kate M; Morrow, Anne S; Nadel, Jeffrey L; Evans, Brittney C; Vesselinovitch, Diana M; Sheeler, Carrie A; Balkin, Thomas J; Smith, Carolyn B

2018-05-15

If protein synthesis during sleep is required for sleep-dependent memory consolidation, we might expect rates of cerebral protein synthesis (rCPS) to increase during sleep in the local brain circuits that support performance on a particular task following training on that task. To measure circuit-specific brain protein synthesis during a daytime nap opportunity, we used the L-[1-(11)C]leucine positron emission tomography (PET) method with simultaneous polysomnography. We trained subjects on the visual texture discrimination task (TDT). This was followed by a nap opportunity during the PET scan, and we retested them later in the day after the scan. The TDT is considered retinotopically specific, so we hypothesized that higher rCPS in primary visual cortex would be observed in the trained hemisphere compared to the untrained hemisphere in subjects who were randomized to a sleep condition. Our results indicate that the changes in rCPS in primary visual cortex depended on whether subjects were in the wakefulness or sleep condition but were independent of the side of the visual field trained. That is, only in the subjects randomized to sleep, rCPS in the right primary visual cortex was higher than the left regardless of side trained. Other brain regions examined were not so affected. In the subjects who slept, performance on the TDT improved similarly regardless of the side trained. Results indicate a regionally selective and sleep-dependent effect that occurs with improved performance on the TDT.

A salient region detection model combining background distribution measure for indoor robots.

PubMed

Li, Na; Xu, Hui; Wang, Zhenhua; Sun, Lining; Chen, Guodong

2017-01-01

Vision system plays an important role in the field of indoor robot. Saliency detection methods, capturing regions that are perceived as important, are used to improve the performance of visual perception system. Most of state-of-the-art methods for saliency detection, performing outstandingly in natural images, cannot work in complicated indoor environment. Therefore, we propose a new method comprised of graph-based RGB-D segmentation, primary saliency measure, background distribution measure, and combination. Besides, region roundness is proposed to describe the compactness of a region to measure background distribution more robustly. To validate the proposed approach, eleven influential methods are compared on the DSD and ECSSD dataset. Moreover, we build a mobile robot platform for application in an actual environment, and design three different kinds of experimental constructions that are different viewpoints, illumination variations and partial occlusions. Experimental results demonstrate that our model outperforms existing methods and is useful for indoor mobile robots.

Determinants of individual and group performance

NASA Technical Reports Server (NTRS)

Helmreich, Robert L.

1986-01-01

A broad exploration of individual and group/organizational factors that influence performance in demanding environments such as space and air transport was undertaken. Primary efforts were directed toward defining critical issues, developing new methodologies for the assessment of performance in such environments, and developing new measures of personality and attitudes as predictors of performance. Substantial clarification of relevant issues for research and validation was achieved. A reliable instrument to assess crewmembers' attitudes regarding crew coordination and flightdeck management was validated. Major efforts in data collection to validate concepts were initiated. The results suggest that substantial improvements can be made in the prediction of performance and in the selection of crewmembers for aviation and space.

Thermal efficiency and environmental performances of a biogas-diesel stationary engine.

PubMed

Bilcan, A; Le Corre, O; Delebarre, A

2003-09-01

Municipal and agricultural waste, and sludge from wastewater treatment represent a large source of pollution. Gaseous fuels can be produced from waste decomposition and then used to run internal combustion engines for power and heat generation. The present paper focuses on thermal efficiency and environmental performances of dual-fuel engines fuelled with biogas. Experiments have been carried out on a Lister-Petter single cylinder diesel engine, modified for dual-fuel operation. Natural gas was first used as the primary fuel. An empirical correlation was determined to predict the engine load for a given mass flow rate for the pilot fuel (diesel) and for the primary fuel (natural gas). That correlation has then been tested for three synthesized biogas compositions. Computations were performed and the error was estimated to be less than 10%. Additionally, NOx and CO2 contents were measured from exhaust gases. Based on exhausts gas temperature, the activation energy and the pre-exponential factor of an Arrhenius law were then proposed, resulting in a simpler mean to predict NOx.

THE CONCEPT OF A COMMUNITY INFORMATION SYSTEM TO MEASURE THE QUALITY OF PUBLIC SERVICES,

DTIC Science & Technology

The community information system would consist of the collection of data relevant to public service quality , the periodic reporting of this data in a summarized, sharply focused form, and the application of reliable performance measures to it. The primary purpose of the CIS...groups in forming balanced judgments and making decisions concerning the service they receive. A secondary purpose would be to increase service quality by making it more visible to the public. (Author)

Choquet integral as an alternative aggregation method to measure the overall academic performance of primary school students: A case study

NASA Astrophysics Data System (ADS)

Kasim, Maznah Mat; Abdullah, Siti Rohana Goh

2014-07-01

Many average methods are available to aggregate a set of numbers to become single number. However these methods do not consider the interdependencies between the criteria of the related numbers. This paper is highlighting the Choquet Integral method as an alternative aggregation method where the interdependency estimates between the criteria are comprised in the aggregation process. The interdependency values can be estimated by using lambda fuzzy measure method. By considering the interdependencies or interaction between the criteria, the resulted aggregated values are more meaningful as compared to the ones obtained by normal average methods. The application of the Choquet Integral is illustrated in a case study of finding the overall academic achievement of year six pupils in a selected primary school in a northern state of Malaysia.

Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study.

PubMed

Eccles, Martin P; Hrisos, Susan; Francis, Jill J; Stamp, Elaine; Johnston, Marie; Hawthorne, Gillian; Steen, Nick; Grimshaw, Jeremy M; Elovainio, Marko; Presseau, Justin; Hunter, Margaret

2011-06-09

Type 2 diabetes is an increasingly prevalent chronic illness and an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of primary care teams. This study aimed to: investigate theoretically-based organisational, team, and individual factors determining the multiple behaviours needed to manage diabetes; and identify multilevel determinants of different diabetes management behaviours and potential interventions to improve them. This paper describes the instrument development, study recruitment, characteristics of the study participating practices and their constituent healthcare professionals and administrative staff and reports descriptive analyses of the data collected. The study was a predictive study over a 12-month period. Practices (N = 99) were recruited from within the UK Medical Research Council General Practice Research Framework. We identified six behaviours chosen to cover a range of clinical activities (prescribing, non-prescribing), reflect decisions that were not necessarily straightforward (controlling blood pressure that was above target despite other drug treatment), and reflect recommended best practice as described by national guidelines. Practice attributes and a wide range of individually reported measures were assessed at baseline; measures of clinical outcome were collected over the ensuing 12 months, and a number of proxy measures of behaviour were collected at baseline and at 12 months. Data were collected by telephone interview, postal questionnaire (organisational and clinical) to practice staff, postal questionnaire to patients, and by computer data extraction query. All 99 practices completed a telephone interview and responded to baseline questionnaires. The organisational questionnaire was completed by 931/1236 (75.3%) administrative staff, 423/529 (80.0%) primary care doctors, and 255/314 (81.2%) nurses. Clinical questionnaires were completed by 326/361 (90.3%) primary care doctors and 163/186 (87.6%) nurses. At a practice level, we achieved response rates of 100% from clinicians in 40 practices and > 80% from clinicians in 67 practices. All measures had satisfactory internal consistency (alpha coefficient range from 0.61 to 0.97; Pearson correlation coefficient (two item measures) 0.32 to 0.81); scores were generally consistent with good practice. Measures of behaviour showed relatively high rates of performance of the six behaviours, but with considerable variability within and across the behaviours and measures. We have assembled an unparalleled data set from clinicians reporting on their cognitions in relation to the performance of six clinical behaviours involved in the management of people with one chronic disease (diabetes mellitus), using a range of organisational and individual level measures as well as information on the structure of the practice teams and across a large number of UK primary care practices. We would welcome approaches from other researchers to collaborate on the analysis of this data.

ASPECT: A Survey to Assess Student Perspective of Engagement in an Active-Learning Classroom

ERIC Educational Resources Information Center

Wiggins, Benjamin L.; Eddy, Sarah L.; Wener-Fligner, Leah; Freisem, Karen; Grunspan, Daniel Z.; Theobald, Elli J.; Timbrook, Jerry; Crowe, Alison J.

2017-01-01

The primary measure used to determine relative effectiveness of in-class activities has been student performance on pre/posttests. However, in today's active-learning classrooms, learning is a social activity, requiring students to interact and learn from their peers. To develop effective active-learning exercises that engage students, it is…

The Effect of Digital Storytelling in Improving the Third Graders' Writing Skills

ERIC Educational Resources Information Center

Yamac, Ahmet; Ulusoy, Mustafa

2016-01-01

The aim of this action research was to investigate the effects of digital storytelling in improving the writing skills of third grade students enrolled in rural primary schools. The writing performances of the students were measured before and after the teaching procedures of digital storytelling. Then, the process of narrative writing with…

Bilingualism and Learning: The Effect of Language Pair on Phonological Awareness Abilities

ERIC Educational Resources Information Center

Dodd, Barbara J.; So, Lydia K. H.; Lam, Kobe K. C.

2008-01-01

Children first exposed to English as a second language when they start school are at risk for poor academic outcome. They perform less well than their monolingual peers, matched for socio-economic background, at the end of primary school on measures of language and literacy, despite immersion in English at school. Previous research suggests,…

Measuring What Students Entering School Know and Can Do: PIPS Australia 2006-2007

ERIC Educational Resources Information Center

Wildy, Helen; Styles, Irene

2008-01-01

This paper reports analysis of 2006-2007 on-entry assessment data from the Performance Indicators in Primary Schools Baseline Assessment (PIPS-BLA) of random samples of students in England, Scotland, New Zealand and Australia. The analysis aimed, first, to investigate the validity and reliability of that instrument across countries and sexes, and,…

Physical fitness as an indicator of health status and its relationship to academic performance during the prepubertal period.

PubMed

Fonseca Del Pozo, Francisco Javier; Alonso, Joaquín Valle; Álvarez, Manuel Vaquero; Orr, Siobhan; Cantarero, Francisco Jesús Llorente

2017-01-01

Background: Physical activity (PA) is considered one of the most important determinants of the health status in children, and predictor of morbidity/mortality in adults. The aim is to examine the relationship between physical fitness (PF), PA, obesity and academic performance (AP) in primary school children. Methods: Cross-sectional studies including 91 primary school students, aged 9 to 12 years, from the province of Córdoba. Data was collected from April to June 2014. We measured PF using part of the EUROFIT fitness testing battery. The level of PA was measured as low or high PF and the level of obesity was measured using body mass index, waist circumference, percentage of fat mass, lean body mass, percentage of lean mass and basal metabolism. AP by scores on the second quarter was based on the total average of scores of basic subjects and other subjects, including physical education. Cognitive performance was assessed by the Spanish overall and factorial intelligence test. Results: The results of AP were positively related to levels of PF. Students who achieve better PF score better in Maths, (P=0.019), Natural Sciences (P=0.024), Religion (P=0.018) and Physical Education (P<0.001). A direct association between maximal aerobic capacity with Mathematics (r=0.325, P=0.02), AP (r=0.349, P=0.001) and cognitive performance (CP)(r=0.312, P=0.003) was observed. There was also a direct association of better jump tests with higher AP (r=0.328, P=0.002). Conclusion: The AP is associated with higher levels of fitness. Therefore, the education system should consider implementing curriculum strategies favouring the improvement of the PF, and therefore the health and AP of students.

Predicting the performance of a strategic alliance: an analysis of the Community Clinical Oncology Program.

PubMed

Kaluzny, A D; Lacey, L M; Warnecke, R; Hynes, D M; Morrissey, J; Ford, L; Sondik, E

1993-06-01

This study is designed to examine the effects of environment and structure of the Community Clinical Oncology Program (CCOP) on performance as measured by patient accrual to National Cancer Institute (NCI)-approved treatment protocols. Data and analysis are part of a larger evaluation of the NCI Community Clinical Oncology Program during its second funding cycle, June 1987-May 1990. Data, taken from primary and secondary sources, included a survey of selected informants in CCOPs and research bases, CCOP grant applications, CCOP annual progress reports, and site visits to a subsample of CCOPs (N = 20) and research bases (N = 5). Accrual data were obtained from NCI records. Analysis involved three complementary sets of factors: the local health care resources environment available to the CCOP, the larger policy environment as reflected by the relationship of the CCOP to selected research bases and the NCI, and the operational structure of the CCOP itself. A hierarchical model examined the separate and cumulative effects of local and policy environment and structure on performance. Other things equal, the primary predictors of treatment accrual were: (1) the larger policy environment, as measured by the attendance of nurses at research base meetings; and (2) operational structure, as measured by the number and character of components within participating CCOPs and the number of hours per week worked by data managers. These factors explained 73 percent of the total variance in accrual performance. Findings suggest criteria for selecting the types of organizations to participate in the alliance, as well as for establishing guidelines for managing such alliances. A future challenge is to determine the extent to which factors predicting accrual to cancer treatment clinical trials are equally important as predictors of accrual to cancer prevention and control trials.

Initial experience using a femtosecond laser cataract surgery system at a UK National Health Service cataract surgery day care centre

PubMed Central

Dhallu, Sandeep K; Maurino, Vincenzo; Wilkins, Mark R

2016-01-01

Objectives To describe the initial outcomes following installation of a cataract surgery laser system. Setting National Health Service cataract surgery day care unit in North London, UK. Participants 158 eyes of 150 patients undergoing laser-assisted cataract surgery. Interventions Laser cataract surgery using the AMO Catalys femtosecond laser platform. Primary and secondary outcome measures Primary outcome measure: intraoperative complications including anterior and posterior capsule tears. Secondary outcome measures: docking to the laser platform, successful treatment delivery, postoperative visual acuities. Results Mean case age was 67.7±10.8 years (range 29–88 years). Docking was successful in 94% (148/158 cases), and in 4% (6/148 cases) of these, the laser delivery was aborted part way during delivery due to patient movement. A total of 32 surgeons, of grades from junior trainee to consultant, performed the surgeries. Median case number per surgeon was 3 (range from 1–20). The anterior capsulotomy was complete in 99.3% of cases, there were no anterior capsule tears (0%). There were 3 cases with posterior capsule rupture requiring anterior vitrectomy, and 1 with zonular dialysis requiring anterior vitrectomy (4/148 eyes, 2.7%). These 4 cases were performed by trainee surgeons, and were either their first laser cataract surgery (2 surgeons) or their first and second laser cataract surgeries (1 surgeon). Conclusions Despite the learning curve, docking and laser delivery were successfully performed in almost all cases, and surgical complication rates and visual outcomes were similar to those expected based on national data. Complications were predominately confined to trainee surgeons, and with the exception of intraoperative pupil constriction appeared unrelated to the laser-performed steps. PMID:27466243

A Review of Preventative Methods against Human Leishmaniasis Infection

PubMed Central

Stockdale, Lisa; Newton, Robert

2013-01-01

Background Leishmaniasis is an intracellular parasitic infection transmitted to humans via the sandfly. Approximately 350 million people are at risk of contracting the disease and an estimated 1.6 million new cases occur annually. Of the two main forms, visceral and cutaneous, the visceral form is fatal in 85–90% of untreated cases. Aims This literature review aims to identify and evaluate the current evidence base for the use of various preventative methods against human leishmaniasis. Methods A literature search was performed of the relevant database repositories for primary research conforming to a priori inclusion and exclusion criteria. Results A total of 84 controlled studies investigating 12 outcome measures were identified, implementing four broad categories of preventative interventions: animal reservoir control, vector population control, human reservoir control and a category for multiple concurrently implemented interventions. The primary studies investigated a heterogeneous mix of outcome measures using a range of different methods. Conclusions This review highlights an absence of research measuring human-specific outcomes (35% of the total) across all intervention categories. The apparent inability of study findings to be generalizable across different geographic locations, points towards gaps in knowledge regarding the biology of transmission of Leishmania in different settings. More research is needed which investigates human infection as the primary outcome measure as opposed to intermediate surrogate markers, with a focus on developing a human vaccine. PMID:23818997

A Recommended Scale for Cognitive Screening in Clinical Trials of Parkinson’s Disease

PubMed Central

Chou, Kelvin L.; Amick, Melissa M.; Brandt, Jason; Camicioli, Richard; Frei, Karen; Gitelman, Darren; Goldman, Jennifer; Growdon, John; Hurtig, Howard I.; Levin, Bonnie; Litvan, Irene; Marsh, Laura; Simuni, Tanya; Tröster, Alexander I.; Uc, Ergun Y.

2010-01-01

Background Cognitive impairment is common in Parkinson’s disease (PD). There is a critical need for a brief, standard cognitive screening measure for use in PD trials whose primary focus is not on cognition. Methods The Parkinson Study Group (PSG) Cognitive/Psychiatric Working Group formed a Task Force to make recommendations for a cognitive scale that could screen for dementia and mild cognitive impairment in clinical trials of PD where cognition is not the primary outcome. This Task Force conducted a systematic literature search for cognitive assessments previously used in a PD population. Scales were then evaluated for their appropriateness to screen for cognitive deficits in clinical trials, including brief administration time (<15 minutes), assessment of the major cognitive domains, and potential to detect subtle cognitive impairment in PD. Results Five scales of global cognition met the predetermined screening criteria and were considered for review. Based on the Task Force’s evaluation criteria the Montreal Cognitive Assessment (MoCA), appeared to be the most suitable measure. Conclusions This Task Force recommends consideration of the MoCA as a minimum cognitive screening measure in clinical trials of PD where cognitive performance is not the primary outcome measure. The MoCA still requires further study of its diagnostic utility in PD populations but appears to be the most appropriate measure among the currently available brief cognitive assessments. Widespread adoption of a single instrument such as the MoCA in clinical trials can improve comparability between research studies on PD. PMID:20878991

Toward graduate medical education (GME) accountability: measuring the outcomes of GME institutions.

PubMed

Chen, Candice; Petterson, Stephen; Phillips, Robert L; Mullan, Fitzhugh; Bazemore, Andrew; O'Donnell, Sarah D

2013-09-01

Graduate medical education (GME) plays a key role in the U.S. health care workforce, defining its overall size and specialty distribution and influencing physician practice locations. Medicare provides nearly $10 billion annually to support GME and faces growing policy maker interest in creating accountability measures. The purpose of this study was to develop and test candidate GME outcome measures related to physician workforce. The authors performed a secondary analysis of data from the American Medical Association Physician Masterfile, National Provider Identifier file, Medicare claims, and National Health Service Corps, measuring the number and percentage of graduates from 2006 to 2008 practicing in high-need specialties and underserved areas aggregated by their U.S. GME program. Average overall primary care production rate was 25.2% for the study period, although this is an overestimate because hospitalists could not be excluded. Of 759 sponsoring institutions, 158 produced no primary care graduates, and 184 produced more than 80%. An average of 37.9% of internal medicine residents were retained in primary care, including hospitalists. Mean general surgery retention was 38.4%. Overall, 4.8% of graduates practiced in rural areas; 198 institutions produced no rural physicians, and 283 institutions produced no Federally Qualified Health Center or Rural Health Clinic physicians. GME outcomes are measurable for most institutions and training sites. Specialty and geographic locations vary significantly. These findings can inform educators and policy makers during a period of increased calls to align the GME system with national health needs.

Tightening force and torque of nonlocking screws in a reverse shoulder prosthesis.

PubMed

Terrier, A; Kochbeck, S H; Merlini, F; Gortchacow, M; Pioletti, D P; Farron, A

2010-07-01

Reversed shoulder arthroplasty is an accepted treatment for glenohumeral arthritis associated to rotator cuff deficiency. For most reversed shoulder prostheses, the baseplate of the glenoid component is uncemented and its primary stability is provided by a central peg and peripheral screws. Because of the importance of the primary stability for a good osteo-integration of the baseplate, the optimal fixation of the screws is crucial. In particular, the amplitude of the tightening force of the nonlocking screws is clearly associated to this stability. Since this force is unknown, it is currently not accounted for in experimental or numerical analyses. Thus, the primary goal of this work is to measure this tightening force experimentally. In addition, the tightening torque was also measured, to estimate an optimal surgical value. An experimental setup with an instrumented baseplate was developed to measure simultaneously the tightening force, tightening torque and screwing angle, of the nonlocking screws of the Aquealis reversed prosthesis. In addition, the amount of bone volume around each screw was measured with a micro-CT. Measurements were performed on 6 human cadaveric scapulae. A statistically correlated relationship (p<0.05, R=0.83) was obtained between the maximal tightening force and the bone volume. The relationship between the tightening torque and the bone volume was not statistically significant. The experimental relationship presented in this paper can be used in numerical analyses to improve the baseplate fixation in the glenoid bone. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Optimal primary febrile neutropenia prophylaxis for patients receiving docetaxel-cyclophosphamide chemotherapy for breast cancer: a systematic review.

PubMed

Fernandes, Ricardo; Mazzarello, Sasha; Stober, Carol; Vandermeer, Lisa; Dudani, Shaan; Ibrahim, Mohamed F K; Majeed, Habeeb; Perdrizet, Kirstin; Shorr, Risa; Hutton, Brian; Fergusson, Dean; Clemons, Mark

2017-01-01

Due to the high rate of febrile neutropenia (FN) with docetaxel-cyclophosphamide (DC) chemotherapy, primary FN prophylaxis is recommended. However, the optimal choice of prophylaxis [i.e., granulocyte-colony stimulating factors (G-CSF) or antibiotics] is unknown. A systematic review was performed to address this knowledge gap. Embase, Ovid Medline, Pubmed, the Cochrane database of systematic reviews, and Cochrane register of controlled trials were searched from 1946 to April 2016 for studies evaluating primary prophylactic FN treatments in breast cancer patients receiving DC chemotherapy. Outcome measures evaluated included: incidence of FN and treatment-related hospitalizations, chemotherapy dose reduction/delays/discontinuations, and adverse events. Screening and data collection were performed by two independent reviewers. Of 2105 identified records, 7 studies (n = 2535) met the pre-specified eligibility criteria. Seven additional studies (n = 621) were identified from prior systematic reviews. There were 3 randomized controlled trials (RCTs) (n = 2256) and 11 retrospective studies (n = 900). Study sample sizes ranged from 30 to 982 patients (median 99.5), evaluating pegfilgrastim (n = 1274), filgrastim (n = 1758), and oral ciprofloxacin (n = 108). Given the heterogeneity of patients and study design, a narrative synthesis of results was performed. Median FN rates with and without primary prophylaxis were 6.6 % (IQR 3.9-10.6 %) and 31.3 % (IQR 25-33 %), respectively. No FN-related deaths were reported. No RCT directly compared G-CSF with antibiotic interventions. Primary FN prophylaxis reduces the incidence of FN. Despite considerable cost and toxicity differences between G-CSF and antibiotics, there is insufficient data to make a recommendation of one strategy over another.

Impacts of pay for performance on the quality of primary care

PubMed Central

Allen, T; Mason, T; Whittaker, W

2014-01-01

Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers’ payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data. PMID:25061341

Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

PubMed

Ludt, Sabine; Campbell, Stephen M; Petek, Davorina; Rochon, Justine; Szecsenyi, Joachim; van Lieshout, Jan; Wensing, Michel; Ose, Dominik

2013-03-09

Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score 'Preventive Services' (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology.

Which practice characteristics are associated with the quality of cardiovascular disease prevention in European primary care?

PubMed Central

2013-01-01

Background Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. Methods An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. Results The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score ‘Preventive Services’ (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). Conclusions There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology. PMID:23510482

Effects of Direct Instruction and Strategy Modeling on Upper-Primary Students’ Writing Development

PubMed Central

López, Paula; Torrance, Mark; Rijlaarsdam, Gert; Fidalgo, Raquel

2017-01-01

Strategy-focused instruction is one of the most effective approaches to improve writing skills. It aims to teach developing writers strategies that give them executive control over their writing processes. Programs under this kind of instruction tend to have multiple components that include direct instruction, modeling and scaffolded practice. This multi-component nature has two drawbacks: it makes implementation challenging due to the amount of time and training required to perform each stage, and it is difficult to determine the underlying mechanisms that contribute to its effectiveness. To unpack why strategy-focused instruction is effective, we explored the specific effects of two key components: direct teaching of writing strategies and modeling of strategy use. Six classes (133 students) of upper-primary education were randomly assigned to one of the two experimental conditions, in which students received instruction aimed at developing effective strategies for planning and drafting, or control group with no strategy instruction: Direct Instruction (N = 46), Modeling (N = 45), and Control (N = 42). Writing performance was assessed before the intervention and immediately after the intervention with two tasks, one collaborative and the other one individual to explore whether differential effects resulted from students writing alone or in pairs. Writing performance was assessed through reader-based and text-based measures of text quality. Results at post-test showed similar improvement in both intervention conditions, relatively to controls, in all measures and in both the collaborative and the individual task. No statistically significant differences were observed between experimental conditions. These findings suggest that both components, direct teaching and modeling, are equally effective in improving writing skills in upper primary students, and these effects are present even after a short training. PMID:28713299

The Productivity and Cost-Efficiency of Models for Involving Nurse Practitioners in Primary Care: A Perspective from Queueing Analysis

PubMed Central

Liu, Nan; D'Aunno, Thomas

2012-01-01

Objective To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how. Data Sources and Study Design The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings. Principal Findings Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery. Conclusions The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model. PMID:22092009

The Classroom Environment Questionnaire (CEQ): Development and preliminary structural validity.

PubMed

Lyons, Carissa; Brown, Ted; Bourke-Taylor, Helen

2018-04-16

Occupational therapists offer a unique perspective regarding the contribution of the environment to occupational performance. Therefore, a scale that measures the unique characteristics of the primary school classroom environment where children complete their daily schoolwork occupations is needed. The aim of this study was to develop and psychometrically evaluate a new teacher-report questionnaire that measures a number of environmental characteristics of primary school classrooms. Participants (N = 117) completed the Classroom Environment Questionnaire (CEQ), which utilises a 4-point Likert scale where teachers rate 51 environmental characteristics of their classroom. Teachers also rate the extent to which they believe the physical, social, temporal, institutional and cultural classroom environmental domains contribute to students' schoolwork performance using a 10-point scale. The structural validity of the CEQ was examined using principal component analysis (PCA). Inter-item correlations were examined using Pearson r correlations, while the internal consistency of the CEQ was assessed using Cronbach's alpha. PCA revealed the CEQ to be multidimensional, with 31 items loading onto nine viable factors, representing the unique nature of classroom environments. Based on the PCA results, 20 items were removed from the CEQ. Cronbach's alpha and correlation analysis indicated that most CEQ subsections had acceptable internal consistency (alpha range 0.70-0.82), with four subsections demonstrating a lower level of internal consistency (alpha range 0.55-0.69). Preliminary structural validity and internal consistency analysis findings confirm that the CEQ has potential to be a useful scale for professionals wishing to examine the unique characteristics of primary school classrooms that influence the occupational performance of students. Ongoing analyses will be undertaken to further explore the CEQ's validity and reliability. © 2018 Occupational Therapy Australia.

[Drug consumption in diabetes mellitus (IV). The utilization of reactive material and systems for assessing blood glucose control from the viewpoint of primary care. The Group for the Study of Diabetes in Tarragona (GEDT)].

PubMed

Costa, B; Huguet, M

1994-03-12

A study was performed to analyze the use of reactive material in the periodic follow up of diabetes. Likewise, the use of systems to assess glycemic control by primary care physicians was investigated. Analysis of the habits of use of reactive material was performed on the diabetic population of Tarragona (548,900 inhabitants) by randomized survey of prescription in 525 patients attended in 12 primary care centers. The estimation of amount was carried out by a counting of the public prescriptions made. Similarly the periodicity and the results of the applications of glucoproteins in the reference laboratories were studied. A total of 253 diabetics (48%) were exclusively attended in the centers and 272 (52%) performed some type of home self-analysis; 26 (5%) in urine samples, and 246 (47%) in capillary blood. The estimated mean consumption was of 14 blood sugar strips per patient per month (168 strips/year) and 2.7 glucosuria-glucocetonuria strips (32.4 strips/year). The relative urine/blood ratio was 1/5.2. In 343 cases (65%) some glucoprotein measurement was reported within the last year, 330 (63%) corresponding to glucohemoglobin A1. The mean value was 8.3% (normal: 5-8%). The mean number of applications was 1.6 applications per patient per year. An enormous increase was observed in the amount consumed at the province of reactive material in blood and in the measurement of glucoproteins as the system to assess carbohydrate control in diabetes. A significant reduction was found in the use of reactive strips in urine by the diabetic population.

Performance of a continuously rotating half-wave plate on the POLARBEAR telescope

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

Takakura, Satoru; Aguilar, Mario; Akiba, Yoshiki

A continuously rotating half-wave plate (CRHWP) is a promising tool to improve the sensitivity to large angular scales in cosmic microwave background (CMB) polarization measurements. With a CRHWP, single detectors can measure three of the Stokes parameters, I, Q and U, thereby avoiding the set of systematic errors that can be introduced by mismatches in the properties of orthogonal detector pairs. We focus on the implementation of CRHWPs in large aperture telescopes (i.e. the primary mirror is larger than the current maximum half-wave plate diameter of ~0.5 m), where the CRHWP can be placed between the primary mirror and focalmore » plane. In this configuration, one needs to address the intensity to polarization (I→P) leakage of the optics, which becomes a source of 1/f noise and also causes differential gain systematics that arise from CMB temperature fluctuations. In this paper, we present the performance of a CRHWP installed in the {\\scshape Polarbear} experiment, which employs a Gregorian telescope with a 2.5 m primary illumination pattern. The CRHWP is placed near the prime focus between the primary and secondary mirrors. We find that the I→P leakage is larger than the expectation from the physical properties of our primary mirror, resulting in a 1/f knee of 100 mHz. The excess leakage could be due to imperfections in the detector system, i.e. detector non-linearity in the responsivity and time-constant. We demonstrate, however, that by subtracting the leakage correlated with the intensity signal, the 1/f noise knee frequency is reduced to 32 mHz (ℓ ~ 39 for our scan strategy), which is very promising to probe the primordial B-mode signal. We also discuss methods for further noise subtraction in future projects where the precise temperature control of instrumental components and the leakage reduction will play a key role.« less

Performance of a continuously rotating half-wave plate on the POLARBEAR telescope

DOE PAGES

Takakura, Satoru; Aguilar, Mario; Akiba, Yoshiki; ...

2017-05-03

A continuously rotating half-wave plate (CRHWP) is a promising tool to improve the sensitivity to large angular scales in cosmic microwave background (CMB) polarization measurements. With a CRHWP, single detectors can measure three of the Stokes parameters, I, Q and U, thereby avoiding the set of systematic errors that can be introduced by mismatches in the properties of orthogonal detector pairs. We focus on the implementation of CRHWPs in large aperture telescopes (i.e. the primary mirror is larger than the current maximum half-wave plate diameter of ~0.5 m), where the CRHWP can be placed between the primary mirror and focalmore » plane. In this configuration, one needs to address the intensity to polarization (I→P) leakage of the optics, which becomes a source of 1/f noise and also causes differential gain systematics that arise from CMB temperature fluctuations. In this paper, we present the performance of a CRHWP installed in the {\\scshape Polarbear} experiment, which employs a Gregorian telescope with a 2.5 m primary illumination pattern. The CRHWP is placed near the prime focus between the primary and secondary mirrors. We find that the I→P leakage is larger than the expectation from the physical properties of our primary mirror, resulting in a 1/f knee of 100 mHz. The excess leakage could be due to imperfections in the detector system, i.e. detector non-linearity in the responsivity and time-constant. We demonstrate, however, that by subtracting the leakage correlated with the intensity signal, the 1/f noise knee frequency is reduced to 32 mHz (ℓ ~ 39 for our scan strategy), which is very promising to probe the primordial B-mode signal. We also discuss methods for further noise subtraction in future projects where the precise temperature control of instrumental components and the leakage reduction will play a key role.« less

Performance of a continuously rotating half-wave plate on the POLARBEAR telescope

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

Takakura, Satoru; Aguilar, Mario; Akiba, Yoshiki

A continuously rotating half-wave plate (CRHWP) is a promising tool to improve the sensitivity to large angular scales in cosmic microwave background (CMB) polarization measurements. With a CRHWP, single detectors can measure three of the Stokes parameters, I , Q and U , thereby avoiding the set of systematic errors that can be introduced by mismatches in the properties of orthogonal detector pairs. We focus on the implementation of CRHWPs in large aperture telescopes (i.e. the primary mirror is larger than the current maximum half-wave plate diameter of ∼0.5 m), where the CRHWP can be placed between the primary mirrormore » and focal plane. In this configuration, one needs to address the intensity to polarization ( I → P ) leakage of the optics, which becomes a source of 1/f noise and also causes differential gain systematics that arise from CMB temperature fluctuations. In this paper, we present the performance of a CRHWP installed in the (\\scshape Polarbear) experiment, which employs a Gregorian telescope with a 2.5 m primary illumination pattern. The CRHWP is placed near the prime focus between the primary and secondary mirrors. We find that the I → P leakage is larger than the expectation from the physical properties of our primary mirror, resulting in a 1/f knee of 100 mHz. The excess leakage could be due to imperfections in the detector system, i.e. detector non-linearity in the responsivity and time-constant. We demonstrate, however, that by subtracting the leakage correlated with the intensity signal, the 1/f noise knee frequency is reduced to 32 mHz (ℓ ∼ 39 for our scan strategy), which is very promising to probe the primordial B-mode signal. We also discuss methods for further noise subtraction in future projects where the precise temperature control of instrumental components and the leakage reduction will play a key role.« less

Rheumatoid factor testing in Spanish primary care: A population-based cohort study including 4.8 million subjects and almost half a million measurements.

PubMed

Morsley, Klara; Miller, Anne; Luqmani, Raashid; Fina-Aviles, Francesc; Javaid, Muhammad Kassim; Edwards, Christopher J; Pinedo-Villanueva, Rafael; Medina, Manuel; Calero, Sebastian; Cooper, Cyrus; Arden, Nigel; Prieto-Alhambra, Daniel

2018-02-26

Rheumatoid factor (RF) testing is used in primary care in the diagnosis of rheumatoid arthritis (RA); however a positive RF may occur without RA. Incorrect use of RF testing may lead to increased costs and delayed diagnoses. The aim was to assess the performance of RF as a test for RA and to estimate the costs associated with its use in a primary care setting. A retrospective cohort study using the Information System for the Development of Research in Primary Care database (contains primary care records and laboratory results of >80% of the Catalonian population, Spain). Participants were patients ≥18 years with ≥1 RF test performed between 01/01/2006 and 31/12/2011, without a pre-existing diagnosis of RA. Outcome measures were an incident diagnosis of RA within 1 year of testing, and the cost of testing per case of RA. 495,434/4,796,498 (10.3%) patients were tested at least once. 107,362 (21.7%) of those tested were sero-positive of which 2768 (2.6%) were diagnosed with RA within 1 year as were 1141/388,072 (0.3%) sero-negative participants. The sensitivity of RF was 70.8% (95% CI 69.4-72.2), specificity 78.7% (78.6-78.8), and positive and negative predictive values 2.6% (2.5-2.7) and 99.7% (99.6-99.7) respectively. Approximately €3,963,472 was spent, with a cost of €1432 per true positive case. Although 10% of patients were tested for RF, most did not have RA. Limiting testing to patients with a higher pre-test probability would significantly reduce the cost of testing. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Variations in the service quality of medical practices.

PubMed

Ly, Dan P; Glied, Sherry A

2013-11-01

To examine regional variation in the service quality of physician practices and to assess the association of this variation with the supply and organization of physicians. Secondary analyses of the Community Tracking Study (CTS) household and physician surveys. A total of 40,339 individuals who had seen a primary care physician because of an illness or injury and 17,345 generalist physicians across 4 survey time periods in 60 CTS sites were included. Service quality measures used were lag between making an appointment and seeing a physician, and wait time at the physician's office. Our supply measure was the physician-to-population ratio. Our organizational measure was the percentage of physicians in group practices. Multivariate regressions were performed to examine the relationship between service quality and the supply and organization of physicians. There was substantial variation in the service quality of physician visits across the country. For example, in 2003, the average wait time to see a doctor was 16 minutes in Milwaukee but more than 41 minutes in Miami; the average appointment lag for a sick visit in 2003 was 1.2 days in west-central Alabama but almost 6 days in Northwestern Washington. Service quality was not associated with the primary care physician-to-population ratio and had varying associations with the organization of practices. Cross-site variation in service quality of care in primary care has been large, persistent, and associated with the organization of practices. Areas with higher primary care physician-to-population ratios had longer, not shorter, appointment lags.

Long-term disability progression in primary progressive multiple sclerosis: a 15-year study.

PubMed

Rocca, Maria A; Sormani, Maria Pia; Rovaris, Marco; Caputo, Domenico; Ghezzi, Angelo; Montanari, Enrico; Bertolotto, Antonio; Laroni, Alice; Bergamaschi, Roberto; Martinelli, Vittorio; Comi, Giancarlo; Filippi, Massimo

2017-11-01

Prognostic markers of primary progressive multiple sclerosis evolution are needed. We investigated the added value of magnetic resonance imaging measures of brain and cervical cord damage in predicting long-term clinical worsening of primary progressive multiple sclerosis compared to simple clinical assessment. In 54 patients, conventional and diffusion tensor brain scans and cervical cord T1-weighted scans were acquired at baseline and after 15 months. Clinical evaluation was performed after 5 and 15 years in 49 patients. Lesion load, brain and cord atrophy, mean diffusivity and fractional anisotropy values from the brain normal-appearing white matter and grey matter were obtained. Using linear regression models, we screened the clinical and imaging variables as independent predictors of 15-year disability change (measured on the expanded disability status scale). At 15 years, 90% of the patients had disability progression. Integrating clinical and imaging variables at 15 months predicted disability changes at 15 years better than clinical factors at 5 years (R2 = 61% versus R2 = 57%). The model predicted long-term disability change with a precision within one point in 38 of 49 patients (77.6%). Integration of clinical and imaging measures allows identification of primary progressive multiple sclerosis patients at risk of long-term disease progression 4 years earlier than when using clinical assessment alone. © The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The LOPES experiment

NASA Astrophysics Data System (ADS)

Link, Katrin; Apel, W. D.; Arteaga, J. C.; Asch, T.; Bähren, L.; Bekk, K.; Bertaina, M.; Biermann, P. L.; Blümer, J.; Bozdog, H.; Brancus, I. M.; Buchholz, P.; Buitink, S.; Cantoni, E.; Chiavassa, A.; Daumiller, K.; de Souza, V.; Doll, P.; Engel, R.; Falcke, H.; Finger, M.; Fuhrmann, D.; Gemmeke, H.; Grupen, C.; Haungs, A.; Heck, D.; Hörandel, J. R.; Horneffer, A.; Huber, D.; Huege, T.; Isar, P. G.; Kampert, K.-H.; Kang, D.; Krömer, O.; Kuijpers, J.; Lafebre, S.; Łuczak, P.; Ludwig, M.; Mathes, H. J.; Melissas, M.; Morello, C.; Nehls, S.; Oehlschläger, J.; Palmieri, N.; Pierog, T.; Rautenberg, J.; Rebel, H.; Roth, M.; Rühle, C.; Saftoiu, A.; Schieler, H.; Schmidt, A.; Schröder, F. G.; Sima, O.; Toma, G.; Trinchero, G. C.; Weindl, A.; Wochele, J.; Wommer, M.; Zabierowski, J.; Zensus, J. A.

2011-03-01

Cosmic ray particles hit the Earth's atmosphere and induce extensive air showers (EAS). These EAS mainly consist of electrons and positrons that produce radio emission due to their interaction with the Earth's magnetic field. Measuring this radio emission is the purpose of the LOPES (LOFAR Prototype Station) experiment. LOPES is located at Campus North of the Karlsruhe Institute of Technology at the same site as the EAS particle detector KASCADE-Grande. Since the first measurements in 2003, LOPES was improved by various experimental setups and could establish the radio technique. By now, detailed studies of the measured radio signal are performed, like the behaviour of the lateral distribution or the polarization of the electric field. Furthermore, with LOPES the dependence of the radio pulse on properties of the incoming cosmic ray, like primary energy, primary mass, or incoming direction is investigated. In this article we describe the different LOPES setups, next we explain our standard analysis procedure and then we discuss some highlights of our recent results.

Importance-Satisfaction Analysis for Primary Care Physicians’ Perspective on EHRs in Taiwan †

PubMed Central

Ho, Cheng-Hsun; Wen, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

2014-01-01

The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians’ perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians. PMID:24914640

Rachis morphology cannot accurately predict the mechanical performance of primary feathers in extant (and therefore fossil) feathered flyers

NASA Astrophysics Data System (ADS)

Lees, John; Garner, Terence; Cooper, Glen; Nudds, Robert

2017-02-01

It was previously suggested that the flight ability of feathered fossils could be hypothesized from the diameter of their feather rachises. Central to the idea is the unvalidated assumption that the strength of a primary flight feather (i.e. its material and structural properties) may be consistently calculated from the external diameter of the feather rachis, which is the only dimension that is likely to relate to structural properties available from fossils. Here, using three-point bending tests, the relationship between feather structural properties (maximum bending moment, Mmax and Young's modulus, Ebend) and external morphological parameters (primary feather rachis length, diameter and second moment of area at the calamus) in 180 primary feathers from four species of bird of differing flight style was investigated. Intraspecifically, both Ebend and Mmax were strongly correlated with morphology, decreasing and increasing, respectively, with all three morphological measures. Without accounting for species, however, external morphology was a poor predictor of rachis structural properties, meaning that precise determination of aerial performance in extinct, feathered species from external rachis dimensions alone is not possible. Even if it were possible to calculate the second moment of area of the rachis, our data suggest that feather strength could still not be reliably estimated.

The Development of Quality Measures for the Performance and Interpretation of Esophageal Manometry

PubMed Central

Yadlapati, Rena; Gawron, Andrew J.; Keswani, Rajesh N.; Bilimoria, Karl; Castell, Donald O.; Dunbar, Kerry B.; Gyawali, Chandra P.; Jobe, Blair A.; Katz, Philip O.; Katzka, David A.; Lacy, Brian E.; Massey, Benson T.; Richter, Joel E.; Schnoll-Sussman, Felice; Spechler, Stuart J.; Tatum, Roger; Vela, Marcelo F.; Pandolfino, John E.

2016-01-01

Background and Aims Esophageal manometry (EM) is the gold standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of EM result in discrepant diagnoses and unnecessary repeated procedures, and may negatively impact patient outcomes. A method to benchmark the procedural quality of EM is needed. The primary aim of this study was to develop quality measures for performing and interpreting EM. Methods The RAND/University of California, Los Angeles Appropriateness Methodology (RAM) was utilized. Fifteen experts in esophageal manometry were invited to be a part of the panel. Potential quality measures were identified through a literature search and interviews with experts. The expert panel ranked the proposed quality measures for appropriateness via a two-round process on the basis of RAM. Results Fourteen experts participated in all processes. A total of 29 measures were considered; 17 of these measures were ranked as appropriate and related to competency (2), pre-procedure (2), procedure (3) and interpretation (10). The latter 10 were integrated into a single composite measure. Thus, 8 final measures were determined to be appropriate quality measures for EM. Five strong recommendations were also endorsed by the experts, however they were not ranked as appropriate quality measures. Conclusions Eight formally validated quality measures for the performance and interpretation of EM were developed on the basis of RAM. These measures represent key aspects of a high-quality EM study and should be uniformly adopted. Evaluation of these measures in clinical practice is needed to assess their impact on outcomes. PMID:26499925

The Effects of Phacoemulsification and Intraocular Lens Implantation on Anatomical and Functional Parameters in Patients with Primary Angle Closure: A Prospective Study. (An American Ophthalmological Society Thesis).

PubMed

Traverso, Carlo Enrico; Cutolo, Carlo Alberto

2017-08-01

To investigate the clinical, anatomical, and patient-reported outcomes of phacoemulsification (PE) with intraocular lens implantation performed to treat primary angle closure (PAC) and primary angle-closure glaucoma (PACG). Patients were evaluated at baseline and at 6 months after PE. The examination included visual acuity, intraocular pressure (IOP), visual field, optic nerve head, endothelial cell count (ECC), aqueous depth, and ocular biometric parameters. Patient-reported visual function and health status were assessed. Coprimary outcome measures were IOP changes, angle widening, and patient-reported visual function; secondary outcome measures were visual acuity changes, use of IOP-lowering medications, and complications. Univariate and multivariate analyses were performed to determine the predictors of IOP change. Thirty-nine cases were identified, and postoperative data were analyzed for 59 eyes, 39 with PACG and 20 with PAC. Globally, PE resulted in a mean reduction in IOP of -6.33 mm Hg (95% CI, -8.64 to -4.01, P <.001). Aqueous depth and angle measurements improved ( P <.01), whereas ECC significantly decreased ( P <.001). Both corrected and uncorrected visual acuity improved ( P <.01). The EQ visual analog scale did not change ( P =.16), but VFQ-25 improved ( P <.01). The IOP-lowering effect of PE was greater in the PACG compared to the PAC group ( P =.04). In both groups, preoperative IOP was the most significant predictor of IOP change ( P <.01). No sight-threatening complications were recorded. Our data support the usefulness of PE in lowering the IOP in patients with PAC and PACG. Although PE resulted in several anatomical and patient-reported visual improvements, we observe that a marked decrease in ECC should be carefully weighed before surgery.

Efficacy of early controlled motion of the ankle compared with no motion after non-operative treatment of an acute Achilles tendon rupture: study protocol for a randomized controlled trial.

PubMed

Barfod, Kristoffer Weisskirchner; Hansen, Maria Swennergren; Holmich, Per; Troelsen, Anders; Kristensen, Morten Tange

2016-11-29

Early controlled ankle motion is widely used in the non-operative treatment of acute Achilles tendon rupture, though its safety and efficacy have never been investigated in a randomized setup. The objectives of this study are to investigate if early controlled motion of the ankle affects functional and patient-reported outcomes. The study is performed as a blinded, randomized, controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged from 18 to 70 years are eligible for inclusion. The intervention group performs early controlled motion of the ankle in weeks 3-8 after rupture. The control group is immobilized. In total, 130 patients will be included from one big orthopedic center over a period of 2½ years. The primary outcome is the patient-reported Achilles tendon Total Rupture Score evaluated at 12 months post-injury. Secondary outcome measures are the heel-rise work test, Achilles tendon elongation, and the rate of re-rupture. The primary analysis will be conducted as intention-to-treat analyses. This trial is the first to investigate the safety and efficacy of early controlled motion in the treatment of acute Achilles tendon rupture in a randomized setup. The study uses the patient-reported outcome measure, the Achilles tendon Total Rupture Score, as the primary endpoint, as it is believed to be the best surrogate measure for the tendon's actual capability to function in everyday life. ClinicalTrials.gov: NCT02015364 . Registered on 13 December 2013.

Health System Perspective: Variation, Costs, and Physician Behavior.

PubMed

Jevsevar, David S

2015-01-01

With the generalized rise in cost of US health care, renewed emphasis has been placed on defining the relationship between costs and outcome. The quality of health care delivery has been uneven, as measured by existing quality and performance measures, significant variation in the delivery of care, lack of standardization of care leading to avoidable error, lack of meaningful outcomes measurement, and apparent disconnect with cost. Orthopaedic surgeons are at the nexus of implementing change, as we are the primary decision makers regarding care of our patients. This summary will review efforts that address quality, cost, outcome, safety, and variation in care.